How to Manage a Melanoma-like Advanced NSCLC with BRAF V600E in an Elderly Patient-Case Study: How to Manage a Melanoma-like Advanced NSCLC with BRAF V600E in an Elderly Patient (PDF)

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This case study, presented by Dr. Lorenzo Belluomini, focuses on managing advanced non-small cell lung cancer (NSCLC) with BRAF V600E mutation in an elderly patient. The learning goals aim to develop a comprehensive histological and molecular diagnosis, assess differential diagnoses, and manage effective treatments for elderly and frail patients.<br /><br />The patient, experiencing shortness of breath, uncontrollable cough, and anxiety, required supplemental oxygen. Initial examinations revealed ECOG performance status 2, indicating a need for continuous oxygen therapy. Imaging and lab tests showed thickening in lung regions, pleural effusion, lymphadenopathies, and a potentially cancerous pancreatic lesion. Comprehensive molecular profiling identified BRAF V600E and CTNNB1 S45F mutations. Immunohistochemistry indicated an enteric-type adenocarcinoma with a specific protein expression profile, leading to further diagnostic procedures like gastroscopy and colonoscopy, both yielding negative results.<br /><br />Treatment involved targeted therapy with Dabrafenib and Trametinib. After three months, the patient's clinical condition improved significantly, no longer requiring oxygen therapy. A follow-up CT scan showed reduced tumor size, and skin lesions resolved completely, confirmed by negative biopsy results.<br /><br />Key takeaways include recognizing the importance of biomarker testing in advanced NSCLC, understanding evidence-based, personalized treatment approaches, and managing effective treatment paths in elderly and frail patients. The case underscores the significance of molecular diagnostics and targeted therapies for better patient outcomes. The learning resource aims to support continuous education in thoracic oncology, providing a comprehensive approach to managing NSCLC cases with specific genetic mutations. For further education, additional microlearning cases and resources are available through LungCancer 360.

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Keywords

NSCLC

BRAF V600E mutation

elderly patient

molecular diagnosis

targeted therapy

Dabrafenib

Trametinib

biomarker testing

thoracic oncology

personalized treatment