BRAF-driven pancreatic cancer: prevalence, molecular features and therapeutic opportunities


 BRAF-altered pancreatic cancer is an important molecular subgroup that activates the mitogen-activated protein kinase pathway and promotes tumorigenesis. This manuscript reviews the prevalence and molecular features of BRAF-driven pancreatic cancer and also explores the published data about targeted approaches for this subgroup. A review of the existing literature was undertaken through the PubMed database using the search terms BRAF mutation, BRAF fusion, BRAF deletion, mitogen-activated protein kinase pathway and pancreatic cancer. Pathogenic BRAF variants are enriched in KRAS wild-type tumors and drive tumorigenesis in in-vitro and experimental animal models. The majority of clinical cases are comprised of V600E mutations, N486-P490 deletions and fusions. Anecdotal evidence is building that KRAS wild-type, BRAF-driven pancreatic cancers are sensitive either to BRAF inhibitors, MEK inhibitors or combination strategies. Precision-medicine has transformed the treatment landscape for several cancers. With increasing knowledge about molecular drivers in pancreatic cancer, it is critical to characterize each distinct subgroup and evaluate targeted approaches to improve clinical outcomes.