Kras Mutation NSCLC Stage IIb adjuvant therapy question - 1270921

Hello,

Welcome to GRACE. It's good to hear that your surgeon feels confident that he got all of the cancer, but I know that the decision about adjuvant chemotherapy can be a difficult one. Here is what Dr. West has said about the adjuvant chemo for KRAS-positive lung cancer:

"Though there is one study that suggested that the benefit of adjuvant chemotherapy was only really present for patients who don't have a KRAS mutation, that isn't really something that most oncologists focus on, since it isn't a consistent finding across several studies. In fact, though Dr. Heather Wakelee, who has a significant expertise in this field, wrote a section about molecular markers in adjuvant therapy for early stage NSCLC, she didn't even mention KRAS.

I'm far more swayed by whether the rest of the case suggests that adjuvant therapy would be indicated. As Dr. Weiss noted, we do consider the size cutoff of 4 cm to be pretty important and are far more inclined to recommend chemo in patients with larger tumors. If someone were really on the fence about adjuvant therapy, or I was very ambivalent about the risk/benefit of adjuvant chemo, I could see potentially using KRAS as a very minor factor that might lead me away from chemo, all else being equal. But I don't recall ever actually using KRAS in a decision for adjuvant therapy and don't routinely order it." - http://cancergrace.org/forums/index.php?topic=11177.msg91850#msg91850

In the post that followed Dr. West's, Dr. Weiss concurred.

Good luck with chemo if you choose that path.

JimC
Forum moderator

Since mine was probably KRAS also, I would recommend the chemo on the size of the tumor itself. I had a recurrence of adeno with a 5.2cm tumor that progressed into the pleura. If they didn't recommend chemo, I would have asked for it. Chemo is not as bad as it's made out to be. Granted, it's no picnic but it's doable for the short time that you do it and can give you greater than a 5-10% survival benefit. What chemo is being recommended for what type of LC?
Take care, Judy

The analysis of the studies you've posted above suggest there shouldn't be a decision made because of KRAS mutation. Under the heading, Effect of Mutation Status, it reads "...the presence of KRAS mutation vs wild-type KRAS was not associated with a significant effect on overall survival among all patients...".
That statement is comparing the outcomes of adjuvant treatment for resected nsclc in general. These studies have proven people with a large tumor do better in general with adjuvant treatment.

In fact second primary cancers were higher without adjuvant treatment and trend toward lower with adjuvant treatment.

Am I reading this wrong?

You're also not early stage. I think Janine got it right. This is also what Dr. West says, that you don't go by KRAS mutation alone just because it doesn't have a targeted drug like some mutations. There are also several clinical trials if you're interested.
Take care, Judy

I would agree with Janine's and Judy's reading of the cited article, in which it's stated in the opening paragraphs:

"KRAS mutation status was not significantly associated with overall prognosis or predictive of differential effects of adjuvant chemotherapy versus observation.

Nevertheless, their findings did suggest a detrimental effect of chemotherapy in patients with codon 13 mutations and increased risk of secondary tumors in patients with KRAS mutations not receiving adjuvant therapy."

In summary, in this study KRAS status was not a factor either way in terms of response of the treated cancer to adjuvant chemotherapy, and that such chemotherapy reduces the risk of secondary cancers developing.

JimC
Forum moderator