@kjc12 , Yes, I did 12 rounds of biweekly mFolfirinox in the six months before the Whipple on a Stage-IIa tumor in the pancreas head. CA19-9 bounced around, but the trendline over time was upward, ranging in the mid-100's to mid-200's, but no evidence of spread on MRI.

In hindsight, given my much better response to the Gemcitabine/Abraxane/Cisplatin since the recurrence, I wish they had found some way to test me out against both and use the more appropriate therapy sooner in the neoadjuvant therapy. Either way, the recurrence was really (most likely) a failure of the intraoperative pathology during Whipple to detect malignant cells in the margin, and my current metastatic condition a failure of the biopsy 3.5 months after Whipple to obtain malignant tissue, and a delay in beginning treatment after that. I was also a bit surprised (months later) to see how common the adjuvant chemo is after surgery in contrast to my not receiving any. I have no idea if that would have allowed detection of the recurrence before it metastasized.

I don't want to derail the original poster's topic too much, but part of my "lesson learned" here is to be as prepared as possible in advance and never delay anything.