Binimetinib and Encorafenib for the Treatment of Pancreatic Cancer in Patients With a Somatic BRAF V600E Mutation
NCT ID: NCT04390243
Last Updated: 2024-05-06
Study Results
Results available
Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.
View full resultsBasic Information
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Recruitment Status
TERMINATED
Clinical Phase
PHASE2
Total Enrollment
6 participants
Study Classification
INTERVENTIONAL
Study Start Date
2020-11-16
Study Completion Date
2023-11-01
Brief Summary
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This phase II trial studies the side effects and how well the combination of binimetinib and encorafenib work in treating patients with pancreatic cancer with a somatic BRAF V600E mutation. Binimetinib and encorafenib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving binimetinib and encorafenib may work better compared to the usual treatment in treating patients with pancreatic cancer and a somatic BRAF V600E mutation.
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Detailed Description
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PRIMARY OBJECTIVE:
I. To determine the efficacy of the combination of binimetinib and encorafenib as \>= 2nd line of treatment for patients with metastatic pancreatic cancer with BRAF V600E mutation.
SECONDARY OBJECTIVES:
I. To determine in patients treated with the combination of binimetinib and encorafenib as \>= 2nd line of treatment for patients with metastatic pancreatic cancer with BRAF V600E mutation:
Ia. The median progression-free survival. Ib. The median overall survival. Ic. Duration of response. Id. Time to response. Ie. The safety and tolerability.
OUTLINE:
Patients receive encorafenib orally (PO) once daily (QD) and binimetinib PO twice daily (BID) on days 1-25. Treatment repeats every 28 days for up to 36 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for up to 5 years.
I. To determine the efficacy of the combination of binimetinib and encorafenib as \>= 2nd line of treatment for patients with metastatic pancreatic cancer with BRAF V600E mutation.
SECONDARY OBJECTIVES:
I. To determine in patients treated with the combination of binimetinib and encorafenib as \>= 2nd line of treatment for patients with metastatic pancreatic cancer with BRAF V600E mutation:
Ia. The median progression-free survival. Ib. The median overall survival. Ic. Duration of response. Id. Time to response. Ie. The safety and tolerability.
OUTLINE:
Patients receive encorafenib orally (PO) once daily (QD) and binimetinib PO twice daily (BID) on days 1-25. Treatment repeats every 28 days for up to 36 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for up to 5 years.
Conditions
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Locally Advanced Pancreatic Carcinoma
Metastatic Pancreatic Carcinoma
Recurrent Pancreatic Carcinoma
Stage III Pancreatic Cancer AJCC v8
Stage IV Pancreatic Cancer AJCC v8
Study Design
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Allocation Method
NA
Intervention Model
SINGLE_GROUP
Primary Study Purpose
TREATMENT
Blinding Strategy
NONE
Study Groups
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Treatment (encorafenib, binimetinib)
Patients receive encorafenib PO QD and binimetinib PO BID on days 1-25. Treatment repeats every 28 days for up to 36 cycles in the absence of disease progression or unacceptable toxicity.
Group Type
EXPERIMENTAL
Binimetinib
Intervention Type
DRUG
Given PO
Encorafenib
Intervention Type
DRUG
Given PO
Interventions
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Binimetinib
Given PO
Intervention Type
DRUG
Encorafenib
Given PO
Intervention Type
DRUG
Other Intervention Names
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ARRY-162
ARRY-438162
MEK162
Mektovi
Braftovi
LGX 818
LGX-818
LGX818
Eligibility Criteria
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Inclusion Criteria
* PRE-REGISTRATION:
* Histological confirmation of a pancreatic malignancy as confirmed by the local pathology lab
* Patients whose disease has progressed on (or who were intolerant of) at least one line of therapy for metastatic disease
* Patients whose disease has recurred with metastatic disease =\< 12 weeks of completion of neoadjuvant or adjuvant systemic chemotherapy; or patients with locally advanced disease whose disease progressed to metastatic disease on, or =\< 12 weeks after completion of systemic chemotherapy would also be eligible
* Provide informed written consent =\< 28 days prior to pre-registration
* Central electronic/paper confirmation of the presence of a BRAF V600E mutation. This review is mandatory prior to pre-registration to confirm eligibility. Results from a Clinical Laboratory Improvement Act (CLIA)/College of American Pathologists (CAP) certified testing lab (commercial or institutional) that confirm the presence of a BRAF V600E mutation in the patient's tumor must be submitted for central review
