Rectal case from Hong Kong (UPDATE: Lung Met, NRAS MUTATED, FOLFOX+Avastin)

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Mercy110
Posts: 114
Joined: Wed Aug 16, 2017 12:13 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met)

Postby Mercy110 » Sun Sep 03, 2017 8:39 pm

ocstacy wrote:Thank you!! Prayers to you and family. Have you thought about getting a colonoscopy yourself? I had one done about two weeks ago. I am so glad I did. Benign Polp was found. Just glad I had my colon checked as I have issues with hemorrhoids' as the rest of my whole entire family. It's an embarrassing subject but that is one pain in my life that I cannot get rid of. Diet and exercise seem to help. Trying to lose some weight as the dr. mentioned that should help too.



Yes I did colonoscopy on August and it's all clean. Properly will have another check 5 years afterwards.
My Mum (age 56), NRAS-mutate Q61R
2017-05: Surgery with stoma. T4N1M0. Stage3C. Xeloda Only. Increasing CEA. CT: Multiple lung nodules. Stage4.
2017-09: 85% FOLFOX + Avastin, stable CT
2018-03 to 05: Folfox Allergy, Folfiri (with Avastin since Oct)
2019: CEA:178, started Irinotecan+Zaltrip+TS-1, 25 times radio with xeloda
2020: CEA: 217.3, pending treatment


WISH ALL MIGHTY GOD HEALS MUM WITH HIS MIRACLE

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Shana
Posts: 401
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Rectal case from Hong Kong (UPDATE: Lung Met)

Postby Shana » Sun Sep 03, 2017 9:30 pm

ocstacy wrote:
It is difficult to accept stoma but my mum's stoma is doing well right now


My mom is terrified to get a "Stoma bag" How long has your mom had hers? Is is easy to clean? My mom handled the therapy well, however, when radiation ended, she experienced more pain in her rectum. I don't want to see her in pain anymore. She rely's on Coating. So sad to see our mother's in pain. God bless


I had a blockage June 2017 and had surgery resulting in a transverse colostomy, It is to the right of my navel just below my waist. I had no other choice and was grateful that I had an option which would save my life and allow me to continue fighting cancer.

That said, I will honestly tell you that it was extremely difficult the first week at the hospital. I didn't want to touch, or look or participate in the care of the ostomy. The person who helped me the most was my Ostomy nurse, she came several times the first week that I was home. She helped me accept my situation and showed me how to care for the stoma. My husband calls her Mary Poppins because she has a British accent and he's not far off, she's a truly wonderful nurse. It has been nearly three months since I have been dealing with this and it's really okay now. There are many products to help with skin care and there are many options in regards to ostomy bags. I hated the drainable ones because I never felt clean so I switched to disposable bags which snap off the flange which is attached to your skin, toss the bag and then snap on a new clean bag. I clean the area around the flange before snapping on a new one.

It's not what I wanted to deal with but I have adjusted and maybe one day I can get resected and get rid of the ostomy. My one tip regarding public restrooms is try to find single occupancy handicapped ones for privacy and access to a sink. It just makes me feel more secure using a single person restroom knowing that no one else is going to wonder what the heck I'm doing in the bathroom stall!

Best of luck to your moms! My daughters have been remarkable helping me as I'm sure you are to your mother.

Shana
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...

Mercy110
Posts: 114
Joined: Wed Aug 16, 2017 12:13 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KARS MUTATED, PLZ HELP!)

Postby Mercy110 » Mon Sep 04, 2017 3:36 am

UPDATE

The Onco we met last time told us my mum is a KRAS-mutated patient. All we know is that there are fewer drugs that can be used so we are properly in a more difficult situation.
We would like to know WHAT ELSE WE CAN DO in this situation. We do know that we can use Avastin, but we would like to know further is that any choices left other than traditional chemos and Avastin? As the genes has been mutated already, does it mean that is impossible to cure unless the KRAS gene reverses?
And is this mutation related to immunotherapy?
Thank you!! Please help!!
My Mum (age 56), NRAS-mutate Q61R
2017-05: Surgery with stoma. T4N1M0. Stage3C. Xeloda Only. Increasing CEA. CT: Multiple lung nodules. Stage4.
2017-09: 85% FOLFOX + Avastin, stable CT
2018-03 to 05: Folfox Allergy, Folfiri (with Avastin since Oct)
2019: CEA:178, started Irinotecan+Zaltrip+TS-1, 25 times radio with xeloda
2020: CEA: 217.3, pending treatment


