| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Colorectal cancer (BRAF V600E-mutant mCRC) |
|
| E.1.1.1 | Medical condition in easily understood language |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 21.0 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10061451 |
| E.1.2 | Term | Colorectal cancer |
| E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
Safety Lead-In:
To determine the safety and tolerability of EC + mFOLFOX6 and EC + FOLFIRI
Phase 3:
• To compare the efficacy of EC + mFOLFOX6 (Arm B) vs SOC (Control Arm [Arm C]) as measured by PFS and by ORR
Cohort 3:
• To compare the efficacy of EC + FOLFIRI (Arm D) vs FOLFIRI with or without bevacizumab (Control Arm [Arm E]) as measured by ORR |
|
| E.2.2 | Secondary objectives of the trial |
Safety Lead-In:
Assess the overall safety and tolerability of EC + mFOLFOX6 and EC + FOLFIRI
Estimate the efficacy of EC + mFOLFOX6 and EC + FOLFIRI
Estimate the efficacy of EC + mFOLFOX6 and EC + FOLFIRI
Characterize the PK of encorafenib, irinotecan, oxaliplatin and relevant metabolite
Assess drug-drug interaction of encorafenib with irinotecan or oxaliplatin
Ph3
Further compare the efficacy of Arm B vs the Control Arm as measured by OS
Further evaluate efficacy of Arm B vs the Control Arm as measured by ORR, DOR, PFS, PFS2 and TTR
Evaluate efficacy of EC (Arm A) vs the Control Arm as measured by ORR, DOR, PFS, PFS2, TTR and OS
Evaluate efficacy of Arm A vs Arm B as measured by OS, PFS, PFS2, ORR, DOR and TTR
Determine the safety and tolerability of EC
Determine the safety and tolerability of EC + mFOLFOX6
Cohort 3:
Further compare the efficacy of Arm D vs Arm E as measured by PFS
For full list please see section 3 of the protocol |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
Molecular Prescreening Inclusion Criteria
Age and Sex:
1. SLI: Male or female participants age ≥18 years at the time of informed consent.
Phase 3 and Cohort 3: Male or female participants age ≥16 years at the time of informed consent/assent in all countries where permitted. In countries or sites where enrollment of adolescents is not permitted (eg, Germany), male or female participants age ≥18 years at the time of informed consent.
Refer to Appendix 4 for reproductive criteria for male (Section 10.4.1) and female (Section 10.4.2) participants.
Weight:
2. Body weight ≥40 kg.
Type of Participant and Disease Characteristics:
3. Participants with histologically or cytologically confirmed colorectal adenocarcinoma.
4. Participants with evidence of Stage IV metastatic disease.
Note: Patients with oligometastatic disease previously treated with curative intent are eligible to participate in the study as long as they have baseline measurable disease per RECIST 1.1. Oligometastatic colorectal cancer is characterized by a limited metastatic spread of disease. Oligometastatic disease is defined as the involvement of up to 3 sites with 5 or sometimes more metastases that for their anatomic localization is amenable to local therapies, thus rendering the patient free of disease.
5. Able to provide a sufficient amount of representative tumor specimen for central testing of BRAF V600E mutation status and tumor tissue assessment
Note: Tumor sample can be archival or de novo (newly collected fixed biopsy sample) and must be in an FFPE block, or provide a minimum of 15 unstained slides of analyzable tissue. This tissue specimen should be obtained from a biopsy or surgery that was performed within 2 years prior to study enrollment. Participants with fewer than the required number of slides with analyzable tissue may be considered eligible if the Sponsor determines that the slides are sufficient for central testing.
Informed Consent/Assent:
6. Capable of giving signed informed consent/assent as described in 54TAppendix 154T, which includes compliance with the requirements and restrictions listed in the ICD and in this protocol.
Note: Participants ≥16 years old that are under guardianship may participate with the consent of their legally authorized guardian if permitted by local regulations. When appropriate, adolescent participants will be included in all discussions (see Section 10.1.3).
5.1.2. Screening Inclusion Criteria
Type of Participant and Disease Characteristics:
7. Participants who have met all Molecular Prescreening inclusion criteria.
8. Participants who are willing and able to comply with all scheduled visits, treatment plan, laboratory tests, lifestyle considerations, and other study procedures.
