NT-03 * DRAMATIC RESPONSE INDUCED BY VEMURAFENIB IN A BRAF V600E-MUTATED BEVACIZUMAB REFRACTORY GLIOBLASTOMA

Abstract

A significant number of patients with high-grade gliomas do not respond to standard therapy. For relapsed bevacizumab refractory Glioblastoma (GBM), no effective treatment options exist. Recently, BRAF V600 mutations have been recognized in higher frequency in younger patients with epithelioid GBM (E-GBM) and other primary brain tumors. We describe the case of a 40 year old Caucasian woman with left temporal epithelioid GBM who originally presented at age 39 with seizures. She underwent gross total resection followed by external beam radiation with concurrent temozolomide and two cycles of adjuvant temozolomide. Her tumor recurred 5 months from diagnosis and she underwent radiosurgery followed by bevacizumab. Four months later she developed marked interval radiographic progression associated with a severe non-fluent aphasia. Because molecular analysis of the primary tumor revealed a BRAF V600E mutation, she was placed on the BRAF inhibitor vemurafenib. After only two months of vemurafenib therapy we observed a robust partial radiographic response along with complete recovery of language and return to near normal neurologic function. While not a common mutation, there may be a role for BRAF inhibitors in a subset of GBM with BRAF V600 mutations. BRAF V600E mutational analyses should be performed on GBMs, and prospective trials are warranted.