A randomized trial of consolidation-targeted adjuvant therapy with encorafenib and cetuximab versus usual care for patients with stage II/III BRAF V600E colon cancer: Alliance for Clinical Trials in Oncology A022004.

Authors

null

Rona Yaeger

Memorial Sloan Kettering Cancer Center, New York, NY

Rona Yaeger , Qian Shi , Amylou C. Dueck , Elie G. Dib , Syed Mohammad Ali Kazmi , Olatunji B. Alese , Smitha S. Krishnamurthi , Andrew B. Nixon , Ardaman Shergill , Eileen Mary O'Reilly , Jeffrey A Meyerhardt

Organizations

Memorial Sloan Kettering Cancer Center, New York, NY, Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, Trinity Health Saint Joseph Mercy Hospital, Ann Arbor, MI, University of Texas Southwestern Medical Center, Dallas, TX, Winship Cancer Institute of Emory University, Atlanta, GA, Cleveland Clinic, Cleveland, OH, Duke University Medical Center, Durham, NC, Alliance Protocol Operations Office, University of Chicago, Chicago, IL, Dana-Farber Cancer Institute, Boston, MA

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health, Pfizer, Eli Lilly

Background: Patients with mismatch repair proficient (pMMR) BRAF V600E mutant high-risk stage II (T4) or stage III colon cancer have a substantial risk of recurrence despite standard adjuvant therapy. In patients with metastatic BRAF V600E mutant colorectal cancer, the combination of the RAF inhibitor encorafenib and the EGFR inhibitor cetuximab has been shown to improve overall and progression-free survival compared to standard therapy after at least one prior line of therapy. This study will evaluate if this combination improves disease-free survival (DFS) in patients with resected BRAF V600E mutant pMMR/microsatellite stable (MSS) high-risk stage II (T4) or stage III colon cancer after standard adjuvant therapy. Methods: The study has a seamless phase II/III design, enrolling a maximum of 394 patients. BRAF mutation status can be determined locally or submitted for central testing in trial pre-screening. Eligible patients will be randomized 1:1 to usual surveillance versus 6 months of treatment with encorafenib (300mg oral daily) plus cetuximab (500mg/m2 intravenous every 14 days). Stratification factors are adjuvant chemotherapy regimen (FOLFOX versus CAPOX), duration of adjuvant therapy (3 months versus > 3 months), tumor stage (T4N0 versus T1-3N1 versus T4N1/TanyN2), and ctDNA marker status (detectable versus undetectable) at randomization. Adjuvant therapy must be completed at most 8 weeks prior to registration. For the phase II component, in the ctDNA detectable cohort, the primary endpoint will be ctDNA clearance rate at 6 months, and, in the ctDNA undetectable cohort, the primary endpoint will be 6-month ctDNA recurrence-free survival, where events consist of death, recurrence, or ctDNA positivity. The primary endpoint of the phase III component is DFS, and secondary endpoints are overall survival, adverse events, and alternative DFS calculated from the date of primary resection, rather than date of study randomization. Patient reported symptoms (PRO-CTCAE) will be collected and analyzed as an exploratory endpoint, and serial blood banking will support future correlative studies. The trial will proceed to the phase III portion if either of the two endpoints in the phase II cohorts is statistically superior in patients receiving encorafenib plus cetuximab. The phase III study sample size will provide 80% power at a one-sided α of 0.05 to detect an approximately 10% improvement in the three-year DFS rate, assuming 68% in the control arm. Two interim analyses will be performed for DFS endpoint. Support: U10CA180821, U10CA180882; https://acknowledgments.alliancefound.org. U10CA180820 (ECOG-ACRIN); U10CA180868 (NRG); U10CA180888 (SWOG); Pfizer, Eli Lilly; Clinicaltrials.gov ID: NCT05710406. Clinical trial information: NCT05710406.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Local-Regional Disease

Clinical Trial Registration Number

NCT05710406

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr TPS3641)

DOI

10.1200/JCO.2023.41.16_suppl.TPS3641

Abstract #

TPS3641

Poster Bd #

332b

Abstract Disclosures