r/lungcancer • u/WishboneAgile9397 • 7d ago
KRAS and BRAF question
If genomic testing identifies both KRAS and BRAF variants as non targetable, what does this mean?
Does it mean they cannot be treated at all?
The exact wording is:-
KRAS c.35G>A p.(Gly12Asp) variant detected
BRAF c.1396G>C p,(Gly466Arg) variant detected.
If they can be treated, what is the treatment?
Thank you.
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u/Typical-Meringue-890 6d ago
KRAS G12C is now targetable with Sotorasib and Adagrasib. The results aren’t hugely spectacular, but they’re better than those from standard front-line treatments.
Other versions, I’m not aware of targeted therapies.
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u/Capable-Score-4432 6d ago
KRAS G12D- Trials for zoldonrasib are ongoing.. I think MRTX1133 failed stage 2. Not sure about bortezomib.
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u/Designer_Art1578 5d ago
Tambien Daraxonrasib RMC 6236 Revolution Medicines vivo en Francia y a mi epsoso le dijeron esa pero lamentablemente no alcanzo cupo
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u/missmypets 5d ago
Mine is KRAS G12F. (This is my second, completely different, stage 4, lung cancer in 14 years). There is no targeted radiation. I was treated with carboplatin, pemetrexed, and pembrolizumab. My nodules either shrank or are stable and my bone Mets are completely inactive according to a PET scan I recently had.
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u/WishboneAgile9397 5d ago
That's really good news that your treatment is working.
Do you know how they will treat brain metastasis, please? My friend has one single node of his left thalamus that has cancer. The oncologist said it's spread from the lung. He's had numbness down the left side of his body, problems sleeping, and woke up one morning and couldn't see in his left eye, but this recovered over a few hours. They are giving him Dexamethasone which helps him with his energy levels.
With the brain met, does that actually mean there is a tumour there, or is it just infected?
Thanks for your help.
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u/missmypets 4d ago
A brain met is a tumor. Most likely they will administer stereotactic radiation to it. This type of radiation is highly focused and causes less damage to the surrounding tissue.
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u/WishboneAgile9397 4d ago
Thank you for letting me know. It's all very confusing.
On his diagnosis letter, it reads Adenocarcinoma of the right lung followed by t2b n2 m1c.
We were told this means he has Stage 2 cancer but I don't think that's correct. It would be Stage 4b? As I think the m1c means it's spread to several distant parts of the body from the lung.
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u/missmypets 4d ago
T2b means the tumor is larger that 3cm but less than or equal to 4cm. You are correct. The brain mets makes this stage 4. Edit to add: no idea why they might call it stage 2.
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u/WishboneAgile9397 3d ago
I am so worried for my friend about his brain met. It's just on his left thalamus but he's having trouble with numbness down the left side of his body. Generally, I wondered if brain met is common, and if it can be treated? The oncology dept said the Azetolizumab might help, but ultimately, they would need targeted therapy, like radiotherapy to "zap it".
The oncology team seem to be taking their time in getting the brain met addressed: MRI scan booked for 7 Sept at a distant hospital (about an hours' drive away) and promised a consultant with neurologist, thereafter. The nurses say treatment will begin after that.
I am very frightened for him what will happen if the brain met spreads or is left untreated for months.
The diagnosis letter spoke of a "large necrotic mass" in his lung. I guess these cells are now dead and will never grow again. What happens with that "large necrotic mass"? Does it have to be surgically removed? Can it cause problems, or is it just dead cells? I read (correct me if I'm wrong) that this happens around the tumour, sometimes.
I am trying my hardest to remain strong for him, but I'm broken by his diagnosis. So many questions and frightened about losing him.
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u/RtElectricalHippo 3d ago
A necrotic mass means it has cells that are dieing but that doesnt mean that the tumour is dead and there are no active cells
7th of September from now seems like a reasonable time scale unless they've already been waiting for a couple of weeks from referral
They may off him surgery or radiotherapy for his brain tumour.
Im sorry you and your friend are going through this, I've been there with my dad, try not to focus on the details and take each day as it comes for now
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u/WishboneAgile9397 3d ago
Thank you for your kind words. I really appreciate it. I am very sorry you have been through this with your dad.
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u/missmypets 2d ago
Regarding the brain mets-lung cancer metastasizes most often to the brain or bones.
The atezolizumab doesn't cross the blood brain barrier but it does trigger other activity that slows growth down in the brain.
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u/WishboneAgile9397 2d ago
Thanks for this.
Will the necrotic mass around the tumour in his lung cause any long-term problems? I don't like the thought of all those dead cells just being there. I know that the tumour itself is not dead, but hopefully the Atezolizumab will shrink it.
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u/missmypets 1d ago
The body may attempt to slough off the necrotic epithelial cells (adenocarcinoma) and deposit them in the airway. It can't manage large amounts though. I've been walking around with a large necrotic mass for almost 15 years.
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u/WishboneAgile9397 1d ago edited 1d ago
Thanks again for your help. When I read my friend's diagnosis letter and it said "large necrotic mass", it was those words that concerned me. I'm really sorry you have been through this.
You know, you are a true inspiration with your positive posts, and your story of survival over almost 15 years. Thank you, thinking of you and your bravery.
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u/Capable-Score-4432 7d ago
While genomic testing identifies most cancer-driving mutations, it also highlights if these mutations can be targeted by FDA approved drugs. In this context, it likely means there are no approved inhibitors targeting KRAS G12D or BRAF G466R for lung cancer.
First- consult your oncologist. There are investigational drugs for KRAS G12D being tested in trials, though Im unsure of any trials for that specific BRAF mutation. It's worth asking if your oncologist thinks this is a viable option for this specific case.
Second, if there are no targeted therapies (e.g., those that go after specific mutations) likely treatments are going to be a combination of surgery/immuno/chemo/radiation, depending on specific patient and tumor factors.