* REGISTRATION: NOTE: Registration must occur =\< 30 days after pre-registration
* Confirmation of the presence of BRAF V600E mutation in the patient's tumor
* Measurable disease
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2. (Form is available on the Academic and Community Cancer Research United \[ACCRU\] web site)
* Absolute neutrophil count (ANC) \>= 1500/mm\^3 (obtained =\< 14 days prior to registration)
* Platelet count \>= 75,000/mm\^3 (obtained =\< 14 days prior to registration)
* Hemoglobin \>= 9.0 g/dL (obtained =\< 14 days prior to registration)
* Total bilirubin =\< 1.5 x upper limit of normal (ULN) (obtained =\< 14 days prior to registration)
* Aspartate transaminase (AST) =\< 2.5 x ULN; in participants with liver metastases =\< 5 x ULN (obtained =\< 14 days prior to registration)
* Aminotransferase (ALT) =\< 2.5 x ULN; in participants with liver metastases =\< 5 x ULN (obtained =\< 14 days prior to registration)
* Calculated creatinine clearance must be \>= 45 ml/min using the Cockcroft Gault formula (obtained =\< 14 days prior to registration)
* Negative pregnancy test done =\< 7 days prior to registration, for women of childbearing potential only
* Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study). Note: During the active monitoring phase of a study (i.e., active treatment), participants must be willing to return to the consenting institution for follow-up
* Ability to swallow the investigational product tablets and capsules
* Willing to provide tissue and blood samples for correlative research purposes
* Histological confirmation of a pancreatic malignancy as confirmed by the local pathology lab
* Patients whose disease has progressed on (or who were intolerant of) at least one line of therapy for metastatic disease
* Patients whose disease has recurred with metastatic disease =\< 12 weeks of completion of neoadjuvant or adjuvant systemic chemotherapy; or patients with locally advanced disease whose disease progressed to metastatic disease on, or =\< 12 weeks after completion of systemic chemotherapy would also be eligible
* Provide informed written consent =\< 28 days prior to pre-registration
* Central electronic/paper confirmation of the presence of a BRAF V600E mutation. This review is mandatory prior to pre-registration to confirm eligibility. Results from a Clinical Laboratory Improvement Act (CLIA)/College of American Pathologists (CAP) certified testing lab (commercial or institutional) that confirm the presence of a BRAF V600E mutation in the patient's tumor must be submitted for central review
* REGISTRATION: NOTE: Registration must occur =\< 30 days after pre-registration
* Confirmation of the presence of BRAF V600E mutation in the patient's tumor
* Measurable disease
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2. (Form is available on the Academic and Community Cancer Research United \[ACCRU\] web site)
* Absolute neutrophil count (ANC) \>= 1500/mm\^3 (obtained =\< 14 days prior to registration)
* Platelet count \>= 75,000/mm\^3 (obtained =\< 14 days prior to registration)
* Hemoglobin \>= 9.0 g/dL (obtained =\< 14 days prior to registration)
* Total bilirubin =\< 1.5 x upper limit of normal (ULN) (obtained =\< 14 days prior to registration)
* Aspartate transaminase (AST) =\< 2.5 x ULN; in participants with liver metastases =\< 5 x ULN (obtained =\< 14 days prior to registration)
* Aminotransferase (ALT) =\< 2.5 x ULN; in participants with liver metastases =\< 5 x ULN (obtained =\< 14 days prior to registration)
* Calculated creatinine clearance must be \>= 45 ml/min using the Cockcroft Gault formula (obtained =\< 14 days prior to registration)
* Negative pregnancy test done =\< 7 days prior to registration, for women of childbearing potential only
* Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study). Note: During the active monitoring phase of a study (i.e., active treatment), participants must be willing to return to the consenting institution for follow-up
* Ability to swallow the investigational product tablets and capsules
* Willing to provide tissue and blood samples for correlative research purposes
Exclusion Criteria
* REGISTRATION:
* Patients whose tumor harbors a BRAF non-V600E mutation or a BRAF fusion
* Prior therapy with BRAF inhibitor (e.g., encorafenib, dabrafenib, vemurafenib) and/or a MEK inhibitor (e.g., binimetinib, trametinib, cobimetinib)
* Known hypersensitivity or contraindication to any component of binimetinib or encorafenib or their excipients
* Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
* Pregnant women
* Nursing women
* Men or women of childbearing potential who are unwilling to employ adequate contraception
* NOTE: Female participants of childbearing potential must agree to use methods of contraception that are highly effective or acceptable, and to not donate ova from screening until 30 days after the last dose of study drug
