Pancreatic Cancer Surgery Q&A w/ Dr. Stauffer on September 4

Have you added Nanoknife to your options? Why or why not?
What type of radiation approaches do you consider prior to surgery?

I am writing from Antalya, Turkey. I underwent distal pancreatectomy and liver resection surgery on August 4. The surgery went smoothly, and I am currently resting. What do you recommend following this surgical procedure? My oncologist suggested chemotherapy. What do you think? Thank you.

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I have adenocarcinoma pancreatic CA, stage 1b, Whipple done 6/10, and have completed 8/12 chemo cycles. Surgeon said there were no attachments or invasions, CA was encapsulated within the mass, nothing in my lymph nodes. But the CA may still come back?

Wife will complete 12 Folfirinox treatments. It has not determined if she is stage 3 or 4. Oncologist has delayed biopsy indicating Folfirinox would be the treatment for either stage. Suspicious spots on liver but no biopsy until full chemo is completed. What is your opinion of NanoKnife for either stage 3 or 4 (liver involvement) and is SBRT a better approach than conventional radiology after completion of chemo?

I can comment on SBRT. My local doctors wanted to halt chemo to do SBRT. My consulting physician( a high volume Pcan oncologist, told me do not stop systemic treatment when doing SBRT. Proton or SBRT are very directed, precise treatment to attack a tumor and not harm the tissue surrounding it. Thus hopefully leaving you available for further radiation or surgery if needed later.

what is the difference between the new trials with the KRAS inhibitors and the RMC-6236?

Are there any new treatments for the mutation KRAS G12V?

Would you recommend any surgery/nanoknife for metastatic pancreatic cancer in the tail, stage IV?

Do you feel SBRT is better than conventional radiotion after 12 Folfirinox Chemo treatments?

I had my whipples in jan 2016 and now I need to loose weight for some surgery on my very large apron. I have been told I need to loose 14kg before they can do the procedure, is there any weight loss jabs or pills I can take to help. I understand MJ etc.. can NOT be prescribed due to pancreatic reactions.
Many thanks Anita

There is an excellent clinical trial finder at TriCanHealth.com. You can look up the different trials for the specific KRAS mutation and it explains the mode of action. There are several KRAS trials using drugs such as RMC-6236 which is a pan KRAS inhibitor drug. It has the ability to target a wide number of KRAS variants whereas drugs line RMC-9805 and MRTX-1133 target a specific KRAS mutation-in this case G12D. Some trials combine drugs to see if a synergistic effect is obtained. An example is a trial by Revolution Medicine combining RMC-6236 and RMC-9805 to see if enhanced efficacy is achieved over monotherapy with either drug. In the trial descriptor using TriCanHealth.com or clinicaltrials.gov, there will be a section describing mode of action and trial objective.

The RMC-6236 is closed at Huntsman in Utah (close to where we live) and waiting for data and hopefully FDA approval. My husband is on Gem-Abr now, but it may not be working. He had to go off folfirinox because it may have been what was causing him to have bleeding ulcers. He had never had ulcers before. The other KRAS trials seem to be targeting specific mutations. His is KRAS G12V. But, we are trying to stay researching. My husband and I have stayed super active and eat a pretty strict diet. He is also trying intermittent fasting, which seems to be helping with energy.