Int J Thyroidol.  2024 Nov;17(2):299-303. 10.11106/ijt.2024.17.2.299.

BRAF/ MEK Inhibitors in Downstaging BRAF^V600E Mutated Papillary Thyroid Cancer to Allow Resection: Case Report and Literature Review

• Dodbiba L
• Zhang H
• Luthra M
• Meyers B

• KMID: 2561611
• DOI: http://doi.org/10.11106/ijt.2024.17.2.299

Abstract

Well-differentiated thyroid cancer is managed with surgical resection, and adjuvant radioactive iodine (RAI) treatment reserved for moderate to high-risk patients. However, some patients with locally advanced disease are not candidates for upfront surgical resection. Within this rare patient population, VEGF tyrosine kinase inhibitors (TKI) and BRAF inhibitors have shown to successfully control and even reduce the size of RAI resistant thyroid cancers. In this case report, we elucidate the efficacy of a tumor agnostic strategy in facilitating the surgical resection of a locally advanced papillary thyroid cancer (PTC) with carotid involvement. A 60-year-old female presented with a large right sided papillary thyroid carcinoma with a BRAF^V600E mutation. Initial stability was achieved through the use of Lenvatinib and subsequent use of dabrafenib and trametinib resulted in significant partial response. Following the aforementioned treatments, the patient successfully advanced to definitive surgery and RAI. BRAF/MEK inhibitors can be used in the neo-adjuvant setting to ensure resection in patients with locally advanced/unresectable well-differentiated thyroid cancer.

Keyword

Thyroid cancer; Radioactive iodine; Lenvatinib; Trametinib; Dabrafenib

Figure

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  Fig. 1 At year 7, the patient presented with a large, 7 cm right sided mass with extension to the right carotid artery (A). Lenvatinib treatment was initiated and despite some initial side effects, there was a marginal response (B, C). Unfortunately, surgical intervention was still not possible and dabrafenib/trametinib treatment was initiated. BRAF/MEK inhibition has a drastic response (D) allowing for surgical resection and RAI therapy.

Reference

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