* NOTE: Male participants must agree to use methods of contraception that are highly effective or acceptable, and to not donate sperm from screening until 90 days after the last dose of study drug
* Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
* Immunocompromised patients and patients known to be HIV positive and currently receiving antiretroviral therapy. NOTE: Patients known to be human immunodeficiency virus ( HIV) positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* History of acute coronary syndromes (including myocardial infarction, unstable angina, coronary artery bypass grafting, coronary angioplasty or stenting) \< 6 months prior to registration
* Left ventricular ejection fraction (LVEF) =\< 50% as determined by multigated acquisition scan (MUGA) or echocardiogram (ECHO)
* Uncontrolled hypertension defined as persistent systolic blood pressure \>= 150/100 mmHg or diastolic blood pressure \>= 100 mmHg despite current therapy
* Triplicate average baseline corrected QT (QTc) interval \>= 480 ms
* Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
* Patients who have had another active malignancy within the past two years are ineligible EXCEPT FOR patients with cervical cancer in situ, in situ carcinoma of the bladder, non-melanoma carcinoma of the skin, or patients who have had therapy with curative intent for breast or prostate cancer, but remain on adjuvant hormonal therapy
* Received anticancer therapy including chemotherapy, immunotherapy, or antineoplastic biologic therapy (e.g., erlotinib, cetuximab, bevacizumab etc.), =\<14 days (=\< 28 days for an antibody-based therapy) prior to registration
* Patients who have undergone major surgery (e.g., in-patient procedures) =\< 6 weeks prior to registration or who have not recovered from side effects of such procedure
* Patients who have had radiotherapy =\< 14 days prior to registration or who have not recovered from side effects of such procedure. NOTE: Palliative radiation therapy must be complete 7 days prior to the first dose of study treatment
* Patient has not recovered to =\< grade 1 from toxic effects of prior therapy before registration. EXCEPTIONS: Stable chronic conditions (=\< grade 2) that are not expected to resolve (such as neuropathy, myalgia, alopecia, prior therapy-related endocrinopathies)
* Uncontrolled or symptomatic brain metastases or leptomeningeal carcinomatosis that are not stable, require steroids, are potentially life-threatening or have required radiation =\< 28 days prior to registration.
* NOTE: Patients with previously treated brain metastases may participate provided they are stable (e.g., without evidence of progression by radiographic imaging for =\< 28 days prior to registration and neurologic symptoms have returned to baseline), and have no evidence of new or enlarging brain metastases or central nervous system (CNS) edema, and does not require steroids at least 7 days before the first dose of study treatment.
* Impairment of gastrointestinal function or disease which may significantly alter the absorption of study drug (e.g., active ulcerative disease, uncontrolled vomiting or diarrhea, malabsorption syndrome, small bowel resection with decreased intestinal absorption), or recent (=\< 12 weeks) history of a partial or complete bowel obstruction, or other condition that will interfere significantly with the absorption or oral drugs
* Known history of acute or chronic pancreatitis
* Concurrent neuromuscular disorder that is associated with elevated creatine kinase (CK) (e.g., inflammatory myopathies, muscular dystrophy, amytrophic lateral sclerosis, spinal muscular atrophy)
* History or current evidence of RVO or current risk factors for retinal vein occlusion (RVO) (e.g., uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability syndromes); history of retinal degenerative disease
* Current use of prohibited medication (including herbal medications, supplements, or foods), or use of prohibited medication =\< 7 days prior to registration
* History of thromboembolic or cerebrovascular events =\< 12 weeks prior to registration. Examples include transient ischemic attacks, cerebrovascular accidents, hemodynamically significant (i.e. massive or sub-massive) deep vein thrombosis or pulmonary emboli.
* NOTE: Patients with either deep vein thrombosis or pulmonary emobli that do not result in hemodynamic instability are allowed to enroll as long as they are on a stable dose of anticoagulants for =\< 4 weeks prior to registration
* NOTE: Patients with thromboembolic events related to indwelling catheters or other procedures may register
* Evidence of hepatitis B Virus (HBV) or hepatitis C Virus (HCV) infection.
* NOTE: Patients with laboratory evidence of cleared HBV or HCV infection may register.
