Appointment sheet
KRAS G12C-mutant non-small-cell lung cancer
Prepared with OnCo (onco.cc/prep/kras-g12c-nsclc/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
18 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example KRAS G12C by tissue or plasma sequencing, PD-L1 tumour proportion score, STK11 and KEAP1 co-mutations, TP53 co-mutation, Acquired KRAS mutations, MET amplification or bypass alterations at progression), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Advanced, first line
- 5.For my situation (advanced, first line), which of the standard options do you recommend and why?
- 6.Am I a candidate for Pembrolizumab, Carboplatin, Pemetrexed or related drugs, and what side effects should I expect?
- 7.How do the results of KEYNOTE-024 & KEYNOTE-189 apply to someone like me?
Advanced, after chemoimmunotherapy
- 8.For my situation (advanced, after chemoimmunotherapy), which of the standard options do you recommend and why?
- 9.Am I a candidate for Sotorasib, Adagrasib, Docetaxel or related drugs, and what side effects should I expect?
- 10.How do the results of CodeBreaK 200 and KRYSTAL-12 apply to someone like me?
Advanced, clinical trials
- 11.For my situation (advanced, clinical trials), which of the standard options do you recommend and why?
- 12.Am I a candidate for Divarasib, Olomorasib, Daraxonrasib, and what side effects should I expect?
- 13.How do the results of Krascendo 1 and A Study of First-Line Olomorasib (LY3537982) and Pembrolizumab With or Without Chemotherapy in Patients With Advanced KRAS G12C-Mutant Non-small Cell Lung Cancer apply to someone like me?
Any stage
- 14.Are there clinical trials I could join, for example of Divarasib, Krascendo 1, Olomorasib, A Study of First-Line Olomorasib (LY3537982) and Pembrolizumab With or Without Chemotherapy in Patients With Advanced KRAS G12C-Mutant Non-small Cell Lung Cancer?
- 15.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 16.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 17.I read that “Responses to G12C inhibitors are shallower and shorter in lung cancer than EGFR or ALK inhibitors achieve, and no overall survival benefit over docetaxel has been shown”. How does that affect my plan?
- 18.I read that “Liver toxicity when a G12C inhibitor follows or accompanies a checkpoint inhibitor limits first-line combinations”. How does that affect my plan?
The words I may hear
- Oncogene: A gene that, when over-activated by mutation or extra copies, pushes a cell to grow and divide.
- Hepatotoxicity (liver enzyme elevation): Liver injury from a drug, usually detected as a rise in liver enzymes (ALT, AST) on routine blood tests before symptoms appear.
- Tumour proportion score (TPS): The PD-L1 score used in lung cancer: the percentage of tumour cells that stain positive.
- KRAS mutation subtypes (G12C, G12D, G12V): KRAS, the most commonly mutated cancer gene, comes in flavours named by the exact amino acid change.
- Driver mutation: One of the few mutations in a tumour that actually causes it to grow.
- Drug resistance (primary and acquired): Why cancer drugs stop working: the tumour either never depended on the target or evolves around the block.
- Brain metastases (intracranial disease): Tumour deposits that have travelled to the brain from a cancer elsewhere, ten times more common than cancers that start in the brain, mostly from lung, breast, melanoma and kidney cancer.
Tests and results to bring
Biomarker results to ask for: KRAS G12C by tissue or plasma sequencing, PD-L1 tumour proportion score (first-line choice), STK11 and KEAP1 co-mutations (prognostic, immunotherapy resistance), TP53 co-mutation, Acquired KRAS mutations, MET amplification or bypass alterations at progression, Liver enzymes on a G12C inhibitor, especially soon after immunotherapy.
Scans and tests linked to this cancer: Comprehensive genomic profiling, Liquid biopsy (ctDNA).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Advanced, first line: As for driver-negative disease: pembrolizumab plus platinum doublet, or pembrolizumab alone if PD-L1 is 50 percent or more; KRAS inhibitors are not yet approved first line. (Pembrolizumab, KEYNOTE-024 & KEYNOTE-189, Carboplatin, Pemetrexed, Paclitaxel / nab-paclitaxel, Tumour proportion score (TPS))
- Advanced, after chemoimmunotherapy: Sotorasib (CodeBreaK 200) or adagrasib (KRYSTAL-12), preferred to docetaxel; adagrasib for active brain metastases; docetaxel with or without ramucirumab afterwards. (Sotorasib, CodeBreaK 200, Adagrasib, KRYSTAL-12, Docetaxel, Ramucirumab, KRAS & RAS inhibitors)
- Advanced, clinical trials: Divarasib versus sotorasib or adagrasib (Krascendo 1); olomorasib or adagrasib with pembrolizumab first line (SUNRAY-01, KRYSTAL-7); pan-RAS inhibitors. (Divarasib, Krascendo 1, Olomorasib, A Study of First-Line Olomorasib (LY3537982) and Pembrolizumab With or Without Chemotherapy in Patients With Advanced KRAS G12C-Mutant Non-small Cell Lung Cancer, Phase 2 Trial of Adagrasib Monotherapy and in Combination With Pembrolizumab and a Phase 3 Trial of Adagrasib in Combination in Patients With a KRAS G, Daraxonrasib)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call