A 31-year-old woman with a history of BRAF V600E-mutant papillary craniopharyngioma who has been maintained on dual BRAF/MEK inhibitor therapy as salvage treatment for the past five years, primarily for durable symptom control. Disease has remained radiographically stable throughout this period.
Attempts at treatment interruption have consistently resulted in prompt recurrence of debilitating headaches (the patient remains highly physically active). In addition, she has developed progressive renal impairment beyond her previously elevated baseline creatinine, with imaging now demonstrating mild renal atrophy.
We would welcome colleagues' experience regarding:
1. Optimal criteria and timing for discontinuation of long-term BRAF/MEK inhibition in the setting of radiographic stability but symptomatic dependence;
2. Any available long-term outcome data informing duration of therapy in BRAF-mutant papillary craniopharyngioma; and
3. Recommended strategies for managing progressive renal toxicity and atrophy in this context.
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Sonikpreet Aulakh
Associate Professor
West Virginia University
Morgantown WV
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