WISH ALL MIGHTY GOD HEALS MUM WITH HIS MIRACLE

NHMike
Posts: 2425
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby NHMike » Mon Sep 04, 2017 5:26 am

I've never really understood the KRAS thing and I read the article at Wikipedia and I still don't understand it as far as the cellular mechanisms go but this is the practical stuff for us:

Colorectal cancer

The impact of KRAS mutations is heavily dependent on the order of mutations. Primary KRAS mutations generally lead to a self-limiting hyperplastic or borderline lesion, but if they occur after a previous APC mutation it often progresses to cancer.[17] KRAS mutations are more commonly observed in cecal cancers than colorectal cancers located in any other places from ascending colon to rectum.[18][19]

KRAS mutation is predictive of a very poor response to panitumumab (Vectibix®) and cetuximab (Erbitux®) therapy in colorectal cancer.[20] Currently, the most reliable way to predict whether a colorectal cancer patient will respond to one of the EGFR-inhibiting drugs is to test for certain “activating” mutations in the gene that encodes KRAS, which occurs in 30%-50% of colorectal cancers. Studies show patients whose tumors express the mutated version of the KRAS gene will not respond to cetuximab or panitumumab.[21]

Although presence of the wild-type (or normal) KRAS gene does not guarantee that these drugs will work, a number of large studies[22][23] have shown that cetuximab has significant efficacy in mCRC patients with KRAS wild-type tumors. In the Phase III CRYSTAL study, published in 2009, patients with the wild-type KRAS gene treated with Erbitux plus chemotherapy showed a response rate of up to 59% compared to those treated with chemotherapy alone. Patients with the KRAS wild-type gene also showed a 32% decreased risk of disease progression compared to patients receiving chemotherapy alone.[23]

Emergence of KRAS mutations is a frequent driver of acquired resistance to cetuximab anti-EGFR therapy in colorectal cancers. The emergence of KRAS mutant clones can be detected non-invasively[how?] months before radiographic progression. It suggests to perform an early initiation of a MEK inhibitor as a rational strategy for delaying or reversing drug resistance.[24]

I don't recall seeing KRAS information on my tests and will ask my doctor about it. I'm on 5 FU which doesn't seem to be involved here but it would be nice to know if there are other drugs which might work or improve things.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

Mercy110
Posts: 114
Joined: Wed Aug 16, 2017 12:13 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby Mercy110 » Mon Sep 04, 2017 5:33 am

NHMike wrote:I've never really understood the KRAS thing and I read the article at Wikipedia and I still don't understand it as far as the cellular mechanisms go but this is the practical stuff for us:

Colorectal cancer

The impact of KRAS mutations is heavily dependent on the order of mutations. Primary KRAS mutations generally lead to a self-limiting hyperplastic or borderline lesion, but if they occur after a previous APC mutation it often progresses to cancer.[17] KRAS mutations are more commonly observed in cecal cancers than colorectal cancers located in any other places from ascending colon to rectum.[18][19]

KRAS mutation is predictive of a very poor response to panitumumab (Vectibix®) and cetuximab (Erbitux®) therapy in colorectal cancer.[20] Currently, the most reliable way to predict whether a colorectal cancer patient will respond to one of the EGFR-inhibiting drugs is to test for certain “activating” mutations in the gene that encodes KRAS, which occurs in 30%-50% of colorectal cancers. Studies show patients whose tumors express the mutated version of the KRAS gene will not respond to cetuximab or panitumumab.[21]

