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Swapan Kumar Nath
I think immunotherapy (pembrolizumab) plus chemotherapy ( platinum plus pemitrexate) would be the best first choice.
I would suggest Pembrolizumab + chemotherapy (Platinum Pemetrexed), my main rational for adding chemo here is the presence of liver metastasis that respond poorly to immunotherapy and are a bad prognostic factor
I would also remember the Kras G12D mutation and look for a clinical trial (if any!) with a targeted agent in later line.
Pending Moderator approval.
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