Zhang Simeng, Yang Zichang, Cheng Yu, Guo Xiaoyu, Liu Chang, Wang Shuo, Zhang Lingyun
Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.
Front Pharmacol. 2023 Jan 6;13:1019217. doi: 10.3389/fphar.2022.1019217. eCollection 2022.
The combination therapy of BRAF inhibitors (BRAFis) and MEK inhibitors (MEKis) has been approved as a first-line treatment for metastatic melanoma with BRAF V600 mutants. Recently, BRAF mutations have been divided into three subtypes based on biochemical and signaling characteristics. Unlike V600 mutants that show class I BRAF mutations, evidence of the effects of using BRAF inhibitors and MEK inhibitors in patients with non-V600 BRAF mutations remains unclear. The exploration of effective therapy for non-V600 BRAF mutations in melanoma has thus attracted much interest. We reported a case of a 64-year-old female metastatic melanoma patient with a novel BRAF .L485-P490 deletion mutation. The patient received anti-PD1 agent pembrolizumab (100 mg) therapy as the first-line treatment for two cycles, which was terminated due to an intolerable adverse effect. Considering the .L485-P490 deletion mutation signal as an active dimer which is akin to a class II BRAF mutation, the patient underwent dabrafenib and trametinib combination therapy as a second-line treatment. After two cycles of combination treatment, the patient achieved a partial response confirmed by radiological examinations. At the last follow-up date, the patient had obtained over 18 months of progression-free survival, and the treatment was well tolerated. The combination therapy of dabrafenib and trametinib has been proven to be an effective method as a later-line therapy for metastatic melanoma patients with class II BRAF in-frame deletion mutations.
BRAF抑制剂(BRAFis)与MEK抑制剂(MEKis)联合疗法已被批准作为BRAF V600突变转移性黑色素瘤的一线治疗方案。最近,BRAF突变根据生化和信号特征被分为三个亚型。与显示I类BRAF突变的V600突变不同,在非V600 BRAF突变患者中使用BRAF抑制剂和MEK抑制剂的疗效证据仍不明确。因此,探索针对黑色素瘤非V600 BRAF突变的有效治疗方法引起了广泛关注。我们报告了一例64岁女性转移性黑色素瘤患者,其携带一种新的BRAF.L485 - P490缺失突变。该患者接受抗PD1药物帕博利珠单抗(100 mg)作为一线治疗两个周期,但因无法耐受的不良反应而终止。考虑到.L485 - P490缺失突变信号作为一种类似于II类BRAF突变的活性二聚体,该患者接受了达拉非尼和曲美替尼联合治疗作为二线治疗。经过两个周期的联合治疗,患者通过影像学检查证实获得了部分缓解。在最后一次随访时,患者已获得超过18个月的无进展生存期,且治疗耐受性良好。达拉非尼和曲美替尼联合疗法已被证明是一种有效的治疗方法,可作为具有II类BRAF框内缺失突变的转移性黑色素瘤患者的后线治疗。
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