1. Don't put .exe after cmd, I'm pretty sure it's a keyword command, not a reference to cmd.exe
2. Don't use 'start', running a program with address cmd (at least from VXREXX) will already start a separate session (and minimize it, IIRC).
The following should suffice for running a program from VX-REXX:
ADDRESS CMD "P:\test\pdftotext.exe source.PDF input.txt"
Plus any output redirection you need, of course.