Case Summary:

  • 47 year female

  • Non smoker

  • Cough for 2 months

  • Diagnosed as metastatic carcinoma lung in 2014

  • Adenocarcinoma

  • NO ACTIONABLE MUTATION

Treatment

  • Pemetrexed and carboplatin was started (JMDBstudy)

  • PET/CT s/o PARTIAL RESPONSE

  • Pemetrexed maintenance ( PARAMOUNT STUDY)

  • Post 11 cycles patient progressed

  • DOCETAXEL ( TAX 317 and 320 study)

  • Post 3 cycles assessment was done , WB PET /CT scan s/o PARTIAL RESPONSE

  • Regular follow up - STABLE DISEASE in subsequent scans

  • Patient was doing well clinically

  • Post 50 cycles of DOCETAXEL - Progressed with brain metastasis (June 2018)

  • WBRT and RT to right lung lesion

  • Atezolizumab 1200 mg every 3 weeks for 7 cycles (June 2018 to Nov 2018)

  • WB PET/CT scan -PROGRESSIVE DISEASE (Nov 2018)

  • Started on gemcitabine and carboplatin

  • Reassessed after 2 cycles PET/CT scan s/o STABLE DISEASE

  • So gemcitabine and carboplatin continued for total 6 cycles

  • Post 6 cycles PET/CT s/o STABLE DISEASE (June 2019)

  • Meanwhile pleurodhesis was done in view of persistent pleural effusion

Lung cancer new case study

Treatment continues

  • Patient was started on weekly paclitaxel and bevacizumab, completed 1st cycle

  • Report of repeated NGS s/o BRAF V600E mutation and SMAD4 mutation positive

  • Started on DABRAFENIB 150 mg BD & TRAMETINIB 2mg OD ( since July 2019) on compassionate basis

Lung cancer new case study

PRESENTLY: As of now patient is tolerating the combination of BRAF inhibitor and MEK inhibitor well and she had her last evaluation in May 2020 which was s/o stable disease.

Lung cancer new case study

BRAF positive NSCLC

  • BRAF mutations have been documented in only 3.5-5% of the non-small cell lung cancer (NSCLC) patients (1)

  • The occurrence of BRAF V600E mutations account for 50% of these cases, and the rest of BRAF mutations are non-V600E

  • It is an oncogene that is a part of the RAS/MPK pathway that regulates cell growth and division

*(1) Clinical features and outcome of patients with non-small-cell lung cancer harboring BRAF mutations. Marchetti A, Felicioni L, Malatesta S, et al.*

  • BRAF- V600E mutations occur predominantly in females, smokers, and also has a pathology of adenocarcinoma (1,2)

  • On basis of phase ll study (Planchard et al) in previously treated advanced NSCLC with BRAF V600E mutation DABRAFENIB & TRAMETINIB had ORR of 63 % & DCR OF 79 % & mPFS of 9.7 months

*(2) Clinical characteristics and course of 63 patients with BRAF mutant lung cancers. Litvak AM, Paik PK, Woo KM, et al.*