BRAF - 1245043

Hi Luke,

Please note that the faculty cannot provide advice on a treatment choice, even if it's stated hypothetically. You can review the forum guidelines here: http://cancergrace.org/grace-discussion-forums#guidelines

There are three drugs generally approved for second-line treatment in lung cancer: alimta, taxotere and tarceva. Since your father is currently being treated with alimta, you have identified the other two drugs that would be the approved choices for his next treatment. Whether a theoretical BRAF inhibitor would be a better choice is not a question that can be answered here, in light of the forum guidelines but also since the BRAF inhibitor is theoretical - it's impossible to compare real treatment choices to an agent that doesn't exist. If there is a trial of a new BRAF inhibitor, you would need to review that treatment choice with his doctor in light of any information about that trial agent's efficacy/promise and your father's situation at that time.

I hope that his alimta maintenance is successful for a long time and that you do not face this question any time soon.

JimC
Forum Moderator

It's difficult, and by that I mean impossible, to recommend one options over another in the second line setting when there are not comparative data to address the issue. There is no information, no evidence at all to guide specific thoughts or recommendations for people with lung cancer and a BRAF mutation, so any recommendation of one treatment over another would essentially just be making up an answer.

Various clinical trials have indicated that Taxotere (docetaxel) and Tarceva (erlotinib) are both active and can prolong survival. While one randomized trial, called INTEREST, showed extremely comparable efficacy for Taxotere and the EGFR inhibitor Iressa (gefitinib) (which I would consider to be comparable or inferior to Tarceva for people without an EGFR mutation), one recent but quite flawed trial called TAILOR was just presented that suggested an inferior response rate and progression-free survival (but no results available yet on overall survival) for Taxotere compared with Tarceva for patients with EGFR wild type (no mutation).

Without any actual trials to point to for results with BRAF inhibitor therapy in NSCLC, there's no way to do anything more than speculate about the comparative value of this approach over a more established therapy.

Good luck.

-Dr. West

FYI, here's a "reading list" of random things I've run across about BRAF, if you're trying to come up to speed on research for BRAF-driven lung cancer. I don't see anything amazing, just some progress. (Character count limits prevent including captions.)

http://cancergrace.org/lung/2011/03/25/braf-inhibitors-in-lung-cancer/

Do you know which variant of BRAF? Is it BRAF-Y472C?
http://www.bloomberg.com/news/2012-05-30/bristol-myers-tests-sprycel-in…

http://www.ncbi.nlm.nih.gov/pubmed/22743296

http://www.sciencedaily.com/releases/2012/02/120228185828.htm
http://clincancerres.aacrjournals.org/content/early/2012/02/18/1078-043…

http://www.ncbi.nlm.nih.gov/pubmed/21818706

dabrafenib (GSK2118436), vemurafenib (PLX4032), &/or GSK1120212:
http://mct.aacrjournals.org/content/11/4/909

http://cancergrace.org/lung/2012/04/10/molecular-markers-in-lung-cancer…
(this mentions experimental drugs GSK2118434 or GSK1120212 for BRAF)

http://www.inspire.com/groups/lung-cancer-survivors/discussion/braf-mut…

http://cancerres.aacrjournals.org/content/early/2011/11/15/0008-5472.CA…

http://www.ncbi.nlm.nih.gov/pubmed/22649091

http://www.ncbi.nlm.nih.gov/pubmed/22433711

http://clinicaltrials.gov/ct2/results?term=BRAF+lung&recr=Open

Best hopes,