Repeating Full Genomic Panel When KRAS Is The Driver Mutation

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC Repeating Full Genomic Panel When KRAS Is The Driver Mutation

This topic contains 5 replies, has 3 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 3 months ago.

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August 8, 2017 at 10:10 am  #1291212    

cat11

If a patient had full genomic testing at diagnosis and learned they have a KRAS driver mutation, is there any benefit, to this patient, of doing full genomic testing again at progression? (Especially, given the cost of these tests)

I’ve never heard of a KRAS mutation changing.

Thank you, Cathy


Dx Stage IV Adeno, Dec 2014
KRAS G12D, PDL1+ 90% of Tumor Sample
1st Line: Carboplatin/Alimta & Alimta Maintenance (Worked Well)
2nd Line: Keytruda (Didn’t work)
3rd Line: 30 IMRT Lung Radiation, 60 gy
Currently Watching & Waiting

August 8, 2017 at 2:02 pm  #1291213    
catdander forum moderator
catdander forum moderator

Hi Cathy,

Just 2 or 3 years ago most oncologists would agree that if you have adeno nsclc egfr, ros1, and alk testing would be enough. Today more mutations are being tested and some drugs being tested are showing promise.

The thought is still, if you have one driver mutation it’s highly unlikely you’ll have another. On the other hand tumors develop mutations to resist treatments. There still are no new mutations for which there are FDA approved treatments past the ones mentioned above. Though with kras mutation it’s probable you won’t have a high enough PDL-1 number but it’s worth testing for because immunotherapies have shown efficacy in those with a high percentage of PDL-1 expressed on tumors. (I think there’s also talk about the amount of PD-1 expression on its receptors, though I don’t know what happened with using the amount of pd-1 on receptors as an indicator of efficacy).

I’d start here: The following article (is an exciting resourse find) is from a site that is new to me but the authors are also contributors on Grace. It give detailed info on the status of, Genotypes with suggested off-label targeted therapies and Genotypes with targeted therapies offered on trial only.

https://www.uptodate.com/contents/personalized-genotype-directed-therapy-for-advanced-non-small-cell-lung-cancer

I don’t know if there’s anything new to you in this video but it is up to date, http://cancergrace.org/lung/2016/04/08/gcvl_lu_multiplex_testing_rare_mutations_potential_benefits/

This recent video speaks about retesting and blood testing. (Though all the fda approved blood tests are related to egfr which isn’t something that would be expected to be found in one with a kras mutation there may be a trial that is testing for other acquired mutations that would relate to you)

http://cancergrace.org/lung/2016/01/20/gcvl_lu_bloodbased_mutation_testing_circulating_tumor_cells_dna/

I hope this will get you thinking in the right direction.
All best,
Janine

August 9, 2017 at 7:25 am  #1291220    

cat11

Janine,
Thank you very much for the links…very good articles and videos that I know I will be referring back to. I don’t think full genomic testing would make sense for me, if I progress any time soon. Maybe if/when more mutations are discovered to be tested for, but as of right now, I don’t think I would uncover anything worthwhile.
Cathy


Dx Stage IV Adeno, Dec 2014
KRAS G12D, PDL1+ 90% of Tumor Sample
1st Line: Carboplatin/Alimta & Alimta Maintenance (Worked Well)
2nd Line: Keytruda (Didn’t work)
3rd Line: 30 IMRT Lung Radiation, 60 gy
Currently Watching & Waiting

August 9, 2017 at 8:43 am  #1291222    
catdander forum moderator
catdander forum moderator

Cathy,

I understand the wish or should I say need to plan for the next thing but I think you’re right about not deciding until you’re there. Who knows what will be what by then. I hope it’s a long time before you need to make that move.

All best,
Janine

August 15, 2017 at 11:22 am  #1291250    

cat11

Janine,

Have you ever heard of a KRAS mutation mutating to something other than another KRAS mutation?

I have a friend, who is on an ALK Facebook group, and thinks there are people in the group who originally had a KRAS driver and have become EGFR or ALK positive. Could she be mistaken?

Thank you, Cathy


Dx Stage IV Adeno, Dec 2014
KRAS G12D, PDL1+ 90% of Tumor Sample
1st Line: Carboplatin/Alimta & Alimta Maintenance (Worked Well)
2nd Line: Keytruda (Didn’t work)
3rd Line: 30 IMRT Lung Radiation, 60 gy
Currently Watching & Waiting

August 15, 2017 at 2:15 pm  #1291253    
JimC Forum Moderator
JimC Forum Moderator

Hi Cathy,

Although it’s possible that a patient could develop a new EGFR or ALK mutation at some point after initial biopsy/diagnosis, I think it’s more likely that such patients had EGFR or ALK mutated cells that weren’t picked up in the initial biopsy. Those cells multiplied over time to the point where a new biopsy detected them.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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