Tafinlar and/ or Mekinist for papillary BRAF+ thryoid cancer – pro
Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, representing ~80% of all cases. In PTC, mutations of genes encoding effectors of the MITOGEN-ACTIVATED PROTEIN KINASE (MAPK) PATHWAY are central to malignant transformation. In 70% of all cases rearrangements of the genes encoding the receptor tyrosine kinases RET or NTRK leading to expression of constitutively active fusion proteins, as well as activating-point mutations of RAS or BRAF, are found.A number of biomarkers involved in the pathogenesis of differentiated thyroid cancer have undergone intensive study, not only for their role in tumorigenesis, but also for their potential utility as diagnostic and prognostic indicators and therapeutic targets. At least two clinical trials of multikinase inhibitors with strong activity against RAF (BAY 43-9006, Bayer Health Care, West Haven, CT and AMG706, Amgen, Thousand Oaks, CA) are ongoing in differentiated thyroid cancer. However, until some published literature can be produced to support this therapy for BRAF+ thyroid cancer, it cannot be considered medically necessary.
Lionel Groussin; James A. FaginSignificance of BRAF Mutations in Papillary Thyroid Carcinoma: Prognostic and Therapeutic Implications. Nat Clin Pract Endocrinol Metab. 2006;2(4):180-181.
Adrienne L. Melck, Linwah Yip and Sally E. Carty, The Utility of BRAF Testing in the Management of Papillary Thyroid Cancer. The Oncologist December 2010 vol. 15 no. 12 1285-129