title: Targeting the BRAF V600E mutation in multiple myeloma.
abstract: In multiple myeloma, there has been little progress in the specific therapeutic targeting of oncogenic mutations. Whole-genome sequencing data have recently revealed that a subset of patients carry an activating mutation (V600E) in the BRAF kinase. To uncover the clinical relevance of this mutation in multiple myeloma, we correlated the mutation status in primary tumor samples from 379 patients with myeloma with disease outcome. We found a significantly higher incidence of extramedullary disease and a shorter overall survival in mutation carriers when compared with controls. Most importantly, we report on a patient with confirmed BRAF V600E mutation and relapsed myeloma with extensive extramedullary disease, refractory to all approved therapeutic options, who has rapidly and durably responded to low doses of the mutation-specific BRAF inhibitor vermurafenib. Collectively, we provide evidence for the development of the BRAF V600E mutation in the context of clonal evolution and describe the prognostic and therapeutic relevance of this targetable mutation.
authors.affiliation: Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Andrulis
authors.forename: Nicola
authors.initials: N
authors.lastname: Lehners
authors.forename: David
authors.initials: D
authors.lastname: Capper
authors.forename: Roland
authors.initials: R
authors.lastname: Penzel
authors.forename: Christoph
authors.initials: C
authors.lastname: Heining
authors.forename: Jennifer
authors.initials: J
authors.lastname: Huellein
authors.forename: Thorsten
authors.initials: T
authors.lastname: Zenz
authors.forename: Andreas
authors.initials: A
authors.lastname: von Deimling
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: Kai
authors.initials: K
authors.lastname: Neben
authors.forename: Marc S
authors.initials: MS
authors.lastname: Raab
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001483:Base Sequence; D060965:Clonal Evolution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D058990:Molecular Targeted Therapy; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D009154:Mutation; D010950:Plasma Cells / Q000378:metabolism; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000032:analysis* / Q000235:genetics*; D017421:Sequence Analysis; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D000077484:Vemurafenib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib; D048493:Proto-Oncogene Proteins B-raf