Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

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Jack&KatiesMommy
Posts: 607
Joined: Wed Dec 21, 2011 1:08 pm
Location: Columbus, OH

Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

Postby Jack&KatiesMommy » Thu Dec 20, 2018 1:28 pm

Here is a link to a Foundation One Article that is, in part, based upon the results of my case and relates specifically to MSS TMB and Colorectal Cancer's response to immunotherapy:

https://www.foundationmedicine.com/blog ... tal-cancer
Cynthia
Mommy to Jack (8) now (17) and Katie (4) now (13)
(My Most Precious Things)
Dx 8/11 Stage IV CRC (liver mets) CEA 2,600+
9/11 Folfiri 2/12: Failed Liver Resection
5/12 HAI pump/removed primary
4/13 Liver Resection
8/13-12/15 (10) RFAs lungs
5/17: Upper Left Lobe of lung resected.
02/18: 3 new lymph mets lung
05/18: Keytruda (MSS w/Intermediate TMB): NED CEA: 66.4, 39.2, 23.8, 13, 3.5 1.8, 1.0, 2.8 3.9, 5.0, 5.6, 1.5, .8,

chadwick1
Posts: 23
Joined: Sat Oct 13, 2018 9:04 am

Re: Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

Postby chadwick1 » Thu Dec 20, 2018 8:57 pm

Thanks for the link, it's really interesting stuff! I'll cross-link to your other thread in case anyone finds this and wants to read more of that discussion.

http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60593
DX 6/2017, 37yo father of two
Stage IIIb rectal cancer (T3N1bM0) no genetic indicators, normal CEA
7/2017 radiation + 5FU
10/2017 LAR w/ temp loop ileo. clear margins, 2/33 nodes
11/2017-3/2018 FOLFOX, 9 rounds
2/2018 clear CT
4/2018 ileo reversal
10/2018 CT shows suspicious mass in liver (1.7 cm), and in lung (0.6 cm)
MRI confirms 1 liver met, Stage IV
11/2018 liver resection, clear margins
1/2019 CT: lung node shrank to 0.3 cm
3/2019 CT: unchanged/clear!

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henry123
Posts: 209
Joined: Sun Oct 08, 2017 3:25 am

Re: Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

Postby henry123 » Sat Dec 22, 2018 8:22 pm

That's good news if a new biomarker is found that indicates potentially immunotherapy could work for some CRC patients.
46yo M msi-high Lynch +ve
5/16 lap AR 14/21 L nodes +ve
T4N2M1
7/16 Capox 9 cyc
9/16 cea 2
1/17 550
PET CT mets in lung & peri
iri+ avast fail
3/17 10577
4/17 regro fail
5/17 cea 28800
5/17 CT inc in size of mes nodes ,onset of multi nodules in liver
6/17 Opdivo start
7/17 26754
8/17 5623
9/17 497
10/17 52
11/17 12
CT all clear exc a nodule in Lung. liver norm
1/18 3.6
4/18 2
Aspirin start
6/18 1.5 CT clear
12/18 1.1 NED
6/19 .9 CT clear
1/20 NED Opdivo stop

boswind
Posts: 72
Joined: Fri Apr 11, 2014 12:04 pm

Re: Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

Postby boswind » Thu Dec 27, 2018 4:17 pm

It is new that TMB guides cancer treatment, but it is really exciting. I read the paper that Foundation One’s article has a link to. The paper published on J Gastrointestinal Oncology includes two successful cases.

case 1: a patient with stage 4 rectal cancer, MSS, TMB = 223 mut/Mb, is having partial response to Keytruda. Tumors have shrunk by over 50%.

Case 2: another patient with stage 3 rectal cancer, MSS, TMB=14 mut/Mb, achieved a complete response to nivolumab, having 18 month NED.

If we add Cynthia who also had complete response, we see three good cases, although TMB guiding treatment is so new.
01.24.14 Male, DX @54 Rectosigmoid Cancer, MRI: T3N0M0
03.19.14 Completed 5-week Radia+Xeloda
05.07.14 Had surgery
02.25.15 CT showed stage 4.
03.15 - 08.15, folfox + Avastin
08.15 - 07.17, 5FU+leucovorin+Avastin
07.17 - 01.18, Folfuri + Avastin
02.18 - 03.19, Centuximab + Irinotecan
03.19 - 05.19, Keytruda
05.19 - 9.19, Folfox+Avastin
10.22.19 - rechallenge Centuximab+Irinotecan
110 rounds of chemos received (as of 12.31.19)
MSS, KRAS wt, BRAF wt

boswind
Posts: 72
Joined: Fri Apr 11, 2014 12:04 pm

Re: Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

Postby boswind » Fri Dec 28, 2018 3:45 pm

Cynthia and other members,

I contacted Foundation One again. I have to correct the info I posted in another thread. To get their TMB, they require tissue samples; their gene tests based on peripheral blood do not provide TMB.

My Onc. stated: to get new tissue samples i have to have a liver biopsy. I feel it is too much to have a liver biopsy just for a TMB test. Most importantly, I believe the chance that I have a TMB higher than 12 mut/Mb is very small statistically, although I have done two targeted medicines: Avastin and Centuximab. If I had a 30% chance of high TMB, I would be happy to have a liver biopsy.

What do you think? What do other members think?

Thank you,
01.24.14 Male, DX @54 Rectosigmoid Cancer, MRI: T3N0M0
03.19.14 Completed 5-week Radia+Xeloda
05.07.14 Had surgery
02.25.15 CT showed stage 4.
03.15 - 08.15, folfox + Avastin
08.15 - 07.17, 5FU+leucovorin+Avastin
07.17 - 01.18, Folfuri + Avastin
02.18 - 03.19, Centuximab + Irinotecan
03.19 - 05.19, Keytruda
05.19 - 9.19, Folfox+Avastin
10.22.19 - rechallenge Centuximab+Irinotecan
110 rounds of chemos received (as of 12.31.19)
MSS, KRAS wt, BRAF wt

boswind
Posts: 72
Joined: Fri Apr 11, 2014 12:04 pm

Re: Article On CRC MSS and Tumor Mutation Burden and response to Immunotherapy

Postby boswind » Fri Dec 28, 2018 3:58 pm

Their paper published in J Gastrointestinal Oncology states that for 5,702 advanced MSS colorectal cancers, their median TMB is only 3.6 mut/Mb. On the other hand, for those 302 cases with MSI-H, their median TMB is 46.8 mut/Mb.
01.24.14 Male, DX @54 Rectosigmoid Cancer, MRI: T3N0M0
03.19.14 Completed 5-week Radia+Xeloda
05.07.14 Had surgery
02.25.15 CT showed stage 4.
03.15 - 08.15, folfox + Avastin
08.15 - 07.17, 5FU+leucovorin+Avastin
07.17 - 01.18, Folfuri + Avastin
02.18 - 03.19, Centuximab + Irinotecan
03.19 - 05.19, Keytruda
05.19 - 9.19, Folfox+Avastin
10.22.19 - rechallenge Centuximab+Irinotecan
110 rounds of chemos received (as of 12.31.19)
MSS, KRAS wt, BRAF wt


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