Complete response of lymph node metastasis following adjuvant dabrafenib and trametinib treatment for BRAF V600-mutant anaplastic thyroid cancer – case report
Robert Bränström, Henrik Andersson, Martin Hysek, David Goldstein, Andreas Ekborn, Ivan ShaboIntroduction:
Anaplastic thyroid cancer (ATC) is a rare malignancy with a poor prognosis. A substantial subset harbors the BRAF V600E mutation, enabling targeted therapy with dabrafenib and trametinib.
Presentation of case:
We present the case of a 56-year-old woman with BRAF V600E–mutated ATC who developed acute airway obstruction and asphyxia-induced cardiac arrest. Due to critical tracheal stenosis, surgery was performed in combination with targeted therapy using dabrafenib plus trametinib. Total thyroidectomy successfully relieved tracheal compression and enabled continued treatment. Follow-up with a computed tomography examination demonstrated complete regression of nodal metastases, and subsequent lymph node dissection was performed, confirming the absence of residual disease. After about 1 year of follow-up, the patient remains disease-free postoperatively, illustrating the importance of molecular testing, multidisciplinary management, and a multimodal treatment strategy for ATC.
Discussion:
Approximately one-third of cases of ATC may have the BRAF V600E mutation and thus be sensitive to treatment with dabrafenib plus trametinib. This is a paradigm shift in the treatment of ATC, where surgery should be adapted to the mutational status of the tumor, even if the cancer is metastatic and locally advanced.
Conclusion:
In selected patients, combining surgery with BRAF/MEK inhibition may transform ATC from an invariably fatal disease into a potentially curable condition.