Inclusion Criteria:
- Ability to understand and the willingness to sign a written informed consent document
- Histologically (or cytologically) confirmed diagnosis of metastatic, radioiodine (RAI)
refractory, BRAFV600E/M mutant differentiated thyroid cancer (DTC)
- Note: RAI refractoriness is defined as:
- The absence of uptake of RAI on either a low-dose diagnostic whole body
scan, or a post-treatment RAI scan in measurable lesions
- Radiographic progression of disease within 12 months of the last course of
RAI treatment, or
- Having a cumulative lifetime administered dose of > 600 mCi of RAI
- Measurable disease meeting the following criteria and confirmed by radiography review:
- At least 1 lesion of >= 1.0 cm in the longest diameter for a non-lymph node or >
1.5 cm in the short-axis diameter for a lymph node metastasis that is serially
measurable according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
using computed tomography/magnetic resonance imaging (CT/MRI). If there is only 1
target lesion and it is a non-lymph node, it should have a longest diameter of >=
1.5 cm
- Lesions that have had external beam radiotherapy or locoregional therapies such
as radiofrequency (RF) ablation must show evidence of progressive disease based
on RECIST 1.1 to be deemed a target lesion.
- Eastern Cooperative Oncology Group (ECOG) performance status =< 1
- Absolute neutrophil count (ANC) >= 1.5 x 10^9/L
- Hemoglobin (Hgb) >= 9 g/dL
- Platelets (PLT) >= 75 x 10^9/L
- Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) =< 2.5 x upper
limit of normal (ULN); participants with liver metastases =< 5 x ULN
- Total bilirubin =< 1.5 x ULN
- Note: Individuals who have a total bilirubin level > 1.5 x ULN will be allowed if
their indirect bilirubin level is =< 1.5 x ULN (i.e., participants with suspected
or known diagnosis of Gilbert?s syndrome)
- Serum creatinine =< 1.5 x ULN, or calculated creatinine clearance (determined as per
Cockcroft-Gault) >= 40 mL/min at screening
- Left ventricular ejection fraction (LVEF) >= 50% as determined by a multigated
acquisition (MUGA) scan or echocardiogram
- Triplicate average baseline corrected QT (QTc) interval =< 480 ms
- Participants of childbearing potential must have a negative serum or urine pregnancy
test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin
[HCG]) within 72 hours prior to the start of assigned study intervention
- Participants of child-bearing potential agree to use highly effective methods of
contraception starting with the first dose of assigned study intervention through 6
months after the last dose of study therapy
- Participants of childbearing potential are those who are not proven postmenopausal.
Postmenopausal is defined as any of the following:
- Amenorrheic for 1 year or more following cessation of exogenous hormonal
treatments
- Luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels in the
post-menopausal range for women under 50
- Radiation-induced oophorectomy with last menses > 1 year ago
- Chemotherapy-induced menopause with > 1 year interval since last menses
- Surgical sterilization (bilateral oophorectomy or hysterectomy)
- Male participants must agree to use an adequate method of contraception starting with
the first dose of study therapy through 6 months after the last dose of study therapy
Exclusion Criteria:
- Currently participating and receiving study therapy or has participated in a study of
an investigational agent and received study therapy or used an investigational
agent/device within 4 weeks of first dose of study intervention
- Note: Individuals in the follow-up phase of a prior investigational study may
participate as long as it has been 4 weeks since last dose of the previous
investigational agent of device
- Participants with active, known, or suspected autoimmune disease. Participants with
type I diabetes mellitus, residual hypothyroidism due to autoimmune thyroiditis only
requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or
alopecia) not requiring systemic treatment are permitted to enroll
- Prior treatment with selective/potent BRAF/MEK inhibitors including vemurafenib,
dabrafenib, encorafenib, selumetinib, trametinib, cobimetinib, binimetinib.
- Note: Prior therapy with oral multikinase inhibitors (e.g., lenvatinib,
sorafenib, cabozantinib, pazopanib, sunitinib, etc.) remain eligible for study
participation.
- Prior treatment with anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-CTLA-4
antibody (including ipilimumab or any other antibody or drug specifically targeting T
cell co-stimulation or immune checkpoint pathways)
- Participants with a condition requiring systemic treatment with either corticosteroids
(>= 10 mg daily prednisone or equivalent) or other immunosuppressive medications
within 14 days of study drug administration. Inhaled or topical steroids are permitted
in the absence of active autoimmune disease
- History of allergy or hypersensitivity to any monoclonal antibody
- History or current evidence of retinal vein occlusion (RVO) or current risk factors to
RVO (e.g. uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or
hypercoagulability syndromes); history of retinal degenerative 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; OR
- Other solid tumors treated curatively in which the expected rate of recurrence
within 5 years is < 5%
- Impaired cardiovascular function or clinically significant cardiovascular diseases,
including any of the following:
- History of acute coronary syndromes (including myocardial infarction, unstable
angina, coronary artery bypass grafting, coronary angioplasty, or stenting) < 6
months prior to screening
- Symptomatic congestive 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. Exceptions include
asymptomatic/well-controlled atrial fibrillation/flutter or paroxysmal
supraventricular tachycardia
- Uncontrolled hypertension defined as persistent elevation of systolic blood
pressure >= 150 mmHg or diastolic blood pressure >= 100 mmHg, despite medical
therapy
- History of thromboembolic or cerebrovascular events =< 12 weeks prior to the first
dose of study treatment. Examples include transient ischemic attacks, cerebrovascular
accidents, hemodynamically significant (i.e., massive or sub-massive) deep vein
thrombosis or pulmonary emboli
- Note: Individuals with either deep vein thrombosis or pulmonary emboli that does
not result in hemodynamic instability are allowed to enroll as long as they are
on a stable dose of anticoagulants for at least 4 weeks
- Note: Individuals with thromboembolic events related to indwelling catheters or
other procedures may be enrolled
- Known positive serology for HIV (human immunodeficiency virus), active hepatitis B,
and/or active hepatitis C infection
- Known history of acute or chronic pancreatitis
- Impaired gastrointestinal function or disease that may significantly alter the
absorption of encorafenib or binimetinib (e.g., uncontrolled vomiting or malabsorption
syndrome)
- Concurrent neuromuscular disorder that is associated with the potential of elevated
creatine kinase (CK) (e.g., inflammatory myopathies, muscular dystrophy, amyotrophic
lateral sclerosis, spinal muscular atrophy)
- Current use of a prohibited medication (including herbal medications, supplements, or
foods), as described, or use of a prohibited medication =< 1 week prior to the start
of study treatment
- Any other condition that would, in the investigator?s judgment, contraindicate an
individual?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, social/ psychological issues, etc
- Participants who have undergone major surgery (e.g., intracranial, intrathoracic, or
intra-abdominal surgery) =< 3 weeks prior to starting study drug or who have not
recovered from side effects of such procedure
- Participants that are pregnant or nursing (lactating)
- Prisoners or individuals who are involuntarily incarcerated
- Medical, psychiatric, cognitive or other conditions that may compromise the
participant?s ability to understand the patient information, give informed consent,
comply with the study protocol or complete the study