Sponsor: University of Utah (other)
Phase: 1/2
Start date: March 7, 2024
Planned enrollment: 33
Defactinib (PF-04554878; VS-6063) is an oral small‑molecule inhibitor of focal adhesion kinase (FAK; PTK2) with additional activity against PYK2. It has been studied as monotherapy and in combinations across multiple solid tumors, including mesothelioma, ovarian cancer, and pancreatic cancer. In May 2025, the FDA granted accelerated approval to the combination of avutometinib (RAF/MEK clamp) plus defactinib for adults with KRAS‑mutated, recurrent low‑grade serous ovarian cancer (LGSOC) after prior systemic therapy. Defactinib itself remains investigational outside this co‑packaged combination. (pubmed.ncbi.nlm.nih.gov)
Phase 1/2 (FRAME, first‑in‑human combo): In LGSOC, ORR 42.3% and median PFS 20.1 months; in KRAS‑mutant LGSOC, ORR 58.3% and median PFS 30.8 months. (pubmed.ncbi.nlm.nih.gov)
Malignant pleural mesothelioma (maintenance monotherapy)
COMMAND randomized, double‑blind, phase 2 (post‑platinum maintenance; merlin‑stratified): No improvement versus placebo in PFS (4.1 vs 4.0 months) or OS (12.7 vs 13.6 months); results did not support use as maintenance therapy. (ascopubs.org)
Pancreatic ductal adenocarcinoma (investigator‑initiated combinations)
Last updated: Oct 2025
Avutometinib (also known as RO-5126766, CKI-27, CH-5126766, R-7304, RG-7304, VS-6766) is an oral, small‑molecule “RAF–MEK clamp” developed to inhibit the MAPK pathway by simultaneously blocking MEK activity and preventing RAF from phosphorylating and reactivating MEK via feedback. In May 2025, the FDA granted accelerated approval to avutometinib combined with the FAK inhibitor defactinib for adults with recurrent, KRAS‑mutated low‑grade serous ovarian cancer (LGSOC) after prior systemic therapy. (pubmed.ncbi.nlm.nih.gov)
Low‑grade serous ovarian cancer (LGSOC)
Other tumor types (emerging data)
Confirmatory/ongoing trials
Notes: As of October 7, 2025, avutometinib + defactinib holds U.S. accelerated approval for recurrent, KRAS‑mutated LGSOC based on ORR; confirmatory benefit on PFS is being tested in RAMP‑301. (fda.gov)
Last updated: Oct 2025
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
Inclusion Criteria:
* Age ≥ 18 years at the time of informed consent.
* Provide written informed consent and comply with the study protocol as judged by the Investigator. Of note, If the subject has an impairment that prevents him/her from providing written consent, the site may follow local institutional procedures for obtaining consent.
* Histologically confirmed diagnosis of cutaneous melanoma with radiographically confirmed metastases to the brain.
* Must have a tumor with known RAS, BRAF, and NF1 mutation status using a validated testing method prior to enrollment.
* Cohort A: RAS, BRAF, NF1, or triple wildtype
* Cohort B: BRAF V600E or BRAF V600K
* Must have at least 1 untreated (no prior resection or radiation of the target lesion) parenchymal brain metastasis with minimal dimensions of ≥ 0.5 cm diameter and maximal dimensions ≤ 4 cm diameter, measured from a gadolinium enhanced MRI T1 sequence.
* Note: Subject may have received prior resection or radiation therapy for prior brain metastases.
* Must have received at least 1 line of prior systemic immunotherapy.
* For Cohort B, may have received 1 or more lines of prior BRAF or MEK inhibitor therapy.
* An ECOG Performance Status of 0 or 1, or Karnofsky score \>= 70
* Adequate bone marrow, organ function and laboratory parameters:
* ANC ≥ 1.5 × 109/L;
* Hemoglobin ≥ 9 g/dL with or without transfusions;
* Platelets ≥100,000/mm2;
* AST and ALT ≤ 2.5 × ULN; in patients with liver metastases ≤ 5 × ULN;
* Total bilirubin ≤ 1.5 × ULN; NOTE: Patients with documented Gilbert syndrome or hyperbilirubinemia due to non-hepatic cause (e.g., hemolysis, hematoma) may be enrolled
* Serum creatinine ≤ 1.5 × ULN; OR calculated creatinine clearance \> 50 mL/min by Cockcroft-Gault formula; OR estimated glomerular filtration rate \> 50 mL/min/1.73m2.
* International normalized ratio (INR), prothrombin time (PT), or activated partial thromboplastin time (aPTT) as follows:
* In the absence of therapeutic intent to anticoagulate the patient:
* INR \< 1.5 × ULN.
* PT \< 1.5 × ULN.
* aPTT \< 1.5 × ULN.
* Adequate cardiac function with left ventricular ejection fraction ≥ 55% by echocardiography (ECHO) or multiple-gated acquisition (MUGA) scan.
* For women (any individual assigned female at birth) who are not postmenopausal (ie, \< 2 years after last menstruation) or surgically sterile (absence of ovaries and/or uterus) and who are sexually active, must have a negative serum pregnancy test and agree to use a highly effective method of contraception for the duration of the study and for 90 days following the last dose of study drug.
* Male patients (any individual assigned male at birth) of reproductive potential must avoid pregnancy in partners who are women of childbearing potential, and such partners should not consider getting pregnant during the study and for at least 90 days after treatment is discontinued or longer if requested by local authorities. Male patients are considered to be of reproductive potential unless permanently sterile by bilateral orchidectomy or vasectomized with appropriate post-vasectomy documentation of absence of sperm in ejaculate.
