A 69-Year Old Man With Metastatic BRAF V600E-Mutated Metastatic NSCLC

Case: A 69-Year Old Man With MetastaticBRAFV600E—Mutated Metastatic NSCLC

Initial presentation

• A 69-year old man presented with a chronic dry cough and dyspnea on exertion
• PMH: history of hypercholesterolemia, medically treated; 20 pack-year smoking history, quit 6 years ago
• PE: decreased breath sounds on auscultation

Clinical workup

• Labs: WNL
• Chest X-ray showed a ~4-cm
• Chest/abdomen/pelvic CT showed a 3.7-cm solid pulmonary lesion in the right lobe, ipsilateral mediastinal and subcarinal lymph node involvement
• Bronchoscopy biopsy of the lung lesion and lymph nodes revealed lung adenocarcinoma
• Contrast-enhanced MRI of the head showed a small brain lesion
• Molecular and biomarker testing:
  • PD-L1 TPS 20%
  • EGFR-, ALK-,BRAFV600E+,ROS1-
• Stage T2aN2M1b; ECOG PS 0

Treatment and Follow-Up

• Patient started on dabrafenib 150 mg PO qDay BID + trametinib 2 mg PO qDay; achieved partial response
  • Patient developed intermittent grade 1 fatigue, which was tolerable; continued treatment
• Imaging at 3, 6 and 9 months showed sustained partial response