63 yo man w/ stage IV lung adeno EGFR+ who was on osimertinib 80 mg w/ progressive brain + hilar LN mets. We just increased him to the 160 mg CNS dose and sent liquid molecular testing. Looks like he is BRAF V600E + now and also has a BRCA2 mutation. Would you see how he responds to the increased osimertinib dosing or switch him to dabrafenib/trametinib? Would you incorporate olaparib into this or wait for that until he needs chemo?
Since you have already increased him to 160, I might do a short interval scan to see if it is working before switching. If that is not working, since the EGFR mutation is likely still active in the tumor, what has been done successfully is to continue the osimertinib at 80 mg/d and ADD the BRAF inhibition. The problem here is getting insurance to pay for it (or get it for free from the company), but it has been done successfully. Also, encorafenib with binimetinib has recently been approved for lung cancer and is highly effective and less toxic.
