KRAS and other findings help

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SilverWedding
Posts: 71
Joined: Sat May 18, 2019 5:54 am
Facebook Username: Cynthia Harding Marshall

KRAS and other findings help

Postby SilverWedding » Wed Oct 30, 2019 3:29 pm

Just more concern?

Could someone explain implications or anything on:

KRAS RESULTS
Heterozygous mutation in KRAS codon 13 detected. This mutation in Exon 2 may respond to monoclonal antibody therapy.

BRAF RESULTS
Not detected

NRAS RESULTS
Not detected

MSI RESULTS
MSS/MSI-L (Instability observed in 0 of 5 informative markers)

MMR PROTEIN, IHC ONLY, TUMOR RESULTS
IHC: Normal expression of MLH-1, MSH-2, MSH-6, & PMS-2
Last edited by SilverWedding on Wed Oct 30, 2019 9:47 pm, edited 1 time in total.
DH, 56, Sigmoid & rectum
Adenocarcinoma 2cm
 G2: Moderately differentiated
T3N2aM0
Stage IIIb
LN 6/22
5/19 Baseline CEA value - 18.9
Lymphovascular invasion (LVI): present
Perineural invasion (PNI): not identified
Surgical margins: proximal -negative; distal - negative 1.5cm; circumferential - negative 1mm)
MSI status: Waiting‬
Lynch status: ?
KRAS/BRAF: ?
Open Restorative Proctectomy, J-Pouch Coloanal Anastomosis, Loop Ileo w/Appendectomy
Neo-adjuvant Xeloda/radiation
Adjuvant Chemo: to begin 11/19

Claudine
Posts: 165
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: KRAS and other findings help

Postby Claudine » Wed Oct 30, 2019 3:41 pm

In summary, your husband is KRAS mutated (codon 13), BRAF wild, WSS (microsatellite stable). This means that he is not a good candidate for immunotherapy (which works better if you're MSI), and because of the KRAS mutation the anti-EGFRdrugs (cetuximab or panitumumab) will not work. As you can see in my signature, that's similar to my husband, except that his KRAS mutation in on codon 12. These results should help his oncologist orient your treatment.
Wife of Dx 04/2018 (51 yo). MSS, KRAS mutated G12A
No primary, lytic tumor L4 vertebrae, CEA 10
Radiation 04/2018
Resection small intestine 05/18 (no cancer found - Crohn's)
Xelox * 6, 05/2018 to 10/2018
6.7 cm left adrenal mass 03/14/2019, 4.4 cm 05/21, 4.1 cm 09/16
SBRT L4 02/2019
Folfiri + Avastin
CEA since 03/15: 58, then low of 3.2 now at 5.0 (twice)
Scan 03/14: Multiple small lung nodules
Scan 05/21: shrinking
Scan 09/16: lungs show no abnormalities (YAY!!!)

Claudine
Posts: 165
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: KRAS and other findings help

Postby Claudine » Wed Oct 30, 2019 3:56 pm

Oh, I'm reading your post again and despite being MSS, it looks like the KRAS mutation your husband has may make him a candidate for immunotherapy! Yay, one more possible treatment! So maybe I read this all wrong. Others, please chime in!
Wife of Dx 04/2018 (51 yo). MSS, KRAS mutated G12A
No primary, lytic tumor L4 vertebrae, CEA 10
Radiation 04/2018
Resection small intestine 05/18 (no cancer found - Crohn's)
Xelox * 6, 05/2018 to 10/2018
6.7 cm left adrenal mass 03/14/2019, 4.4 cm 05/21, 4.1 cm 09/16
SBRT L4 02/2019
Folfiri + Avastin
CEA since 03/15: 58, then low of 3.2 now at 5.0 (twice)
Scan 03/14: Multiple small lung nodules
Scan 05/21: shrinking
Scan 09/16: lungs show no abnormalities (YAY!!!)

User avatar
SilverWedding
Posts: 71
Joined: Sat May 18, 2019 5:54 am
Facebook Username: Cynthia Harding Marshall

Re: KRAS and other findings help

Postby SilverWedding » Wed Oct 30, 2019 3:59 pm

Thank you, Claudine. What was I hoping to get regarding KRAS and BRAD and MSI? Is this very bad news?
DH, 56, Sigmoid & rectum
Adenocarcinoma 2cm
 G2: Moderately differentiated
T3N2aM0
Stage IIIb
LN 6/22
5/19 Baseline CEA value - 18.9
Lymphovascular invasion (LVI): present
Perineural invasion (PNI): not identified
Surgical margins: proximal -negative; distal - negative 1.5cm; circumferential - negative 1mm)
MSI status: Waiting‬
Lynch status: ?
KRAS/BRAF: ?
Open Restorative Proctectomy, J-Pouch Coloanal Anastomosis, Loop Ileo w/Appendectomy
Neo-adjuvant Xeloda/radiation
Adjuvant Chemo: to begin 11/19

Claudine
Posts: 165
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: KRAS and other findings help

