PRIMARY OBJECTIVES:
I. To describe overall response rate (ORR) upon treatment with encorafenib, cetuximab, and
nivolumab.
II. To determine the safety and tolerability of nivolumab, encorafenib, and cetuximab.
SECONDARY OBJECTIVES:
I. To estimate median progression-free survival (PFS) upon treatment with encorafenib,
cetuximab, and nivolumab.
II. To estimate median overall survival (OS) upon treatment with encorafenib, cetuximab, and
nivolumab.
III. To estimate median time to response (TTR) upon treatment with encorafenib, cetuximab,
and nivolumab.
IV. To estimate median duration of response (DOR) upon treatment with encorafenib, cetuximab,
and nivolumab.
V. To estimate disease control rate (DCR) upon treatment with encorafenib, cetuximab, and
nivolumab.
EXPLORATORY OBJECTIVES:
I. To assess genomic and immune changes upon treatment with encorafenib, cetuximab, and
nivolumab.
II. To demonstrate feasibility of establishing humanized patient-derived xenograft models in
matched patients with BRAFV600E metastatic colorectal cancer (mCRC).
OUTLINE: This is a phase I, dose-escalation study followed by a phase II study.
Patients receive encorafenib orally (PO) once daily (QD) on days 1-28, cetuximab
intravenously (IV) over 1 hour on days 1 and 15, and nivolumab IV over 30 minutes on day 1.
Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 and 100 days, at 3
months, and then every 3 months thereafter.
Inclusion Criteria:
- Provision of signed informed consent prior to any screening procedures being performed
- Histologically (or cytologically) confirmed diagnosis of adenocarcinoma of the colon
or rectum, with clinical confirmation of unresectable and/or metastatic disease that
is measurable according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
criteria
- Confirmation of BRAFV600E tumor as detected by a Clinical Laboratory Improvement
Amendments (CLIA)-certified laboratory
- Confirmation of microsatellite stable (MSS) status in a CLIA-certified laboratory
- Prior treatment with at least one, but no more than two, systemic chemotherapy
regimen(s) for mCRC, or recurrence/progression with development of unresectable or
metastatic disease within 6 months of adjuvant chemotherapy for resected colorectal
cancer
- Eastern Cooperative Oncology Group (ECOG) performance status =< to 1
- Absolute neutrophil count (ANC) >= 1.0 x 10^9/L
- Hemoglobin (Hgb) >= 9 g/dL with or without transfusions
- Platelets (PLT) >= 100 x 10^9/L without transfusions
- Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) =< 2.5 x upper
limit of normal (ULN)
- Total bilirubin =< to 1.5 x ULN and < 2 mg/dL
- Note: Patients who have a total bilirubin level > 1.5 x ULN will be allowed if
their indirect bilirubin level is =< 1.5 x ULN
- Serum creatinine =< 1.5 x ULN, or calculated creatinine clearance (determined as per
Cockcroft-Gault) >= 50 mL/min at screening
- Corrected QT (QTc) interval =< 480 ms (preferably the mean) from triplicate
electrocardiograms (ECGs)
- Able to take oral medications
- Female patients are either postmenopausal for at least 1 year, are surgically sterile
for at least 6 weeks, or must agree to take appropriate precautions to avoid pregnancy
from screening through follow-up if of childbearing potential. Note: Permitted
contraception methods should be communicated to the patients and their understanding
confirmed. For all females, the pregnancy test result must be negative within 24 hours
of starting treatment with nivolumab. Males to avoid fathering a child from screening
through 100 days following the end of therapy
Exclusion Criteria:
- Concurrent corticosteroid therapy or concurrent use of any other immunosuppressive
medication (corticosteroid use on study as a pre-medication for IV contrast
allergies/reactions is allowed). Subjects who are receiving daily steroid replacement
therapy (the equivalent of prednisone =< 10 mg daily) serve as an exception to this
rule
- Prior treatment with a BRAF inhibitor, MEK inhibitor, or ERK inhibitor (of note,
regorafenib is not considered a BRAF inhibitor for the context of eligibility
criteria)
- Prior treatment with anti-EGFR therapies
- Prior immune checkpoint therapy including, but not limited to, an anti-PD-1,
anti-PD-L1, anti-PD-L2, anti-CD137, or anti-cytotoxic T-lymphocyte-associated
antigen-4 (CTLA-4) antibody, or any other prior immune-modulating agent administered
with antineoplastic intent (monoclonal antibodies used against VEGF are permitted)
- Prior allogeneic tissue/solid organ transplant
- History of (non-infectious) pneumonitis that has required oral or IV steroids
- Receipt of a live vaccine within 30 days prior to the first administration of study
medication. Seasonal flu vaccines that do not contain a live virus are permitted
- History of a grade 3 or 4 allergic reaction attributed to humanized or human
monoclonal antibody therapy
- Active infection requiring concurrent antibiotic use
- Any symptomatic brain metastasis. Note: Patients previously treated or untreated for
this condition who are asymptomatic in the absence of corticosteroid and
anti-epileptic therapy are allowed. Brain metastases must be stable for > or equal to
4 weeks, with imaging (e.g., magnetic resonance imaging [MRI] or computed tomography
[CT]) demonstrating no current evidence of progressive brain metastases at screening
- Leptomeningeal disease
- Previous or concurrent malignancy within 3 years of study entry, with the following
exceptions: adequately treated basal or squamous cell skin cancer, superficial bladder
cancer, prostate intraepithelial neoplasm, carcinoma in-situ of the cervix, or other
noninvasive or indolent malignancy; other solid tumors treated curatively without
evidence of recurrence for at least 3 years prior to study entry
- History of acute coronary syndromes (including myocardial infarction, unstable angina,
coronary artery bypass grafting, coronary angioplasty, or stenting) < 6 months prior
to screening, symptomatic chronic heart failure (i.e. grade 2 or higher), history or
current evidence of clinically significant cardiac arrhythmia and/or conduction
abnormality < 6 months prior to screening except atrial fibrillation and paroxysmal
supraventricular tachycardia
- Uncontrolled hypertension defined as persistent elevation of systolic blood pressure
>= 170 mmHg or diastolic blood pressure >= 100 mm Hg, despite current therapy
- Known positive serology for HIV (human immunodeficiency virus), active hepatitis B,
and/or active hepatitis C infection
- Known history of acute or chronic pancreatitis (history of acute pancreatitis with no
recurrent events in the prior 24 months are permitted)
- Patients with a history of inflammatory bowel disease, including ulcerative colitis
and Crohn's disease, are excluded from this study, as are patients with a history of
symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic progressive
sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [e.g.,
Wegener's granulomatosis]); central nervous system (CNS) or motor neuropathy
considered of autoimmune origin (e.g., Guillain-Barre syndrome and myasthenia gravis,
multiple sclerosis). Patients with Graves' disease will be allowed
- Impaired gastrointestinal function or disease that may significantly alter the
absorption of study drug (e.g., ulcerative diseases, uncontrolled vomiting,
malabsorption syndrome, small bowel resection with decreased intestinal absorption)
- Any other condition that would, in the investigator's judgment, contraindicate the
patient's participation in the clinical study due to safety concerns or compliance
with clinical study procedures
- Major surgery =< 6 weeks prior to starting study drug or failure to recover from side
effects of such procedure at the discretion of the treating investigator
- Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a
female after conception and until the termination of gestation, confirmed by a
positive human chorionic gonadotropin (hCG) laboratory test
- Medical, psychiatric, cognitive or other conditions, according to investigator
judgment, that may compromise the patient's ability to understand the patient
information, give informed consent, comply with the study protocol or complete the
study