KRAS G12V and Avastin

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Spazzyjanet
Posts: 47
Joined: Mon Oct 01, 2018 3:28 pm
Facebook Username: Heather Stoker

KRAS G12V and Avastin

Postby Spazzyjanet » Tue Nov 06, 2018 6:03 pm

I met with a medical oncologist today who is considered to be a specialist in genomic testing and research.

He told me today that a KRAS G12V mutation does not rule out Avastin. Yet a quick Google search shows qualified studies that say differently. What do you think? The Onc can't be wrong, can he? Am I just worrying about nothing here?
40 yr old, 3 kids. Dx 9/2018, Stage IV
KRAS G12V (resistant to Cetuximab)
CEA levels normal at diagnosis
4.2 cm Tumor, PT3, PN2B
11 of 18 with adenocarcinoma
+ removal of one cancerous node in Peritoneum.
9/2018, Colon resection and Ostomy-- Margins Negative
10/2018, PET shows 6 liver mets
10/2108, begin FOLFOX (Oxi+5 FU)
11/2018, MRI updates potential liver metastasis to 11 mets, both lobes.

WarriorSpouse
Posts: 148
Joined: Tue Aug 16, 2016 9:02 pm

Re: KRAS G12V and Avastin

Postby WarriorSpouse » Tue Nov 06, 2018 9:25 pm

My wife is KRAS mutant, not certain of G12V. Check with a major cancer center for a second opinion concerning your question. They see everything and share everything.
Best wishes.
WS
Spouse of wife 47 years old
10/2014, Stage IV Metastatic CC
Lymph node involvement 12/15, w/ positive PET on para-aortic lymph nodes.
5 cm sigmoid tumor resection as well as positive Virchow lymph node.
KRAS mut, Highly Differentiated, Lynch Negative
Folfox and Avastin 1 YR (Oxi for 5 months) NED 05/2015
Zeloda and Avastin since 01/2016
Chemo break 03/2017, back on Zeloda and Avastin 04/2017.

"...Perseverance is not a long race; it is many short races one after the other."
-Walter Elliot

teri3
Posts: 389
Joined: Fri Jan 09, 2015 11:03 am

Re: KRAS G12V and Avastin

Postby teri3 » Wed Nov 07, 2018 12:04 am

I'm g12v Kras mutant and have good luck.with Folfiri + Avistin. This is my second go round and my nodules have shrunk. My CEA went from a 331 in April to a 7.5 in August. If you aren't comfortable is get a second opinion. I've had two oncologist and they've both had me on Avistin.
Good luck
Teri
58 yrs old female
MSS KRAS mutation G12V
adenocarcinoma sigmoid colon dx 11-14
sigmoidectomy 11-14
Stage 3A
3 out of 20 lymph nodes involved
started FolFox 1-27-15
11 rounds FOLFOX last one 6-30-2015
7-29-2015 PET clear
5-14-2016 CT 2 nodules one in each lung
Confirmed pulmonary metastasis stage 4
FOLFIRi + Avistin started 8-16 11 rounds complete 12-16
CT 12-16 nodules shrunk chemo break wait and see :?
CT growth
VATS l lung 4 10 17
VATS r lung 4 24 17
CT 2 nodules r up and l low :(

Spazzyjanet
Posts: 47
Joined: Mon Oct 01, 2018 3:28 pm
Facebook Username: Heather Stoker

Re: KRAS G12V and Avastin

Postby Spazzyjanet » Wed Nov 07, 2018 6:17 am

Thank you for your replies. This had me up in the middle of the night so I tried a different search methodology.

Instead of looking for G12V + Avastin, which gets me to a study titled "G12V and G12A KRAS mutations are associated with poor outcome in patients with metastatic colorectal cancer treated with bevacizumab," I tried searching for G12V Avastin Chemotherapy. This led me to a 2015 study that seems to confirm what the Oncologist said, titled "Efficacy of bevacizumab and chemotherapy in the first-line treatment of metastatic colorectal cancer: broadening KRAS-focused clinical view." The conclusion in this study was that "KRAS mutation does not interfere with clinical benefit from first-line treatment with bevacizumab plus chemotherapy in mCRC patients."

This is a bit of good news that I was hoping for, since Cetuximab/Panitumumab are already ruled out for me.
40 yr old, 3 kids. Dx 9/2018, Stage IV
KRAS G12V (resistant to Cetuximab)
CEA levels normal at diagnosis
4.2 cm Tumor, PT3, PN2B
11 of 18 with adenocarcinoma
+ removal of one cancerous node in Peritoneum.
9/2018, Colon resection and Ostomy-- Margins Negative
10/2018, PET shows 6 liver mets
10/2108, begin FOLFOX (Oxi+5 FU)
11/2018, MRI updates potential liver metastasis to 11 mets, both lobes.

