case_images: PMC10140402_01
case_images: Case summary. (A) Summary of disease course and treatment procedure. pCR, pathological complete response; SD, stable disease; PD, progressive disease; mo, months. (B) H&E, TG, BRAF V600E and PD-L1 staining of the primary tumor. Scale bars: 50 microm. H&E: hematoxylin and eosin. (C) Representative images showing disease recurrence/progression on sintilimab plus anlotonib, and the patient's response to the triplet regime of sintilimab, dabrafenib, and trametinib.
case_images: fimmu-14-1178682-g001.jpg
case_images: PMC10140402_01_fimmu-14-1178682-g001.jpg
case_images: f1
case_images: TG (weak, 1+), BRAF V600E (weak, 1+), and negative for AE1/AE3, CD56, Calcitonin, LCA, and HMB45 (Figure 1B). Two months later, a progressively enlarging mass appeared in her right neck, indicating disease progression (Figure 1A). PET-CT imaging revealed multiple hypoechoic nodules in cervical region VI, with the largest located in the center of 4.0x2.8 cm (Figures 1C, 2A). The patient was then referred to our hospital. Panscan , Genetron Health) revealed a tumor mutational burden of 1.41 mutations per megabase (mut/Mb), microsatellite status stable (MSS), TERT promoter mutation, an NRAS Q61R mutation with a variant allele fraction (VAF) of 10.6%, and a BRAF D594N mutation with a VAF of 12.6% (Table 1). PD-L1 IHC assay (PD-L1 IHC 22C3 pharmDx assay, Agilent Technologies, Carpinteria, CA, USA) showed a TPS of 60% and a CPS of 80 (Figure 1B). And this doublet regime was left off after one cycle (Figures 1A, C). After nine days, regression of all metastases in the bilateral neck was noted, and breathing/swallowing returned to normal (Figures 1A, C). After one cycle, the neck mass continued to shrink, and the ulcerated area was healed (Figures 1C, 2B). After two cycles (six weeks) of treatment, radical surgery was evaluated as feasible (Figures 1C, 2C). Given the high risk of ATC patients with concomitant BRAF/RAS and TERT mutations, she continued on the triplet regime from Sep 20th and remained in remission with an excellent quality of life until the last follow-up in March 2023 (Figure 1A).
case_images: Computed tomography images showing the patient' recurrence (A), as well as response to the triplet regime of sintilimab, dabrafenib, and trametinib after 20 (B), 60 (C) days of treatment.
case_images: fimmu-14-1178682-g002.jpg
case_images: PMC10140402_01_fimmu-14-1178682-g002.jpg
case_images: f2
case_images: TG (weak, 1+), BRAF V600E (weak, 1+), and negative for AE1/AE3, CD56, Calcitonin, LCA, and HMB45 (Figure 1B). Two months later, a progressively enlarging mass appeared in her right neck, indicating disease progression (Figure 1A). PET-CT imaging revealed multiple hypoechoic nodules in cervical region VI, with the largest located in the center of 4.0x2.8 cm (Figures 1C, 2A). The patient was then referred to our hospital. After one cycle, the neck mass continued to shrink, and the ulcerated area was healed (Figures 1C, 2B). After two cycles (six weeks) of treatment, radical surgery was evaluated as feasible (Figures 1C, 2C).