Clinical responses to vemurafenib in patients with metastatic papillary thyroid cancer harboring BRAF(V600E) mutation

Abstract

Background: Clinical benefit from cytotoxic chemotherapy for metastatic papillary thyroid carcinoma (PTC) is disappointing, and effective therapeutic approaches for these patients are urgently needed. Because kinase-activating mutations in the BRAF proto-oncogene commonly occur in advanced PTC, and inhibition of BRAF(V600E) has shown promising clinical activity in melanoma, BRAF inhibitor therapy may be an effective strategy to treat metastatic PTC.

Methods: The dose escalation portion of a first-in-human, phase I study of vemurafenib, a selective RAF inhibitor, included three patients with metastatic PTC harboring the BRAF(V600E) mutation. Vemurafenib was initially dosed at 240-360 mg twice a day, later escalated to 720 mg twice a day. Response evaluation was performed every 8 weeks per Response Evaluation Criteria in Solid Tumors (RECIST).

Results: Among the three patients, one had a confirmed partial response with reduction of pulmonary target lesions by 31%, and the duration of response was 7.6 months before the disease progressed in the lungs and the bones. The time to progression was 11.7 months. The other two patients had stable disease, and the time to progression was 13.2 and 11.4 months, respectively.

Conclusions: Vemurafenib appears to have a promising clinical activity in patients with metastatic PTC, and our data suggest that the BRAF(V600E) mutant kinase is a relevant target for therapy in this patient population. Further investigation of inhibitors of mutated BRAF kinase in patients with PTC in a phase II study is warranted.

Trial registration: ClinicalTrials.gov NCT00215605.

Figures

FIG. 1.

Histologic evaluation for patient 2. (A) Hematoxylin and eosin (H&E, 200×) stained section showing classical papillary thyroid carcinoma arising within the thyroid (initial surgery, 2001); higher power showing nuclear clearing, elongation and grooving (inset, 400×) positive for BRAFV600E mutation. (B) Recurrent papillary thyroid carcinoma involving peritracheal soft tissue with squamoid features (2003) (H&E, 200×and inset 400×) and nuclear hyperchromasia. (C) Biopsy of the lung mass in 2009 with squamous features (H&E, 200×) and hyperchromatic nuclei (inset, 200×), also positive for BRAFV600E mutation. (D) Strong, diffuse EGFR expression by immunohistochemical evaluation was present in this recurrent tumor (100×, inset 400×).