KRAS Mutation Implications?

peterz54

My wife is stage IV (diagnosed thanksgiving weekend 2011, spread to liver) with colon tumor biopsy indicating KRAS mutation. I am only recently becoming aware of implications during research this weekend as ONC did not mention. I will take it up with her next week.

Other than making EGFR inhibitors ineffective, are there any other implications of having this mutation, such as shorter overall survival, etc ?

thanks

NJC

Not enough data. Some
Not enough data. Some studies say, "yes" and others say, "no." However, until something comes along it poses a problem for 3rd line. Each cancer and individual is different. So, don't listen to the numbers! They are just that, numbers.

M wife was diagnosed, age 33, with Stage IV mucinous adenocarcinoma with 15-20 liver mets and KRAS mutant 18m ago after the birth of our son. Our Onc told us last week that there is something different about her and her cancer. If that wasn't the case, she'd be dead by now instead of currently showing NED.

Colon resection 9/10, 5 rounds of FOLFOX+ Avastin, Isolated Liver Perfusion with Oxy 1/11, HAI Pump 1/11, 6 rounds FOLFOX, Liver resection 1/12, and RFA 1/12. Mop up and maintenance: Xeloda and Avastin - starts 3/12.

David Barrlett - University of Pittsburgh
Nathan Bahary - University of Pittsburgh

Best of luck!

-Joe

jasminsaba

NJC said:

Not enough data. Some
Not enough data. Some studies say, "yes" and others say, "no." However, until something comes along it poses a problem for 3rd line. Each cancer and individual is different. So, don't listen to the numbers! They are just that, numbers.

M wife was diagnosed, age 33, with Stage IV mucinous adenocarcinoma with 15-20 liver mets and KRAS mutant 18m ago after the birth of our son. Our Onc told us last week that there is something different about her and her cancer. If that wasn't the case, she'd be dead by now instead of currently showing NED.

Colon resection 9/10, 5 rounds of FOLFOX+ Avastin, Isolated Liver Perfusion with Oxy 1/11, HAI Pump 1/11, 6 rounds FOLFOX, Liver resection 1/12, and RFA 1/12. Mop up and maintenance: Xeloda and Avastin - starts 3/12.

David Barrlett - University of Pittsburgh
Nathan Bahary - University of Pittsburgh

Best of luck!

-Joe

Isolated liver perfusion ...
Hi Joe - I am so happy to learn of your wife's successful treatment journey and wish her continuing good health and a life-long remission. I had never heard of isolated liver perfusion with oxaliplatin and was hoping to learn more ... would you mind telling me more about the goals and course of this treatment? Thank you.

NJC

jasminsaba said:

Isolated liver perfusion ...
Hi Joe - I am so happy to learn of your wife's successful treatment journey and wish her continuing good health and a life-long remission. I had never heard of isolated liver perfusion with oxaliplatin and was hoping to learn more ... would you mind telling me more about the goals and course of this treatment? Thank you.

There is quite a bit of
There is quite a bit of information to relay. I'd suggest you Google Isolated Liver Purfusion and David Bartlett. In fact, Grays Anatomy contacted him to be their consultant for this procedure on one of their shows. He's at the top of the food chain! Anyway, your liver is isolated from your circulation and hyperthermic chemo(oxy) is run through your liver for 60min. Very dangerous procedure for her, but benefits certainly outweighed the risks given her situation at the time.

Best of luck to you!

-Joe

Doc_Hawk

KRAS
Hi Peter, I have the KRAS mutation also and from what I gather from my Onc, this is a good thing. I've been on an anti-biotic, Victebix, since June 2011 and other than the 5FU, this is the longest I've been on any drug. The side effects I've experienced with this treatment is first a facial rash that looks like Rosacia, but there's drugs they can give (both pill and topical gels) to lessen these effects.

The trouble comes after a few months when the skin becomes dry and flaky. Then the cracks begin at the finger tips and bottoms of the feet and they get worse with each treatment. Your wife is going to need a LOT of support from you. At first she can use ointments and creams to treat the dry skin, but after awhile the cracks and splits are so bad that it's even painful washing her hands with just water and not even using soap. Forget about hand sanitizers, those are agony! I have to carry rubber gloves (make sure they have NO powder)in case I want to eat something with my hands like a sandwich.

Walking can be the worst part of it. The cracks are huge on the bottom of the feet and at times walking is so painful that it brings tears to my eyes. You're going to want to get her a pair of slippers at are very soft, well cushioned and very easy to slip on and off. If she wears trousers, you'll want to get her pairs that do not require a fastener. I wear hospital scrubs pretty much all of the time because the simple acts of pulling up a zipper, doing a button and fastening a belt are very painful to the fingers. If she tends to wear dresses more this can be to your great favor by making it your personal pleasure to zip up and down the zipper.

Most of all, she's going to need to be held and reassured. Unfortunately, I'm not in a relationship right now, so my service doing is my significant other. But she's pretty good and sensing when her daddy is feeling down and comes over to let me know that she loves me. This is a very trying time for her and you both, so may God give special Blessings to you and all couples fighting affliction.

God Bless
Doc Ray

pepebcn

Doc_Hawk said:

KRAS
Hi Peter, I have the KRAS mutation also and from what I gather from my Onc, this is a good thing. I've been on an anti-biotic, Victebix, since June 2011 and other than the 5FU, this is the longest I've been on any drug. The side effects I've experienced with this treatment is first a facial rash that looks like Rosacia, but there's drugs they can give (both pill and topical gels) to lessen these effects.

