Response to Dabrafenib Plus Trametinib in a Patient With an Uncommon Activating BRAF Mutation: A First in Non-Small Cell Lung Cancer.

Mutations in BRAF are present in 4% of non-small cell lung cancer (NSCLC), of which half are well-characterized activating variants affecting codon 600 (classified as class I). These mutations, most commonly BRAF V600E, have been associated with response to BRAF/MEK-directed small molecule kinase inhibitors. NSCLC with kinase-activating BRAF mutations occurring at other codons (class II variants) represent a substantial portion of BRAF-mutated NSCLC, but use of targeted therapy in these tumors is still under investigation. Class II mutations have been described in other tumor types and have been associated with response to BRAF/MEK-targeted agents, although optimal treatment strategies for these patients are lacking. This report presents a case of a woman with metastatic NSCLC harboring a class II BRAF p.N486_P490del variant who had a sustained clinical response to combination therapy with dabrafenib and trametinib. This first report of the use of BRAF/MEK-targeted therapy for this variant in NSCLC supports consideration of such treatment for tumors with class II BRAF variants.

Simple limbal epithelial transplantation.

PURPOSE OF REVIEW: Simple limbal epithelial transplant (SLET) is a technique for addressing limbal stem cell deficiency. Limbal tissue from a donor eye, typically the patient's fellow healthy eye, is transplanted onto an amniotic membrane attached to the surface of the diseased eye. SLET was developed to address limitations of other techniques, specifically the technical difficulty of ex-vivo expansion of cells required in some techniques and the larger amount of valuable limbal tissue harvested in techniques not relying on ex-vivo expansion. We described how the provision of this procedure adds to the armamentarium of techniques available to treat some of the many thousands of uniocular corneal blind around the world. RECENT FINDINGS: A total of 125 patients from a recent series from our centre and 68 from a multicentre study provide evidence for efficacy mainly in cases of unilateral corneal burn. Results were comparable to other stem cell techniques described in other papers. Numerous small case reports describe the use of SLET in other contexts including ocular surface squamous neoplasia and pterygium excision. SUMMARY: SLET offers a cheaper and perhaps safer alternative to other techniques. Further evaluation of clinical success against its most similar analogues of conjunctival limbal autograft and cultivated limbal autograft is required.

Calcification of hydrophilic acrylic intraocular lenses in combined phacovitrectomy surgery.

UNLABELLED: Two cases of postoperative intraocular lens (IOL) calcification in patients implanted with the Akreos Adapt IOL at the time of combined phacovitrectomy are described, along with clinical review of all patients implanted with this IOL type at our institution between November 2006 and September 2008. The IOLs explanted from the 2 cases were examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The SEM of the explanted IOLs showed crystalline anterior surface and subsurface deposits; by EDX, the deposits showed high concentrations of calcium and phosphorous, consistent with calcium apatite. Twenty patients (20 eyes) attended for cohort review, and none showed IOL opacification. The reason calcification occurred in the 2 cases remains unknown, but clinicians should be aware of this potential complication. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.