What current clinical trials are underway for targeted therapies for KRAS G12R?

Thanks for submitting your inquiry.  Just to confirm, it sounds like the tumor remains inoperable after the 9 chemo sessions of Folfirinox, but if the tumor shrinks, there is the possibility to remove it via surgery.  The KRAS targeting drugs are quite new for G12R, so until you go through further therapy (at least another regimen), it would be hard to recommend a specific one at this time.

Here are some ideas that you can consider and discuss with your oncologist, in addition to others listed below:

1. One idea is to switch from FOLFIRINOX to Gemcitabine/Abraxane, which is considered another 'standard' therapy and has some chance (about 25%) of significantly shrinking the tumor. It is likely that your oncologist could provide this treatment, since it is considered standard.

2. There is a very interesting innovative approach being offered at West Virginia University Medicine in Morgantown, studying a new device to administer the gemcitabine (mentioned above) directly to the tumor. The device is called the RenovoCath, which administers the medication into the artery directly that leads to the tumor.  Dr. Brian Boone is the one offering the trial there and though you won't qualify for the trial (the trial excludes any prior treatment), I think it would be great to get an assessment from Dr. Boon if the tumor could shrink with this device (off study).  His office number is 855-988-2273.  Please let us know if you need help setting up an appointment with him.

3. There is also the possibility to add focal radiation onto the current treatment to shrink the tumor. Two methods, called EBRT and SBRT, can be provided by a Radiation Oncologist.  You can ask for a recommendation from your oncologist, or please let us know if you need further information to find the right one for you (we would need your current cancer center to make a recommendation).

4. Finally, doctors are studying the addition of an immunotherapy drug, pembrolizumab, to standard FOLFIRINOX, as exemplified by this trial. This makes the most sense for patients who are MSI-high (also called dMMR).  In addition to the KRAS mutation, other genes may have been analyzed, and if you have a copy of the genetic analysis report, we'd be happy to take a look and guide you further about what other treatments may be suitable.

A quick look at surgeons who do the Appleby procedure turned up Dr. Zeh at UT Southwestern in Texas, but once additional treatment is tried, we'd be happy to evaluate surgical options closer to you, based on the scan results at that time.

We hope these ideas are helpful!  Please let us know which of the above options you may have already considered, which you think seem interesting and are willing to consider, and if you have more questions or if we can help in any other way.

Let us know too how things go.  We are always here and interested in seeing you do well.