Multidisciplinary Therapy Managed Recurrent Glioblastoma in a BRAF-V600E Mutant Pregnant Female: A Case Report and Review of the Literature

Abstract

Background: Glioblastoma (GBM) is the most malignant intracranial tumor in adults. However, the overall management of GBM in pregnancy is rarely reported. How to balance the therapeutic benefits to the mother and risks to the fetus remains hugely challenging for clinicians. The application of specific targeting therapy combined with conventional treatment sheds light on a longer lifetime for the patients suffering from GBM. Case Presentation: We present a pregnant female at 20 weeks gestation diagnosed with GBM. Surgical resection was initially performed without adjuvant therapy, and the tumor recurred de novo 2 months later. A secondary craniotomy and cesarean section were performed simultaneously at 32 weeks gestation, both the patient and infant were survived. She was subsequently treated with traditional chemo-radiotherapy. No other identified genetic alterations indicating an optimistic prognosis were detected except for BRAF V600E mutation. Thus, the BRAF inhibitor was placed on her with achieving a good clinical outcome of more than 2-year survival without recurrence. Conclusion: Personalized multidisciplinary therapy should be considered when GBMs occur in pregnancy. Response to the therapy in this presenting case suggests that BRAF V600E mutation is a favorable biomarker for GBM. The mortality of GBM might be reduced through genetic testing and targeted treatment. However, more studies must be conducted to confirm our observation.

Clinical and radiological findings of glioblastomas harboring a BRAF V600E mutation

“…However, a recent study suggested that a combination of well-circumscribed borders, large cysts, and cortical involvement was more definitive in BRAF-mutant cases rather than the extent of perifocal edemas [31]. Although one patient in our study had multifocal lesions and cases with diagnosis of gliomatosis cerebri harboring a BRAF mutation have been reported [6,29,34], the majority of BRAF-GBMs show a single lesion on MRI [9,20,22,25,29,31].…”

“…The efficacy of targeting therapy for BRAF V600E using dabrafenib and trametinib have been reported in clinical experiences [16][17][18][19][20][21][22][23][24][25]. To screen the potential targeting therapy candidates for BRAF V600E, clinical sequencing of cancer-associated genes would be the most appropriate approach in clinical practice [26].…”

BRAF Signaling Inhibition in Glioblastoma: Which Clinical Perspectives?

“…Sporadic cases of impressive treatment responses with vemurafenib have been reported, including cases of complete radiological regression of the disease, with prolonged symptomatic control (26)(27)(28).…”