I am in radiologic Remission at almost 2 years. My CA–19 tests are climbing, now over 500. My oncologist tells me the levels are not high enough to get a liquid biopsy, (Next GEN testing), is this true?
I have had 10 rounds of chemo with Folfirinox, and 25 rounds of chemo with Folfiri. I am getting very chemo fatigued and hoping for treatment with fewer side effects.
Thank you for sending us your question. I appreciate your fear of a rising CA-19-9 during remission and agree that now would be a very good time to either have 1) Next Gen Sequencing of the ORIGINAL tumor (if not done previously) and/or 2) a ctDNA test. Since your doctor has already said the levels are not high enough, I would recommend saying that "it takes weeks for the results to return so you are concerned with waiting further."
In addition, it may be helpful to seek a second opinion from someone who is working on early detection for relapsed pancreatic cancer. I would recommend reaching out to Dr. Nadine Abi-Jaoudeh who is running a study at University of California Irvine that is testing this exact question about ctDNA. The study is available for patients who are about to undergo a biopsy, but you can ask for an opinion about your situation now. Her office number is: (714) 456-6921 and email: nadine@uci.edu. Let us know if you would like help in reaching her or requesting her support.
Are you currently still being treated with FOLFIRI? Should the tumor return (and we hope not!), some patients will go on to receive standard Gemcitabine/Abraxane, that has a different side effect profile, but in addition, there are multiple therapies available on study that offer non-chemo options, including immunotherapy.
Please let us know if any next gen sequencing has been previously done, and include the results if possible, since there are multiple options that will be available with specific genetic changes (for example BRCA or MSI-High). Once we see this and learn more about how the early detection goes, we'd be happy to guide you about potential treatment ideas.
Please let us know what you think of our idea, and if you have any additional questions now (or later). We always appreciate hearing how things turn out.
Jason Sager, MD
