KRAS trial or not?

Mom finished 3 rounds chemo carbo/Alimta/Avastin. 3 weeks later she had a PET. Onc visit shows cancer activity on side where she had surgery. It shows outside the lung and before the rib cage. Onc feels cancer is active. He said radiation did a good job on the tumor, but activity is outside the radiation area. He tells mom to take a chemo vacation. Get her tooth fixed (implant) and go travel for a few months.

Onc wants to get her into a trail GSK1120212. He needs a base line to start, so he orders a CT scan. He needs a measurable tumor to get her into the trial. He said they are seeing good results with breast cancer on this trial, and mom's cancer acts the same way. It would be Phase II.

1 week later, Tue 5/22/12 she got her CT scan and results. She has planned the dentist visit and vacation with her sisters. Onc comes in and shows CT image and results. He can't find anything on the CT. He tells us that without the PET scan, he would have thought that there was no activity going on. He recommends 3 more rounds of carbo/alimta/avastin. Start immediately. After chemo, he said he will put her on Alimta for maintenance. Mom was shocked. No break, no long vacation, and more of the triplet cocktail that knocks her down.

Ok, did she just get good news? Is it worth doing assay testing if a new tumor developes? Would it even matter now that she is this far along with KRAS? Should she get a second opinion from Dr. Alice Shaw like a few others on team inspire have done?

I asked mom's Onc if he would work with other Oncs' and he said "Sure, get a second opinion. We encourage that. You can go anywhere you would like too." I asked about HSP90, and he said they are not FDA approved, and mom would only get FDA at Mayo unless it is one of the trials they are in. His trial that he originally talked about is like docetaxol. That did not work. Her tumor grew when she was on the cisplatin/docetaxol. I told him that I read where platin drugs do not work with KRAS, and he said there is nothing else out there for KRAS. It is standard treatment in oncology.

I also learned that her first rounds of cisplatin/docetaxol were standard treatments after LC surgery. I thought it was her first line. He said no, the carbo/alimta/avastin were first line. He also said that to get her into a trial, she needs to stay on that triplet. If he tried Gemzar or anything else, it would be second line and she would not qualify for a trial.

Thanks, RIck

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Rick, you posted this same thing yesterday. Are you looking for more info as I see you did receive responses. I'd get a second opinion. Take care, Judy

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Yes. I wasn't sure if I got this out correctly Judy. The responses to the first were me adding more info. This is just a simplified version. I am curious if anybody had their Onc change their recommendation so quickly. Trial No trial etc. I wish I could say I love my mom's Onc, but I just don't feel that way yet. Maybe I never will. It is her decision, and I just want to help her make the best informed decision possible. People like you have given us a lot of helpful and informative info on Team Inspire. I also thought, if I put KRAS in the heading, maybe someone with it might be able to check into this trial. Sorry for double dipping.

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Don't be sorry, just looking for clarification. Has she ever had a second opinion? I think I've mentioned this a few times, would probably be a good idea. It just involves her signing a medical release and then all her records will be sent to the onc of your choice, which could be Dr. Shaw if she agreed to take it on. Then they'd either have her meet or video conference their recommendations. As for an assay, this involves another biopsy which has to be sent within 24 hours of removal. Not sure if she'd want to go that route or not. Wishing her the best.
Take care, Judy

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She got a second opinion in Dec. '11. At that time, it was discovered that she has malignant pleural effusion. Re-staged to Stage IV. The second opinion agreed with the first, at that time. Palliative care.

Thanks, Rick

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I'm catching up on some discussions. Although this doesn't address the specific trial you're asking about, it might be useful reading anyway about some KRAS trials:

https://www.inspire.com/groups/lung-cancer-survivors/discussion/good-day-5/ ?reply_sort=asc#cmnt_3065996

Regarding GSK1120212, I don't see much research on that, but you can see what I did find:
http://www.ncbi.nlm.nih.gov/pubmed?term=GSK1120212

It looks like this might be the clinical trial you're talking about:
http://clinicaltrials.gov/ct2/show/NCT01362296

For other background info, you might hunt through google:
https://www.google.com/search?q=GSK1120212+kras+lung

Best hopes,

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HI Rick

Thanks for accepting my friendship Sounds like whatever your mom is doing maybe working for now. If you need backups,did you think about functional profiling (I guess that's what you were asking about when you mentioned assays?) I'e been told the test has up to 80 percent success rates in finding a drug that works for the time. Also Keith Block in Chicago does something called chronotherapy where he is able to give less chemo, and thus less bad side effects by timing when it's given. Research shows our healthy cells thrive more at certain hours and cancer cells thrive more at others; so knowing the biological rhythm, he can give least amount of chemo for best possible outcomes and least side effects.

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FWIW, I've heard the term "assays" used more commonly as referring to techniques that test for dozens of (up to more than 100) driving mutations at one time. I don't know if the term is also used for functional profiling testing (chemosensitivity testing).

Published research on functional profiling for lung cancer seems scarce, but there is this one:
http://www.rationaltherapeutics.com/downloads/pdfs/EVAPCD.pdf
where table 1 seems to show that for NSCLC that ex-vivo functional testing seemed to have a 67% chance of correctly predicting chemosensitivity, and if it predicted chemoresistance for a drug instead that result was 93% accurate. (I'm not sure if predicts resistance very often.) You could ask your oncologist what the odds of response are for whatever treatment he/she recommends.

Best hopes,

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Onc from Dana Farber told me there was nothing going on for KRAS right now..no trials expected. just the chemo..

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eastside,

Perhaps not at Dana Farber, but here's 15 clinical trials that mention KRAS as a condition being treated, but you'll need to cull through those to skip ones that are actually just referring to KRAS wild type / KRAS negative:
http://clinicaltrials.gov/ct2/results?term=lung&recr=Open&rslt=&type=&cond= KRAS+

Here's a wider search result that might find a couple more, but will require more work to find the relevant ones and rule out the rest:
http://clinicaltrials.gov/ct2/results?term=KRAS+lung&recr=Open

Whether a trial is already looking promising enough to be worth trying is a different matter. Those are scarce. E.g.,
http://www.inspire.com/groups/lung-cancer-survivors/discussion/ganetespib-f or-kras-trial-60-responded/
also discussed at
http://cancergrace.org/lung/2012/07/09/ganetespib-phase2-kras-and-ldh/

To a lesser degree, maybe:
http://www.dana-farber.org/Newsroom/News-Releases/Study-reports-first-succe ss-of-targeted-therapy-in-most-common-genetic-subtype-of-non-small-cell-lun g-cancer.aspx
(Ironically, that press release comes from Dana Farber.)

This preclinical work from the UK also caught my eye, but that's of no value here in the US yet.
https://www.inspire.com/groups/lung-cancer-survivors/discussion/kras-resear ch-velcade-bortezomib-or-fasudil-via-gata2/

And there's Alimita (a type of chemo):
http://www.inspire.com/groups/lung-cancer-survivors/discussion/kras-mutant- may-make-alimta-more-likely-to-help/

A long list of possiblities (mostly not so good) was complied a while ago:
https://www.inspire.com/groups/lung-cancer-survivors/discussion/any-drugs-c linical-trials-for-kras-mutation/

Best hopes,

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eastside,
When the time comes, my mom's onc said he will look for KRAS trials for her. They are not doing any local here either, but he said there are other trials at different cancer centers. Tell your Dr that if a trial opens somewhere else, you would be interested in it. My mom is at Mayo. When the Onc pulled up trials on his computer, it had a lot more than we could find on our own research.

Thanks for all your research and help Craig! You are awesome!

RIck

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