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Kata K, Rodriguez-Quintero JC, Arevalo OD, Zhang JJ, Bhattacharjee MB, Ware C, Dono A, Riascos-Castaneda R, Tandon N, Blanco A, Esquenazi Y, Ballester LY, Amsbaugh M, Day AL, Zhu JJ. BRAF/MEK Dual Inhibitors Therapy in Progressive and Anaplastic Pleomorphic Xanthoastrocytoma: Case Series and Literature Review. J Natl Compr Canc Netw 2022; 20:1193-1202.e6. [PMID: 36351333 DOI: 10.6004/jnccn.2022.7046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
Recurrent and anaplastic pleomorphic xanthoastrocytoma (r&aPXA) is a rare primary brain tumor that is challenging to treat. Two-thirds of PXA tumors harbor a BRAF gene mutation. BRAF inhibitors have been shown to improve tumor control. However, resistance to BRAF inhibition develops in most cases. Concurrent therapy with MEK inhibitors may improve tumor control and patient survival. In this study, we identified 5 patients diagnosed with BRAF-mutated PXA who received BRAF and MEK inhibitors over a 10-year interval at our institution. Patient records were evaluated, including treatments, adverse effects (AEs), outcomes, pathology, next-generation sequencing, and MRI. The median age was 22 years (range, 14-66 years), 60% male, and 60% anaplastic PXA. Median overall survival was 72 months (range, 19-112 months); 1 patient died of tumor-related hemorrhage while off therapy, and the other 4 experienced long-term disease control (21, 72, 98, and 112 months, respectively). Dual BRAF/MEK inhibitors were well tolerated, with only grade 1-2 AEs, including rash, neutropenia, fatigue, abdominal discomfort, and diarrhea. No grade 3-5 AEs were detected. A literature review was also performed of patients diagnosed with BRAF-mutated PXA and treated with BRAF and/or MEK inhibitors through August 2021, with a total of 32 cases identified. The median age was 29 years (range, 8-57 years) and the median PFS and OS were 8.5 months (range, 2-35 months) and 35 months (range, 10-80 months), respectively. The most common AEs were grade 1-2 fatigue and skin rash. Results of this case series and literature review indicate that dual-drug therapy with BRAF and MEK inhibitors for r&aPXA with BRAF V600E mutation may delay tumor progression without unexpected AEs.
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Affiliation(s)
- Karolina Kata
- 1St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
- 2Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas
| | - Juan C Rodriguez-Quintero
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 4Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Octavio D Arevalo
- 5Department of Radiology, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Jackie J Zhang
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 6Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | - Meenakshi Bidwai Bhattacharjee
- 7Department of Pathology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Cornelius Ware
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Antonio Dono
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Roy Riascos-Castaneda
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
- 9Department of Radiology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas; and
| | - Nitin Tandon
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Angel Blanco
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Yoshua Esquenazi
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Leomar Y Ballester
- 7Department of Pathology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 10Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Amsbaugh
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Arthur L Day
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Jay-Jiguang Zhu
- 3Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 4Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
- 8Memorial Hermann-Texas Medical Center, Houston, Texas
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