New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
A patient with BRAF-mutant, advanced NSCLC who had a durable response to vemurafenib
2:09 minutes.
TRANSCRIPTION:
DR KRIS: The case I have in mind is a person who had multiplex testing, was found to have a BRAF mutation. And at the time we had a trial of selumetinib, and she qualified for that. So she got the selumetinib. DR LOVE: Can you just remind us what that is? DR KRIS: It’s a MEK inhibitor, M-E-K inhibitor, one step downstream from that. And she did not respond. And those of you who have used this drug, it’s not a friendly drug, cutaneous edema and hospitalized, actually, for toxicity. So I then looked for a clinical trial, and, as it turned out, the dabrafenib trials excluded people who had prior MEK inhibitors. That’s the craziest thing I’ve ever heard of, but they did. So she didn’t qualify for dabrafenib. So I wrote her a script for vemurafenib, and she then went on to have a 1 plus-year major response. DR LOVE: She responded. How did she tolerate the vemurafenib? DR KRIS: Very well. Compared to the selumetinib, tremendously well, and she was never hospitalized. And she did have cutaneous toxicity, which was manageable. DR LOVE: Any second squamous cancers? That’s been seen in melanoma. DR KRIS: She did not. She had some skin changes that were managed by one of our dermatologists, but she didn’t have squamous cancers, though they can be found. DR LOVE: The other thing that we’re hearing in the melanoma patients is exquisite, exquisite sun sensitivity, very quick to sunburn. Did she have any problem like that? DR KRIS: She did not, but again, I’m in a slightly northern climate and she was not a sunbather. But obviously those kinds of toxicities can happen with all kinds of drugs. DR LOVE: Anne, what are your thoughts about patients with BRAF-mutant disease? And have you treated these people with BRAF inhibitors? DR TSAO: Yes. So I’ve treated 2 patients with vemurafenib, but I’ve had 2 different responses. Like one lady, she just progressed rapidly, and the other one has stable disease. And then when I took her off of the drug, she had stable disease for another 3 years. |