Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China;
Yungchang Chen , Xiaoqian Li , Man Yuxin , Hai Hu , Liyang Wang , Zhixuan Zhang , Ping Chen , Yang Liu , Jin Lu , Tongyu Lin
Background: The low efficacy of single-agent BRAF inhibitor in metastatic colorectal cancer (mCRC) is usually due to EGFR feedback upregulation caused by BRAF blockade. Therefore, multi-drug combination therapy with BRAF inhibitor has been tried. Here, we reported the preliminary results of quadruple therapy with dabrafenib, a selective BRAF inhibitor, trametinib, a selective MEK inhibitor, irinotecan and cetuximab in patients with BRAF V600E-mutated mCRC. Methods: This was an ongoing phase Ib study, patients with mCRC who relapse or refractory to standard treatments were enrolled. Patients were treated with dabrafenib (150mg/150mg doses orally twice daily), trametinib (2mg orally once daily), irinotecan (80mg/m2 weekly) and cetuximab (400mg/m2 in first dose and 250mg/m2 weekly). Treatment was continued until disease progression, development of unacceptable toxicity, or drawal of consent. The primary end-point was disease control rate (DCR), and the secondary end-points included progression-free survival (PFS) and duration of disease remission (DOR). This trial is registered with Chinese ClinicalTrials.gov, number ChiCTR2200063316. Results: From July 2018 to January 2021, 10 patients were enrolled. The median age was 53.5 (age 25-65), nine with colon cancer and one with rectal cancer. The most common adverse events (AEs) (50% or more) were fatigue, fever, rash, vomit, leukopenia, anemia, ALT elevation, and AST elevation. Four patients suffered rash which was the most common severe AE (SAE). Two patients presented with grade 3/4 anemia. Only one patient suffered grade 3/4 AEs with nausea and vomit. The DCR was 90% (9/10). After a median follow-up of 19.7 months, the median PFS was 7.5 months (range 1.8-32.4 months). The median DOR was 5.2 months (range 0-27.7 months). Conclusions: Dabrafenib, trametinib, irinotecan and cetuximab has tolerable toxicity and promising antitumor activity in BRAF V600E-mutated mCRC. This regimen warrants a further phase II clinical trial. Clinical trial information: ChiCTR2200063316.
AE, n | All Grade | Grade3/4 |
---|---|---|
Fatigue | 5 (50) | 1 (10) |
Oral mucositis | 0 | 0 |
Fever | 5 (50) | 1 (10) |
Rash | 8 (80) | 4 (40) |
Loss of appetite | 4 (40) | 0 |
Insomnia | 0 | 0 |
Nausea | 4 (40) | 1 (10) |
Vomit | 5 (50) | 1 (10) |
Diarrhea | 4 (40) | 1 (10) |
Constipation | 3 (30) | 0 |
Pneumonia | 0 | 0 |
Leukopenia | 5 (50) | 0 |
Anemia | 6 (60) | 2 (20) |
Thrombocytopenia | 3 (30) | 0 |
Neutropenia | 2 (20) | 0 |
Hypoalbuminemia | 4 (40) | 0 |
ALT elevation | 5 (50) | 0 |
AST elevation | 5 (50) | 0 |
Lipase elevation | 2 (20) | 0 |
Hypercholesteremia | 3 (30) | 0 |
Hypertriglyceridemia | 3 (30) | 0 |
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