Although presence of the wild-type (or normal) KRAS gene does not guarantee that these drugs will work, a number of large studies[22][23] have shown that cetuximab has significant efficacy in mCRC patients with KRAS wild-type tumors. In the Phase III CRYSTAL study, published in 2009, patients with the wild-type KRAS gene treated with Erbitux plus chemotherapy showed a response rate of up to 59% compared to those treated with chemotherapy alone. Patients with the KRAS wild-type gene also showed a 32% decreased risk of disease progression compared to patients receiving chemotherapy alone.[23]

Emergence of KRAS mutations is a frequent driver of acquired resistance to cetuximab anti-EGFR therapy in colorectal cancers. The emergence of KRAS mutant clones can be detected non-invasively[how?] months before radiographic progression. It suggests to perform an early initiation of a MEK inhibitor as a rational strategy for delaying or reversing drug resistance.[24]

I don't recall seeing KRAS information on my tests and will ask my doctor about it. I'm on 5 FU which doesn't seem to be involved here but it would be nice to know if there are other drugs which might work or improve things.



Thank you. I have read these data through, actually. Most of them focus on KRAS wild type instead of mutated type. It seems there are actually no breakthrough whatsoever for mutated-type. That rely worried me. As my mum have multiple lung mets, the onco has asked her to use Avastin. We are yet exploring any more options for her. After knowing the mutation, she is down and wonder if this has a cure.
My Mum (age 56), NRAS-mutate Q61R
2017-05: Surgery with stoma. T4N1M0. Stage3C. Xeloda Only. Increasing CEA. CT: Multiple lung nodules. Stage4.
2017-09: 85% FOLFOX + Avastin, stable CT
2018-03 to 05: Folfox Allergy, Folfiri (with Avastin since Oct)
2019: CEA:178, started Irinotecan+Zaltrip+TS-1, 25 times radio with xeloda
2020: CEA: 217.3, pending treatment


WISH ALL MIGHTY GOD HEALS MUM WITH HIS MIRACLE

veckon
Posts: 131
Joined: Thu Jul 27, 2017 7:44 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby veckon » Mon Sep 04, 2017 6:44 am

We need a Maia bat signal. Any immunotherapy or other trials for KRAS mutations?
27 yo male
Metastatic rectal cancer diagnosed 12/16
Liver metastases and peritoneal carcinomatosis
Lynch syndrome, MSI-H
Failed liver resection 3/17
FOLFOX6 12/16 - 05/17
Keytruda 5/17 - present
@Memorial Sloan Kettering

NHMike
Posts: 2425
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby NHMike » Mon Sep 04, 2017 6:45 am

My son was upset that the standard treatment for CRC is 5FU, a treatment that has been around for 50 years, when we're seeing targeted treatments for various kinds of cancer. He knows that it's all about the numbers but it can be frustrating when there's a miracle drug for others but not for you or your loved ones. I think that there are a few here that have gone after aggressive and not-well-known procedures that have done well with them.

I have seen the KRAS results in the signatures of some here. It appears that I didn't have this test done. Is this test done only if the cancer has spread so that other drugs could be used for the mets?
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

veckon
Posts: 131
Joined: Thu Jul 27, 2017 7:44 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby veckon » Mon Sep 04, 2017 6:49 am

NHMike wrote:My son was upset that the standard treatment for CRC is 5FU, a treatment that has been around for 50 years, when we're seeing targeted treatments for various kinds of cancer. He knows that it's all about the numbers but it can be frustrating when there's a miracle drug for others but not for you or your loved ones. I think that there are a few here that have gone after aggressive and not-well-known procedures that have done well with them.

I have seen the KRAS results in the signatures of some here. It appears that I didn't have this test done. Is this test done only if the cancer has spread so that other drugs could be used for the mets?


