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Kathryn Jones from Generation NP, Rami Abumasmah from Doctor Unite Commented on a Post
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A 64-year-old female patient, light current smoker was diagnosed in November 2019 with a cT2aN2M1c lung adenocarcinoma (EGFR wild-type, ALK/ROS1-, HER2-, PD-L1 < 1% by molecular assay). However, molecular testing via NGS panel sequencing revealed a KRAS p.G12C mutation.

Patient was started on pembrolizumab, pemetrexed, and carboplatin in December 2019. In March 2019, the patient began pemetrexed maintenance therapy, which was successfully completed. However, in late December 2020, metastases in the lung, adrenal gland, and brain were found during a routine follow-up scan. The patient has since received successful Gamma Knife surgery for the brain lesions. Repeat molecular testing has confirmed the presence of a KRAS p.G12C mutation. The patient has an ECOG PS
of 1.

What treatment(s) would you recommend for this patient? What factors would you consider when deciding how to treat this patient?

  • from Generation NP 5 days 23 hours
    Make sure PET is performed skull-thigh, Brain CT for METS to brain Immunology medication for non Alk-1 and non GFR mutations. Chemo considered if pt not too weak. Consider what has been attempted previously. Try to t into Cancer Research for this patient. Echo if Taxo is being utilized, Taxatere is option.Make sure nutrious diet no refined sugar or simple CHO's, NO TOBACCO smoking or smokeless. KBJ
  • from Doctor Unite 6 days 3 hours
    sotorasib is probably best option
  • 6 days 4 hours
    Sotorasib or a clinical trial
  • 6 days 18 hours
    sotorasib,clinical trial if not then chemotherapy
  • 6 days 23 hours
    This is the right patient for sotorasib. At this point, treat with Docetaxel/Cyramza. As soon as sotorasib is available, treat with sotorasib. The results look good. I am hoping its approved in the next 3-6 months. The factors to consider would be performance status, brain metastasis, patient choices, available options, co-morbidities etc.
  • from Generation NP 1 month
    As per above I would try to enroll in a clinical trial for KRASG12C and if not eligible consider Sotorasib and if that is not possible Ramucirumab
  • 1 month
    I would evaluate to enroll in a clinical trial for KRASG12C and if not eligible or available then try to obtain Sotorasib. If that’s also not available then traditional chemotherapy taxotere and Ramucirumab. Hope this helps
  • 1 month
    If possible, would consider Sotorasib or trial by QED or Mirati KRAS G12C molecules. Otherwise would move toward Taxol/Cyramza
  • 1 month
    I would try to get the patient access to sotorasib or another similar targeted antiKRAS G12C agent either on a clinical trial or through the AMGEN expanded access mechanism. If that was unsuccessful I would try docetaxel/ramucirumab
  • 1 month
    I would try to enroll on ongoing KRASG12C inhibitor trial