Challenges of targeting BRAF V600E mutations in adult primary brain tumor patients: a report of two cases

CNS Oncol. 2019 Dec 1;8(4):CNS48. doi: 10.2217/cns-2019-0018. Epub 2019 Dec 10.

Abstract

Aim: Therapeutic targeting of BRAF alterations in primary brain tumor patients has demonstrated clinical activity in case reports and early trials; however, there is limited high-level evidence of the efficacy. Patients & results: Targeting BRAF V600E mutations with concurrent dabrafenib and trametinib in anaplastic pleomorphic xanthoastrocytoma resulted in a transient radiographic and clinical response and no therapeutic benefit in a patient with an epithelioid glioblastoma. Conclusion:BRAF/MEK inhibition did not produce a durable treatment effect in glioblastoma or pleomorphic xanthoastrocytoma with BRAF V600E alterations. Heterogenicity of related cases in the literature makes an evaluation of efficacy BRAF targeting therapies in gliomas difficult and requires additional investigation.

Keywords: BRAF inhibitor; BRAFV600E mutation; MEK inhibitor; dabrafenib; glioblastoma; glioma; pleomorphic xanthoastrocytoma; targeted therapy; trametinib.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Astrocytoma / diagnostic imaging
  • Astrocytoma / drug therapy*
  • Astrocytoma / genetics
  • Astrocytoma / surgery
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / drug therapy*
  • Brain Neoplasms / genetics
  • Brain Neoplasms / surgery
  • Female
  • Humans
  • Imidazoles / therapeutic use*
  • Male
  • Middle Aged
  • Mutation
  • Oximes / therapeutic use*
  • Protein Kinase Inhibitors / therapeutic use*
  • Proto-Oncogene Proteins B-raf / genetics*
  • Pyridones / therapeutic use*
  • Pyrimidinones / therapeutic use*
  • Treatment Failure
  • Young Adult

Substances

  • Imidazoles
  • Oximes
  • Protein Kinase Inhibitors
  • Pyridones
  • Pyrimidinones
  • trametinib
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf
  • dabrafenib