WarriorSpouse
Posts: 148
Joined: Tue Aug 16, 2016 9:02 pm

Re: KRAS G12V and Avastin

Postby WarriorSpouse » Wed Nov 07, 2018 9:02 am

Don't get too tied down on what local Oncologists may say at first... The one thing I have learned here is that every patient is unique and so is the cancer. Get as much information you can find to the decision makers of your care. Get a second opinion at a major cancer center. Local hospitals will follow the plans of the major cancer center if written for their file and process forward. It is worth the visit and consult.

This is the study that was used to support maintenance chemo with Avastin for my wife, Cairo-3 study.
https://www.ncbi.nlm.nih.gov/pubmed/28911067

Best wishes,
WS
Spouse of wife 47 years old
10/2014, Stage IV Metastatic CC
Lymph node involvement 12/15, w/ positive PET on para-aortic lymph nodes.
5 cm sigmoid tumor resection as well as positive Virchow lymph node.
KRAS mut, Highly Differentiated, Lynch Negative
Folfox and Avastin 1 YR (Oxi for 5 months) NED 05/2015
Zeloda and Avastin since 01/2016
Chemo break 03/2017, back on Zeloda and Avastin 04/2017.

"...Perseverance is not a long race; it is many short races one after the other."
-Walter Elliot

User avatar
betsydoglover
Posts: 934
Joined: Mon Aug 14, 2006 2:31 pm
Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: KRAS G12V and Avastin

Postby betsydoglover » Wed Nov 07, 2018 10:39 am

Don't be too discouraged. I Have the same KRAS mutation. I have had lots of Avastin. And, as you can see from my signature, I have done really well. Both my onc and I agree that Avastin most likely had a significant (positive) impact on the course of my disease. Best wishes.
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

Punky44
Posts: 76
Joined: Mon Oct 01, 2018 4:29 pm

Re: KRAS G12V and Avastin

Postby Punky44 » Wed Nov 07, 2018 1:07 pm

Just a reminder from a fellow Dr Googler to another: the terms we search on Google can affect what results pop up. The algorithms are only as smart as the terms we type in. I find myself scouring the internet often for some piece of information, usually coming up with the exact opposite of what I wanted to hear, then I ask a human doctor the same question and get a much different answer.
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17
MRI/CT/PET puts staging at T3N2M0
Trying total neoadjuvant therapy—chemo first, then short course radiation, then surgery
11/5/18 started Folfox—1 down, 7 to go!

Spazzyjanet
Posts: 47
Joined: Mon Oct 01, 2018 3:28 pm
Facebook Username: Heather Stoker

Re: KRAS G12V and Avastin

Postby Spazzyjanet » Thu Nov 08, 2018 6:02 am

I always ask the human doctor. I just wish that the human doctor would tell me WHY something I bring up does or does not apply instead of just dismissing me outright. I am data driven and explanations are important to me, but sometimes I feel like asking for those can be a tall order.
40 yr old, 3 kids. Dx 9/2018, Stage IV
KRAS G12V (resistant to Cetuximab)
CEA levels normal at diagnosis
4.2 cm Tumor, PT3, PN2B
11 of 18 with adenocarcinoma
+ removal of one cancerous node in Peritoneum.
9/2018, Colon resection and Ostomy-- Margins Negative
10/2018, PET shows 6 liver mets
10/2108, begin FOLFOX (Oxi+5 FU)
11/2018, MRI updates potential liver metastasis to 11 mets, both lobes.

Punky44
Posts: 76
Joined: Mon Oct 01, 2018 4:29 pm

Re: KRAS G12V and Avastin

Postby Punky44 » Thu Nov 08, 2018 12:15 pm

Totally understand—I feel the same way. I hope you can find a doc who will listen to your concerns. It is annoying when doctors dismiss a patient who has an intelligent research-based question. Sometimes I think we are probably the toughest patients because we have those hard-hitting questions that challenge them.
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17
MRI/CT/PET puts staging at T3N2M0
Trying total neoadjuvant therapy—chemo first, then short course radiation, then surgery
11/5/18 started Folfox—1 down, 7 to go!

User avatar
GrouseMan
Posts: 764
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: KRAS G12V and Avastin

Postby GrouseMan » Sun Nov 11, 2018 11:11 am

The KRAS mutation itself does NOT rule out the use of Avastin which is an Antiangiogenic MAB. It interacts with VEGF-A and prevents solid tumors from recruiting the development of blood vessels to provide a food supply if you will. The KRAS mutation is not involved with the VEGF, FGF, PDGF pathway, but instead with the EGFr ERB2, 3, and 4 path ways. So although those papers indicate that it use in KRAS mutant cases may not have improved overall survival in these cases. It is not counter indicated, and when used with FOLFOX and FOLFIRI has been shown to have some benefit.

Good luck in your journey

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017


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