The trouble comes after a few months when the skin becomes dry and flaky. Then the cracks begin at the finger tips and bottoms of the feet and they get worse with each treatment. Your wife is going to need a LOT of support from you. At first she can use ointments and creams to treat the dry skin, but after awhile the cracks and splits are so bad that it's even painful washing her hands with just water and not even using soap. Forget about hand sanitizers, those are agony! I have to carry rubber gloves (make sure they have NO powder)in case I want to eat something with my hands like a sandwich.

Walking can be the worst part of it. The cracks are huge on the bottom of the feet and at times walking is so painful that it brings tears to my eyes. You're going to want to get her a pair of slippers at are very soft, well cushioned and very easy to slip on and off. If she wears trousers, you'll want to get her pairs that do not require a fastener. I wear hospital scrubs pretty much all of the time because the simple acts of pulling up a zipper, doing a button and fastening a belt are very painful to the fingers. If she tends to wear dresses more this can be to your great favor by making it your personal pleasure to zip up and down the zipper.

Most of all, she's going to need to be held and reassured. Unfortunately, I'm not in a relationship right now, so my service doing is my significant other. But she's pretty good and sensing when her daddy is feeling down and comes over to let me know that she loves me. This is a very trying time for her and you both, so may God give special Blessings to you and all couples fighting affliction.

God Bless
Doc Ray

My onc says no!
The only difference is that erbitux will not work for her , but other drugs will do it normally, in my case I'm playing with the three drugs available going from folfox to folfiri and back to folfox successfully until today, sometimes we use avastin as maintenance!
Hugs.

NJC

Doc_Hawk said:

KRAS
Hi Peter, I have the KRAS mutation also and from what I gather from my Onc, this is a good thing. I've been on an anti-biotic, Victebix, since June 2011 and other than the 5FU, this is the longest I've been on any drug. The side effects I've experienced with this treatment is first a facial rash that looks like Rosacia, but there's drugs they can give (both pill and topical gels) to lessen these effects.

The trouble comes after a few months when the skin becomes dry and flaky. Then the cracks begin at the finger tips and bottoms of the feet and they get worse with each treatment. Your wife is going to need a LOT of support from you. At first she can use ointments and creams to treat the dry skin, but after awhile the cracks and splits are so bad that it's even painful washing her hands with just water and not even using soap. Forget about hand sanitizers, those are agony! I have to carry rubber gloves (make sure they have NO powder)in case I want to eat something with my hands like a sandwich.

Walking can be the worst part of it. The cracks are huge on the bottom of the feet and at times walking is so painful that it brings tears to my eyes. You're going to want to get her a pair of slippers at are very soft, well cushioned and very easy to slip on and off. If she wears trousers, you'll want to get her pairs that do not require a fastener. I wear hospital scrubs pretty much all of the time because the simple acts of pulling up a zipper, doing a button and fastening a belt are very painful to the fingers. If she tends to wear dresses more this can be to your great favor by making it your personal pleasure to zip up and down the zipper.

Most of all, she's going to need to be held and reassured. Unfortunately, I'm not in a relationship right now, so my service doing is my significant other. But she's pretty good and sensing when her daddy is feeling down and comes over to let me know that she loves me. This is a very trying time for her and you both, so may God give special Blessings to you and all couples fighting affliction.

God Bless
Doc Ray

Doc,
Vectibex has no
Doc,

Vectibex has no clinical significance for KRAS mutants. In fact, studies have shown to cause a worsening of the cancer. If your currently on it, and have had a KRAS test you're KRAS Wild, not mutant. If you're mutant, you need to contact your onc, ASAP!

-Joe

peterz54

Doc_Hawk said:

KRAS
Hi Peter, I have the KRAS mutation also and from what I gather from my Onc, this is a good thing. I've been on an anti-biotic, Victebix, since June 2011 and other than the 5FU, this is the longest I've been on any drug. The side effects I've experienced with this treatment is first a facial rash that looks like Rosacia, but there's drugs they can give (both pill and topical gels) to lessen these effects.

The trouble comes after a few months when the skin becomes dry and flaky. Then the cracks begin at the finger tips and bottoms of the feet and they get worse with each treatment. Your wife is going to need a LOT of support from you. At first she can use ointments and creams to treat the dry skin, but after awhile the cracks and splits are so bad that it's even painful washing her hands with just water and not even using soap. Forget about hand sanitizers, those are agony! I have to carry rubber gloves (make sure they have NO powder)in case I want to eat something with my hands like a sandwich.

Walking can be the worst part of it. The cracks are huge on the bottom of the feet and at times walking is so painful that it brings tears to my eyes. You're going to want to get her a pair of slippers at are very soft, well cushioned and very easy to slip on and off. If she wears trousers, you'll want to get her pairs that do not require a fastener. I wear hospital scrubs pretty much all of the time because the simple acts of pulling up a zipper, doing a button and fastening a belt are very painful to the fingers. If she tends to wear dresses more this can be to your great favor by making it your personal pleasure to zip up and down the zipper.

Most of all, she's going to need to be held and reassured. Unfortunately, I'm not in a relationship right now, so my service doing is my significant other. But she's pretty good and sensing when her daddy is feeling down and comes over to let me know that she loves me. This is a very trying time for her and you both, so may God give special Blessings to you and all couples fighting affliction.

God Bless
Doc Ray

Confusion?
Doc, my reading of the literature suggests that having the KRAS mutation, as about 35% of mcrc have, is not a good thing. at a minimum it cuts out the use of EGFR inhibitors such as erbitux. As NJC suggests, double check with your onc asap, and let the Dr fill you in. Here is a link to an NYU presentation which covers drugs for mcrc patients and explains Kras.

NYU Presentation