* Adequate recovery to baseline or ≤ Grade 1 CTCAE v5 from toxicities related to any prior treatments, unless AE(s) are clinically nonsignificant and/or stable on supportive therapy per the treating investigator. Exceptions include alopecia and peripheral neuropathy grade ≤ 2.
Exclusion Criteria:
* Receiving other investigational agents.
* Prior systemic anti-cancer therapy or any investigational therapy ≤ 28 days or within five half-lives prior to starting study treatment, whichever is shorter.
* Patients with symptomatic brain metastasis, defined as neurologic symptoms with localization attributable to an untreated brain metastases with severity \>= Grade 2 by CTCAE criteria.
* History of allergy or hypersensitivity to any of the study treatments or any of their excipients.
* Inability to swallow and retain study treatment.
* Uveal or mucosal melanoma.
* History of or current leptomeningeal metastases.
* QTcF \> 450 msec if male and QTcF \> 470 msec if female.
* Any hemorrhage or bleeding event that is ≥ Grade 3 based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event (CTCAE) or Grade 2 intracranial hemorrhage within 4 weeks prior to the start of study treatment.
* Uncontrolled or severe cardiac disease (eg, history of unstable angina, myocardial infarction, coronary stenting, or bypass surgery within the last 6 months prior to initiation of study treatment), symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia (including atrial flutter/fibrillation), requirement for inotropic support or use of devices for cardiac conditions (eg, pacemakers/defibrillators), or hypertension (patients with systolic blood pressure \[BP\] of \> 160 mm Hg or diastolic BP of \> 100 mm Hg despite optimal medical management are to be excluded).
* History of interstitial lung disease, history of slowly progressive dyspnea and unproductive cough, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis, or symptomatic pleural effusion.
* Active, known, or suspected uncontrolled autoimmune disease, which required therapy in the past 2 years, including but not limited to systemic lupus erythematosus, Hashimotos thyroiditis, scleroderma, polyarteritis nodosa, or autoimmune hepatitis.
* Known HIV infection with a detectable viral load within 6 months of the anticipated start of treatment. Note: Participants on effective antiretroviral therapy with an undetectable viral load within 6 months of the anticipated start of treatment are eligible for this trial.
* Systemic active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination, radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), or hepatitis C. Note: Participants with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody \[anti-HBc\] and absence of HBsAg) are eligible. Participants positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
* History of bleeding diathesis (irrespective of severity) in the absence of therapeutic anticoagulation.
* Uncontrolled intercurrent illness including, but not limited to ongoing or active infection.
* Any condition that could make the patient noncompliant with the study procedures and/or study requirements, as judged by the Investigator.
* Active skin disorder that has required systemic therapy within the past 1 year.
* History of rhabdomyolysis.
* Concurrent ocular disorders:
* Patients with history of glaucoma, history of retinal vein occlusion (RVO), predisposing factors for RVO, including uncontrolled hypertension, uncontrolled diabetes.
* Patients with history of retinal pathology or evidence of visible retinal pathology that is considered a risk factor for RVO, intraocular pressure \> 21 mm Hg as measured by tonometry, or other significant ocular pathology, such as anatomical abnormalities that increase the risk for RVO.
* Patients with active or chronic, visually significant corneal disorders, other active ocular conditions requiring ongoing therapy or clinically significant corneal disease that prevents adequate monitoring of drug-induced keratopathy. Examples of visually significant corneal disorders include corneal degeneration, active or recurrent keratitis, and other forms of serious ocular surface inflammatory conditions. Visually significant corneal disorders do NOT include dry eyes, blepharitis, and uncomplicated corneal erosions.
* Patients with a history of hypersensitivity to any of the active (avutometinib, defactinib, encorafenib) or inactive ingredients of the investigational products.
* Exposure to medications (with or without prescriptions), supplements, herbal remedies, or foods with potential for drug-drug interactions with study interventions within 14 days prior to the first dose of study intervention and during the course of therapy, including:
* Strong CYP3A4 inhibitors or inducers, due to potential drug-drug interactions with both avutometinib and defactinib.
* Strong CYP2C9 inhibitors or inducers, due to potential drug-drug interactions with defactinib.
* Strong P-glycoprotein (P-gp) inhibitors or inducers, due to potential drug-drug interactions with both avutometinib and defactinib.
* Strong breast cancer resistance protein (BCRP) inhibitors or inducers, due to potential drug-drug interactions with avutometinib.
* Concomitant treatment with warfarin. Patients who require anticoagulation but cannot discontinue warfarin must be excluded from the study.
* Participants taking other prohibited medications in protocol, including anticancer therapy or investigational agents and colony-stimulating factors (CSFs). A washout period of prohibited medications for a period of at least five half-lives or as clinically indicated should occur before the start of treatment.
* The diagnosis of another malignancy within ≤ 2 years before study enrollment, except for those considered to be adequately treated with no evidence of disease or symptoms and/or will not require therapy during the study duration (i.e., basal cell or squamous cell skin cancer, carcinoma in situ of the breast, bladder or of the cervix, or low-grade prostate cancer with Gleason Score ≤ 6)
* Any other condition that would, in the Investigator's judgment, contraindicate the subject's participation in the clinical study due to safety concerns or compliance with clinical study procedures (e.g., infection/inflammation, intestinal obstruction, unable to swallow medication, \[subjects may not receive the drug through a feeding tube\], social/ psychological issues, etc.)
* Medical, psychiatric, cognitive, or other conditions that may compromise the subject's ability to understand the subject information, give informed consent, comply with the study protocol or complete the study.
Iowa City, Iowa, 52242, United States
No email / 319-356-2324
Status: Recruiting
Salt Lake City, Utah, 84112, United States
[email protected] / 801-585-0115
Status: Recruiting