ABSTRACT
The treatment of BRAFV600E mutant melanoma has been revolutionized by BRAF inhibitors. Furthermore, the BRAF/MEK combination has shown further improvement in clinical outcomes in advanced and in adjuvant melanoma patients. In low-grade ovarian tumors, BRAF inhibitor use has been also proposed. Here we present a patient with an excellent, lasting response to BRAF therapy alone. At first progression, after more than two years on BRAF monotherapy, we could not identify any molecular mechanisms explaining resistance. After a switch to dual BRAF/MEK therapy, the patient responded. However, despite the initial response clinical the patient again progressed, this time with the appearance of a KRAS G12C mutation, which could not be overcome by BRAF/MEK therapy. We provide evidence that BRAF inhibitor alone can be highly beneficial in BRAF mutant low-grade ovarian tumors and the resistance mechanisms are similar to that of other BRAF mutant tumors, including in melanoma.
Subject(s)
Melanoma , Ovarian Neoplasms , Humans , Female , Proto-Oncogene Proteins B-raf/genetics , Melanoma/drug therapy , Melanoma/genetics , Melanoma/pathology , Protein Kinase Inhibitors/pharmacology , Protein Kinase Inhibitors/therapeutic use , Mitogen-Activated Protein Kinase Kinases , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/genetics , MutationABSTRACT
Positron emission tomography with 18F-fluorodesoxyglucose allows to locate pathological foci expressing a high metabolism. Originally shown in the investigation of neoplasia, this procedure is increasingly used as a new tool to search for inflammatory syndromes. Systemic vasculitis is a complex disorder, often manifested by non specific symptoms. Diagnosis at early stages allows early treatment, which may prevent progression to later complications. Through a case report and a review of the literature, this article describes the important role of PET/CT for the diagnosis when traditional tests remain unsuccessful.
