This phase I/II trial investigates the best dose, possible benefits and/or side effects of tazemetostat in combination with dabrafenib and trametinib in treating patients with melanoma that has a specific mutation in the BRAF gene (BRAFV600) and that has spread from where it first started (primary site) to other places in the body (metastatic). Tazemetostat, dabrafenib, and trametinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving tazemetostat in combination with dabrafenib and trametinib may stabilize BRAFV600 mutated melanoma.
PRIMARY OBJECTIVES: I. To identify a maximum tolerated dose for the EZH2 inhibitor, tazemetostat hydrobromide (tazemetostat), when used in combination with dual BRAF inhibitor (dabrafenib mesylate \[dabrafenib\]) and MEK inhibitor (trametinib dimethyl sulfoxide \[trametinib\]) therapy in BRAF/MEK inhibitor-resistant, BRAF\^V600-mutated metastatic melanoma. (Phase 1) II. To determine if the addition of the EZH2 inhibitor, tazemetostat, to BRAF and MEK inhibitor therapy improves progression-free survival over single-agent EZH2 inhibitor therapy in patients with BRAF/MEK inhibitor-resistant, BRAF\^V600-mutated melanomas harboring an EZH2 alteration. (Phase 2) SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity. (Phase 1) II. To determine the overall response rate of single-agent EZH2 inhibitor therapy (tazemetostat) and triplet EZH2 inhibitor (tazemetostat), BRAF inhibitor (dabrafenib) and MEK inhibitor (trametinib) therapy in patients with BRAF/MEK inhibitor-resistant BRAF\^V600-mutated melanomas harboring an EZH2 alteration. (Phase 2) EXPLORATORY OBJECTIVE: I. To explore alterations in the gene expression profile (ribonucleic acid \[RNA\]-sequencing), H3K27 methylome (immunohistochemistry \[IHC\], chromatin immunoprecipitation \[ChIP\]-Sequencing), and open chromatin landscape (assay for transposase accessible chromatin \[ATAC\]-sequencing) with EZH2 inhibition in fresh clinical or patient derived xenograft (PDX)-derived tumor samples, which may reveal underlying transcriptional/epigenetic pathways mediating response to treatment. OUTLINE: This is a phase I, dose-escalation trial of tazemetostat followed by a phase II trial. Patients in the phase I trial receive treatment as in Arm 2. Patients in the phase II trial are randomized to Arm 1 or Arm 2. Phase I Dose Level 1: Patients receive tazemetostat 400 mg orally (PO) twice daily (BID), dabrafenib 150 mg PO BID, and trametinib 2 mg PO once daily (QD) on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo tumor biopsy, computed tomography (CT) scan, magnetic resonance imaging (MRI), and multigated acquisition scan (MUGA) or echocardiography (ECHO) throughout the study. Dose Level 2: Patients receive tazemetostat 600 mg PO BID, dabrafenib 150 mg PO BID, and trametinib 2 mg PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo tumor biopsy, CT scan, MRI, and MUGA or ECHO throughout the study. Dose Level 3: Patients receive tazemetostat 800 mg PO BID, dabrafenib 150 mg PO BID, and trametinib 2 mg PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo tumor biopsy, CT scan, MRI, and MUGA or ECHO throughout the study. Phase II ARM 1: Patients receive tazemetostat PO BID on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan and MRI throughout the study. At the time of progression, patients may crossover to Arm 2 after completion of radiation therapy. ARM 2: Patients receive tazemetostat PO BID, dabrafenib PO BID, and trametinib PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo tumor biopsy, CT scan, MRI, and MUGA or ECHO throughout the study. After completion of study treatment, patients are followed up at 30 days, and then annually thereafter.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
Undergo tumor biopsy
Undergo CT scan
Given PO
Undergo ECHO
Undergo MRI
Undergo MUGA
Given PO
Given PO
UM Sylvester Comprehensive Cancer Center at Aventura
Aventura, Florida, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables, Florida, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, United States
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation, Florida, United States
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, United States
Northwestern University
Chicago, Illinois, United States
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, United States
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, United States
Washington University School of Medicine
St Louis, Missouri, United States
...and 7 more locations
Recommended Phase 2 Dose (Phase I)
In the phase I portion of the study, eligible patients with dual BRAF/MEK inhibitor-resistant BRAFV600-mutated metastatic melanoma will be treated with escalating doses of tazemetostat plus dabrafenib and trametinib. The maximum tolerated dose (MTD) is defined as the highest dose level at which ≤1 out of 6 subjects experience a Dose Limiting Toxicity (DLT). The MTD will be the recommended phase 2 dose (RP2D) for the expansion cohort. The RP2D will be determined using the standard 3+3 algorithm. Toxicities by grade, number of cycles administered, and response to treatment will be listed for each dose level.
Time frame: The DLT observation window is 30 days
Median Progression-free Survival (PFS) (Phase II)
Median PFS in each arm will be assessed using Kaplan-Meier product limit methods and the randomized arms will be compared using log-rank test (at 0.15 one-sided significance level) when 36 PFS events are observed.
Time frame: At 6 and 12 months
Overall Response Rates (Complete Response, Partial Response)
Assessed by Response Evaluation Criteria in Solid Tumors 1.1, and 95% confidence intervals will be calculated. Response assessments were performed every 3 months. Responses were categorized as follows: Complete Response (CR); disappearance of all target lesions, Partial Response (PR); at least a 30% decrease in the sum of target lesions, Progressive Disease (PD); at least a 20% increase in the sum of target lesions, Stable Disease (SD); to enough increase to be PR, nor enough decrease to be PD.
Time frame: Up to 3 years
Overall Survival
Will be estimated in each arm using Kaplan-Meier product limit methods, and its 95% confidence interval will be calculated.
Time frame: Up to 3 years
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