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SDH-deficient GIST — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapySDH-deficient GISTSCE Medical Oncology

A patient with unresectable anaplastic thyroid carcinoma has a secured airway but rapidly progressive neck and lung disease. Molecular testing shows BRAF V600E, with no RET or NTRK fusion. Which tumour-directed systemic strategy should be prioritised while local-control options remain under MDT review?

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Correct answer: D — Start dabrafenib plus trametinib as BRAF-MEK inhibition

BRAF V600E is a treatment-defining alteration in anaplastic thyroid carcinoma, and the ROAR cohort demonstrated substantial activity for dabrafenib plus trametinib. Lenvatinib has activity in differentiated thyroid cancer but is not the genotype-matched priority here. Pembrolizumab monotherapy is not selected by BRAF V600E. Cytotoxic chemotherapy may be considered in other circumstances but forfeits the strongest molecular match. Selpercatinib requires a RET alteration, which is absent.

Reference: ROAR phase II study of dabrafenib plus trametinib in BRAF-V600E anaplastic thyroid cancer (Published April 2022): https://pubmed.ncbi.nlm.nih.gov/35026411/; NICE NG230 thyroid cancer: recommendations (Published December 2022; current surveillance): https://www.nice.org.uk/guidance/ng230/chapter/Recommendations