For a patient with metastatic colon cancer which is MSI-H/dMMR and BRAF V600E+, what would be your preferred first line treatment?

In line with current NCCN guidelines, I would treat all MSI-H patients, regardless of their BRAF status, with immune checkpoint therapy in first-line unless there were clear contraindications. BREAKWATER excluded MSI-H patients, so this data should not be extrapolated to MSI-H/BRAF V600E mutated pat...

MSI-H/dMMR metastatic colorectal cancer (mCRC) is molecularly heterogeneous. Patients with proven germline MMR gene mutations are classified as Lynch-associated CRC, while those with loss of MLH1/PMS2 expression associated with MLH1 promoter hypermethylation or BRAFV600E mutation and with biallelic ...

I prefer to start with immunotherapy as the responses are more "deep" (larger) and treatment is better tolerated, but I also choose to restage frequently as I would have a low threshold to change to BRAF-targeted treatment if needed. Please note that the BREAKWATER study excluded patients with MSI-h...