The goal of this interventional clinical trial is to provide proof-of-principle data for the biologic activity of defactinib in combination with avutometinib in brain metastases from melanoma, and to define the potential role of the combination with mutant BRAF inhibitors or after BRAF/MEK inhibitors in BRAF V600E/K mutant tumors, in individuals with advanced melanoma who experience the development or progression of brain metastases after treatment with immune checkpoint inhibitors. The main questions it aims to answer are: * What is the preliminary response rate of defactinib and avutometinib in patients with RAS mutant, BRAF mutant, NF1 mutant, triple RAS/BRAF/NF1 wild type (wt) melanoma (including RAF fusions)? * What is the safety and tolerability of the combination of defactinib, avutometinib, and encorafenib in patients with BRAF V600E/K mutant melanoma with at least one untreated brain metastases? * What is the preliminary response rate of the three drug combination of defactinib, avutometinib, and encorafenib in patients with BRAF V600E/K mutant melanoma.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
33
Defactinib will be administered at 200 mg twice daily orally per arm description.
Avutometinib will be administered at 3.2 mg twice a week orally per arm description.
Encorafinib administered orally per arm description.
University of Iowa
Iowa City, Iowa, United States
RECRUITINGHuntsman Cancer Institute
Salt Lake City, Utah, United States
RECRUITINGResponse rate defined as Partial Response (PR) + Complete Response (CR) using Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria of all measurable target lesions present at the time of enrollment on trial.
For Cohort A, the primary objective will be to evaluate preliminary response rate of defactinib and avutometinib in patients with RAS mutant, BRAF mutant, NF1 mutant, and triple RAS/BRAF/NF1 wild type (wt) melanoma (includes RAF fusions). Measurable target lesions to be defined as all untreated and measurable (≥ 0.5 cm by 2 dimensional diameter measurements) present at the time of enrollment on study.
Time frame: 6 months
Frequency of dose limiting toxicities (DLTs).The frequency of adverse events (AEs) and serious adverse events (SAEs) characterized by type, severity (as defined by the NIH CTCAE, version 5.0), seriousness, duration, and relationship to study treatment.
For Cohort B, a Phase 1 run-in will be performed with the primary objective of evaluating the safety and tolerability of the combination of defactinib, avutometinib, and encorafenib in patients with BRAF V600E/K mutant melanoma with at least one untreated brain metastasis.
Time frame: 4 weeks
Response rate defined as Partial Response (PR) + Complete Response (CR) using Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria of all measurable target lesions present at the time of enrollment on trial.
For Cohort B, the primary objective will be to evaluate the preliminary response rate of the three drug combination of defactinib, avutometinib, and encorafenib in patients with BRAF V600E/K mutant melanoma. Measurable target lesions to be defined as all untreated and measurable (≥ 0.5 cm by 2 dimensional diameter measurements) present at the time of enrollment on study.
Time frame: 6 months
Duration of response (DoR)
To assess the duration of response (DoR) of the study population. Duration of response is defined as the interval of time from the date of initial documented response (PR or better per Neuro-Oncology Brain Metastases (RANO-BM) criteria) to the time of progression from the best response, the start of a new therapy, or death
Time frame: up to 5 years
Disease control rate as defined by the proportion of subjects achieving a confirmed PR, CR, and SD as defined by Neuro-Oncology Brain Metastases (RANO-BM) criteria.
To assess the disease control rate in the study population.
Time frame: 6 months
Progression-free survival (PFS) as defined as the time from study drug initiation to the time documented disease progression (as assessed by Neuro-Oncology Brain Metastases (RANO-BM) criteria) or death from any cause.
To assess progression-free survival (PFS)
Time frame: up to 5 years
Time to development of new brain metastases as defined as the mean time from registration until development of new measurable (≥0.5 cm diameter) brain metastases not present on baseline MRI.
To assess the time to development of new brain metastases in the study population
Time frame: up to 5 years
Rate of new brain metastases defined as percent of study population that develop new measurable brain metastases between time of enrollment and time of documented progression (target or new lesions).
To assess the rate and frequency of development of new brain metastases of the study population. Frequency of new brain metastases defined as the number of new measurable brain metastases that develop in a particular patient between time of enrollment and time of documented progression (target or new lesions).
Time frame: up to 5 years
Overall survival (OS) defined as the time of study drug initiation until death from any cause
To assess overall survival
Time frame: up to 5 years
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