After my experience, I'm afraid to take any chemo break at all.

My Whipple for Stage-II was considered "perfect" (R0 resection and 22/22 lymph nodes clean). MRI and CA19-9 a month after Whipple agreed, as did 3 DNA-based blood tests (1 Galleri and 2 Signateras) and a biopsy over the next 3.5 months.

BUT, despite all the NED suggestions above, MRI discovered tumor recurrence at the original site that went from non-existent to 1.3 cm in 3.5 months since the previous MRI. In hindsight, that seems like a pretty fast growth rate. 🙁 After 6 more weeks to redo MRI, Signatera, and CA19-9, the tumor was 2 cm with at least one met in the abdomen before I resumed chemo.

A full year of chemo (26 biweekly treatments of Gemcitabine + Abraxane + Cisplatin) has kept it mostly in check: A few new mets early on, but stable or slight shrinkage over the last ~8 months.

So I'm at a huge crossroads today... Two oncs are suggesting I cut back to a maintenance therapy, which would (ideally by them) be Gemcitabine only. (ATM mutation here, not amenable to PARPi as maintenance.) At the same time, I think I can now get into a clinical trial that would require me to be off all chemo for at least 3-4 months.

Both oncs agree that I'm responding so well to the current chemo that it would be risky to come off for an unproven trial. Part of the justification for a trial (even though I have not progressed and am basically "stable") would be to give my body a break from the chemo-induced neuropathy and anemia, but I'm actually handling it well enough to keep going at the full dose.

Going on Gemcitabine alone seems almost as risky as going chemo-free, so that's a non-starter. If I don't do the trial, cutting Abraxane and Cisplatin by 50% is as far as I'm willing to go.

In fact, I would be willing to try piling an additional therapy on top of the current therapy to deliver a knockout blow rather than just cruising along as "stable."

As @ncteacher said, I'm also resigned to viewing this as a chronic condition that requires ongoing treatment. That would be the biweekly chemo unless insurance quits covering it or a better treatment comes along.

The fast return, growth, and spread of my cancer is a big reason I advocate for everyone doing as much up-front work (monitoring, testing, seeking out trials and treatment centers) in parallel as possible, to avoid long, serialized delays before attacking the real problem.

@stageivsurvivor 's 2-year chemo beatdown of his tumor serves as a huge motivation for me to consider doing the same.

Wishing you the best, @spicerpa , and hoping your cancer went on vacation along with the chemo.