Worried -genetic results are in. KRAS MSS

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Nohogirl
Posts: 69
Joined: Sun Oct 14, 2018 12:15 am

Re: Worried -genetic results are in. KRAS MSS

Postby Nohogirl » Thu Nov 08, 2018 10:33 am

CrossfitChick1980 wrote:My husband is KRAS, MSS with condone 12/13 mutation. He is still alive and kicking but going through a rough spot right now. He has been on almost every chemo with the greatest success on Folfiri+Avastin. He stayed on maintenance 5fu and Avastin for over 2 years before a pesky spot showed up in his liver again. He is currently being treated with theraspheres to the liver and lonsurf. Currently trying to nurse him back to health!

Thank you CrossfitChick1980.
Internet scares me to death. Every single research and article I read mentions poor prognosis with these two.

Hope your husband beats it soon. I was reading your stories and its so sad that your husbands stage 2 went up to 4 even after full chemo regimen. I am now scared to death :(
04/18 DH 49 diag.stage 2A T3N0M0 rectal cancer moderately differentiated.
05/18 chemorad. (Xeloda) 28 days
08/18 Surgery- 24 cm including entire rectum out
Stage II T2N0M0 moderate to poorly diff. adenocarcinoma
0 of 15 lymph nodes
No PNI
No LVI
Clear margins
Regression Grade 3
10/29 Started Folfox

Nohogirl
Posts: 69
Joined: Sun Oct 14, 2018 12:15 am

Re: Worried -genetic results are in. KRAS MSS

Postby Nohogirl » Thu Nov 08, 2018 10:36 am

rp1954 wrote:Take a deep breath. I would look very hard now at CEA, LDH and CA199 (you probably need to order these your self for speed and convenience, at least a first time).

It may be that a choice could be made between normal Xeloda treatment, Xeloda+mild, generic adjuncts, and Folfox. The results from some papers suggest circumstances that oral 5FU + mild adjuncts might be superior to Folfox for recurrence, and a lot less debilitating. Also, to avoid chemos' worst side effects is a plus.

Thank you RP1954.

So far he had a favorable outcome from his neoadjuvent Xeloda. He is now on Folfox and still don't know what will be the outcome. Holding my breath.
04/18 DH 49 diag.stage 2A T3N0M0 rectal cancer moderately differentiated.
05/18 chemorad. (Xeloda) 28 days
08/18 Surgery- 24 cm including entire rectum out
Stage II T2N0M0 moderate to poorly diff. adenocarcinoma
0 of 15 lymph nodes
No PNI
No LVI
Clear margins
Regression Grade 3
10/29 Started Folfox

Nohogirl
Posts: 69
Joined: Sun Oct 14, 2018 12:15 am

Re: Worried -genetic results are in. KRAS MSS

Postby Nohogirl » Thu Nov 08, 2018 10:39 am

heiders33 wrote:I didn't find out my genetic mutation until I switched to MSK. Why my previous oncologist never told me I was KRAS I'll never know. I just looked up my surgical pathology report again and I'm KRAS G12A. Yes, I did end up with a pesky liver met that escaped the initial treatment. But I've had it removed and I'm currently NED and (fingers crossed) plan to stay that way. My KRAS mutation was one of my motivations for pursuing aggressive follow-up chemo -- FOLFIRI plus FUDR through the Medtronic HAI pump, which I'm starting soon. The biggest disadvantage as lpas said is that KRAS mutants aren't candidates for EGFR inhibitors like Vectibix and Erbitux. That's why I'm doing everything I can to keep it from coming back.

Thank you heiders33. Congrats on your NED. Wishing many more scans with NED. I can't wait for my husband to have his post chemo scan with NED
04/18 DH 49 diag.stage 2A T3N0M0 rectal cancer moderately differentiated.
05/18 chemorad. (Xeloda) 28 days
08/18 Surgery- 24 cm including entire rectum out
Stage II T2N0M0 moderate to poorly diff. adenocarcinoma
0 of 15 lymph nodes
No PNI
No LVI
Clear margins
Regression Grade 3
10/29 Started Folfox

Nohogirl
Posts: 69
Joined: Sun Oct 14, 2018 12:15 am

Re: Worried -genetic results are in. KRAS MSS

Postby Nohogirl » Thu Nov 08, 2018 10:44 am

GrouseMan wrote:There is evidence accumulating I believe that the KRAS G13D mutant is actually sensitive to treatment with EGFr Inhibitors like Erbitux. See the following two links, they are both pretty new:

https://www.omicsonline.org/open-access ... ?aid=88407
https://www.biorxiv.org/content/biorxiv ... 6.full.pdf

Most Kras mutations turn the Kras pathway on. It cannot be inhibited by its natural substrate so it remains activated and this often results in downstream activation of other growth factors of which EGF is one.

Here are some other publications that are older but talk about Kras Mutations. Most of these are in Lung Cancer but the idea still applies to Colon Cancer as well.

The following talks about Mutations and testing:
https://biochemmack.ru/upload/iblock/42 ... 9ab5ba.pdf

This one is about he new third generation EGFr Inhibitors and why they may work with KRAS mutant Lung Cancers. Again This is lung Cancer but I suspect this will also be true for colon cancer as well. The drug they discuss in this paper is neratinib which is similar to a drug I worked on recently approved as Vizimpro (dacomitinib). Take note of a statement made in the third paragraph of the introduction!

http://stm.sciencemag.org/content/10/44 ... citransmed

I suspect that when all is said and done and proper clinical trials are run some of the new Pan Erbb inhibitors will start to make their way into colon cancer treatment regardless of KAS status.

Good luck

GrouseMan

Thank you GrouseMan. Good information. This whole mutation and biomarker thing is so complicated
I almost want to go and study DNa and genetics lol.
I am praying and hoping that my husband doesnt get to a point where he will need trials.
04/18 DH 49 diag.stage 2A T3N0M0 rectal cancer moderately differentiated.
05/18 chemorad. (Xeloda) 28 days
08/18 Surgery- 24 cm including entire rectum out
Stage II T2N0M0 moderate to poorly diff. adenocarcinoma
0 of 15 lymph nodes
No PNI
No LVI
Clear margins
Regression Grade 3
10/29 Started Folfox


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