Practical Monitoring Strategies and Early Treatment Assessments in Patients with BRAF V600E-Mutant Metastatic NSCLC

This segment centers on key safety takeaways from the PHAROS study and how those findings influence real-world clinical practice when initiating BRAF-MEK-directed therapy. The speakers note that, compared with single-agent targeted therapies such as EGFR or ALK inhibitors, BRAF-MEK combinations have a more complex toxicity profile, including gastrointestinal side effects, fatigue, and the need for closer monitoring. However, these toxicities are generally manageable with proactive counseling and supportive care, and permanent discontinuation rates remain relatively low.

A major distinguishing safety feature of encorafenib plus binimetinib in PHAROS is the markedly lower rate of pyrexia compared with older regimens such as dabrafenib plus trametinib. Fever has historically been a challenging toxicity for both patients and clinicians, often complicating infection workups and affecting quality of life. The substantially reduced pyrexia rates in PHAROS are viewed as a meaningful advantage and, alongside long-term safety data, support the preferential use of this regimen in current practice.

The discussion then turns to practical management. Early response assessment is emphasized, often with imaging around six weeks after treatment initiation. Close follow-up during the first weeks of therapy helps address gastrointestinal side effects promptly. Baseline and ongoing monitoring include laboratory tests, cardiac evaluations, dermatologic exams, and ophthalmologic assessments, reflecting the importance of structured, multidisciplinary monitoring for patients expected to remain on therapy long term.