I have to disagree with you on the statement that once stage IV, always stage IV. That was the prevailing thought with Whipple surgery the only means for achieving cure when a patient was diagnosed at a low stage. The first effective chemotherapy regimen being Folfirinox was FDA approved in 2011 and its modified form in 2018. So no long term studies were available to see whether aggressive treatment with Folfirinox was possible to achieve cure.

Today there are increasing reports of stage IV patients being pronounced cured. I am one of those that advocated for going well beyond standard of care 12 cycles in an attempt to achieve cure and being stage IV after having the Whipple procedure. Surgeon John Chabot of the Columbia Presbyterian Pancreas Center in NYC during the annual Pancreatic Cancer Awareness Day program made mention of the increasing reports of patients termed cure and my case was mentioned. Other oncologists familiar with my case concur.

I recently became aware of a large international study underway looking at patients termed by the NCI as exceptional responders to see what factors may have played a role. One of those in the study is someone whose case I am very familiar with. Like me she advocated for more aggressive chemotherapy. She did less then I did (37 cycles to my 46). She was non-resectable and now like me an 11 year survivor. She is surveilled frequently but I am not aware of the specific surveillance she gets. As for me, I have twice yearly MRI of the abdomen, low dose CT for the lungs and since 2014 have been having the ultra-sensitive ctDNA blood measurement to check for minimal residual disease. This test is orders of magnitude more sensitive than a CT, MRI or PET and is able to measure molecular residual disease-fragments of DNA shed by a metastatic cell that are traceable to the original primary tumor.