There are no miracle drugs. If you are referring to pembrolizumab I am 1-3% of patients who respond as well as I have so far and it could stop at any moment or not. They have no idea why.
27 yo male
Metastatic rectal cancer diagnosed 12/16
Liver metastases and peritoneal carcinomatosis
Lynch syndrome, MSI-H
Failed liver resection 3/17
FOLFOX6 12/16 - 05/17
Keytruda 5/17 - present
@Memorial Sloan Kettering

Mercy110
Posts: 114
Joined: Wed Aug 16, 2017 12:13 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby Mercy110 » Mon Sep 04, 2017 6:52 am

NHMike wrote:My son was upset that the standard treatment for CRC is 5FU, a treatment that has been around for 50 years, when we're seeing targeted treatments for various kinds of cancer. He knows that it's all about the numbers but it can be frustrating when there's a miracle drug for others but not for you or your loved ones. I think that there are a few here that have gone after aggressive and not-well-known procedures that have done well with them.

I have seen the KRAS results in the signatures of some here. It appears that I didn't have this test done. Is this test done only if the cancer has spread so that other drugs could be used for the mets?



I am not sure for US as most of the research I have done say US patients are most likely undergone this genetic test once they have CRC.
But in HK it is being checked in late stage.
My Mum (age 56), NRAS-mutate Q61R
2017-05: Surgery with stoma. T4N1M0. Stage3C. Xeloda Only. Increasing CEA. CT: Multiple lung nodules. Stage4.
2017-09: 85% FOLFOX + Avastin, stable CT
2018-03 to 05: Folfox Allergy, Folfiri (with Avastin since Oct)
2019: CEA:178, started Irinotecan+Zaltrip+TS-1, 25 times radio with xeloda
2020: CEA: 217.3, pending treatment


WISH ALL MIGHTY GOD HEALS MUM WITH HIS MIRACLE

veckon
Posts: 131
Joined: Thu Jul 27, 2017 7:44 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby veckon » Mon Sep 04, 2017 6:54 am

Also, chemo/radiation adjuvant with surgery can actually cure you with relatively good probability so long as they can resect everything. Immunotherapy offers no cure. At best it makes the disease chronically manageable for a vanishingly small minority of patients. I’d much rather be in a situation where a cure was still on the table and deal with chemoradiation.
27 yo male
Metastatic rectal cancer diagnosed 12/16
Liver metastases and peritoneal carcinomatosis
Lynch syndrome, MSI-H
Failed liver resection 3/17
FOLFOX6 12/16 - 05/17
Keytruda 5/17 - present
@Memorial Sloan Kettering

Mercy110
Posts: 114
Joined: Wed Aug 16, 2017 12:13 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby Mercy110 » Mon Sep 04, 2017 7:04 am

veckon wrote:Also, chemo/radiation adjuvant with surgery can actually cure you with relatively good probability so long as they can resect everything. Immunotherapy offers no cure. At best it makes the disease chronically manageable for a vanishingly small minority of patients. I’d much rather be in a situation where a cure was still on the table and deal with chemoradiation.


I understand, but what I am thinking now is that if it is all about mutation, then even though the tumors are removed, they are still going to grow again as the mutated genes still exists. Am I understanding this issue correctly?
My Mum (age 56), NRAS-mutate Q61R
2017-05: Surgery with stoma. T4N1M0. Stage3C. Xeloda Only. Increasing CEA. CT: Multiple lung nodules. Stage4.
2017-09: 85% FOLFOX + Avastin, stable CT
2018-03 to 05: Folfox Allergy, Folfiri (with Avastin since Oct)
2019: CEA:178, started Irinotecan+Zaltrip+TS-1, 25 times radio with xeloda
2020: CEA: 217.3, pending treatment


WISH ALL MIGHTY GOD HEALS MUM WITH HIS MIRACLE

NHMike
Posts: 2425
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby NHMike » Mon Sep 04, 2017 7:09 am

Mercy110 wrote:
NHMike wrote:My son was upset that the standard treatment for CRC is 5FU, a treatment that has been around for 50 years, when we're seeing targeted treatments for various kinds of cancer. He knows that it's all about the numbers but it can be frustrating when there's a miracle drug for others but not for you or your loved ones. I think that there are a few here that have gone after aggressive and not-well-known procedures that have done well with them.

I have seen the KRAS results in the signatures of some here. It appears that I didn't have this test done. Is this test done only if the cancer has spread so that other drugs could be used for the mets?


