@tomrennie yes, that was the next step. We met with the second opinion surgeon yesterday and he had about the same recommendations, although he slightly favors doing some sort of systemic treatment before surgery, whether that is chemo or daraxonrasib. However, he said if the diagnostic laparoscopy truly just shows the solitary nodule, upfront CRS/HIPEC would be a very reasonable choice.
upfront CRS/HIPEC would be the best option.

Her medical oncologist can get daraxonrasib for her if she wants it. I am sort of inclined to wait for daraxonrasib because I know if she would start on this it could disqualify her from future clinical trials. My thinking is that it will be there regardless in the near future, so maybe save it for if disease would pop up in other places later? I’ve also read positive things about clinical trials targeting KRAS G12D, which is the KRAS mutation she has along with her ATM, so it would be nice to keep the door open for one of those.

She did just have Signatera testing that was negative, but I have read that with peritoneal mets, this can often be negative even in the presence of disease.

I’m really thankful she has options. The waiting and decision making is really taking a toll on her mental health.