Exploring using a SAGE Oncotest for my liver biopsy next week. Do you have recommnedations of which drugs and...

I appreciate you sharing this question—it shows you're being thoughtful about your testing strategy. Let me help clarify what a SAGE Oncotest can and can't do, and then address your situation specifically.

What SAGE Oncotest Does (Educational Context)

SAGE Oncotest is a functional drug sensitivity assay—meaning it takes tumor cells from your biopsy and tests them in the lab against various drugs to see which ones are most effective against YOUR specific cancer cells. It's different from genetic testing (like Guardant 360) because it measures actual cell death responses rather than just identifying mutations.

The test can screen hundreds of compounds, including:

• Standard chemotherapies
• Targeted therapies
• Repurposed drugs (medications originally developed for other conditions)
• Combination approaches

Here's the Important Context for YOUR Case

Given your medical profile, there are a few things to consider:

Your current treatment approach: You're on gemcitabine/abraxane + avutometinib/defactinib—this is a sophisticated combination already targeting specific pathways (KRAS/MEK inhibition with avutometinib/defactinib). You've also previously received FOLFIRINOX and RMC-6236, showing your team has been strategically escalating therapy.

Your biomarker status: Your proficient mismatch repair (pMMR) status and normal tumor markers (CEA 4.9, CA 19-9 28.7) suggest your current regimen may be working reasonably well. A liver biopsy for drug sensitivity testing makes sense if there's concern about progression or resistance.

What You Should Ask Your Oncology Team

Rather than me recommending which drugs to prioritize, your oncologist should guide this based on:

1. "What is the clinical question we're trying to answer with this SAGE test?" — Are we looking for resistance mechanisms, or exploring alternatives if current therapy stops working?

2. "Given my pMMR status and current response, which drug classes should the lab prioritize testing?" — For example:

   • Additional KRAS pathway inhibitors?
   • Immunotherapy combinations (though pMMR typically limits this)?
   • Metabolic pathway inhibitors?
   • Repurposed drugs with pancreatic cancer data?

3. "How will these results change my treatment plan?" — Will positive results lead to a switch, or are they exploratory?

4. "What's the turnaround time, and how does that fit my current treatment timeline?"

5. "Are there specific drugs on the SAGE panel that you're particularly interested in testing given my treatment history?"

Important Boundary

I can't recommend which specific drugs the lab should prioritize because that requires:

• Your complete imaging and clinical response data
• Your oncologist's assessment of whether you're progressing
• Knowledge of which drugs are actually available to you
• Understanding of your overall performance status and liver function (your AST is elevated at 57 U/L, which matters for drug metabolism)

According to NCCN Guidelines for pancreatic cancer, treatment decisions at your stage are highly individualized and should be based on response assessment, tolerability, and available clinical trial options—not just lab testing alone.

One More Thing About Your Earlier Question

You also asked about CAR-T cell therapy. For context: CAR-T is primarily used for blood cancers (lymphomas, leukemias), not solid tumors like pancreatic adenocarcinoma. This is why it hasn't been part of your treatment discussions. Your team's focus on targeted therapy combinations and clinical trials is the appropriate approach for metastatic pancreatic cancer.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.