Abstract：
BACKGROUND: Thyroid cancer is the most common malignancy of the endocrine system, accounting for ~ 5% of all thyroid nodules and 1% of all systemic malignancies. BRAF mutations, primarily p.V600E hot spot mutations, are found in 60 - 70% of papillary thyroid cancer cases (PTC) and in 33 - 40% of fatal anaplastic thyroid cancers (ATC), also called poorly differentiated thyroid cancer. Dabrafenib was approved by the United States Food and Drug Administration (FDA) in 2018 to be applied in combination with trametinib for unresectable advanced or metastatic anaplastic thyroid cancer harboring the BRAFV600E mutation. Unfortunately, there are few reports on the pathophysiology, molecular mechanism, and risk factors of interstitial lung disease induced by combined BRAF- and MEK-targeted therapy.
METHODS: We treated a 73-year-old man with metastatic BRAFV600E-mutated poorly differentiated thyroid cancer using the combination of dabrafenib and trametinib. Although a significant morphologic tumor response was observed in our patient using combined BRAF- and MEK-targeted therapy, he presented with non-febrile respiratory failure, and his chest computed tomography (CT) revealed bilateral reticulation and pleural effusion. Withdrawal from dabrafenib-trametinib and administration of methylprednisolone rapidly improved his respiratory status and imaging features.
CONCLUSIONS: The mechanisms of lung disease after the combined treatment with dabrafenib and trametinib are unclear. We hypothesized that dual-targeted therapy with a BRAF inhibitor, dabrafenib, and a MEK inhibitor, trametinib, might prevent the regeneration and proliferation of fibrotic epithelium in lung disease by blocking downstream proliferative signals.
METHODS: We treated a 73-year-old man with metastatic BRAFV600E-mutated poorly differentiated thyroid cancer using the combination of dabrafenib and trametinib. Although a significant morphologic tumor response was observed in our patient using combined BRAF- and MEK-targeted therapy, he presented with non-febrile respiratory failure, and his chest computed tomography (CT) revealed bilateral reticulation and pleural effusion. Withdrawal from dabrafenib-trametinib and administration of methylprednisolone rapidly improved his respiratory status and imaging features.
CONCLUSIONS: The mechanisms of lung disease after the combined treatment with dabrafenib and trametinib are unclear. We hypothesized that dual-targeted therapy with a BRAF inhibitor, dabrafenib, and a MEK inhibitor, trametinib, might prevent the regeneration and proliferation of fibrotic epithelium in lung disease by blocking downstream proliferative signals.
摘要：
背景：甲状腺癌是内分泌系统最常见的恶性肿瘤，约占所有甲状腺结节的5%和所有系统性恶性肿瘤的1%。BRAF突变,主要是p.V600E热点突变，在60-70％的乳头状甲状腺癌病例（PTC）和33-40％的致命间变性甲状腺癌（ATC）中发现，也称为低分化甲状腺癌。Dabrafenib于2018年被美国食品和药物管理局（FDA）批准与曲美替尼联合应用于具有BRAFV600E突变的不可切除的晚期或转移性间变性甲状腺癌。不幸的是,关于病理生理学的报道很少，分子机制，BRAF和MEK联合靶向治疗诱发间质性肺病的危险因素。
方法：我们使用达拉非尼和曲美替尼联合治疗一名73岁的BRAFV600E突变低分化甲状腺癌患者。尽管我们的患者使用BRAF和MEK靶向联合治疗观察到了显著的形态学肿瘤反应，他出现了非发热性呼吸衰竭,他的胸部计算机断层扫描（CT）显示双侧网状和胸腔积液。dabrafenib-trametinib戒断和甲基强的松龙的给药迅速改善了他的呼吸状态和影像学特征。
结论：达拉非尼和曲美替尼联合治疗后肺部疾病的机制尚不清楚。我们假设使用BRAF抑制剂的双靶向治疗，Dabrafenib,和MEK抑制剂，曲美替尼,可能通过阻断下游增殖信号来阻止肺部疾病中纤维化上皮的再生和增殖。
方法：我们使用达拉非尼和曲美替尼联合治疗一名73岁的BRAFV600E突变低分化甲状腺癌患者。尽管我们的患者使用BRAF和MEK靶向联合治疗观察到了显著的形态学肿瘤反应，他出现了非发热性呼吸衰竭,他的胸部计算机断层扫描（CT）显示双侧网状和胸腔积液。dabrafenib-trametinib戒断和甲基强的松龙的给药迅速改善了他的呼吸状态和影像学特征。
结论：达拉非尼和曲美替尼联合治疗后肺部疾病的机制尚不清楚。我们假设使用BRAF抑制剂的双靶向治疗，Dabrafenib,和MEK抑制剂，曲美替尼,可能通过阻断下游增殖信号来阻止肺部疾病中纤维化上皮的再生和增殖。
