Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Gregory J. Riely , Egbert F. Smit , Myung-Ju Ahn , Enriqueta Felip , Suresh S. Ramalingam , Anne S. Tsao , Melissa Lynne Johnson , Francesco Gelsomino , Raymond M. Esper , Ernest Nadal , Michael Offin , Mariano Provencio-Pulla , Gregory Alan Otterson , Ibiayi Dagogo-Jack , Ann Alcasid , Tiziana Usari , Keith D. Wilner , Nuzhat Pathan , Bruce E. Johnson
Background: The combination of dabrafenib, a BRAF inhibitor, and trametinib, a MEK inhibitor, is a current standard of care for patients (pts) with BRAFV600E NSCLC. We report efficacy and safety of enco+bini in pts with BRAFV600E metastatic NSCLC. Methods: PHAROS is an ongoing, open-label, single-arm, phase 2 study that enrolled pts with BRAFV600E metastatic NSCLC who had measurable disease by RECIST 1.1 and Eastern Cooperative Oncology Group performance status of 0 or 1, and who were either treatment-naive or had received 1 prior therapy (chemotherapy, monotherapy, or combination immunotherapy) for metastatic disease. Exclusion criteria included prior treatment with a BRAF or MEK inhibitor. Pts received enco 450 mg QD + bini 45 mg BID administered orally in 28-day cycles. The primary endpoint was confirmed objective response rate (ORR) by independent radiology review (IRR). Secondary endpoints included duration of response (DOR), disease control rate (DCR), progression-free survival (PFS), and time to response (TTR), all by IRR, and safety. Exploratory endpoints included biomarker assessments. Results: At the data cutoff (Sep 22, 2022), 98 pts (59 treatment-naive, 39 previously treated) received enco+bini. The median duration of treatment was 9.2 months with enco and 8.4 months with bini. Treatment is ongoing in 34% of the pts; 38% permanently discontinued due to disease progression and 18% due to adverse events (AEs). The ORR (95% CI) by IRR was 75% (62, 85) in treatment-naive and 46% (30, 63) in previously treated pts. Secondary endpoints are shown in the table. The most frequent (≥30%) treatment-related AEs (TRAEs) were nausea (50%), diarrhea (43%), and fatigue (32%). AEs led to permanent discontinuation of enco+bini in 15% of pts and dose reductions in 24% of pts. One grade 5 TRAE of intracranial hemorrhage was reported. Next-generation sequencing analysis was conducted with archival tumor biopsies from 48 treatment-naive and 32 previously treated pts. The most frequent genomic alterations, in addition to BRAFV600E, were SETD2 and TP53 (43% each), SMAD4 (21%), ATM, MLL2, CSF1R, and SMARCA4 (14% each), and CDKN2A (11%). Conclusions: The combination of enco+bini showed meaningful clinical benefit in treatment-naive and previously treated pts with BRAFV600E metastatic NSCLC. The safety profile of enco+bini was generally consistent with that established for pts with BRAFV600E/K melanoma. ClinicalTrials.gov: NCT03915951. Clinical trial information: NCT03915951.
Secondary endpoints by IRR. | ||
---|---|---|
Treatment-naive | Previously treated | |
n | 44 | 18 |
Median DOR (95% CI), months | NE (23.1-NE) | 16.7 (7.4-NE) |
DOR ≥12 months, n (%) | 26 (59) | 6 (33) |
Median TTR (range), months | 1.9 (1.1-19.1) | 1.7 (1.2-7.3) |
n | 59 | 39 |
DCR after 24 weeks, % (95% CI) | 64 (51-76) | 41 (26-58) |
Median PFS (95% CI), months | NE (15.7-NE) | 9.3 (6.2-NE) |
NE, not estimable. |
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Abstract Disclosures
2024 ASCO Annual Meeting
First Author: Baohui Han
2021 ASCO Annual Meeting
First Author: April A. N. Rose
2015 ASCO Annual Meeting
First Author: David Planchard
2016 ASCO Annual Meeting
First Author: David Planchard