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Living with cancer· Appointment prep

Appointment sheet: KRAS wild-type pancreatic ductal adenocarcinoma

One page to bring and write on: your details, the questions for KRAS wild-type pancreatic ductal adenocarcinoma plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

KRAS wild-type pancreatic ductal adenocarcinoma

Prepared with OnCo (onco.cc/prep/kras-wild-type-pdac/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

23 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example KRAS wild-type status on tumour or plasma sequencing, RNA-based or comprehensive fusion testing for NRG1, NTRK, ALK, ROS1, FGFR2, RET, MET and BRAF fusions, BRAF V600E and in-frame deletion status, Mismatch repair immunohistochemistry or microsatellite instability testing, ERBB2 amplification and GNAS mutation), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Diagnosis
  1. 5.For my situation (diagnosis), which of the standard options do you recommend and why?
First line
  1. 6.For my situation (first line), which of the standard options do you recommend and why?
  2. 7.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Gemcitabine + nab-paclitaxel, and what side effects should I expect?
NRG1 fusion
  1. 8.For my situation (nrg1 fusion), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Zenocutuzumab, and what side effects should I expect?
NTRK fusion
  1. 10.For my situation (ntrk fusion), which of the standard options do you recommend and why?
  2. 11.Am I a candidate for Larotrectinib, Entrectinib, Repotrectinib, and what side effects should I expect?
BRAF alteration
  1. 12.For my situation (braf alteration), which of the standard options do you recommend and why?
  2. 13.Am I a candidate for Dabrafenib + trametinib, and what side effects should I expect?
Other fusions
  1. 14.For my situation (other fusions), which of the standard options do you recommend and why?
  2. 15.Am I a candidate for Repotrectinib, Pembrolizumab, and what side effects should I expect?
No identified driver
  1. 16.For my situation (no identified driver), which of the standard options do you recommend and why?
  2. 17.Am I a candidate for Nimotuzumab, Gemcitabine, and what side effects should I expect?
  3. 18.How do the results of NOTABLE (nimotuzumab, KRAS wild-type pancreatic cancer) apply to someone like me?
Any stage
  1. 19.Are there clinical trials I could join, for example of Zenocutuzumab, Repotrectinib, Nimotuzumab, NOTABLE (nimotuzumab, KRAS wild-type pancreatic cancer)?
  2. 20.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 21.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 22.I read that “Fusion testing is still missed when DNA panels are used alone, so many actionable tumours go unrecognised”. How does that affect my plan?
  5. 23.I read that “Each driver is too rare for pancreatic-specific randomised trials; evidence is extrapolated from lung cancer and basket studies”. How does that affect my plan?

The words I may hear

Tests and results to bring

Diagnosis: Comprehensive genomic profiling with fusion detection (RNA sequencing where DNA panels are negative) for every KRAS wild-type tumour; pathology review to exclude a periampullary primary.

Biomarker results to ask for: KRAS wild-type status on tumour or plasma sequencing (prompts fusion testing), RNA-based or comprehensive fusion testing for NRG1, NTRK, ALK, ROS1, FGFR2, RET, MET and BRAF fusions, BRAF V600E and in-frame deletion status, Mismatch repair immunohistochemistry or microsatellite instability testing, ERBB2 amplification and GNAS mutation (IPMN-derived cancers), Review of histology and site to exclude ampullary, bile duct or duodenal primaries.

Scans and tests linked to this cancer: Comprehensive genomic profiling, Liquid biopsy (ctDNA).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call