BRAF Testing

[Catherine Poole]

If your Braf testing was some time ago, you may want to have it retested as the new tests are more sensitive. According to Keith Flaherty: ” it is true that better assays are coming along and finding BRAF mutations that were missed by first generation approaches.” Also, as suggested in other posts, be sure to ask for the NRAS testing which is even newer and opening up possible therapies for BRAF negative folks. If you are BRAF negative you may be NRAS positive. But you cannot be both NRAS positive and BRAF positive, they are mutually exclusive. An NRAS mutation may occur in a progression of a tumor after BRAF therapy in a BRAF positive person however.

It is complicated, but it seems like we are learning more daily that will help patients!

[keesvp]

Catherine,

Do you have more information about therapies for NRAS positive?

Thanks

Kees

[keesvp]

I found this:

http://www.mdanderson.org/newsroom/news-releases/2012/drug-combination-against-nras-mutant-melanoma-discovered.html

That looks very promising.

[Catherine Poole]

The MEK therapy is what researchers are looking at for the NRAS positive folks. Novartis will be having large trials starting next April focused on their MEK product and NRAS positive folks. Also, GSK will be having a possible approval of their MEK agent. I’m not sure how it will all work out.

[msue5]

I am confused. There are trials using Braf/Mek drugs in combination. Are they finding that those aren’t working. Now that I am Braf pos does that automatically make the Nras neg? I forgot to ask my Onc about the Nras test. My local Onc was the one ordering these tests on my metastatic thoracic nodes. He doesn’t specialize in Melanoma but I am grateful he had the foresight to order the tests which only increases my confidence in him.

I have enough Melanoma experts at Washington Hospital Center and now the Lombardi Cancer Center at Georgetown. Am I mistaken about the Braf/Mek trials?

Mary Sue

[Catherine Poole]

Yes, if you are BRAF positive you are NRAS negative. The dual therapy of Braf and MEk would only be for BRAF positive folks and this combo is very promising. The single agent MEK is a possibility for NRAS positive people. The GSK BRAF and MEK drugs are going for approval in the near future (maybe early 2013) and they will be approved individually.

[msue5]

So what would a Braf/Mek combination do for me if I am Nras neg?

Mary Sue

[Catherine Poole]

You can only be BRAF positive to do the braf/mek combo and you would likely be NRAS negative.. If you are BRAF positive you are NOT NRAS positive. There is a small portion of patients that are neither BRAF positive or NRAS positive. Is that clearer?

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