The first 60 days: BRAF V600E-mutant non-small-cell lung cancer

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• Medical oncologistNamed in the standard of care for: Advanced BRAF V600E, first line, Advanced BRAF V600E, after targeted therapy, Non-V600 BRAF mutations.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Advanced BRAF V600E, first lineNCCN Guidelines: Non-Small Cell Lung Cancer

   Dabrafenib plus trametinib or encorafenib plus binimetinib (PHAROS); pembrolizumab with platinum doublet is an alternative, particularly with high PD-L1.

   Dabrafenib + trametinibDabrafenibTrametinibEncorafenibBinimetinibPHAROSPembrolizumabBRAF V600E mutation
2. 2.Advanced BRAF V600E, after targeted therapyNCCN Guidelines: Non-Small Cell Lung Cancer

   Pembrolizumab plus platinum doublet, or the other BRAF plus MEK pair if the first was stopped for toxicity rather than progression.

   PembrolizumabCarboplatinPemetrexedEncorafenibBinimetinib
3. 3.Non-V600 BRAF mutationsNCCN Guidelines: Non-Small Cell Lung Cancer

   Treated as driver-negative disease with chemoimmunotherapy; MEK or pan-RAF inhibitor trials.

   PembrolizumabCarboplatinPemetrexedTrametinib

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• Phase II Study Investigating the Combination of Encorafenib and Binimetinib in BRAF V600E Mutated Chinese Patients With Metastatic Non-Small Cell LungPhase 2 · active · NCT05195632Multicenter, Open-label, Phase II Study With a Safety Lead-in Part Investigating the Efficacy, Safety and Pharmacokinetics of Encorafenib and Binimetinib Combination in BRAF V600E Mutated Chinese Patients With Metastatic Non-Small Cell Lung Cancer Who Are BRAF- and MEK Inhibitor Treatment-naïve

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• BRAF V600E-mutant non-small-cell lung cancer: the full pageBRAF V600E lung cancer carries the same mutation as many melanomas and is treated with the same pairs of pills that block BRAF and MEK together. Dabrafenib with trametinib and encorafenib with binimetinib each shrink about two thirds to three quarters of untreated tumours.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.