Randomized phase II trial of encorafenib and cetuximab with or without nivolumab for patients with previously treated, microsatellite stable, BRAFV600E metastatic and/or unresectable colorectal cancer: SWOG S2107.

Authors

null

Van K. Morris II

MD Anderson Cancer Center, Houston, TX;

Van K. Morris II, Katherine A Guthrie , Scott Kopetz , Rimini Breakstone , Thomas Benjamin Karasic , Zishuo Ian Hu , Shay Bellasea , Marwan Fakih , Sepideh Gholami , Philip Jordan Gold , Philip Agop Philip

Organizations

MD Anderson Cancer Center, Houston, TX; , Fred Hutchiinson Cancer Research Center, and SWOG Statistics and Data Management Center, Seattle, WA; , The University of Texas MD Anderson Cancer Center, Houston, TX; , Brown University, The Miriam Hospital, Providence, RI; , University of Pennsylvania, Philadelphia, PA; , WUSM\Siteman Cancer Center, Saint Louis, MO; , Fred Hutchinson Cancer Research Center, Seattle, WA; , City of Hope National Medical Center, Duarte, CA; , University of California Davis Comprehensive Cancer Center, Sacramento, CA; , Swedish Cancer Institute, Seattle, WA; , Karmanos Cancer Center, Wayne State University, and SWOG, Farmington Hills, MI;

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Patients with microsatellite stable (MSS), BRAFV600E metastatic colorectal cancer (mCRC) experience poor survival outcomes. Treatment with the BRAF inhibitor encorafenib (E) and anti-EGFR antibody cetuximab (C) is an approved treatment combination, with a reported overall response rate (ORR) of 20% and median progression-free survival (PFS) of 4.1 months. Anti-PD-1 antibodies like nivolumab (N) are ineffective as monotherapy for patients with MSS, BRAFV600E mCRC. In preclinical models of MSS, BRAFV600E CRC, inhibition of BRAF and EGFR induces a loss of expression of mismatch repair genes and promotes a microsatellite instability-high phenotype, which may prime these tumors for response to immunotherapy. In support of these findings, a single-institution clinical trial of E + C + N for 26 patients with MSS, BRAFV600E mCRC reported an ORR of 50% and median PFS of 7.2 months. We hypothesize that the addition of N to E + C will improve median PFS for patients with MSS, BRAFV600E mCRC. Methods: In this prospective phase II clinical trial (N = 75), patients with previously treated MSS, BRAFV600E mCRC will be randomized 2:1 into 2 arms, respectively: experimental treatment (E + C + N) or standard treatment (E + C). No prior BRAF, EGFR, or immunotherapy agents are allowed. All patients will receive E (300 mg PO daily) and C (500 mg/m2 IV every 14 days), and patients in the experimental arm will receive N (480 mg IV every 28 days). The primary endpoint is PFS. Secondary endpoints include overall survival, best overall response, duration of response, and safety/tolerability. Using a one-sided α = .10 and power 80%, we target an improvement in median PFS from 4.2 to 7.3 months and a hazard ratio of 0.57. Additional patient specimens will be collected for exploratory correlative research. The study activated across the United States in June 2022 and as of September 2022 has enrolled 2 of 75 planned participants. Funding: NIH/National Cancer Institute grants U10CA180888, U10CA180819, U10CA180820, U10CA180821, U10CA180868; and in part by The Hope Foundation for Cancer Research STrS award. Clinical trial information: NCT05308446.

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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

NCT05308446

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr TPS265)

DOI

10.1200/JCO.2023.41.4_suppl.TPS265

Abstract #

TPS265

Poster Bd #

P7

Abstract Disclosures