Anyone have success with tarceva with KRAUS

Mets to spine... Starting tarceva ... Would love insight...thought there should be another drug available...in addition...just did alimta carboplatin and avast in and it took care of liver but now we have spine... KRAs

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Did it shrink the lung tumors? Mom has kras

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Have not started tarceva yet....hence the inquiry

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I'm sOrry, I meant the Altima.

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I would not be optimistic about the odds of Tarceva alone offering shrinkage for KRAS, but there's a chance it could offer some stability for a while:
http://cancergrace.org/lung/2009/08/10/should-patients-with-kras-mutations- be-treated-with-epidermal-growth-factor-receptor-inhibitors-ie-iressa-or-ta rceva/

Here's an example of why the skeptics are skeptics:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC545207/
but the measure of success (sensitivity) for that was shrinkage, not mere stability. Some people did get a period of stability.

There was a tiny amount of data showing a small number of KRAS patients had a response (shrinkage) to the combo of Tarceva + tivantinib, so researchers were curious about that:
http://www.clinicaloncology.com/ViewArticle.aspx?d=Solid+Tumors&d_id=148&i= October+2011&i_id=767&a_id=19161

And this citation speculates that an EGFR inhibitor like Tarceva might be a useful component of a combo to shut down two simultaneous chemical pathways that drive KRAS:
http://www.nature.com/nrc/journal/v7/n10/fig_tab/nrc2190_F4.html

For KRAS, regular chemo might be more promising, and chemo-related drugs like:
http://www.sciencedaily.com/releases/2011/11/111114095721.htm
(Alimta may be effective for KRAS if it is "non-amplified" KRAS.)

Research is beginning to show neutralizing cancer cell defences against the immune system might be useful for some patients:
http://abstract.asco.org/AbstView_114_92250.html
(Experimental anti-PD1 drug showed a response in 19% of patients, plus some more got stable disease.)

For KRAS-targeted inhibitor drugs, there's a couple of possiblities emerging in trials that might offer hope to some:

http://abstract.asco.org/AbstView_114_98430.html
(selumetinib plus docetaxel combo showed a 37% response rate vs. 0% for docetaxel alone, although with only a 3 month difference in progression-free survival.

In the UK, there may soon be trails for a GATA2 treatment that in the lab seems like it might be useful:
http://info.cancerresearchuk.org/news/archive/pressrelease/2012-04-26-exist ing-drugs-lung-cancer
& http://www.ncbi.nlm.nih.gov/pubmed/22541434

In the US, ganetespib seems hopeful (but probably would be much better in some kind of combo):
http://www.inspire.com/groups/lung-cancer-survivors/discussion/ganetespib-f or-kras-trial-60-responded/
(That was a press release marketing about a very preliminary, very small number of KRAS patients in a ganetespib trial where 60% of them showed a response, and one imagine some more had stability.)

There are also trials for ARQ197+erlotinib combo, as mentioned on slide 12 of the slide-set for this webinar, but I don't know how effective it is:
http://cancergrace.org/lung/2012/04/10/molecular-markers-in-lung-cancer-dr- charlie-rudin-on-the-lung-cancer-mutation-consortium/
Here's a little data that doesn't seem to show high odds for that combo for KRAS:
http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&conf ID=74&abstractID=51587

There's also a single-sentence mention of sorafenib offering 61% of KRAS patients some stability for 8 weeks or more, but that seems to have been a pre-selected group of patients for that drug: http://www.onclive.com/publications/contemporary-oncology/2012/Spring-2012/ Therapy-of-Non-Small-Cell-Lung-Cancer-Past-Present-and-Future

Although I have not been tracking KRAS developments too closely, I have a long list of other agents that are being or had recently been explored, but right now the above short-list are those that seem to have either some decent preliminary results or promising pre-clinical lab results at this point.

Most of the above would only be available in clinical trials, although chemo, Tarceva, and Alimta can be prescribed without having to participate in a trial.
You can search for clinical trials here:
http://clinicaltrials.gov/

Best hopes,

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Thank you so much for that Craig!!! Hugs

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I am continually amazed at the amount of knowledge you have, Craig. Do you know how I can get my husband's tumor tested for gene mutations other than the traditional ones for lung cancer. He has been negative in the FDA approved ones.. Can I just call Sloan-Kettering and ask and who? Is the full testing part of a trial? I know you mentioned Mass General before but is there somewhere in PA/NJ I can contact? Does he have to go or is the tumor sent?

