For a patient with metastatic colon cancer who tested positive for MSI (i.e. MLH1 hypermethylation etc) and BRAF mutation, what would be your preferred choice in the second line setting?

Would you choose to use IO or BRAF directed therapy based on BEACON? Or would you continue to use cytotoxic chemotherapy?

Answer from: Medical Oncologist at Community Practice

Approximately 15% of colorectal carcinomas demonstrate mismatch repair deficiency. The majority of these are MLH1/PMS2 deficient due to MLH1 promoter hypermethylation (MLH1ph). BRAF V600E mutations occur in approximately 50% of colorectal carcinomas with MLH1ph. The role of immunotherapy in patients...

Comments

Medical Oncologist at Texas Oncology-San Antonio Babcock
Do you consider MLH1/PMS2 hypermethylation MMR/def...

Medical Oncologist at Texas Oncology-San Antonio Babcock
Especially when they turn out to be BRAF Mutant?

Medical Oncologist at Indiana University Melvin and Bren Simon Cancer Center
Yes, those patients are considered MMR-D.

Medical Oncologist

I agree with @Anita Turk and would utilize IO in the second line for BRAF-mutant MSI-H colorectal cancer, and cetuximab + encorafenib in the third line setting. I also favor first line IO in combination with chemotherapy on study (NRG 004). Pending additional data and approval in the first line sett...

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For a patient with metastatic colon cancer who tested positive for MSI (i.e. MLH1 hypermethylation etc) and BRAF mutation, what would be your preferred choice in the second line setting?

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