Treatment of Metastatic Colon Cancer with BRAF V600E Mutation in pMMR/MSS, KRAS/NRAS Wild-Type Disease
This protocol defines the treatment approach for a molecularly specific subgroup: proficient mismatch repair (pMMR) and microsatellite stable (MSS) metastatic colon adenocarcinoma confirmed KRAS wild-type, NRAS wild-type, and carrying a BRAF V600E mutation. This combination of molecular features narrows both prognosis and the applicable therapeutic options considerably.
Clinical Scenario
Proficient mismatch repair (pMMR) / microsatellite stable (MSS) metastatic colon adenocarcinoma, with confirmed KRAS wild-type and NRAS wild-type status, and BRAF V600E mutation present. This molecular profile excludes immunotherapy-based strategies and directs treatment toward chemotherapy combinations and targeted agents specific to BRAF-mutated, RAS wild-type disease.
Treatment Approach (Partial Overview)
Subsequent therapy in this setting involves chemotherapy backbone combinations paired with targeted agents, with options guided by which prior chemotherapy was received. A less intensive targeted regimen is also available across lines. Full sequencing, regimen details, and agent selection are contained in the structured protocol.
References
- pMMR/MSS
- KRAS WT/NRAS WT/BRAF V600E Mutation
- FOLFIRI ± (Bevacizumab [preferred] or Ziv-aflibercept or Ramucirumab)
- Irinotecan ± (Bevacizumab [preferred] or Ziv-aflibercept or Ramucirumab)
- CAPEOX ± Bevacizumab
- FOLFOX ± Bevacizumab
- Encorafenib + (Cetuximab or Panitumumab)