Thanks for any direction you can give me.

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1813-
My mom got her biopsy at one hospital in NYC but when we decided to go to Sloan they needed slides and a cd of the pt scan sent to them.
Since they wanted the slides I'm guessing they retested for the mutation. So, if he already has the slides, then I would call Sloan.

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(Sorry to have this sidebar conversation, kkhadder, instead of a separate new discussion with 1813.)

1813,

Thank you for the complement, but I don't know that much or at least I don't remember much of it for very long and find it very hard to try to keep up. That's one reason I like to rely on citations; the other is that a citation is the only way you'd know something is being remembered accurately.

It is very easy for a physician to have biopsy sample material shipped to a lab anywhere in the country. So if you want to have ROS1 tested, or if you want to be tested for mutations that might show up in squamous instead, for example, your doctor could send that to MGH.

If you'd like, private-message me and I'll give you Dr. Alice Shaw's email address who could help coordinate things from her end (or you could just google it). Better yet, you could ask about the kinds of mutation testing they can do there. Here's a little intro info:
http://www.massgeneral.org/genotyping/
& http://www.ncbi.nlm.nih.gov/pubmed/20432502

Frankly, I skipped NYC (and MD Anderson in Houston) and went all the way to Boston for my testing because that is where I could get more rare things tested. If you are within driving distance of Boston (which you are), I would very much recommend getting a '2nd opinion' visit with Dr. Shaw there anyway. (She's amazing, but I'm biased because she found my ROS1 mutation and is leading the drug trial for it.) If I had not gone to see Dr. Shaw at MGH, I wouldn't be in very good shape today.

Other places besides MGH and UColorado might be beginning to catch up, but I don't know many places that test for ROS1 yet, at least not in a reliable way that would qualify for the trial for that using crizotinib.

Best hopes,

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Hi,

I'm new to this site but I'm 42, non-smoker, diagnosed with Stage 4 NSCLC in Nov. 2011 with metastatic spread though both lungs and through my bones. Spine, ribs and hips. Given less than 12 months to live. I was started on Gemcitabine Carboplatin chemo which shrunk the primaries dramatically, but mestases increased in the lungs and further spread in the bones. I was switched to Tarceva in March and by May the primaries and mestases are shrinking, and there is evidence on CT scans that the bones may be repairing. That won't be validated until I have bone scans in a couple of months. Run with Tarceva and a sugar free, caveman diet. I feel great and I'm traveling around Australia with my wife and 2 kids. The acne rash is a pain in the arse, but face an chest washing with aveeno body wash and Phisohex anti bacterial wash definitely helps.

Good Luck

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My naturopath also has me on Usana multimineral and mega antioxidant with liquid sachets of Lypospheric vitamin c. It's killing me not to have a beer these days, but the results speak for themselves

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(kkhadder -- sorry for this sidebar in the middle of your discussion)

BradNSCLC,

You should probably write your history info into your profile or start a separate discussion so when you ask questions in the future people can knowing that background. They probably won't be able to find your comment in someone else's discussion.

Was your cancer tested so you know that it is driven by an EGFR mutation? Or were one of the lucky people in whom it it working anyway?

BTW, there are some people who believe that a diet very high in antioxidant supplements might be good for preventing cancer from starting but also might have a risk it could reduce the reactive oxygen species that are part of the mechanism of action for apoptosis (cancer cell death) for some kinds of treatment (esp. radiation). I'm not going to get in the middle of that debate, but just though you'd want to be aware it is a subject of debate about whether the risk is outweighed by the benefits or not. Also, you might also want to read this discussion:
https://www.inspire.com/groups/lung-cancer-survivors/discussion/actions-whi le-waiting-for-tarceva-resistance/?reply_sort=asc#cmnt_3029425

You will probably also want to start following Marie's discussions on Tarceva/Iressa users. She opens an new one every week (which sometimes makes it hard to find the current one).:
http://www.inspire.com/groups/lung-cancer-survivors/member/Marie-Zee100/

Best hopes,

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