I'm 13.5 years out from inoperable IIIB adenocarcinoma and 3 years out from inoperable IA adenocarcinoma, in remission from both. We've been following a number of Ground Glass Opacities for the last 3 years, and in May 2012, one of them showed a slight area of consolidation. CT was unchanged in August, so I had a wedge biopsy via VATS. Pathology showed it was adenocarcinoma in situ with 1-2 mm foci of invasive adeno. Molecular markers just came back with KRAS mutation, codon 12.
I’m trying to get up and running on this situation before I talk with my doctors next week. I think I meet Dr. West’s criteria for “vigilant watchful waiting” (What I Really Do, 8/27/2008). I'm asymptomatic and the GGOs seem to be slow growing, since they haven't changed in 3 years until now. I’m not sure of their sizes, but the tumor in the wedge resection was 1.8 x 1.5 cm, a little over the 1 cm Dr. West recommended.
From what I understand now, my preference is watchful waiting, hoping that by the time I might need it, one of the treatments in trials now (reovirus, ganetespib, etc.) will be available. My question is whether there are other factors to consider in making a decision about how to proceed, especially regarding the risk of metastasis.
Secondly, I wonder about the apparent discrepancy between how well I responded to treatment for my previous 2 lung cancers and the current finding of the KRAS mutation. Is it possible or likely that the previous cancers had a different driving mutation?
Thank you so much for your help.
Sun, 09/09/2012 - 07:33
Hello Kathy and welcome to Grace. You have been on quite a roller coaster with cancer. I'm so sorry. Thank you for your well thought out post. As you probably suspect anything is possible but I hope this cancer behaves as well as your previous ones.
I will contact a doctor for input and you should hear back within the next 12 hours.
Sun, 09/09/2012 - 21:51
I don't know if the driving mutation is the same or different now compared with your prior cancers, but I can definitely say that even if the lesion that was removed in the wedge resection was >1 cm, the fact that only a small 1-2 mm focus was invasive would lead just about any oncologist to recommend against post-operative chemotherapy. The available evidence really indicates that within a lesion that is a combination of adenocarcinoma in situ and some invasive component, we focus on the invasive component as the driver... and that 1-2 mm area is very tiny. It also sounds like it changed over a relatively long period of follow-up, which would also support a very cautious (less is more) approach, I would say.
And while a KRAS mutation raises some concern in terms of perhaps having a trend toward a less favorable prognosis, I consider that a very minor factor compared with the favorable features discussed above.
Sun, 09/09/2012 - 22:12
Thank you very much, Dr. West!
Mon, 09/10/2012 - 00:37
Love your dog and impressed by your story. Hope it all turns out as well as you could hope.
Mon, 09/10/2012 - 07:27
Kathy, Dr. Ramalingam was unable to connect with his forum account yesterday but left this message for you via email;
From the details you have provided, an approach that involves close observation would still be appropriate. It appears that the only lesion that was more prominent in recent times has been resected. If the other lesions are not changing significantly, then continued follow up should be adequate. Your note indicated that you had inoperable cancers before, but did not say how they were managed. It may well be that the present tumor is a distinctly different primary tumor. It does not mean that you had K-ras mutation in those tumors as well.
Also, there have been some recent studies that challenge the notion that tumors with K-ras mutation behave badly and are not responsive to chemotherapies. If confirmed in subsequent studies, this might come as a relief to the 20-25% of lung adenocarcinoma patients that have this mutation.
Suresh S. Ramalingam, MD
Professor of Hematology and Medical Oncology
Director, Division of Medical Oncology
Winship Cancer Institute"
Mon, 09/10/2012 - 09:54
Thank you very much, Dr. Ramalingam.
My only concern now is wondering about the odds of metastasis that may have happened from those small invasive foci before they were resected.
Here is my bio info. I don't know why it doesn't show below my posts.
Former smoker; quit 1991. 1999 7x8 cm IIIB inoperable adenocarcinoma LUL apex. External beam radiation + Taxol/carboplatin. Tumor shrank away to a scar. 2009 1.6 cm IA new primary adenocarcinoma RLL, inoperable due to location. Tomo Therapy + Taxol/cisplatin = remission. Multiple bilateral ground glass opacities followed since 2009. May 2012 area of consolidation in one GGO, unchanged in August. VATS wedge resection August 2012 showed adenocarcinoma in situ with 1-2 mm foci (plural) of invasive adeno. KRAS mutation, codon 12.
Mon, 09/10/2012 - 12:00
Kathy, I must agree with cs. Your pic with your dog is lovely.
A common mistake, there is a difference in bio (that shows up in your profile) and your signature (that shows up on your posts). Copy your bio and paste it in the signature.
Click on your avatar, that will take you to your " forum profile"
Click edit signature and don't forget to hit submit.
For reasons beyond my use there is a profile for WordPress and another for Grace.
I hope that's not tmi ; )
Mon, 09/10/2012 - 12:08