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Living with cancer· Appointment prep

Appointment sheet: Metastatic pancreatic ductal adenocarcinoma

One page to bring and write on: your details, the questions for Metastatic 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

Metastatic pancreatic ductal adenocarcinoma

Prepared with OnCo (onco.cc/prep/metastatic-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

24 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 mutation subtype by tissue or plasma sequencing, Germline BRCA1, BRCA2, PALB2 and ATM, Mismatch repair status by immunohistochemistry or sequencing, NRG1, NTRK, ALK, ROS1, FGFR2 and RET fusions and BRAF alterations in KRAS wild-type tumours, CA 19-9 for response monitoring), 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?
First line, fit patients
  1. 5.For my situation (first line, fit patients), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Gemcitabine + nab-paclitaxel, and what side effects should I expect?
  3. 7.How do the results of NAPOLI 3 apply to someone like me?
First line, less fit patients
  1. 8.For my situation (first line, less fit patients), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Gemcitabine + nab-paclitaxel, Gemcitabine, and what side effects should I expect?
Maintenance and biomarker-directed therapy
  1. 10.For my situation (maintenance and biomarker-directed therapy), which of the standard options do you recommend and why?
  2. 11.Am I a candidate for Olaparib, Pembrolizumab, Zenocutuzumab or related drugs, and what side effects should I expect?
  3. 12.How do the results of POLO apply to someone like me?
Second line
  1. 13.For my situation (second line), which of the standard options do you recommend and why?
  2. 14.Am I a candidate for Daraxonrasib, Irinotecan (and liposomal irinotecan), Fluorouracil (5-FU) or related drugs, and what side effects should I expect?
  3. 15.How do the results of RASolute 302 apply to someone like me?
Supportive care throughout
  1. 16.For my situation (supportive care throughout), which of the standard options do you recommend and why?
Clinical trials
  1. 17.For my situation (clinical trials), which of the standard options do you recommend and why?
  2. 18.Am I a candidate for Zoldonrasib, ELI-002 7P, and what side effects should I expect?
  3. 19.How do the results of Study of Daraxonrasib and Daraxonrasib + GnP as First-line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma and Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut apply to someone like me?
Any stage
  1. 20.Are there clinical trials I could join, for example of Study of Daraxonrasib and Daraxonrasib + GnP as First-line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma, Zoldonrasib, Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut, Study of Zoldonrasib + Chemo of Investigator's Choice vs Placebo + Chemo of Investigator's Choice as First-line Treatment in Metastatic KRAS G12D-muta?
  2. 21.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 22.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 23.I read that “Resistance to RAS inhibitors emerges within months and the best partner drugs are unknown”. How does that affect my plan?
  5. 24.I read that “Checkpoint inhibitors fail outside mismatch repair deficient disease because the tumour excludes T cells”. How does that affect my plan?

The words I may hear

  • Metastasis: Cancer that has spread from where it started to distant parts of the body, travelling through the blood or lymph.
  • Cancer cachexia: Severe loss of weight and muscle in advanced cancer that eating more cannot reverse on its own.
  • Platinum-sensitive / platinum-resistant: Whether a cancer that responded to platinum chemotherapy came back more than six months later (sensitive, so platinum can be used again) or sooner (resistant, so something else is needed).
  • KRAS mutation subtypes (G12C, G12D, G12V): KRAS, the most commonly mutated cancer gene, comes in flavours named by the exact amino acid change.
  • Obstructive jaundice and biliary obstruction: Yellowing of the skin and eyes because a tumour blocks the bile duct, most often pancreatic or bile duct cancer.
  • Peritoneal metastasis: Spread across the lining of the abdomen, the most common way stomach cancer recurs and the hardest to treat.
  • Germline BRCA mutation (gBRCA): An inherited fault in the BRCA1 or BRCA2 gene, present in every cell from birth, that greatly raises the risk of breast, ovarian, prostate and pancreatic cancer and makes those cancers sensitive to PARP inhibitors and platinum.
  • CA 19-9: A sugar molecule shed into the blood by most pancreatic cancers; useful to follow treatment, not to screen.
  • Drug resistance (primary and acquired): Why cancer drugs stop working: the tumour either never depended on the target or evolves around the block.
  • Gene fusion: A gene fusion is two genes broken and joined together, creating a hybrid protein that can drive cancer.

Tests and results to bring

Biomarker results to ask for: KRAS mutation subtype by tissue or plasma sequencing (G12D, G12V, G12R, G12C; wild-type prompts fusion testing), Germline BRCA1, BRCA2, PALB2 and ATM (platinum and PARP inhibitor choice), Mismatch repair status by immunohistochemistry or sequencing (pembrolizumab), NRG1, NTRK, ALK, ROS1, FGFR2 and RET fusions and BRAF alterations in KRAS wild-type tumours, CA 19-9 for response monitoring (uninformative in Lewis-negative patients), Claudin 18.2 and mesothelin expression (trial eligibility), Performance status, bilirubin and neuropathy (regimen choice).

Scans and tests linked to this cancer: Comprehensive genomic profiling, Liquid biopsy (ctDNA), MRD / molecular residual disease testing, FAPI PET.

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