* NOTE: Patients with no prior history of HBV infection who have been vaccinated against HBV and who have a positive antibody against hepatitis B surface antigen as the only evidence of prior exposure may register
* Patients whose tumor harbors a BRAF non-V600E mutation or a BRAF fusion
* Prior therapy with BRAF inhibitor (e.g., encorafenib, dabrafenib, vemurafenib) and/or a MEK inhibitor (e.g., binimetinib, trametinib, cobimetinib)
* Known hypersensitivity or contraindication to any component of binimetinib or encorafenib or their excipients
* Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
* Pregnant women
* Nursing women
* Men or women of childbearing potential who are unwilling to employ adequate contraception
* NOTE: Female participants of childbearing potential must agree to use methods of contraception that are highly effective or acceptable, and to not donate ova from screening until 30 days after the last dose of study drug
* NOTE: Male participants must agree to use methods of contraception that are highly effective or acceptable, and to not donate sperm from screening until 90 days after the last dose of study drug
* Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
* Immunocompromised patients and patients known to be HIV positive and currently receiving antiretroviral therapy. NOTE: Patients known to be human immunodeficiency virus ( HIV) positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* History of acute coronary syndromes (including myocardial infarction, unstable angina, coronary artery bypass grafting, coronary angioplasty or stenting) \< 6 months prior to registration
* Left ventricular ejection fraction (LVEF) =\< 50% as determined by multigated acquisition scan (MUGA) or echocardiogram (ECHO)
* Uncontrolled hypertension defined as persistent systolic blood pressure \>= 150/100 mmHg or diastolic blood pressure \>= 100 mmHg despite current therapy
* Triplicate average baseline corrected QT (QTc) interval \>= 480 ms
* Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
* Patients who have had another active malignancy within the past two years are ineligible EXCEPT FOR patients with cervical cancer in situ, in situ carcinoma of the bladder, non-melanoma carcinoma of the skin, or patients who have had therapy with curative intent for breast or prostate cancer, but remain on adjuvant hormonal therapy
* Received anticancer therapy including chemotherapy, immunotherapy, or antineoplastic biologic therapy (e.g., erlotinib, cetuximab, bevacizumab etc.), =\<14 days (=\< 28 days for an antibody-based therapy) prior to registration
* Patients who have undergone major surgery (e.g., in-patient procedures) =\< 6 weeks prior to registration or who have not recovered from side effects of such procedure
* Patients who have had radiotherapy =\< 14 days prior to registration or who have not recovered from side effects of such procedure. NOTE: Palliative radiation therapy must be complete 7 days prior to the first dose of study treatment
* Patient has not recovered to =\< grade 1 from toxic effects of prior therapy before registration. EXCEPTIONS: Stable chronic conditions (=\< grade 2) that are not expected to resolve (such as neuropathy, myalgia, alopecia, prior therapy-related endocrinopathies)
* Uncontrolled or symptomatic brain metastases or leptomeningeal carcinomatosis that are not stable, require steroids, are potentially life-threatening or have required radiation =\< 28 days prior to registration.
* NOTE: Patients with previously treated brain metastases may participate provided they are stable (e.g., without evidence of progression by radiographic imaging for =\< 28 days prior to registration and neurologic symptoms have returned to baseline), and have no evidence of new or enlarging brain metastases or central nervous system (CNS) edema, and does not require steroids at least 7 days before the first dose of study treatment.
* Impairment of gastrointestinal function or disease which may significantly alter the absorption of study drug (e.g., active ulcerative disease, uncontrolled vomiting or diarrhea, malabsorption syndrome, small bowel resection with decreased intestinal absorption), or recent (=\< 12 weeks) history of a partial or complete bowel obstruction, or other condition that will interfere significantly with the absorption or oral drugs
* Known history of acute or chronic pancreatitis
* Concurrent neuromuscular disorder that is associated with elevated creatine kinase (CK) (e.g., inflammatory myopathies, muscular dystrophy, amytrophic lateral sclerosis, spinal muscular atrophy)
* History or current evidence of RVO or current risk factors for retinal vein occlusion (RVO) (e.g., uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability syndromes); history of retinal degenerative disease
* Current use of prohibited medication (including herbal medications, supplements, or foods), or use of prohibited medication =\< 7 days prior to registration
* History of thromboembolic or cerebrovascular events =\< 12 weeks prior to registration. Examples include transient ischemic attacks, cerebrovascular accidents, hemodynamically significant (i.e. massive or sub-massive) deep vein thrombosis or pulmonary emboli.
* NOTE: Patients with either deep vein thrombosis or pulmonary emobli that do not result in hemodynamic instability are allowed to enroll as long as they are on a stable dose of anticoagulants for =\< 4 weeks prior to registration
* NOTE: Patients with thromboembolic events related to indwelling catheters or other procedures may register
* Evidence of hepatitis B Virus (HBV) or hepatitis C Virus (HCV) infection.
* NOTE: Patients with laboratory evidence of cleared HBV or HCV infection may register.
* NOTE: Patients with no prior history of HBV infection who have been vaccinated against HBV and who have a positive antibody against hepatitis B surface antigen as the only evidence of prior exposure may register
Minimum Eligible Age
18 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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National Cancer Institute (NCI)
NIH
Sponsor Role
collaborator
Academic and Community Cancer Research United
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Andrew E Hendifar
Role: PRINCIPAL_INVESTIGATOR
Academic and Community Cancer Research United
Locations
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Mayo Clinic in Arizona
Phoenix, Arizona, United States
Site Status
Cedars Sinai Medical Center
Los Angeles, California, United States
Site Status
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, United States
Site Status
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Site Status
Mayo Clinic
Rochester, Minnesota, United States
Site Status
Countries
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United States
Provided Documents
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Document Type: Study Protocol and Statistical Analysis Plan
Other Identifiers
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NCI-2020-02972
Identifier Type: REGISTRY
Identifier Source: secondary_id
ACCRU-GI- 1907
Identifier Type: OTHER
Identifier Source: secondary_id
ACCRU-GI-1907
Identifier Type: -
Identifier Source: org_study_id
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