Neoadjuvant dabrafenib and trametinib for functional organ preservation in recurrent BRAF V600E-mutated papillary thyroid cancer

Janice L Farlow; Hilary C McCrary; Jennifer A Sipos; John E Phay; Bhavana Konda; Amit Agrawal

doi:10.1016/j.oraloncology.2023.106625

Neoadjuvant dabrafenib and trametinib for functional organ preservation in recurrent BRAF V600E-mutated papillary thyroid cancer

Oral Oncol. 2023 Dec:147:106625. doi: 10.1016/j.oraloncology.2023.106625. Epub 2023 Nov 8.

Authors

Janice L Farlow¹, Hilary C McCrary², Jennifer A Sipos³, John E Phay⁴, Bhavana Konda⁵, Amit Agrawal⁶

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA.
² Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
³ Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁴ Division of Surgical Oncology, Department of Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁵ Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: amit.agrawal@osumc.edu.

PMID: 37948895
DOI: 10.1016/j.oraloncology.2023.106625

Abstract

Objectives: To describe the first reported use of neoadjuvant dabrafenib and trametinib specifically to permit organ conservation surgery in locally advanced recurrent differentiated thyroid carcinoma.

Patients and methods: A patient presented with locally recurrent, radioiodide-resistant DTC with a BRAF V600E mutation invading the laryngotrachea. Definitive treatment would require a total laryngectomy. She was offered neoadjuvant dabrafenib and trametinib prior to surgery.

Results: A significant radiographic response permitted partial laryngectomy, enabling preservation of voice, early resumption of oral feeding, and avoidance of permanent tracheostomy. At 9 months, she remained free of disease.

Conclusion: Neoadjuvant tyrosine kinase inhibitor treatment prior to definitive surgery for locally-invasive recurrent DTC is a potential approach that may limit the degree of surgery and associated morbidity.

Keywords: Advanced thyroid cancer; BRAF; Dabrafenib; Differentiated thyroid carcinoma; Neoadjuvant kinase inhibitor; Organ conservation; Papillary thyroid carcinoma; Partial laryngectomy; Trametinib.

Publication types

Letter

MeSH terms

Antineoplastic Combined Chemotherapy Protocols
Female
Humans
Mutation
Neoadjuvant Therapy
Organ Preservation
Proto-Oncogene Proteins B-raf* / genetics
Pyridones / pharmacology
Pyridones / therapeutic use
Thyroid Cancer, Papillary / drug therapy
Thyroid Neoplasms* / drug therapy
Thyroid Neoplasms* / genetics

Substances

dabrafenib
trametinib
Proto-Oncogene Proteins B-raf
Pyridones
BRAF protein, human