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

This segment provides actionable guidance on how to monitor patients starting encorafenib/binimetinib. Dr. Rotow explains her routine practice: she performs early assessments, typically within 1–2 weeks of therapy initiation, to evaluate emerging GI side effects and adjust supportive care promptly.

A key component of her monitoring strategy is early imaging, usually at approximately 6weeks, to evaluate for treatment response. For patients with CNS involvement, she incorporates early MRI brain scans as well. Although practices vary, she stresses the value of early confirmation of therapeutic response, particularly in targeted therapy settings where rapid radiographic improvements are common.

Laboratory monitoring includes baseline labs, then monthly liver function tests during the first several months. Once stability is confirmed, frequency may decrease. This flexible approach aims to balance safety oversight with patient convenience and quality of life.

• Additionally, Dr. Rotow outlines the required baseline specialty evaluations:
• Echocardiograms (baseline, then every few months)
• Ophthalmologic exams (baseline and periodically)
• Dermatologic exams (a few times per year)

These requirements distinguish BRAF/MEK therapy from other lung cancer-targeted agents and reflect toxicity patterns more characteristic of melanoma management.

The segment also touches on institutional efforts to streamline ophthalmology referrals, acknowledging that timely specialty access often limits treatment initiation. Dr. Dagogo-Jack underscores the importance of infrastructure, such as rapid referral pathways, particularly as newer agents (e.g., TROP2 antibody-drug conjugates) also carry ocular risks.

The clinicians conclude by exploring how CNS disease affects monitoring strategy. They note that surveillance must be individualized, especially when treating patients with known brain metastases. Overall, the segment presents a comprehensive blueprint for safely initiating and maintaining BRAF/MEK therapy.