My mother, a non-smoker, was diagnosed 2 years ago with Stage IIIb / IV NSCLC (one site w/pleural effusion). The tumor is inoperable due to location (and no radiation option either). After initially beginning chemo (Alimta, Carboplatin, Avastin), she was re-tested for the EGFR mutation, which was verified and she went on Tarceva for just over one year. In November 2014 the cancer showed growth, and they tested for the T790 mutation. However, not only did they find the EGFR and T790 mutations, but they now see the KRAS mutation, which is highly unusual. It's my understanding that KRAS and EGFR are considered to be mutually exclusive. She is currently in a phase 3 clinical trial for the T790 mutation (Rociletinib (CO-1686) and is stable with no new growth. I'm trying to understand what other questions we should be asking with regards to future treatment options and who in the medical community might have expertise in this combination of generally mutually exclusive mutations. Thank you.
Mon, 03/30/2015 - 19:41
Welcome to Grace. I'm sorry your mother is going through this, cancer is such an awful disease. While it's rare to have 2 mutations it's not unheard of, we've had a couple of members with similar questions as yours, again rare. But it's much too little understood because of it's rarity to have specialized treatment options. At this time KRAS doesn't have a specific tx, though there are several clinical trials testing an alternative to chemo based tx.
The good news is 1) Your mother's doing well on co 1686, she may not need to move from that for a long time. 2) So it's hard to know what the best next step is because (again good news) things are moving quickly making it impossible to know what the next best thing is. 3) Chemo and immunotherapies are also available. ]
Just to mentions a few good things. It's tough, no doubt but you can help to go a long way in helping your and her life with cancer.
Treatment looks the same as if your mother had each of these mutations both associated with adeno nsclc. Unfortunately I'd bet this won't be the only individual aspect of your mother's cancer journey. We like to think of them as merely bumps in the road.
I hope she does well for a very long time then new and improved options will be available.
Tue, 03/31/2015 - 06:10
Thank you very much for your response! I will continue to pay attention to research, and fortunately, being in a clinical trial now, we have access to wonderful doctors!