BRAF and Lung Cancer

Support for this educational program provided by Amgen, AstraZeneca, Blueprint Medicines, Bristol Myers Squibb, Genentech, Lilly Oncology, Merck, Novartis and Pfizer.

What is the BRAF-positive lung cancer?

BRAF is one type of lung cancer biomarker. BRAF is the name of both a gene and a protein. The BRAF protein helps control cell growth. When there is a mutation in the BRAF gene, it creates an abnormal protein that sends signals that lead to uncontrolled cell growth and cancer. The BRAF protein works with another protein called MEK to regulate the growth of cells.

There are different mutations within BRAF, but the one with FDA-approved treatments in lung cancer is BRAF V600E. This mutation is a specific variation in the BRAF protein.

How do you know if you have a BRAF-positive lung cancer?

BRAF mutations can be found in several ways. A pathologist can use a test to look specifically for BRAF mutations in the tumor. However, most physicians prefer a comprehensive testing approach called next-generation sequencing (NGS). This type of testing places tissue from a patient’s tumor (gathered from a single biopsy) in a machine that looks for many possible biomarkers at one time. There may be some situations where a patient can’t undergo the biopsy needed to perform NGS, and so a liquid biopsy is recommended. A liquid biopsy can look for certain biomarkers in a patient’s blood. Talk to your doctor to make sure one of these tests was performed.

Learn more about the different types of biomarker tests.

Who is most likely to have BRAF-positive lung cancer?

BRAF mutations have been reported in about 4% of non-small cell lung cancers (NSCLC). They are most common in adenocarcinoma non-small cell lung cancer. BRAF V600E mutations specifically occur in about 1-2% of NSCLC patients.

What is the course of treatment like for someone with a BRAF-positive lung cancer?

For patients with advanced-stage NSCLC with BRAF V600E mutations, two combinations of BRAF and MEK inhibitors are effective as a first-line treatment. These types of drugs work to stop or inhibit cancer growth by targeting the errors in the BRAF and MEK genes.

• Dabrafenib (Taflinar) plus trametinib (Mekinist) or
• Encorafenib (Braftovi) plus binimetinib (Mektovi)

Patients whose cancer grows after first-line treatment may receive immunotherapy with or without chemotherapy.

The standard of care for patients with a different BRAF mutation (non-V600E) is immunotherapy with or without chemotherapy. All BRAF patients should ask their doctors about clinical trials.

Work with your doctor to discuss your goals and options each time you have to make a treatment decision. The three big questions to ask are:

1. What is the goal of this treatment?
2. What are the potential side effects?
3. What other options do I have?

Research is happening at a rapid pace and your doctor should be up to date on the recommendations for your specific type of lung cancer. If you don’t feel comfortable with the answers you are receiving, do not hesitate to seek out a second opinion.