Identification of an unusual combination of actionable mutations through
genomic profiling in a child with an aggressive sarcoma.
Abstract
Rhabdomyosarcoma (RMS) is a highly aggressive pediatric cancer known for
its therapeutic challenges, particularly when it becomes metastatic or
recurrent. Traditional treatment approaches have shown limited success,
prompting a growing interest in targeted therapies. The emergence of
next-generation sequencing (NGS) has revolutionized our ability to
identify actionable mutations in RMS, offering the promise of
personalized treatments and improved patient outcomes. A recent case
involving a 3-year-old child diagnosed with embryonal RMS highlighted
the potential of next-generation sequencing (NGS) in clinical practice.
Despite receiving initial chemotherapy, the patient’s tumor showed
progressive growth. What made this case particularly intriguing was the
discovery of co-occurring somatic mutations in the RAS/MAPK pathway,
specifically in BRAF and HRAS genes, which are traditionally believed to
be mutually exclusive. Notably, the BRAF mutation identified in this
case, N581I, is a non-classical (Class III) hotspot mutation that had
not been previously reported in embryonal RMS. This novel finding
underscores the critical importance of comprehensive genetic profiling
in pediatric cancers and suggests the existence of potential therapeutic
avenues that target BRAF alterations. In conclusion, the integration of
NGS technologies in clinical practice holds great promise for
identifying previously unrecognized mutations in pediatric cancers like
RMS. These findings have the potential to open up new treatment options
and improve outcomes for young patients facing this aggressive disease.