Which Mutations can be targeted with treatment for pancreatic ca?

I have ann ipmn with kras mutation. No worrisome features. Dr said 6 month followup.
I asked about kras inhibitors as prevention. I think he said its not done and there are serious side effects.
I feel like a time bomb waiting to go off.
Anyone else with this and with suggedtions?
Thank you.

If you have peritoneal cancer, there is a protein Claudin 18.2 that may accompany it. It’s not a mutation, “it's not a direct result of a change in the DNA sequence (a mutation) but rather a change in how the gene is processed to produce the protein”. You must have at least a 75% occurrence of it (abdominal, ovarian areas) in order to be able to receive drug which was after trials last couple of years, approved by FDA in December 2024; drug is Zolbetuximab (Vyloy). I had my biopsy tissue tested and I have an 80% occurrence of it. I would like to know if it’s associated with a known mutation like TP53 or ATM. It can occur with adenocarcinoma is all I know. I have ATM VUS (variant of unknown significance) and TP53. I was told by my first Dr (but you don’t have the ATM mutation). I disagreed in that it’s a base substitute that science just doesn’t have enough research on, yet. My father had pancreatic cancer and his mom had breast cancer, certainly there’s a link and my guess is ATM. The gastric cancer was the one that was so insidious at the end.

KRAS xxxx and NRAS xxxx targetable by various trial drugs from Revolution Medicine and Elicio Therapeutics

BRCA1, BRCA2, PALB2 targetable by various approved PARP inhibitors

ATM mutation targetable by various ATR inhibitors (trials only, none approved yet)

Some patients with ATM mutation have gotten benefit from PARP inhibitors used off-label

Another type of targeted drug targets specific proteins that are on the surface of cancer cells. These drugs are called antibody-drug conjugates or "ADCs". There are lots of them in development for various cancer types. A few have been approved.

In theory, these should be more effective and more tolerable than standard chemo. In practice, it seems like some of them have significant side effects.

One problem is that the standard tests that are done on people's tumors don't test for these cell surface proteins, so it's not obvious which ADC might work on your tumor. They're not usually associated with particular mutations. Some trials require a test for the targeted protein before letting you enroll, and others just treat people with the ADC without testing.

I'm currently trying to get into an ADC trial for my third trial in a row. If you're looking for a clinical trial, these may be worth asking about.

Yep, the ADCs have an antibody that homes in on cells expressing a specific target (protein), and then delivers a cytotoxic payload to it.

The drug Datroway ( https://datrowayhcp.com/ ) is another example of an ADC. It was approved earlier this year for very specific breast cancers that also express TROP2.

It targets TROP2 (which I know from last year's trial that my tumors express), so I was hoping it might be an off-label option for my pancreatic cancer, but I've gotten "meh; focus on your KRAS first" from two oncologists so far. I haven't found any clinical trials for Datroway specifically relevant to PDAC.