Nicholas Hornstein, Assistant Professor at Northwell Health, shared a post on LinkedIn:
“Just made a decision I never expected to make in BRAF V600E mCRC:
Stopping treatment.
Peritoneal metastases. BREAKWATER regimen. ctDNA negative >1 year. Direct peritoneal visualization — clear. Two years on treatment.
After initial response, I dropped oxaliplatin and maintained on 5-FU + encorafenib + cetuximab for ~18 months with excellent tolerability and sustained response.
Two questions for GIOnc:
- Should maintenance de-escalation (drop oxali, continue 5-FU/enco/cetux) be standard after response in BRAF+ mCRC?
- For exceptional responders with sustained ctDNA negativity and no detectable disease — is it safe to study treatment holidays?
n=1 ≠ evidence. But exceptional responders reveal biology. And biology should drive the next trial designs.”
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