9. Presence of a BRAF V600E mutation in tumor tissue or blood (eg, ctDNA genetic testing). The following are acceptable:
a. Local laboratory assay (PCR or NGS-based only) performed at any time prior to Screening using either tumor tissue or blood.
b. Central laboratory assay performed during the Screening period using tumor tissue alone (not blood).
Note: For participants enrolled on the basis of a local BRAF mutation assay, tumor samples must be submitted to the central laboratory for BRAF testing as soon as possible following signing of the ICD. The BRAF status must be confirmed no later than 30 days following first dose of study intervention.
10. The Investigator must obtain prior to Cycle 1 Day 1 (SLI) or date of randomization (Phase 3 and Cohort 3) adequate tumor tissue (primary or metastatic, archival or newly obtained) for submission to a central laboratory for confirmation of BRAF V600E (FFPE block or minimum of 15 unstained slides containing recently cut, 4-5 µm sections on positively charged slides). Participants with fewer than 15 slides of analyzable tissue may be considered eligible if the Sponsor determines that the slides are sufficient for central testing of BRAF V600E and tumor tissue assessment.
Note: Once BRAF V600E mutation status is determined by the central laboratory (tumor tissue), the results will be considered definitive for eligibility. No repeat testing will be performed.
Note: Lack of BRAF V600E confirmation by the central laboratory may be due to discordance between the local assay and central laboratory results (potential false positive local assay results), or due to inadequate or poor sample condition for central testing (indeterminate results).
Note: Participants whose sample is determined to be inadequate or who
have an indeterminate result on central testing may have additional
tumor samples submitted for testing.
For a full list please see section 5.1 of the protocol. |
|
| E.4 | Principal exclusion criteria |
Molecular Prescreening Exclusion Criteria
Medical Conditions:
1. Other medical or psychiatric condition including recent (within the past year) or active suicidal ideation/behavior or laboratory abnormality that may increase the risk of study participation or, in the investigator’s judgment, make the participant inappropriate for the study.
2. Presence of acute or chronic pancreatitis.
3. Leptomeningeal disease.
4. History of chronic inflammatory bowel disease requiring medical intervention (immunomodulatory or immunosuppressive medications or surgery) ≤12 months prior to randomization.
5. Known DPD deficiency; refer to local fluorouracil or capecitabine label or local clinical guidances, for DPD status recommendation prior to starting treatment.
6. Gilbert’s syndrome or known homozygous UGT1A1*28/*28 or UGT1A1*6/*6 genotypes or double heterozygous UGT1A1*6/*28 genotype:
a. SLI: Participants with documented Gilbert's syndrome or known homozygous UGT1A1*28/*28 or UGT1A1*6/*6 genotypes or double heterozygous UGT1A1*6/*28 will be excluded from Cohort 1 (EC + FOLFIRI) of the SLI.
b.Phase III: Participants with documented Gilbert's syndrome or known homozygous UGT1A1*28/*28 or UGT1A1*6/*6 genotypes or double heterozygous UGT1A1*6/*28 genotype may be enrolled, but may not receive FOLFOXIRI if randomized to the Control Arm.
c. Cohort 3: Participants with documented Gilbert's syndrome or known homozygous UGT1A1*28/*28 or UGT1A1*6/*6 genotypes or double heterozygous UGT1A1*6/*28 genotype will be excluded from Cohort 3
Arm D and Arm E (EC + FOLFIRI and FOLFIRI ± bevacizumab).
Other Exclusions:
7. Investigator site staff or Pfizer employees directly involved in the conduct of the study, site staff otherwise supervised by the investigator, and their respective family members.
8. Colorectal adenocarcinoma that is RAS mutant or for which RAS mutation status is unknown.
9. Locally confirmed dMMRor MSI-H colorectal carcinoma or unknown MSI/MMR status. If participant is locally confirmed dMMR or MSI-H and unable to receive immune checkpoint inhibitors due to a pre existing medical condition, they may be enrolled.
5.2.2. Screening Exclusion Criteria
Medical Conditions:
10. Impaired gastrointestinal function (eg, uncontrolled nausea, vomiting or diarrhea, malabsorption syndrome, small bowel resection) or disease which may significantly alter the absorption of oral study intervention or recent changes in bowel function suggesting current or impending bowel obstruction.
