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对BRAF和MEK抑制敏感的BRAF L485 - P490缺失突变转移性黑色素瘤:病例报告及文献综述

BRAF L485-P490 deletion mutant metastatic melanoma sensitive to BRAF and MEK inhibition: A case report and literature review.

作者信息

Zhang Simeng, Yang Zichang, Cheng Yu, Guo Xiaoyu, Liu Chang, Wang Shuo, Zhang Lingyun

机构信息

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.

出版信息

Front Pharmacol. 2023 Jan 6;13:1019217. doi: 10.3389/fphar.2022.1019217. eCollection 2022.


DOI:10.3389/fphar.2022.1019217
PMID:36686670
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9853440/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97cc/9853440/f6c8746213bf/fphar-13-1019217-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97cc/9853440/cfe9a7d0ce76/fphar-13-1019217-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97cc/9853440/f6c8746213bf/fphar-13-1019217-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97cc/9853440/cfe9a7d0ce76/fphar-13-1019217-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97cc/9853440/f6c8746213bf/fphar-13-1019217-g002.jpg

相似文献

[1]
BRAF L485-P490 deletion mutant metastatic melanoma sensitive to BRAF and MEK inhibition: A case report and literature review.

Front Pharmacol. 2023-1-6

[2]
Trametinib: a MEK inhibitor for management of metastatic melanoma.

Onco Targets Ther. 2015-8-25

[3]
Combination of dabrafenib plus trametinib for BRAF and MEK inhibitor pretreated patients with advanced BRAF-mutant melanoma: an open-label, single arm, dual-centre, phase 2 clinical trial.

Lancet Oncol. 2017-3-4

[4]
First-line pembrolizumab versus dabrafenib/trametinib treatment for BRAF V600-mutant advanced melanoma.

J Am Acad Dermatol. 2022-11

[5]
Dabrafenib plus trametinib is effective in the treatment of BRAF V600-mutated metastatic melanoma patients: analysis of patients from the dabrafenib plus trametinib Named Patient Program (DESCRIBE II).

Melanoma Res. 2020-6

[6]
Open-label, phase IIa study of dabrafenib plus trametinib in East Asian patients with advanced BRAF V600-mutant cutaneous melanoma.

Eur J Cancer. 2020-6-10

[7]
Trametinib (MEKINIST°) Metastatic or inoperable BRAF V600-positive melanoma: a few extra months of life.

Prescrire Int. 2016-12

[8]
Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations.

N Engl J Med. 2012-9-29

[9]
Combined BRAF and MEK Inhibition With Dabrafenib and Trametinib in BRAF V600-Mutant Colorectal Cancer.

J Clin Oncol. 2015-12-1

[10]
Adverse Event Management in Patients with V600E-Mutant Non-Small Cell Lung Cancer Treated with Dabrafenib plus Trametinib.

Oncologist. 2018-12-31

引用本文的文献

[1]
Transdifferentiation of Multiple Myeloma into Histiocytic Sarcoma: Case Report of a Highly Unusual Phenomenon.

Pathobiology. 2025-6-8

[2]
Hyperbaric Oxygen Therapy for Complications in Nipple-Sparing Mastectomy with Breast Reconstruction: A Systematic Review.

J Clin Med. 2024-6-17

[3]
BRAF in-frame deletion mutants differ in their dimerization propensity, HSP90 dependence, and druggability.

Sci Adv. 2023-9

[4]
Molecular Modeling Unveils the Effective Interaction of B-RAF Inhibitors with Rare B-RAF Insertion Variants.

Int J Mol Sci. 2023-7-31

本文引用的文献

[1]
Knockdown of 15-bp Deletion-Type v-raf Murine Sarcoma Viral Oncogene Homolog B1 mRNA in Pancreatic Ductal Adenocarcinoma Cells Repressed Cell Growth In Vitro and Tumor Volume In Vivo.

Cancers (Basel). 2022-6-28

[2]
Efficacy and Safety of Trametinib in Non-V600 BRAF Mutant Melanoma: A Phase II Study.

Oncologist. 2021-9

[3]
V600E/V600K Mutations versus Nonstandard Alterations: Prognostic Implications and Therapeutic Outcomes.

Mol Cancer Ther. 2021-6

[4]
Targeted and immunotherapies in BRAF mutant melanoma: where we stand and what to expect.

Br J Dermatol. 2021-8

[5]
Cancer statistics, 2020.

CA Cancer J Clin. 2020-1-8

[6]
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J Clin Oncol. 2019-10-3

[7]
Targeting Alterations in the RAF-MEK Pathway.

Cancer Discov. 2019-2-15

[8]
Class Matters: Sensitivity of -Mutant Melanoma to MAPK Inhibition.

Clin Cancer Res. 2018-7-24

[9]
Dual MAPK Inhibition Is an Effective Therapeutic Strategy for a Subset of Class II BRAF Mutant Melanomas.

Clin Cancer Res. 2018-6-14

[10]
Classifying BRAF alterations in cancer: new rational therapeutic strategies for actionable mutations.

Oncogene. 2018-3-15

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