Kras G12D - 1264975

Tue, 07/15/2014 - 15:29

I was diagnosed with stage 1V lung cancer with the Kras mutation. I was told that the cells were microscopic and multiple suspicious nodules on the visceral pleura. They were confirmed adenocarcinomas. EGFR and ALK negative. I was enrolled in a iMPACT-1clinical trial and the tumor showed presence of Kras G12D mutation in about 7.4persent of the tumor. They said I am asymptomatic from this very small volume of disease I have been on surveillance since September 2013. They found a little lesion on the parietal pleura and at least 2 and some small little dots on the visceral pleura.
Since then the tumor has shrunk and no further growth.
I was not put on any treatment and they are taking a watch and see approach. Now I have excellent doctors but it still wonder about why I get no treatment. I was told that chemo would make me sicker since I do not have symptoms and appearing stable. Is it customary for no treatment in my case.
I was also told there are no treatment for Kras. However, I am meeting people with Kras and being treated and have had success. I am so confused.
Thanks for considering this question.

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Dr West

A KRAS mutation tends to be associated with lower responsiveness to EGFR inhibitors (at least lower chance of tumor shrinkage, though still perhaps a survival benefit) and also worse outcomes with chemo in some studies, but it's really an overstatement, and quite incorrect, to say that people with a KRAS mutation don't benefit from treatment and shouldn't get it. The standard of care is to treat patients with a KRAS mutation the same way that patients who don't have a KRAS mutation are treated -- they aren't treated like patients with an EGFR mutation or an ALK rearrangement, but they absolutely CAN benefit from standard treatments for lung cancer. And some new drugs called MEK inhibitors may be very good for those with a KRAS mutation.

This isn't to say that it is critical or even valuable to treat with chemotherapy when there is a very, very small amount of asymptomatic (no cancer symptoms) disease. Some cancers grow slowly, and we know that our treatments do not work indefinitely. If you have no cancer symptoms and have cancer that has spread and is not curable, you are guaranteed that treatment can only make you feel worse, not better -- since you have no symptoms, but you likely will/would have side effects of treatment.

It's not ideal to wait until someone is very sick from progressing cancer before starting treatment, but if you have a tiny amount of cancer that may take a very long time to progress, there is absolutely no rush to using a treatment that will only work for a limited period of time. Why use it to shrink cancer that is so minimal it causes no problems and is barely visible on scans (or not even visible)? Maybe you will go months, maybe you will go years before the cancer grows enough to justify treating. But if you are followed for how you are doing clinically, and your scans are followed over time, it should be possible to intervene only when there is enough disease to justify the potential side effects of treatment and have a greater impact.

eroge

Dr West.
Thank you so much for that quick response to my question. It was the most coherent and succinct description of my results.. Thanks for putting the information in such a way that a lay person could fully comprehend. I have been in a fog since my diagnoses and even though I was told that not treating me was in my best interest at this time, there was a lot of ambiguity around the explanations given. As a result I have walked around for the year since diagnoses totally confused and totally not knowing how to deal with the news.
I am so glad I was given this website. I don't know if you realize what a wonderful service you are doing here for cancer patients but thank you. This is the first few days of feeling a little peaceful.
Thanks again

Dr West

Thank you very much for your kind words. They are sincerely appreciated.

What you're describing is exactly what we strive to offer to patients.

-Dr. West