A patient with malignant pleural mesothelioma carrying BRAF V600E mutation responding to vemurafenib

Our plain-English summary of A patient with malignant pleural mesothelioma carrying BRAF V600E mutation responding to vemurafenib, by Y. Chen, B. Chen, X. Zhu, et al (Lung Cancer, 2018).

The study

• Authors: Y. Chen, B. Chen, X. Zhu, J. Zhong
• Journal: Lung Cancer
• Published: 2018;116:96-98
• Type of article: Case report, Letter
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors reported a 65-year-old Chinese man with advanced malignant pleural mesothelioma carrying a BRAF V600E mutation who was treated with vemurafenib, an inhibitor of mutated BRAF. He presented at Zhuji People's Hospital, Zhejiang Province, China, with three months of fatigue and weight loss, and denied occupational asbestos exposure. CT showed a left pleural effusion, nodules in the opposite lung and bone destruction. Thoracoscopic biopsy confirmed epithelioid mesothelioma, positive for WT-1 and calretinin. He received three cycles of pemetrexed-based chemotherapy, then stopped because of intolerable toxicity; response could not be evaluated. Three months later the disease had progressed, with new liver lesions. He declined a liver re-biopsy, so gene sequencing was performed on circulating tumour cells from blood. It showed a BRAF V600E mutation (52.06% abundance), which Sanger sequencing confirmed. He then took vemurafenib off-label at 960 mg twice daily. Within one week he no longer needed painkillers and his breathlessness eased. At six weeks CT showed a partial response in the pleura, lung and liver. Side effects were grade 2 fatigue, nausea and vomiting. Six weeks later the disease progressed and vemurafenib was stopped, giving 12 weeks of progression-free survival. The authors described this as the first reported case of its kind and concluded that vemurafenib showed modest activity, which needs confirmation in larger series of patients.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is a case report of one patient from Zhuji People's Hospital, China. A 65-year-old man, who denied occupational asbestos exposure, had advanced epithelioid malignant pleural mesothelioma that had spread to the lung and bone. He received three cycles of chemotherapy and then stopped because of side effects. Three months later his disease had progressed, with new lesions in the liver. Gene testing of tumor cells taken from his blood found a BRAF V600E mutation, confirmed by a second method. He then received vemurafenib, a drug that targets this mutation, at 960mg twice daily, outside its approved use. After one week his pain was relieved. Six weeks after starting vemurafenib, scans showed his tumors had shrunk, rated a partial response. Side effects were grade 2 fatigue, nausea and vomiting. Six weeks after that, the disease progressed again. Progression-free survival on vemurafenib was 12 weeks. The authors concluded the case showed modest antitumor activity of vemurafenib. They noted that one case report is not statistically significant and that the findings need confirmation in larger series of patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 65-year-old Chinese man treated at Zhuji People's Hospital, Zhejiang Province, China, with advanced epithelioid malignant pleural mesothelioma that had spread to the lung and bone; dates not given
• Exposure: No asbestos exposure is reported: the patient denied a history of occupational asbestos exposure, and no fiber type is named. The exposure studied was treatment with vemurafenib, 960mg orally twice daily, given off-label after progression on chemotherapy.
• Main results:
  • Biopsy showed epithelioid malignant pleural mesothelioma; the patient was diagnosed with advanced disease with lung and bone metastasis
  • After 3 cycles of chemotherapy, CT confirmed progressive disease, with larger pleural tumors and new liver lesions
  • Sequencing of circulating tumor cells from the patient's blood found a BRAF V600E mutation with 52.06% abundance, with no mutations found in the EGFR, KRAS or NRAS regions tested; the BRAF V600E mutation was confirmed by Sanger sequencing
  • After 1 week of vemurafenib, the patient stopped pain medication and had no complaint of pain
  • Six weeks after the first dose of vemurafenib, CT showed shrinkage of tumors in the left pleura, lung and liver, classed as partial response under RECIST 1.1
  • The patient experienced grade 2 fatigue, nausea and vomiting
  • The disease progressed again; progression-free survival on vemurafenib was 12 weeks
• The authors' conclusion: The authors concluded that this case showed modest antitumor activity of vemurafenib in a patient with malignant pleural mesothelioma carrying a BRAF V600 mutation, and they described it as, to their knowledge, the first such case report
• Limitations the authors state:
  • A single case report is not statistically significant, and the findings need confirmation in larger series of mesothelioma patients

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, BRAF V600E, Asbestos Exposure, Pleural Effusion, Thoracoscopic Biopsy, Epithelioid, Mesothelioma, Wilms Tumor 1 (WT-1).

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