Phase 1b/2 Trial of Defactinib and Avutometinib, With or Without Encorafenib, for the Treatment of Patients With Brain Metastases From Cutaneous Melanoma

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Active drug More information Moderate burden on patient More information

Trial Details

Sponsor: University of Utah (other)

Phase: 1/2

Start date: March 7, 2024

Planned enrollment: 33

Trial ID: NCT06194929
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More trial details at ClinicalTrials.gov More info

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Investigational Drug AI Analysis

chevron Show for: Defactinib (PF-04554878, VS-6063)

chevron Show for: Avutometinib (RO-5126766, CKI-27, CH-5126766, R-7304, RG-7304, VS-6766)

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Goal: Provide proof-of-principle intracranial activity of the FAK/Pyk2 inhibitor defactinib combined with the dual RAF/MEK clamp avutometinib in melanoma brain metastases after immune checkpoint inhibitors, and define the safety, tolerability, and preliminary intracranial response of adding the BRAF inhibitor encorafenib in BRAF V600E/K–mutant disease, including establishing the recommended encorafenib dose with the doublet.

Patients: Adults ≥18 years with histologically confirmed cutaneous melanoma and radiographically confirmed brain metastases, at least one untreated parenchymal brain lesion 0.5–4 cm, post–immune checkpoint inhibitor therapy, ECOG 0–1 (or KPS ≥70), adequate organ function. Molecular eligibility requires known RAS/BRAF/NF1 status: Cohort A includes RAS, BRAF, NF1, or triple wild-type (including RAF fusions); Cohort B includes BRAF V600E/K with allowance for prior BRAF/MEK therapy. Exclusions include symptomatic brain metastases (≥Grade 2 neurologic symptoms), uveal/mucosal melanoma, leptomeningeal disease, significant cardiac, pulmonary, ocular risk for RVO/keratopathy, bleeding diathesis, strong CYP/P-gp/BCRP interacting drugs, and uncontrolled infections.

Design: Phase 1b/2, nonrandomized, multicohort study. Cohort B includes a Phase 1 run-in with Bayesian optimal interval dose escalation of encorafenib with fixed-dose avutometinib/defactinib to establish safety and recommended Phase 2 dose, followed by a Phase 2 expansion. Cohort A is a Phase 2 evaluation of the avutometinib/defactinib doublet. Planned enrollment is 33 participants.

Treatments: Cohort A (Phase 2): Avutometinib 3.2 mg orally twice weekly, 3 weeks on/1 week off; Defactinib 200 mg orally twice daily, 3 weeks on/1 week off, in 28-day cycles. Cohort B Phase 1b: Same fixed doses of avutometinib and defactinib plus encorafenib daily with BOIN dose levels 225, 300, or 450 mg to determine RP2D; Cohort B Phase 2: triplet at selected encorafenib dose. Defactinib (VS-6063, PF-04554878) is an ATP-competitive inhibitor of FAK and Pyk2 that targets tumor cell survival, motility, and microenvironment signaling; early-phase studies identified tolerability with class AEs such as nausea, fatigue, diarrhea, and unconjugated hyperbilirubinemia, and modest single-agent activity across solid tumors. Avutometinib is a dual RAF/MEK allosteric “clamp” that inhibits RAF and MEK and stabilizes RAF–MEK complexes to prevent MEK rephosphorylation; in low-grade serous ovarian cancer, avutometinib plus defactinib yielded higher response rates than monotherapy with manageable toxicity, supporting combination development in MAPK-driven tumors. Encorafenib is an oral BRAF inhibitor commonly used in BRAF V600–mutant melanoma; here it is explored with the FAK and RAF/MEK clamp backbone to enhance intracranial control in BRAF V600E/K brain metastases.

Outcomes: Primary: Intracranial objective response rate by RANO-BM at 6 months in Cohort A (doublet) and Cohort B Phase 2 (triplet); and frequency of dose-limiting toxicities and overall safety in Cohort B Phase 1 run-in. Secondary: Disease control rate at 6 months; progression-free survival; duration of response; overall survival; time to new brain metastases and rate/frequency of new intracranial lesions, all assessed using RANO-BM where applicable over up to 5 years of follow-up.

Burden on patient: Moderate to high. Participants receive continuous oral therapy in 28-day cycles with combination targeted agents, requiring frequent early safety visits for dose-escalation/monitoring (especially in the Phase 1b run-in), laboratory assessments for hepatic function, CPK, bilirubin, and hematology, as well as ECGs and echocardiography/MUGA for cardiac monitoring per protocol standards. Brain MRI with gadolinium at relatively frequent intervals is expected to assess RANO-BM responses and detect new lesions. Ocular monitoring is likely given risks of RVO and keratopathy associated with MEK-pathway agents, increasing visit burden. Drug–drug interaction restrictions and contraception requirements add complexity. No protocolised biopsies or intensive pharmacokinetic sampling are described, which moderates the burden, but travel for frequent imaging and safety evaluations, especially early in treatment or during dose escalation, remains substantial.

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Sites (2)

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University of Iowa

Iowa City, Iowa, 52242, United States

No email / 319-356-2324

Status: Recruiting

Huntsman Cancer Institute

Salt Lake City, Utah, 84112, United States

[email protected] / 801-585-0115

Status: Recruiting

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