Phase 2
N=166
BRAF/MEK/EGFR Inhibitor Combination Study in Colorectal Cancer (CRC)
Cancer
Bottom Line
View on ClinicalTrials.gov: NCT01750918 ↗Enrolled (actual)
166
Serious AEs
50.6%
Results posted
Oct 2021
Primary outcome: Primary: Number of Participants With Adverse Events — 3; 4; 36; 50 Participants
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- Dabrafenib (Drug); Trametinib (Drug); Panitumumab (Drug); 5-fluorouracil (Device)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- Novartis Pharmaceuticals
- Primary completion
- Jun 2020
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Number of Participants With Adverse Events |
3; 4; 36; 50; 13; 20 | — |
| PRIMARY Overall Response Rate (ORR) |
67; 0; 28; 20; 0; 0 | — |
| PRIMARY Part 3: Progression Free Survival (PFS) |
— | — |
| SECONDARY Duration of Response (DoR) |
2.9; 8.9; 6.9; 6.9 | — |
| SECONDARY Progression Free Survival (PFS) |
8.3; 4.0; 7.4; 4.2; 2.9; 1.6 | — |
| SECONDARY Overall Survival (OS) |
20.7; 14.7; 18.8; 8.3; 8.2; 5.8 | — |
| SECONDARY Cmax of Dabrafenib and Derived Metabolites in the Triple Combination (D+T+P) |
2440; 2400; 2180; 1550; 2410; 1800 | — |
| SECONDARY Cmax of Trametinib in the Triple Combination (D+T+P) |
5.31; 5.08; 10.3; 4.65; 24; 20 | — |
| SECONDARY Tmax of Dabrafenib and Derived Metabolites in the Triple Combination (D+T+P) |
2; 1.5; 2; 2; 2.05; 2 | — |
| SECONDARY Tmax of Trametinib in the Triple Combination (D+T+P) |
1; 1.5; 2; 2; 1; 2 | — |
| SECONDARY AUC[0-8] of Dabrafenib and Derived Metabolites in the Triple Combination (D+T+P) |
8750; 8250; 6880; 5200; 7300; 7220 | — |
| SECONDARY AUC[0-8] of Trametinib in the Triple Combination (D+T+P) |
21.3; 22.3; 32.9; 16.4; 141; 134 | — |
| SECONDARY Ctau of Dabrafenib and Derived Metabolites in the Triple Combination (D+T+P) |
36.7; 59.7; 65.8; 63.3; 76.1; 343 | — |
| SECONDARY Ctau of Trametinib in the Triple Combination (D+T+P) |
8.35; 11.8; 10.8; 9.98; 7.37; 10.4 | — |
| SECONDARY Ctau of Panitumumab in the Triple Combination (D+T+P) |
11100; 25600; 9860; 21300; 18100; 37000 | — |
| SECONDARY Apparent Base Clearance (CL0/F) and Apparent Maximum Inducible Clearance at Steady State (CLIND,SS/F) of Dabrafenib in the Triple Combination (D+T+P) Estimated With a PopPK Model |
16.7; 18.6 | — |
| SECONDARY Effect of Combination With Trametinib on Apparent Maximum Inducible Clearance at Steady State of Dabrafenib in the Triple Combination (D+T+P) Estimated With a PopPK Model |
0.625 | — |
| SECONDARY Oral Volume of Distribution (V/F) of Dabrafenib in the Triple Combination (D+T+P) Estimated With a PopPK Model |
58.5 | — |
| SECONDARY Absorption Rate Constant (Ka) of Dabrafenib in the Triple Combination (D+T+P) Estimated With a PopPK Model |
1.22 | — |
| SECONDARY Cmax of Trametinib in the Double Combination (T+P) |
1.53; 22.9; 12; 19.3; 29.9 | — |
| SECONDARY Tmax of Trametinib in the Double Combination (T+P) |
2.5; 4; 3; 4.07; 5.72 | — |
| SECONDARY AUC[0-t] of Trametinib in the Double Combination (T+P) |
2.78; 81; 38.4; 78.6; 171 | — |
| SECONDARY Ctau of Trametinib in the Double Combination (T+P) |
11; 9.44; 11.2; 4.71; 3.36; 7.66 | — |
| SECONDARY Ctau of Panitumumab in the Double Combination (T+P) |
16000; 17400; 8160; 25300; 10000; 9570 | — |
| SECONDARY Apparent Base Clearance (CL0/F) and Apparent Maximum Inducible Clearance at Steady State (CLIND,SS/F) of Dabrafenib in the Double Combination (T+P) Estimated With a PopPK Model |
16.7; 18.6 | — |
| SECONDARY Oral Volume of Distribution (V/F) of Dabrafenib in the Double Combination (T+P) Estimated With a PopPK Model |
58.5 | — |
| SECONDARY Absorption Rate Constant (Ka) of Dabrafenib in the Double Combination (T+P) Estimated With a PopPK Model |
1.22 | — |
| SECONDARY Apparent Clearance (CL/F) of Trametinib in the Double Combination (T+P) Estimated With a PopPK Model |
5.07 | — |
| SECONDARY Apparent Central Volume (V/F) of Trametinib in the Double Combination (T+P) Estimated With a PopPK Model |
184 | — |
| SECONDARY Absorption Rate Constant 1 (Ka1) and Absorption Rate Constant 2 (Ka2) of Trametinib in the Double Combination (T+P) Estimated With a PopPK Model |
0.134; 1.55 | — |
| SECONDARY Time When Ka1 Transitions to Ka2 of Trametinib in the Double Combination (T+P) Estimated With a PopPK Model |
0.404 | — |
| SECONDARY Change in Levels of Proteins/Ribonucleic Acid (RNA) |
60.0; 195.7; 140.7; 148.7; 114.3; 255.3 | — |
| SECONDARY Part 3: Overall Response Rate (ORR) |
— | — |
| SECONDARY Part 3: Duration of Response (DoR) |
— | — |
| SECONDARY Part 3: Overall Survival (OS) |
— | — |
| SECONDARY Part 3: Number of Participants With Treatment Emergent Adverse Events |
— | — |
Summary
