1. Initial Evidence for the Efficacy of Naporafenib in Combination With Trametinib in NRAS-Mutant Melanoma: Results From the Expansion Arm of a Phase Ib, Open-Label Study
- Author
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de Braud, Filippo, Dooms, Christophe, Heist, Rebecca S, Lebbe, Celeste, Wermke, Martin, Gazzah, Anas, Schadendorf, Dirk, Rutkowski, Piotr, Wolf, Jürgen, Ascierto, Paolo A, Gil-Bazo, Ignacio, Kato, Shumei, Wolodarski, Maria, McKean, Meredith, Couselo, Eva Muñoz, Sebastian, Martin, Santoro, Armando, Cooke, Vesselina, Manganelli, Luca, Wan, Kitty, Gaur, Anil, Kim, Jaeyeon, Caponigro, Giordano, Couillebault, Xuân-Mai, Evans, Helen, Campbell, Catarina D, Basu, Sumit, Moschetta, Michele, and Daud, Adil
- Subjects
Cancer ,Genetics ,Clinical Trials and Supportive Activities ,Clinical Research ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Humans ,Proto-Oncogene Proteins B-raf ,Carcinoma ,Non-Small-Cell Lung ,Lung Neoplasms ,Melanoma ,Pyridones ,Pyrimidinones ,Exanthema ,Antineoplastic Combined Chemotherapy Protocols ,Mutation ,Membrane Proteins ,GTP Phosphohydrolases ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeNo approved targeted therapy for the treatment of patients with neuroblastoma RAS viral (v-ras) oncogene homolog (NRAS)-mutant melanoma is currently available.Patients and methodsIn this phase Ib escalation/expansion study (ClinicalTrials.gov identifier: NCT02974725), the safety, tolerability, and preliminary antitumor activity of naporafenib (LXH254), a BRAF/CRAF protein kinases inhibitor, were explored in combination with trametinib in patients with advanced/metastatic KRAS- or BRAF-mutant non-small-cell lung cancer (escalation arm) or NRAS-mutant melanoma (escalation and expansion arms).ResultsThirty-six and 30 patients were enrolled in escalation and expansion, respectively. During escalation, six patients reported grade ≥3 dose-limiting toxicities, including dermatitis acneiform (n = 2), maculopapular rash (n = 2), increased lipase (n = 1), and Stevens-Johnson syndrome (n = 1). The recommended doses for expansion were naporafenib 200 mg twice a day plus trametinib 1 mg once daily and naporafenib 400 mg twice a day plus trametinib 0.5 mg once daily. During expansion, all 30 patients experienced a treatment-related adverse event, the most common being rash (80%, n = 24), blood creatine phosphokinase increased, diarrhea, and nausea (30%, n = 9 each). In expansion, the objective response rate, median duration of response, and median progression-free survival were 46.7% (95% CI, 21.3 to 73.4; 7 of 15 patients), 3.75 (95% CI, 1.97 to not estimable [NE]) months, and 5.52 months, respectively, in patients treated with naporafenib 200 mg twice a day plus trametinib 1 mg once daily, and 13.3% (95% CI, 1.7 to 40.5; 2 of 15 patients), 3.75 (95% CI, 2.04 to NE) months, and 4.21 months, respectively, in patients treated with naporafenib 400 mg twice a day plus trametinib 0.5 mg once daily.ConclusionNaporafenib plus trametinib showed promising preliminary antitumor activity in patients with NRAS-mutant melanoma. Prophylactic strategies aimed to lower the incidence of skin-related events are under investigation.
- Published
- 2023