Published on September 11, 2020
Updates from Our KRAS Lung Cancer Treatment Webinar
“Our approach to lung cancer is now very sophisticated and we don't think of all lung cancers in the same way. We care about the actual biology of the tumor and the specific genetic changes that are present… Now we're really looking at the whole genetic landscape of the tumor in trying to make treatment decisions.” — Dr. Jessica Lin
Over the past couple of years, there has been exciting progress made in KRAS lung cancer treatments thanks to researchers across the globe. On August 26th, we heard from two leading doctors in the field of thoracic oncology, Dr. Jyoti Patel of Northwestern University and Dr. Jessica Lin of Massachusetts General Hospital and Harvard Medical School, who gave us an update on recent progress and options for patients navigating KRAS mutant lung cancer. This informative session was moderated by Terri Conneran, founder of the KRAS Kickers support group and a KRAS patient herself.
What Is KRAS Lung Cancer?
As Dr. Lin explains, KRAS mutations are one of the oldest known oncogenes in lung cancer and also the most prevalent. An oncogene is defined as genetic material that carries the ability to induce cancer. Since its discovery, KRAS lung cancer has been very challenging to treat with targeted therapies (which directly focus on the gene change present in a tumor) and was labeled “undruggable” due to its resistance to treatment. However, through recent developments in research and clinical trials, some of the challenges posed by the KRAS gene are starting to be overcome.
While doctors have known that KRAS mutations occur in 20-30% of lung cancer patients, what they are now learning is that there are different types of KRAS genes. By looking at changes in the gene at the DNA level they can more thoroughly assess the specific KRAS mutation they’re dealing with. They believe these distinct subtypes behave differently and may have different genetic partners that drive the cancer growth.
Dr. Lin says, “10 to 20 years ago we might have said, ‘Okay, this patient has KRAS lung cancer’ and stop at that. But now that naturally leads to the next question of ‘Which KRAS mutation does the patient have?’ Because that is relevant in thinking about treatment options.”
Personalizing Lung Cancer Therapies
Dr. Patel describes the evolution she has seen in the diagnostic process over the course of her career in the lung cancer field. She said that 20 years ago when a patient was diagnosed with advanced lung cancer, the extent of information they would gather from a biopsy was whether it was a non-small cell lung cancer or small cell lung cancer. Within a few years, they were able to gather more specific information about the histology of non-small cell lung cancers and look at how squamous cell carcinoma and adenocarcinoma behave differently and react differently to chemotherapy. As research has continued to progress, doctors have learned much more about the genetic changes that occur in a tumor and continue to refine targeted therapies for specific subsets of patient populations, finding the right drugs to shut down tumor growth.
One of the improvements in personalized treatment that Dr. Patel is most excited about is the increased understanding of when to escalate and when to deescalate therapies. In the past, often the approach was to throw everything they could at a patient to see what would happen with combinations of immunotherapy and chemotherapy. With the ability to gather more detailed real-time information about how a patient’s cancer is responding, doctors can now reduce treatment in some cases, or properly escalate treatment for people who may not be responding to a certain type of therapy.
To Dr. Patel, the important questions are, “What can we do that's functional rather than just sort of ‘everyone gets four cycles of this and then six cycles of this’? Is there a way longitudinally that we can decrease toxicity and increase cure rates by having a more dynamic feedback loop?”
As a KRAS Patient, How Do I Stay Informed?
Patient forums and presentations like those made available by Patient Power are a valuable resource for staying informed and accessing the latest information from experts. Patient advocacy and support groups are also vital for those navigating a cancer diagnosis — as well as for the doctors treating them.
Dr. Lin notes the success of patient groups for other types of lung cancer, such as EGFR positive lung cancer, where information about breakthroughs in targeted therapy can be quickly shared and disseminated to people who might not otherwise have access to current information. On the flip side, patient advocacy groups have become a huge resource for doctors and researchers in search of crucial data, as they can band together a large number of similar patients and gather information from them.
In the words of Dr. Patel, “We're able to work with advocacy groups to further the science. So, we're together. It's very much a co-dependency that I think is very constructive.”
Clinical Trials for KRAS
There is an increasing number of clinical trials becoming available for KRAS lung cancer patients that fall into a few major categories:
- Pills that target specific subtypes of KRAS mutations.
- Exploring combinations of drugs, such as a KRAS inhibitor with another drug to maximize efficacy or overcome the KRAS resistance.
- How to galvanize the immune system in treating KRAS lung cancer, including vaccines and T-cell therapies.
To find a clinical trial, the first thing to do is to speak with your doctor or the nurse navigator at your oncologist’s office. He or she should be able to help you locate which trials might be right for you and what the eligibility and logistical requirements are. It’s important to take your lifestyle into account when seeking out a good fit for a clinical trial, to ensure you can maintain your desired quality of life while participating.
Another resource for viewing all active clinical trials is ClinicalTrials.gov. You can search for trials that may be actively recruiting participants or just get an overview of which studies are currently underway.
To learn more about the latest KRAS lung cancer treatment news, watch “What Is KRAS Lung Cancer?”
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