How do you treat metastatic BRAF-mutated small bowel adenocarcinoma in the first-line setting?  

This is the optimal approach based on the BREAKWATER data and known activity of FOLFOX. There will never be a specific study for this entity. Sometimes we must extrapolate.

I tend to use a FOLFOX-based regimen first and use BRAF-targeted agents in the second line, e.g., dabrafenib and trametinib. The one exception would be if they recently (less than 1 year) got adjuvant fluoropyrimidine-based chemotherapy already. One could also extrapolate from BREAKWATER and use all...

Agree with extrapolating from BREAKWATER and treating with FOLFOX/EC in the frontline if the tumor harbors a BRAF V600E mutation.A lot of SBAs, however, have a class II or III BRAF mutation. Class II mutations may respond to MEK inhibitors such as trametinib, and class III (kinase-dead) mutations ma...