Efficacy and safety of encorafenib (enco) plus binimetinib (bini) in patients with BRAF V600E-mutant (BRAFV600E) metastatic non-small cell lung cancer (NSCLC) from the phase 2 PHAROS study.

Authors

null

Gregory J. Riely

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

Organizations

Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, Netherlands, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain, Emory University School of Medicine, Atlanta, GA, MD Anderson Cancer Center, Houston, TX, Tennessee Oncology, Sarah Cannon Research Institute, Nashville, TN, Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy, Florida Cancer Specialists, Fort Myers, FL, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL. Medical Oncology, Hospitalet, Spain, Memorial Sloan Kettering Cancer Center, New York, NY, Hospital Universitario Puerta de Hierro, Madrid, Spain, Ohio State University Medical Center, Columbus, OH, Massachusetts General Hospital, Boston, MA, Pfizer, Inc., Collegeville, PA, Pfizer, Inc., Milan, Italy, Pfizer Inc., La Jolla, CA, Pfizer, Inc., San Diego, CA, Dana-Farber Cancer Institute, Boston, MA

Research Funding

Pharmaceutical/Biotech Company
Pfizer

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-naivePreviously treated
n4418
Median DOR (95% CI), monthsNE (23.1-NE)16.7 (7.4-NE)
DOR ≥12 months, n (%)26 (59)6 (33)
Median TTR (range), months1.9 (1.1-19.1)1.7 (1.2-7.3)
n5939
DCR after 24 weeks, % (95% CI)64 (51-76)41 (26-58)
Median PFS (95% CI), monthsNE (15.7-NE)9.3 (6.2-NE)
NE, not estimable.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Clinical Trial Registration Number

NCT03915951

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 9018)

DOI

10.1200/JCO.2023.41.16_suppl.9018

Abstract #

9018

Poster Bd #

6

Abstract Disclosures