My brother (diagnosed Stage IV in August of 2020) had been on Gem/Abraxane for nearly a full year - an every two week cycle. It was very effective at lowering his CA 19-9 ....but it took a tremendous toll on him. The side effects were brutal - so much more so than the Folfirinox that he took as a beginning treatment. While his numbers went down, so did his quality of life. He had more bad days than good within that two week cycle. He endured all of it only to have his numbers start to creep up. The standard of care (at least at the comprehensive cancer center where he receives his treatment) after Gem/Abrax is Napoli - Nanoliposomal irinotecan with flouoroucil and folonic acid. My brother has received three treatments of this so far and the side effects are fewer. The most troubling for him is fatigue, but it's only for a few days and on those days he chooses to simply read, watch tv and give in to naps if need be. We've talked to others who have endured Gem/Abrax much better than Folfirinox or other treatments so I think it just goes to show that everyone is so unique and different and what happens to one may or may not happen to another. I wish you the best and pray that you have the support than keeps you hopeful and enjoying each day!