This was a four part, phase I/II study aimed to evaluate the safety, tolerability and efficacy of combination of an anti-EGFR antibody panitumumab (P) either with a BRAF inhibitor (dabrafenib (D); GSK2118436) alone or with the combination of a BRAF inhibitor and a MEK inhibitor (trametinib (T); GSK1120212) in patients with BRAF-mutant V600E advanced or mCRC. The goal was to: 1) Determine RP2R/MTD for doublet (D+P) and triplet (D+T+P) combinations in Part 1; 2) Assess clinical activity for these combinations in Part 2; 3) Determine RP2R/MTD for double (T+P) combination in Part 4A, and assess clinical activity of this combination in two patient populations in Part 4B (patients with BRAF-V600E mutation-positive advanced or metastatic CRC and patients with advanced or metastatic CRC with secondary resistance to anti-EGFR therapy).
Eligibility Criteria
Inclusion Criteria: Subjects eligible for enrolment in this study must meet all of the following criteria
- Provided written informed consent,
- Male or female >=18 years of age and able to swallow and retain orally administered study treatment and does not have any clinically significant gastrointestinal (GI) abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach and/or bowels.
- Part 1 and Part 2: Histologically- or cytologically-confirmed diagnosis of advanced or metastatic BRAF V600E mutation positive CRC
- Part 4A and 4B ONLY: Histologically- or cytologically-confirmed diagnosis of advanced or metastatic CRC that either harbours the BRAF V600E -mutation, as determined by relevant genetic testing OR has developed secondary resistance to anti-EGFR therapy, defined as patients that derived benefit (disease control based on investigator assessment for >6 months OR partial response [confirmed or unconfirmed] based on RECIST 1.1) from prior anti-EGFR-containing therapy (as defined below) and then subsequently progressed on therapy. The anti-EGFR therapy must have been the most recent therapy and the patient must have progressed based on investigator assessment within 3 months of screening. Acceptable prior anti-EGFR-containing therapies include: a. Monotherapy anti-EGFR, including cetuximab or panitumumab OR b. irinotecan/anti-EGFR combo after previously having disease progression (based on investigator assessment) on an irinotecan-containing regimen
- Part 3: Histologically- or cytologically-confirmed diagnosis of BRAFV600E mutation positive advanced or metastatic colorectal cancer (CRC who are eligible to receive fluoropyrimidine-containing chemotherapy regimen that have experienced documented radiographic progression on one prior line of fluoropyrimidine-containing chemotherapy (previous anti-EGFR therapy is excluded), Second-line for advanced/metastatic disease, having failed or been intolerant to at least one regimen of fluoropyrimidine-containing chemotherapy including irinotecan or oxaliplatin in the advanced/metastatic setting. Enrollment in Part 3 may only occur following confirmation of KRAS wild-type cancer.
- Archival tissue is required; if archival tissue is not available or found to not contain tumor tissue, a fresh biopsy is required.
- Measurable disease per RECIST version 1.1.
- Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1.
- Men with a female partner of childbearing potential must have either had a prior vasectomy or agree to use one of the contraception methods listed in protocol.
- Female subjects are eligible if: Non-childbearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or post-menopausal female defined as 12 months of spontaneous amenorrhea to be verified with a follicle-stimulating hormone (FSH) level >40 Milli-international units per milliliter (MIU/mL) and estradiol level =90 days prior to first dose of study drug(s). This must be documented with two consecutive MRI or CT scans using contrast, and Asymptomatic with no corticosteroids requirement for >=30 days prior to first dose of study drug(s), and No enzyme-inducing anticonvulsants for >=14 days prior to first dose of study drug(s). In addition, for subjects that had brain metastases but currently have no evidence of disease (NED), NED for >=12 weeks is required and must be confirmed by two consecutive MRI or CT scans (using contrast) separated by >=6 weeks, prior to randomization. Enrollment of a subject with brain metastases who meet the above criteria requires approval of a GlaxoSmithKline (GSK) Medical Monitor.
- Psychological, familial, sociological or geographical conditions that do not permit compliance with the protocol.
- History or evidence of cardiovascular risk including any of the following: LVEF 30 days prior to randomization are eligible. History of acute coronary syndromes (including myocardial infarction a
Data sourced from ClinicalTrials.gov (NCT01750918). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.