Sorry for the late reply. Has been in hospital twice for the past three days.
Could you share your wife's MSI/MSS/MMR status, genetics or KRAS/BRAF status,
Of course, Hers is MSS(MSI sensor score 1.03), KRAS(Wild), BRAF(Should also be wild since it's not on the alternations list). Complete report is as below:
Positive for the following somatic alternations in the clinically validated panel
1. TP53(NM_000546) exon7 p.R248Q(c.743G>A)
Positive For the following somatic alterations in the investigational panel:
2. SDHA (NM_004168-5p15.33) Gain(Fold Change: 1.9)(Note 1)
3. BCL2L1(NM_138578-20q11.21) Gain(Fold Change: 1.8 ) (Note 1)
4. ASXL1(NM_015338-20q11.21) Gain(Fold Change: 1.8 ) (Note 1)
5. DNMT3B(NM_006892-20q11.21) Gain(Fold Change: 1.8 ) (Note 1)
6. SRC(NM_198291-20q11.23) Gain(Fold Change: 1.8 ) (Note 1)
7. RTEL1(NM_032957-20q13.33) Gain(Fold Change: 1.5)(Note 1)
8. DNAJB1(NM_006145-19p13.12) Deletion(Fold Change: -2.9)
9. SMAD4(NM_005359-18q21.2) Deletion(Fold Change: -2.9)
10.RNF43(NM_017763-17q22) Intragenic deletion(Note 2)
11. ARID1B(NM_020732) exon20 p.E1685del(c.5052_5055delinsT)
12. IRS1(NM_005544) exon1 p.E940K(c.2818G>A)
13. NF1(NM_001042492) exon18 pI719Vfs*34(c.2141_2154dupGTGAGGAAGCAGAT)
14.TCF3(NM_001136139) exon9 splicing variant p.X244_splice(c.732_822+35del)
15. HIST3H3(NM_003493) rearrangement: c.161:HIST3H3_chr1:g.145082149dup(note 3)
Notes:
1. The SDHA, BCL2L1, ASXL1, DNMT3B, SRC, and RTEL1 copy number gains fall slightly below the cut off criteria for amplification. Confirmatory testing by an alternate method is suggested, if clinically indicated.
2. The RNF43 intragenic deletion involves the loss of exon 2
3. The HIST3H3 rearrangement results in the duplication of exon 1. One of the breakpoints is within exon 1. The functional significance is undermined.
4. Copy number profile is suggestive of broad copy number gain on Chromosome arms 8p11 and 13q12
5. This sample has been nominated for further analysis using the Archer targeted RNA seq as an apparent deriver-negative cancer. Assay will be performed if additional material is available and results will be reported under a separate accession number.
and some blood work like Hopie
formatted and did here? (you can see it properly from the quote - edit mode button, [
"]) The most crucial initial lab data people are usually missing in their previous bloodwork are CA199, LDH, hsCRP and 25 hydroxy vitamin D. The first CA199 done helps with the cimetidine question, best done before surgery or any treatment, but even now helps.
(pre chemo) (after 21 rounds) (range)
AFP 2.1, NA, 0.0-5.0
CA125 76, NA, 0-35
CA19-9 298, NA, 0-40
CEA 64.5, 5.9, 0.0-5.0
Vitamin D 25 Hydroxy, NA, 19, 20-50(optimal)
WBC 14.1, 5.8, 4.0-11.0
RBC 3.27, 4.35, 3.8-5.0
HGB 7.9, 13.7, 11.2-15.4
HCT 26.5%, 41.7%, 34.3-46.0%
MCV 81, 96, 80-98
MCH 24.2, 31.5, 27.0-33.0
MCHC 29.8, 32.9, 31.0-36.5
RDW. 15.6%,13.3%,12.2-15.1%
PLT 752, 172,160-400
Neutrophil. 86.4%, 66.3%,32.5-74.8%
Immature Granulocyte 0.6%,0.3%,0.0-0.6%
Lymph 7.2%, 22.2%, 12.2-47.4%
Mono 5.1%, 7.6%,0-12.3%
Eos 0.6%, 3.3%, 0-4.9%
Baso. 01.%,0.3%, 0.0-1.5%
Abs Neut 12.2, 3.8, 1.5-7.5
Abs Lymph 1.0, 1.3, 0.9-3.2
Abs Mono 0.7, 0.4, 0-1.3
Abs Eosinophil 0.1, 0.2, 0-0.7
Abs Basophil 0.0, 0.0, 0.0-0.2
Nucleated RBC 0.0%, 0.0%
Creatinine 0.7, 0.8, 0.6-1.1
Na 136, 139, 133-143
K, 4.6, 4.6, 3.3-4.9
Chloride, 101,109,98-109
CO2 25, 23, 18-29
Calcium 9.2, 9.8, 8.5-10.5
Glucose 131, 96, 70-99
Protein 7.6, 8.1,6.3-8.5
Albumin 3.7,4.7, 3.8-5.0
Anion Gap 10, 7, 8-16
Bilirubin 0.3, 0.8, <=1.2
BUN 10, 18, 6-20
ALK 212,105, <=130
AST 15, 36,<=37
ALT 30, 35, <=55
Fewer untreated gaps (e.g 5FU chemo still working 12 hours before surgery, immunochemo 24 hours after surgery, other chemistry still on during surgery),
We have spoken with our surgeon, and mentioned about the locally curative, multimodal method. Our surgeon said this operation would be palliative to reduce the tumor load by removing the growing and asked us to think about it. The take home message It's not absolutely necessary, but it's an opportunity.
I also asked if taking 5FU 12 hours before the surgery and resuming chemo shortly after would be possible. The answer is no. It has to be 8-10 weeks of window, 4-6 weeks before and 4 weeks after for the chemo per the surgeon.
Would you mind sharing if your wife's surgery was done in the U.S.? To me, it appears there's a protocol surgeons have to follow or they may risk their career. I heard in some countries people can buy Chemo, e.g. 5FU and immunochemo themselves and bring to the oncologist. Just curious how this works out in the U.S.
Thank you.