After first line chemotherapy regimens of (m)Folfirinox and Genzar/Abraxane are no longer effective, there are second, third and fourth-line chemo drug combinations available.

CHEMOTHERAPY PROTOCOLS FOR PANCREATIC CANCER
https://www.cancertherapyadvisor.com/wp-content/uploads/sites/12/2020/03/Pancreatic-Adenocarcinoma-0320.pdf
For metastatic disease to the liver and surgical bed, ablation in the form of cryoablation and Nanoknife/IRE (irreversible electroporation) may be options. Treatment of liver mets may be possible using Y-90 (Yttrium 90 radiotherapy) where albumin and then a radioisotope is perused into the liver.
https://interventionalnews.com/y90-radioembolization-metastatic-pancreatic-cancer/
In later stage pancreatic cancer, clinical trials offer the patient potential of better outcomes through access to new drug compounds not yet available to the general patient population.

Ablation
https://letswinpc.org/promising-science/2022/06/30/ablative-smart-radiotherapy-advanced-pancreatic-cancer/
https://letswinpc.org/promising-science/2020/06/19/study-nanoknife-ire-technology/
https://www.medpagetoday.com/meetingcoverage/astro/101459
Precision Medicine of genetic testing using Next Generation Sequencing (NGS) and or liquid biopsy to detect possible somatic (spontaneous);or germ line (mutations) is important for determining if targeted therapy is available or in finding a suitable clinical trial. After my second chemo regimen was beginning to wane, genetic testing led to my finding a clinical trial resulting in achieving NED status in 2016 after metas disease to the liver.

Genetic Testing
https://pancan.org/news/what-you-need-to-know-about-genetic-and-molecular-testing/
https://pancan.org/news/lets-talk-about-genetic-and-biomarker-testing/
As others responding to this post mention, advocating for better treatment is essential. One needs to be prepared when encountering resistance for one’s private health insurer. Fortunately for me, the private insurance was outstanding, allowed me to obtain treatment wherever necessary and paid for genetic testing and everything thing else. The clinical trial costs and transportation were covered by the trial sponsor.

Lastly, do not hesitate to obtain additional opinions. If you feel your current care team is not meeting your expectations, consult with other pancreatic cancer oncologists who have the depth and breadth in treating pancreatic cancer that the average GI specialist won’t have. When inquiring about clinical trials, my experience has been that a GI oncologist whose sub-specialty is treating cancers of the pancreas is more likely to know of clinical trials than a regular GI specialist whose practice generally consists of few pancreatic cancer patients.

The Pancreatic Cancer Action Network can be of help in providing a list of NCI designated tertiary-level centers of excellence in cancer treatment and the names of pancreatic cancer oncologists and interventional radiologists and surgeons experienced with ablative techniques, Y-90 and other chemotherapy combinations less widely used. PanCan.org can be reached at 877.272.6226, M-F, 7:00am-5:00pm PT.