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: Establish proof-of-principle intracranial antitumor activity of the FAK/Pyk2 inhibitor defactinib combined with the RAF/MEK clamp avutometinib in melanoma brain metastases after immune checkpoint inhibitor exposure, and define the safety, tolerability, and preliminary efficacy of adding the BRAF inhibitor encorafenib in BRAF V600E/K–mutant disease, including determination of the recommended phase II dose for the triplet.

Patients: Adults ≥18 years with histologically confirmed cutaneous melanoma and at least one untreated parenchymal brain metastasis (0.5–4.0 cm), previously treated with at least one line of systemic immunotherapy. Molecularly defined cohorts include Cohort A: RAS-mutant, BRAF-mutant, NF1-mutant, or triple wild type (including RAF fusions); Cohort B: BRAF V600E/K. ECOG 0–1 (or Karnofsky ≥70), adequate organ function, and controlled comorbidities are required. Key exclusions include uveal/mucosal melanoma, symptomatic untreated brain metastases (≥Grade 2 neurologic symptoms), leptomeningeal disease, significant cardiac, pulmonary, ocular or bleeding risk factors, strong CYP/P-gp/BCRP interacting drugs, and recent anticancer therapy within washout windows.

Design: Phase 1b/2, open-label, nonrandomized, multi-cohort study with a Phase 1b BOIN dose-escalation run-in for encorafenib in the triplet (Cohort B), followed by expansion cohorts to estimate intracranial response and characterize safety. Planned enrollment is 33 participants.

Treatments: Cohort A (Phase II): Avutometinib 3.2 mg orally twice weekly on a 3-weeks-on/1-week-off schedule plus defactinib 200 mg orally twice daily on the same 3/1 schedule. Avutometinib is a first-in-class dual RAF/MEK “clamp” that allosterically inhibits RAF and MEK and stabilizes inactive RAF–MEK complexes, limiting pathway reactivation. In LGSOC, avutometinib plus defactinib has shown a 28% response rate and high disease control with a manageable safety profile dominated by CPK elevation, fatigue, and diarrhea, supporting pathway targeting across RAS/RAF-driven tumors. Defactinib is an oral, ATP-competitive FAK/Pyk2 inhibitor (IC50 ~0.6 nM) that modulates tumor cell survival, motility, and stromal interactions; prior trials have demonstrated tolerability with gastrointestinal AEs, fatigue, and unconjugated hyperbilirubinemia, and signal in combination regimens. Cohort B (Phase Ib/II): Same backbone of avutometinib plus defactinib with continuous daily encorafenib administered orally. Phase Ib uses a Bayesian optimal interval design to evaluate safety and define the recommended phase II dose of encorafenib at 225, 300, or 450 mg daily; Phase II treats at the selected dose. Encorafenib is a BRAF inhibitor with established efficacy in BRAF V600–mutant melanoma and is combined here to intensify MAPK pathway suppression in the brain.

Outcomes: Primary endpoints: Cohort A intracranial objective response rate (ORR) by RANO-BM; Cohort B Phase 1b frequency of dose-limiting toxicities and safety to determine RP2D; Cohort B Phase II intracranial ORR by RANO-BM. Secondary endpoints: disease control rate at 6 months, progression-free survival, duration of response, overall survival, time to new brain metastases, and rate/frequency of new brain metastases, all per RANO-BM where applicable.

Burden on patient: Moderate to high. Participants receive continuous oral targeted therapy with a 3-weeks-on/1-week-off schedule for two agents and daily encorafenib in Cohort B, necessitating adherence and monitoring. Early-cycle safety assessments will likely be frequent, particularly in the Phase 1b BOIN run-in, to capture dose-limiting toxicities and manage class-specific risks (ocular exams for MEK/RAF effects, ECGs for QTc, liver and muscle enzymes, bilirubin, and renal function). Regular brain MRI with contrast is required for RANO-BM response assessments, expected every 6–8 weeks initially, adding imaging visits and contrast exposure. No mandated biopsies or PK-intensive procedures are specified, which lowers procedural burden; however, exclusion of interacting drugs and need for ophthalmologic monitoring, cardiovascular evaluation (including baseline and potential follow-up echocardiography), and potential dose modifications increase visit frequency. Travel demands will be higher during dose escalation and early treatment cycles, tapering once on a stable dose and assessment schedule.

Last updated: Oct 2025

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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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