I was in this clinical trial: https://clinicaltrials.gov/study/NCT05922930
last year at MD Anderson.

The trial focus was on peritoneal mets, provided they express the TROP2 protein. The one-time treatment involves adding another port (similar to a traditional chemo port) to access your abdominal / peritoneal space. (My port was placed near the bottom of my righthand rib cage.) Then, after giving approximately three days of chemo to deplete your immune system, they infuse specially engineered Natural Killer cells into your peritoneum, then shake and swish your belly around for a while, let it marinate in there for about 6 weeks, and redo your cancer tests (CA19-9, Signatera, CT). It involves a 3-week inpatient stay to test your blood and peritoneal fluid every day, and also to make sure you don't have a critical immune reaction to the NK cells.

On the bright side, MD Anderson is an amazing facility, and the treatment was painless. My only side effects were a little nausea on the last day of the 3-day chemo, then some sleep interruption from all the midnight wake-ups to draw blood.

On the down side, it didn't work for me at all. The nature of clinical trials; sigh... My cancer progressed and I had to return to some SoC treatments (and after developing resistance to those, a KRAS inhibitor clinical trial). I understand MDACC paused the NK trial later, and resumed with a re-engineered (more potent) NK stem cell and increased the dose. It appears the trial is still open and enrolling a few select patients. I can provide more info if you're interested.

I had the IP (intraperitoneal) port removed about 9 months after exiting the trial. I had kept it in place with hopes that one of my providers would be willing to try a "HIPEC-like" treatment using the port -- basically just infusing some heated chemo there to achieve direct contact with the cancer cells, while foregoing the cytoreductive surgery or surgically "open" application of chemo. One of my PAs told me there were a lot more risks to the HIPEC chemo than I was aware of; apparently it can be rather toxic to various organs it comes into contact with. I didn't get details, but my provider doesn't do much HIPEC and seemed to be distancing themselves from it.

Anyway... I finally gave up and had the port removed to make sleeping on my side more comfortable. Shortly after the removal, I learned that some alternative cancer treatment centers offer intraperitoneal infusions of Ivermectin and/or Mebendazole. Although there is no reliable clinical evidence I'm aware of to support such treatment, as a stage-4 patient, I would have given it a try.

As @val64 mentions, it's important to know what mutations you and your cancer have. I have a germline ATM mutation and a somatic KRAS G12D mutation. I declined an ATR inhibitor trial 2 1/2 years ago because of the timing and travel requirements. It wasn't until later that we learned of my KRAS mutation. Multiple oncologists emphasized how common and strong a driver KRAS is in pancreatic adenocarcinoma, and that targeting it would likely bring more benefit than targeting ATM/ATR. Fortunately, the pharmaceutical industry is working overtime on various RAS inhibitors, and I was able to get into a trial close to home a few weeks ago, taking only oral medications daily (no infusions!). It's too early to know how well it's working (no Signatera or CT yet), but my CA19-9 levels are dropping at an encouraging rate. 🙂 Nausea and diarrhea are the only notable side effects, but well worth the inconvenience if the drug is actually working.