@robee , You're very welcome, and... I might lean toward the opinion of MSK over a local oncologist, but with considerations:

1) Will you be getting the chemo at MSK regularly, or getting it locally? If local, make sure your local oncologist has a good communication channel open w/ your MSK "consulting" oncologist and is willing to collaborate with them on your treatment when appropriate.

2) Since you've already done Folfirinox, you know what it's like, you know its relative (in-)effectiveness, and your system is currently "clean," I would personally choose a different chemo regimen just to see what kind of response it produces. That would include very frequent CA19-9 monitoring, Signatera ctDNA tests if possible, and new scans 2 months out, absolute max no longer than 3, to assess. I'm not sure exactly which cocktail MSK was recommending, but Gem seems like the basis for most, and is affordable. They could couple it with cisplatin (especially if you have an appropriate mutation) and/or Abraxane. Abraxane is very expensive and not always covered by insurance (at least not w/o appeals and paperwork), so it might not be approved by the time you start. (Same thing happened with me.)

If you wanted to try a "somewhat scientifically controlled" experiment, you might increase by one drug at a time; e.g., do 3 treatments on Gem only, then 3 on Gem + Cis, then 3 on Gem + Cis + Abraxane, with CA19-9 testing accompanying every step. That would give your body time to adjust, save the worst effects (hair loss and neuropathy) until last, and allow all the Abraxane paperwork approvals to go through.

I must repeat the disclaimer here that I have no medical training, and that a lot of doctors are not receptive to stuff that requires extra work like that, but if you're a good advocate and basically volunteer yourself as a guinea pig that will do most of the work, maybe they'll be receptive. The biggest, most obvious downside and risk is that if you're not starting with the full dose of everything, there's a chance disease could spread while you're experimenting. But my take is that if they're recommending Folfirinox only and it's not the right med for YOU, disease could spread anyway; and, if the others are recommending ONLY Gem, then planning for immediate escalation with the other two drugs provides a stronger treatment option.

Now 9 months into my GCA regimen, with neuropathy and fatigue adding up, two oncologists have recommended I either reduce the Cis/Abrax doses or eliminate them completely and go with Gem only. But I'm against that so far; I'm not going to stop a treatment that seems to be working otherwise at controlling disease, and I'd rather have neuropathy than a spreading cancer. One onco has a possible trial I'll find out about next month, but until then, I'm going full steam ahead on the present course. I'll switch only if there's something more promising.

Regarding the cycles and schedule of Gem/Cis/Abrax, I don't know how biweekly or 3-on/1-off is chosen, or if it's very specific to my exact combo and dose. For me, biweekly works because of the travel involved. I did ask about a schedule of once every 3 weeks instead of every 2 weeks with a dose reduction, and the PA said the research they followed was based on 2-week intervals (tied to cell growth cycles and rates, etc), but it does seem like 3 weeks out of every 4 provides some extra cytotoxic power.

Finally, I wish I knew a lot more about trials than I do. 🙁 What I've learned, aside from reading, has mostly come from the trials I applied to but didn't qualify for or was accepted into but couldn't travel for.

As far as trials themselves go: Yes, I did register with PanCan.org, and they have provided me updated lists several times, although a bit too broad sometimes. I also registered with CancerCommons.org; they assigned a PhD researcher to my case and provided a short list of very detailed trial recommendations. It's a worthwhile option if you're comfortable providing them as much info as they ask for,