I am not sure for US as most of the research I have done say US patients are most likely undergone this genetic test once they have CRC.
But in HK it is being checked in late stage.


Genetic testing wasn't done for me by my local team and that may be due to the staging. I did have the genetic testing done and am waiting for the results (results were ready last week but the pathologist has been very busy). I don't know whether or not it's an insurance thing or if there are rules as to when to do but it doesn't seem to be done by default for CRC at my stage. Genetic testing is still relatively new. I suspect that I could have pushed my local team to get it done and it is possible that it is the default by some of the better hospitals. But I am pretty sure that it isn't done for everyone. Some stuff that I dug up:

A new genome-sequencing test developed at Memorial Sloan Kettering allows our doctors to quickly find out whether a patient’s tumor carries clinically useful mutations — including aberrations that make cancers vulnerable to particular drugs — and to match individual patients with available therapies or clinical trials that will most benefit them.

Until now, genomic testing of tumors has been done routinely only in certain cancers. For most cancers, the available tests have been limited to analyzing one or a handful of genes at a time, and within each gene, only the most common mutations could be detected.

...

The bulk of the tests will be done for patients with advanced disease, for whom results can help guide treatment choices. The assay will also be offered on a research basis in the newly launched Marie-Josée and Henry R. Kravis Center for Molecular Oncology.


https://www.mskcc.org/blog/new-tumor-se ... e-patients

BTW, I just learned that there's a difference between Genetic testing and Genomic testing. Genetic testing is to gauge your risk factors for cancer. Genomic testing refers to testing a cancer tumor. It's a lot easier to find out about Genomic testing of a tumor if you use Genomic in the search. Using Genetic in the search will bring up a bunch of articles on general testing for risk - not testing the cancer tumor stuff.

Several years ago, tests would be done individually so Assays were done one-at-a-time and probably priced that way. Next-gen sequencing machines came along that could test a ton of them at one time which means that a lot of genes can be analyzed, even if most of them aren't useful for treating the cancer. Having all of the genomic information makes things really interesting for researchers too.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

NHMike
Posts: 2425
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby NHMike » Mon Sep 04, 2017 7:14 am

veckon wrote:
NHMike wrote:My son was upset that the standard treatment for CRC is 5FU, a treatment that has been around for 50 years, when we're seeing targeted treatments for various kinds of cancer. He knows that it's all about the numbers but it can be frustrating when there's a miracle drug for others but not for you or your loved ones. I think that there are a few here that have gone after aggressive and not-well-known procedures that have done well with them.

I have seen the KRAS results in the signatures of some here. It appears that I didn't have this test done. Is this test done only if the cancer has spread so that other drugs could be used for the mets?


There are no miracle drugs. If you are referring to pembrolizumab I am 1-3% of patients who respond as well as I have so far and it could stop at any moment or not. They have no idea why.


I have read an article about a girl that took Keytruda and was cured of her cancer.

I also read about the most famous Keytruda patient, Jimmy Carter though I just read an article and he had Keytruda, radiation and surgery. That was in 2014 or 2015 and I haven't heard of anything since so I assume that he's NED. For some others, I've read that it's a maintenance drug, similar to my coworker on a maintenance drug for lung cancer. But these drugs do allow people to survive, hopefully until there is a cure or vaccine. In some cases, researchers can get ahead of mutations.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

veckon
Posts: 131
Joined: Thu Jul 27, 2017 7:44 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby veckon » Mon Sep 04, 2017 7:36 am

NHMike wrote:
veckon wrote:
NHMike wrote:My son was upset that the standard treatment for CRC is 5FU, a treatment that has been around for 50 years, when we're seeing targeted treatments for various kinds of cancer. He knows that it's all about the numbers but it can be frustrating when there's a miracle drug for others but not for you or your loved ones. I think that there are a few here that have gone after aggressive and not-well-known procedures that have done well with them.

I have seen the KRAS results in the signatures of some here. It appears that I didn't have this test done. Is this test done only if the cancer has spread so that other drugs could be used for the mets?


There are no miracle drugs. If you are referring to pembrolizumab I am 1-3% of patients who respond as well as I have so far and it could stop at any moment or not. They have no idea why.


