What initial systemic therapy would you offer a patient with metastatic colon cancer with BRAF V600E mutation, MSS, who is not an oxaliplatin candidate?

Would you include single-agent fluoropyrimidine, proceed with EC alone (like BEACON/the EC arm of BREAKWATER), or offer FOLFIRI despite the encorafenib-irinotecan drug-drug interaction?

1 Answer

Mednet MemberInvited Expert

Medical Oncology · City of Hope Orange County

Answered on

In patients with BRAF-V600E mutant colon cancer who are not candidates for oxaliplatin, replacing the chemo backbone with FOLFIRI is what I’ve done for a few patients without any clinical or insurance issues.

This is based on the BREAKWATER study, which, of note, had a FOLFIRI/EC arm - results reported at ESMO GI 2024 - safety lead-in arm.

Tabernaro et al., Annals of Oncology, 2024 presented at 2024 ESMO Congress; September 13-17, 2024; Barcelona, Spain.
Discussion also at: https://www.targetedonc.com/view/encorafenib-cetuximab-plus-folfiri-shows-promise-in-mcrc.
Slides at LARVOL.

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