14 Nov Cancer: The Story Of The Target Inside Colorectal Cancer

Imagine a loved one going into the doctors office and learning that he or she has colo-rectal cancer. Now imagine that they are told it has already spread to other areas inside of their body. Can you imagine the scene, the conversation? Can you even fathom understanding or remembering the rest of the conversation after you heard the words, “You have metastatic cool-rectal cancer.”
I know I can’t, and I work in this crazy world of cancer. I cannot even imagine what it is like for all of those patients, families, friends, and loved ones trying to figure out what are the next steps, who to believe, and how do you know that you are getting all the testing and workup that you should ideally be getting.
There was an article published in this month’s Clinical Oncology News titled: “Majority of Metastatic Colorectal Cancer Patients Do Not Undergo KRAS Testing”

So why should you care and know? Well let’s being to understand what all of this complexity means and simplify the story.
KRAS has a fancy long name that I am not going to put here because what we really need to understand as consumers is that a normal KRAS gene performs a grow and divide job in normal tissues. It acts as an on/off switch in the grow and divide process for a growth factor. In normal cells, it turns on and off without any problems. When the grow and divide switch is broken, cells can grow uncontrollably, and thus turn into a colorectal cancer.
So what does this really mean if I am told I have colo-rectal cancer and that it is metastatic?
In patients that happen to be tested for the KRAS mutation, and the test comes back that the KRAS gene is working properly, they can use special drugs that target the colorectal cancer cells to zap them specifically. In a 2009 Phase 3 Study, it was shown that patients treated with a drug called cetuximab (Erbitux) showed a response in 59% of the patients. In addition, these patients have had a 32% decreased risk of disease progression. This is compared to patients only receiving chemotherapy.
So if you have the metastatic colorectal cancer, are tested for the KRAS gene, and the gene is normal, you are eligible for a targeted therapy, and there are better outcomes and quality of life that comes along with those options.
In those patients that are tested and found that the KRAS genes are broken as well, you will most likely be recommended to go on more traditional chemotherapy regimens such as FOLFIRI, FOLFOX, or perhaps 5-FU. These drugs have been shown to be more effective when used in combinations, over several cycles or courses of the chemotherapy.
The interesting item in the report was that even though the National Comprehensive Cancer Network (NCCN) has recommended KRAS testing to be done as part of the workup in patients with metastatic colorectal cancer, that it peaked in 2009 at 29% of eligible patients having the test performed. (2010-27%, 2011-28%)
The other interesting fact is that the majority of the KRAS test is being ordered at the time of initial diagnosis. When a patient is first being worked up for colorectal cancer.
The takeaway story:
If you or a loved one is suspected to have colorectal cancer, ask your physician, navigator, nurse, or anyone on the care team about KRAS. Ask them if it makes sense for you to have the test. Ask them to explain to you if you fit the criteria to have a KRAS test ordered, and if you do not qualify, ask them to explain to you why it does not make sense for you to have the KRAS test.
If you happen to have been treated for colorectal cancer and it is suspected that it has come back again, ask your physician, nurse, navigator, or anyone on the care team if you have already had a KRAS test. If not, ask them if it makes sense to have it performed. If they do not think it makes sense, then again, ask them to explain to you why not.
As always, the story of colorectal cancer could be about you, a loved one, or someone within your social circle. Do not be afraid to ask questions. Do not be afraid to talk about it openly.
Do not let others to control your story or your dialogue about colorectal cancer. You own the conversation, the direction, and your story.
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM
~CancerGeek