TRIDENTE trial: A phase II study of rechallenge with encorafenib, binimetinib, and cetuximab in patients with RAS wild-type/BRAF V600E–mutant metastatic colorectal cancer.

Authors

null

Daisuke Kotani

National Cancer Center Hospital East, Japan, Kashiwa-Shi, Japan;

Daisuke Kotani , Yoshinori Kagawa , Yuki Matsubara , Hideaki Bando , Kazuaki Harada , Naoki Takahashi , Yoshiaki Mihara , Izuma Nakayama , Naoki Izawa , Takeshi Kawakami , Toshiki Masuishi , Hiroko Hasegawa , Takashi Ohta , Masashi Wakabayashi , Takayuki Yoshino

Organizations

National Cancer Center Hospital East, Japan, Kashiwa-Shi, Japan; , Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan; , Aichi Cancer Center Hospital, Nagoya-Shi Chikusa-Ku, Japan; , Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan; , Hokkaido University Graduate School of Medicine, Sapporo, Japan; , Saitama Cancer Center, Saitama-Shi, Japan; , Saiatama Medical University International Medical Center, Hidaka-Shi, Japan; , The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Tokyo, Japan; , St. Marianna University School of Medicine, Kawasaki, Japan; , Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan; , Aichi Cancer Center Hospital, Nagoya, Japan; , Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan; , Kansai Rosai Hospital, Amagasaki, Japan; , Division for the Promotion of Drug and Diagnostic Development, National Cancer Center Hospital East, Kashiwa, Japan; , National Cancer Center Hospital East, Japan, Kashiwa, Chiba, Japan;

Research Funding

Pharmaceutical/Biotech Company
Ono Pharmaceutical

Background: The BEACON CRC trial demonstrated survival benefit of combination therapy with encorafenib (ENCO) + cetuximab (CET) +/- binimetinib (BINI) in patients with RAS wild-type (WT)/BRAF V600E mutant metastatic colorectal cancer (mCRC). However, prognosis of those patients still be poor after the refractoriness to the BEACON combination therapy. One of resistant mechanisms to BRAF inhibitor has been reported as MAPK alterations including RAS mutation, similar to those for anti-EGFR antibody in patients with RAS/BRAF V600E WT mCRC. Promising results of rechallenge therapy with anti-EGFR antibody in patients with RAS/BRAF V600E WT mCRC and with combination of BRAF inhibitor + MEK inhibitor in patients with BRAF V600 mutant melanoma suggest the treatment strategy of rechallenge therapy with the BEACON triplet therapy in patients with RAS WT/BRAF V600E mutant mCRC. Methods: TRIDENTE trial is a multicenter phase II trial to assess efficacy and safety of rechallenge therapy with ENCO + BINI + CET in patients with RAS WT/BRAF V600E mutant mCRC after the refractoriness to either the BEACON doublet or triplet therapy. Key eligibility criteria includes RAS WT/BRAF V600E mutant mCRC; ≥ 20 years old; ECOG PS 0-1; refractory or intolerant to at least one fluoropyrimidine-based regimen (including irinotecan or oxaliplatin); refractory or intolerant to anti-PD-1 antibody if patients with MSI-high; history of previous combination therapy containing ENCO + CET with at least partial response by RECIST v1.1; confirmed disease progression within 4 weeks after last administration of previous ENCO; ≥ 4 months of period between the last administration of previous ENCO and the start of study treatment. Enrolled patients receive the combination therapy with ENCO (300 mg, QD), BINI (45 mg, BID), and CET (initially 400 mg/m2, and subsequently 250 mg/m2, QW) as the study treatment. Primary endpoint is the objective response rate (ORR) by investigators’ assessment in patients receiving at least one dose of study treatment. A target sample size is calculated to be 21 on the hypothesis that the threshold ORR is 3% and expected ORR is 20%, with a significant level of 5% (one-sided) and power of 80%. Secondary endpoint includes progression-free and overall survivals, disease control rate, and safety. Exploratory molecular analysis is performed using targeted next-generation sequencing in circulating-tumor DNA at the timepoints of baseline and discontinuation of study treatment. As of September 19, 2022, 8 patients have been enrolled. Clinical trial information: jRCTs031210511.

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

031210511

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr TPS264)

DOI

10.1200/JCO.2023.41.4_suppl.TPS264

Abstract #

TPS264

Poster Bd #

P6

Abstract Disclosures