I have read an article about a girl that took Keytruda and was cured of her cancer.

I also read about the most famous Keytruda patient, Jimmy Carter though I just read an article and he had Keytruda, radiation and surgery. That was in 2014 or 2015 and I haven't heard of anything since so I assume that he's NED. For some others, I've read that it's a maintenance drug, similar to my coworker on a maintenance drug for lung cancer. But these drugs do allow people to survive, hopefully until there is a cure or vaccine. In some cases, researchers can get ahead of mutations.


It's good to have hope. Believe me, I want to be cured. But there is no evidence that it cures anything on its own. It just makes your immune system able to identify and kill cancer so long as it doesn't mutate and you still respond. There are a handful of examples of remission thanks to pembrolizumab and related drugs. Remission is not the same as cure. It's easy to forget the breakthrough trial for MSI-H and pembrolizumab was only conducted in 2015. Maybe we can make claims about a cure (in combination with surgery) after survival is studied over the next decade. When doing chemotherapy, do you assume a complete pathological response is the most likely outcome of such a treatment? Of course not, at least not if you are realistic and understand probability. Point in fact, more people have complete pathological responses with chemo/radiation alone (> 0) than with pembrolizumab alone (0).
27 yo male
Metastatic rectal cancer diagnosed 12/16
Liver metastases and peritoneal carcinomatosis
Lynch syndrome, MSI-H
Failed liver resection 3/17
FOLFOX6 12/16 - 05/17
Keytruda 5/17 - present
@Memorial Sloan Kettering

User avatar
Maia
Posts: 2443
Joined: Fri Aug 24, 2012 8:00 am

Re: Rectal case from Hong Kong (UPDATE: Lung Met, KRAS MUTATED, PLZ HELP!)

Postby Maia » Mon Sep 04, 2017 7:38 am

Hi, Mercy
In a rush here, so replying your PM in the open forum, in case it helps others

--My mum's genetic test shows KRAS mutation. Practically speaking, I know there are certain kinds of targeted drugs are not useful on her right now.

With a KRAS mutation, Erbitux and Vectibix can't be used. There are certain data that certain submutation of KRAS, G13D, might respond to them, anyway, but you need further testing. Having or not having the mutation adds one more line of therapy, that might last months, but doesn't affect the curable/non curable status.

--Does it mean that my mum cant be cured unless the mutation being cured? (Even Avastin is not curing the disease but just pushing the deadline? And I am wondering even though we remove tumors in her body through surgery, is it very likely to develop again as the mutation is still in place...Am I right?)

You are right on every point. Even if the chemo or the monoclonal antibody, Avastin, make her NED --not evidence of disease--, that lasts during a while. It might be months or one year, but the cancer reappears. The KRAS mutation is not important, regarding that --it is what happens with all the unresectable metastatic CRC. Those who are metastatic and had one/two spots in the liver, or one/two on the lungs and had a resection, have durable responses; they are ''cured'', some people say. Still, we see recurrences.

KRAS mutation is not relevant, at the present, for immunotherapy. What it is important is knowing if a patient is MSS --like 85 per cent of CRC-- or MSI-high --the rest. For those MSI-high, immunotherapy *monotherapy* (that is, on its own, like Keytruda, Opdivo, etc.) might mean ''durable'' response --as cautiously veckon said. For the rest, the MSS, being unresectable, the treatment that offers some chance of durable response is a *combination* immunotherapy trial (many times, an anti PD-1) PLUS ''something else''. That would be also the path for the MSI-high who doesn't respond to immunotherapy on its own, or progress on it.
In my signature, there is a link to a trial finder for MSS --most trials are for MSI-high, too-- that our fellow Tom Marsilje (DK37, in this forum) curates.
I already mentioned one trial that you have available in HK.
On the other hand, the best clinical data that we have of immunotherapy working for MSS is for a cohort where most were KRAS mutant. See literature in the thread from your HK colleague: viewtopic.php?f=1&t=58371

I hope I didn't make many mistakes... Hang in there!


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