采用不可知论方法有效治疗 BRAF V600E 突变肿瘤的病例报告

N.  V. Prokudina, М. М. Kramchaninov
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引用次数: 0

摘要

肿瘤诊断的癌症治疗方法意味着,无论肿瘤起源于哪个部位,都要选择针对特定基因畸变和信号通路的药物,这代表了个性化肿瘤学的一个新方向。Pembrolizumab 是首个获准用于任何部位不可切除的微卫星不稳定性高(MSI-H)肿瘤的疗法。2022 年,美国食品和药物管理局(FDA)批准达拉非尼和曲美替尼联合治疗携带 BRAF V600E 突变的实体瘤患者。黑色素瘤、结直肠癌和非小细胞肺癌中分别有60%、15%和5-8%的病例存在BRAF突变。我们报告了两例 BRAF 基因突变的唾液腺癌和胰腺癌病例,这些患者在接受标准治疗后病情仍在进展,并根据不可知论方法接受了达拉非尼和曲美替尼的联合治疗。这些病例报告表明,不可知论方法和 BRAF / MEK 抑制剂治疗可稳定 BRAF 阳性癌症患者(包括多处转移的患者)的病情,并为罕见的 BRAF 突变癌症患者提供了额外的治疗选择,因为目前只有极少数药物可用于治疗这些癌症。
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Case reports of BRAF V600E-mutated tumors effectively treated using the agnostic approach
A tumor-agnostic approach to cancer treatment that implies the selection of agents targeting specific genetic aberrations and signaling pathways regardless of the tumor site of origin represents a new direction in personalized oncology. Pembrolizumab is the first therapy approved for unresectable microsatellite instability-high (MSI-H) tumors of any location. In 2022, the combination of dabrafenib and trametinib was approved by the US Food and Drug Administration (FDA) for the treatment of patients with solid tumors harboring BRAF V600E mutations. Melanomas, colorectal cancers, and non-small cell lung cancers are BRAF-mutated in 60 %, 15 %, and 5–8 % of cases, respectively. BRAF-mutated glioblastoma (3 %), cholangiocarcinoma (5–7 %), pancreatic cancer (1–16 %), and Langerhans cell histiocytosis (57 %) have also been reported.We present two case reports of BRAF-mutated salivary gland and pancreatic cancers in patients with progressive disease despite standard-of-care therapy who were treated with a combination of dabrafenib and trametinib according to the agnostic approach.The presented case reports have demonstrated that the agnostic approach and treatment with BRAF / MEK inhibitors stabilize the disease in patients with BRAF-positive cancers, including those with multiple metastases, and represent an additional therapeutic option for patients with rare BRAF-mutated cancers for which very few pharmacologic options are available.
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