Treatment of Unresectable BRAF V600E, TERT-Mutated Differentiated Papillary Thyroid Cancer With Dabrafenib and Trametinib

Authors

Neha Bapat, Department of Endocrinology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA.
Tatiana Ferraro, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA.
Layal Esper, Department of Endocrinology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA.
Arjun S. Joshi, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA.
Faysal Haroun, Division of Hematology and Oncology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA.
Chelsey K. Baldwin, Department of Endocrinology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA.

Document Type

Journal Article

Publication Date

8-1-2024

Journal

JCEM case reports

Volume

2

Issue

8

DOI

10.1210/jcemcr/luae112

Keywords

BRAF V600E mutation; aerodigestive invasive thyroid cancer; dabrafenib and trametinib; differentiated papillary thyroid cancer; locally invasive thyroid cancer; unresectable thyroid cancer

Abstract

Complete surgical resection of differentiated papillary thyroid cancer (PTC) is associated with an excellent prognosis. However, for locally invasive PTC, disease-specific morbidity and mortality increases when microscopic margin negative resection (R0) or complete macroscopic resection (R1) is not feasible. Neoadjuvant dabrafenib and trametinib (DT) used in BRAF V600E-positive, unresectable anaplastic thyroid cancer has allowed for R0 or R1 resection and improved survival rates. We demonstrate feasibility of using neoadjuvant DT in a patient with BRAF V600E and TERT-mutated PTC for whom R0/R1 resection was initially aborted due to predicted unacceptable morbidity. The patient was treated with neoadjuvant DT for 5 months, at which time disease was undetectable on imaging with near resolution on final pathology; however, subsequent rapid recurrence after discontinuation of neoadjuvant DT occurred. Neoadjuvant DT offers promise in future cohorts of patients with locally invasive BRAF V600E and TERT-mutated PTC for whom neoadjuvant therapy can reduce surgical morbidity while still allowing for R0/R1 resection.

APA Citation

Bapat, Neha; Ferraro, Tatiana; Esper, Layal; Joshi, Arjun S.; Haroun, Faysal; and Baldwin, Chelsey K., "Treatment of Unresectable BRAF V600E, TERT-Mutated Differentiated Papillary Thyroid Cancer With Dabrafenib and Trametinib" (2024). GW Authored Works. Paper 5543.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5543

Department

Medicine