La activación de la vía MAPK es el sello distintivo del glioma de bajo grado (pLGG) y occ...
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| ID | BMA-MAP2K1-LGG |
|---|---|
| Tipo | Relevancia terapéutica |
| Situación | reviewed 2026-05-04 | pending_clinical_signoff | actionability review required |
| Enfermedades | DIS-GLIOMA-LOW-GRADE |
| Fuentes | SRC-EANO-LGG-2024 SRC-NCCN-CNS-2025 |
Hechos relativos a la posibilidad de adoptar medidas
| Biomarcador | BIO-MAP2K1 |
|---|---|
| Variante | MAP2K1 activando mutación — glioma de bajo grado (LGG); BRAF-fusion-negativo, IDH-wildtype o IDH - mutante; MAPK activación alternativa de la vía |
| Enfermedad | DIS-GLIOMA-LOW-GRADE |
| El nivel de ESCAT | IIA |
| Combinaciones recomendadas | trametinib 0.025 mg/kg PO QD (pediatric dosing; adult 2 mg/day) — MAP2K1-mutant LGG investigational (TRAM-01 regimen), tovorafenib 420 mg/m² PO QW — BRAF-altered or MAPK-pathway-altered pLGG (FIREFLY-1 eligible), clinical trial enrollment preferred for MAP2K1-mutant LGG (adult or pediatric) |
| Resumen de las pruebas | MAPK pathway activation is the hallmark of pediatric-type low-grade glioma (pLGG) and occurs in ~90% via BRAF-KIAA1549 fusion (~70%), BRAF V600E (~15%), or alternative MAPK alterations including MAP2K1 mutations (~5–10% of BRAF-fusion-negative pLGG). The FIREFLY-1 phase II trial (Kilburn et al., JCO 2024) demonstrated tovorafenib (type II RAF inhibitor) activity in pLGG with MAPK pathway alterations including MAP2K1 mutations: ORR 67% overall; MAP2K1 cohort showed responses. Trametinib (MEK1/2 inhibitor) has demonstrated activity in MAPK-pathway-altered pLGG in the TRAM-01 and FIREFLY-2 trials. In adult LGG, MAP2K1 mutations occur in ~5% (predominantly IDH-wildtype histiocytic NEC); data more limited. For adult IDH-mutant LGG, vorasidenib (IDH1/2 inhibitor) is now standard (INDIGO trial; FDA 2024) — see BMA-IDH-MUTATION-GLIOMA-LOW-GRADE. MAP2K1 mutations in adult LGG without IDH: MEK inhibitors investigational. NCCN CNS 2025: trametinib / tovorafenib Category 2A for MAPK-altered pLGG. |
Notas
ESCAT IIA: MAP2K1 is an actionable MAPK pathway alteration in LGG; MEK inhibitors (trametinib) and RAF inhibitors (tovorafenib) active. BRAF fusion testing (FISH/RNA-seq) should be performed first in pLGG — BRAF-KIAA1549 fusion is the dominant driver and is most robustly treated with RAF inhibitors. MAP2K1 mutation may be identified when BRAF fusion and BRAF V600E are absent. IDH1/2 mutation status is critical for adult LGG: IDH-mutant → vorasidenib; IDH-wildtype + MAP2K1 → MEK inhibitors investigational. Comprehensive molecular testing recommended: IDH1/2, BRAF (fusion + V600E), MAP2K1, CDKN2A/B, 1p/19q codeletion (molecular oligodendroglioma), TERT promoter.
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