@wheatley ,

I would say the best place is whichever pancreatic center of excellence you can get into first. Think Mayo, Anderson, Sloan, Farber, Hopkins, and the like... Plenty more listed on the National Pancreas Foundation site, possibly closer to you and with easier scheduling.

Have you had any scans at all since April 2023? If not, you're definitely overdue for that.

Can your current oncologist order an appropriate ctDNA test to help gain insight that might correlate or refute your CA19-9 tests?

If your first FILFORX + (plus SBRT) didn't completely kill your original cancer, I (with no medical training) doubt FILFORX without the oxaliplatin and SBRT is going to do much. *Maybe* time to switch it up and see if one of the alternatives like Gemzar/Abraxane/Cisplatin would be right for you?

If nothing else, you might want to start looking into clinical trials. If you haven't already had germline genetic testing for inherited mutations done, you should ask your oncologist to schedule that for you. Whatever you know about your own genetics can help identify the best treatment for you.