Prolonged Response to Dabrafenib/Trametinib in Grade 3 Metastatic Pancreatic Neuroendocrine Tumor (NET G3) with BRAF V600E Mutation

J Gastrointest Cancer. 2024 Sep;55(3):1448-1452. doi: 10.1007/s12029-024-01072-0. Epub 2024 May 30.

Abstract

Purpose: Treatment of metastatic pancreatic neuroendocrine tumors (pancNETs), particularly grade 2 (G2) and grade 3 (G3), often presents a dilemma in choosing from multiple similarly efficacious therapies. Data on targeted therapies for these tumor types is limited, and this report presents BRAF-targeted therapy as a therapeutic option for metastatic pancNET G3.

Methods: This is a case report of a patient with G3 pancNET metastatic to the liver, lung, lymph node, and scalp (soft tissue) treated with dabrafenib/trametinib (D/T) in the presence of a BRAF V600E mutation detected in tumor tissue.

Results: This patient has demonstrated an ongoing partial response to therapy at all involved sites for nearly 15 months with minimal side effects attributable to D/T.

Conclusion: Dabrafenib/trametinib therapy for BRAF-mutated metastatic pancNETs provides a novel treatment option and, especially in the G3 setting, should be considered a first-line option. Tumor testing for actionable mutations should be undertaken at the time of diagnosis and/or progression to identify novel therapeutic avenues in these rare tumors.

Keywords: BRAF; Carcinoid; Gastrointestinal; Neuroendocrine; Targeted therapy.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Female
  • Humans
  • Imidazoles* / administration & dosage
  • Imidazoles* / adverse effects
  • Imidazoles* / therapeutic use
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / genetics
  • Liver Neoplasms / secondary
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / genetics
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Mutation*
  • Neoplasm Grading
  • Neuroendocrine Tumors* / drug therapy
  • Neuroendocrine Tumors* / genetics
  • Neuroendocrine Tumors* / pathology
  • Oximes* / administration & dosage
  • Oximes* / therapeutic use
  • Pancreatic Neoplasms* / drug therapy
  • Pancreatic Neoplasms* / genetics
  • Pancreatic Neoplasms* / pathology
  • Proto-Oncogene Proteins B-raf* / genetics
  • Pyridones* / administration & dosage
  • Pyridones* / therapeutic use
  • Pyrimidinones* / administration & dosage
  • Pyrimidinones* / therapeutic use
  • Treatment Outcome

Substances

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