Postby Claudine » Wed Oct 30, 2019 4:16 pm

When we got the results of my husband's analysis, I jumped on Google hoping I'd read something like, "Stage 4 CRC is really really bad UNLESS you have a KRAS G12A mutation, in which case there's a miracle drug that will heal you!". Well maybe not exactly like that, but you get my drift.
As you can imagine, that's not the case. I think studies that state that one mutation is "worse" than another can be misleading; they're often based on small sample sizes, and older data. Cancer in general is pretty bad news, but as you can see from survivors who post here, it's not the death sentence that it used to be!
Wife of Dx 04/2018 (51 yo). MSS, KRAS mutated G12A
No primary, lytic tumor L4 vertebrae, CEA 10
Radiation 04/2018
Resection small intestine 05/18 (no cancer found - Crohn's)
Xelox * 6, 05/2018 to 10/2018
6.7 cm left adrenal mass 03/14/2019, 4.4 cm 05/21, 4.1 cm 09/16
SBRT L4 02/2019
Folfiri + Avastin
CEA since 03/15: 58, then low of 3.2 now at 5.0 (twice)
Scan 03/14: Multiple small lung nodules
Scan 05/21: shrinking
Scan 09/16: lungs show no abnormalities (YAY!!!)

zephyr
Posts: 258
Joined: Thu Aug 18, 2016 7:31 am

Re: KRAS and other findings help

Postby zephyr » Wed Oct 30, 2019 7:10 pm

I'm not a medical professional, just another patient. From what I understand, KRAS is a fairly common mutation that can make the cancer difficult to treat. A large percentage of patients (myself included) with colon cancer have the KRAS mutation. I've read estimates as low as 30% - 40% to as high as "over half". With so many people having the mutation, there's a lot of KRAS treatment research on-going. If you search on PubMed for "KRAS Vitamin C", there are interesting studies about high-dose Vitamin C IVs selectively targeting KRAS and other mutations. You may be able to find other treatment suggestions but I've only focused on high dose Vitamin C for now because it seems to be working for me.

Regarding MSS, it limits your treatment options, at least for now. From what I understand, at this time immunotherapy is not an option for patients with MSS. I don't understand enough to try to explain why. There is also a lot of research on-going in that regard, including trials. I haven't yet looked into any but there's an MSS Trial Finder here:
https://fightcolorectalcancer.org/fight/library/dr-toms-late-stage-mss-crc-trial-finder/

I hope this gets you going in the right direction.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr/Jul-2019 Xeloda/Avastin, SBRT
Sept-2019 Stable! Continue Xeloda/Avastin

natelaugh
Posts: 83
Joined: Wed Apr 03, 2019 11:40 pm

Re: KRAS and other findings help

Postby natelaugh » Wed Oct 30, 2019 10:03 pm

Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

NHMike
Posts: 2302
Joined: Fri Jul 21, 2017 3:43 am

Re: KRAS and other findings help

Postby NHMike » Thu Oct 31, 2019 12:12 pm

See http://targetedcancercare.massgeneral.o ... /KRAS.aspx for a technical description of KRAS mutations. KRAS mutations constitute 30% of Colorectal Cancers. KRAS mutations have been difficult to treat with immunotherapy as the mutation is inside the cell and there has been some, but not a lot, of progress in identifying cell surface markers for the mutations. There has been notable progress at the National Cancer Institute for mutations G12D and G12V but there are a lot of KRAS mutations so there is a lot of work to be done. The NCI solutions also require particular patient alleles.

Image
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

Cured
Posts: 533
Joined: Thu Nov 27, 2008 10:53 pm
Location: MO

Re: KRAS and other findings help

Postby Cured » Tue Nov 05, 2019 2:11 pm

Team Colon Club, Thanks for the insight. I have asked my Onc to catch me up on the current descriptors. 11 years ago when I was diagnosed, it was adenocarcinoma and not much else. I get that these genetic/molecular markers allow for more precise treatments and testing of new treatments. I hope to learn what each means. Then I need to update my signature here, too. So far I understand that my markers say that Keytruda and such immunotherapy won’t work for me. Thank God that the traditional treatments have worked.

We know that our bodies were created to fight off cancers. I need to get more exercise, as I am stronger now. Hopefully staying in Ketosis will help to starve the cancer too.
5-08:Stg 3 Rectal: 6/14 Nodes
Ace Surgeon Remvd 90%Rectum,lots of Colon-Full Incision
Ileo Rev'd 6 Mos.
Radiatn+5fu Pre-Surgery
FOLFOX 8 CyclDone 1-09
Clear Scope 8-17; CEA 2-18
Glory to God! Healed by prayers of many: for 10 years
7-18: tumor pressing against brain Removed
Metastatic to lung. CEA 6.9
Folfiri
CEA to 4.5 after 1 chemo
After 8rds CEA 3
CEA 1.8, 2.3,1.7
12 rds Folfiri
Avastin evy 3 wks
Had Seizure Anti-seizure meds work-no driving for 6 months
Neuro allows me to drive again 0 meds


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