6 year survivor with a recurrence in peritoneum

Hello all. Unfortunately I’m back here again looking for advice about treatment. My mom, a 6-year survivor, is now facing a second recurrence and we’re trying to look at all options.

Quick recap - she’s currently 70, had distal pancreatectomy in 2020, then 12 rounds of FOLFIRINOX. NED until 4.5 years later when a recurrence showed up in the ovaries. Had ovaries removed 12/2024, followed by another 12 rounds of FOLFIRINOX, completed 6/2025. NED since then with surveillance CTs and Ca19-9 every 3 months.

Ca19-9 had been slowly rising this year (usually 6ish, now up to 30, was 219 at diagnosis), so CT scan was moved up which was clear, followed by PET scan, which showed a hypermetabolic 1.8cm peritoneal nodule consistent with peritoneal carcinomatosis. One smaller nodule on the mesentery that was not hypermetabolic. PET otherwise clear.

We are meeting with a surgical oncologist this afternoon through Cleveland Clinic (where she currently gets oncology care). We also have a second opinion scheduled in 2 weeks with Dr. Bartlett in PA who does a lot with HIPEC. I know this isn’t standard of care for peritoneal mets, but I’ve read some things suggesting that systemic chemo may not reach the peritoneum enough to be effective? Anyone know if this is valid?

Also, this study just came out that is very interesting and I’m wondering if she might benefit with her (apparently) limited peritoneal disease.
https://www.asco.org/abstracts-presentations/265206
I know there’s a currently recruiting HIPEC study at Mayo we’re looking into for her as well.

I should mention she does have a germline ATM mutation (original pancreatic tumor had ATM and KRAS G12D mutations as well).

She is in excellent health (no other medical conditions, extremely physically fit and active), and wants to do any treatment that may offer her the longest recurrence-free interval possible. The fact that she’s lived for 6 years post surgery, most of them free of visible cancer, makes me hopeful that her tumor biology is mwore indolent and may still be responsive to treatment. She tolerated 24 total rounds of FOLFIRINOX with barely any side effects.

Anyone else have any experience with limited peritoneal recurrence 6 years out from diagnosis? Thanks for any advice. This group is such a wealth of information.