11. Clinically significant cardiovascular diseases, including any of the following:
a. History of acute myocardial infarction, acute coronary syndromes (including unstable angina, coronary artery bypass graft, coronary angioplasty or stenting) ≤6 months prior to randomization;
b. Congestive heart failure requiring treatment (New York Heart Association Class II and above);
c. Recent history (within 1 year prior to randomization) or presence of clinically significant cardiac arrhythmias (including uncontrolled atrial fibrillation or uncontrolled paroxysmal supraventricular tachycardia);
d. History of thromboembolic or cerebrovascular events ≤12 weeks prior to randomization. Examples include transient ischemic attacks, cerebrovascular accidents, hemodynamically significant (ie, massive or sub-massive) deep vein thrombosis or pulmonary emboli.
Note: Participants with either deep vein thrombosis or pulmonary emboli that do 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: Participants with thromboembolic events related to indwelling catheters (including PICC lines) or other procedures may be enrolled.
e. Triplicate average QTcF interval ≥480 ms or a history of prolonged QT syndrome.
Note: Participants with bundle-branch block (BBB) or with an implanted cardiac pacemaker, may enroll into the study following consultation with the Sponsor.
f. Congenital LQTS.
12. Evidence of active noninfectious pneumonitis.
13. Evidence of active and uncontrolled bacterial or viral infection, with certain exceptions, as noted below, for chronic infection with HIV, hepatitis B or hepatitis C, within 2 weeks prior to start of study
intervention.
14. Participants positive for HIV are ineligible unless they meet all of the following:
a. A stable regimen of highly active anti-retroviral therapy that is not contraindicated (see Section 6.5);
b. No requirement for concurrent antibiotics or antifungal agents for the prevention of opportunistic infections;
c. A CD4 count >250 cells/mcL, and an undetectable HIV viral load on standard PCR-based tests.
For a full list please see section 5.2 of the protocol. |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
Safety Lead-In:
Incidence of DLTs
Phase 3:
• PFS by BICR, defined as the time from the date of randomization to the earliest documented disease progression per RECIST v1.1, or death due to any cause
• ORR by BICR
Cohort 3:
• ORR by BICR |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
Safety Lead-In:
The DLT evaluation period is the first 28 days after the first dose of study
intervention.
Phase 3:
PFS and ORR: 42 to 49 days from the date of randomization then Q6W (±7D) for the first 18 months after the date of randomization then Q8W (±7D) thereafter or until BICR-confirmed PD (regardless of new anticancer therapy), withdrawal of consent/assent, participant is lost to followup, death, or final OS analysis.
Cohort 3:
ORR: 42 to 49 days from the date of randomization then Q6W (± 7D) for the first 18 months after the date of randomization then Q8W (± 7D) thereafter or until BICR-confirmed PD (regardless of new anticancer therapy), withdrawal of consent/assent, participant is lost to followup, death, or final OS analysis. |
|
| E.5.2 | Secondary end point(s) |
Safety Lead-In:
Incidence and severity of AEs graded according to the NCI CTCAE v4.03 and changes in clinical laboratory parameters, vital signs and ECGs
Incidence of dose interruptions, dose modifications and discontinuations due to AEs
ORR by Investigator, defined as the proportion of participants who have achieved a confirmed BOR (CR or PR) per RECIST v1.1
DOR by Investigator, defined as the time from the date of first radiographic evidence of response (CR or PR) to the earliest documented disease progression per RECIST v1.1, or death due to any cause
PFS by Investigator, defined as the time from the first dose to the earliest documented disease progression per RECIST v1.1, or death due to any cause
TTR by Investigator, defined as the time from first dose to first radiographic evidence of response (CR or PR) per RECIST v1.1
OS defined as the time from the first dose to death due to any cause
PK parameters of encorafenib, irinotecan, oxaliplatin and relevant metabolites
Changes in exposures of irinotecan and its metabolite (SN-38) on Cycle 1 Day 15 compared to Cycle 1 Day 1 in Cohort 1 (EC + FOLFIRI)
Changes in exposures of oxaliplatin on Cycle 1 Day 15 compared to Cycle 1 Day 1 in Cohort 2 (EC + mFOLFOX6)
Phase 3:
OS, defined as the time from the date of randomization to death due to any cause ORR by Investigator
ORR by BICR (Arm A vs Control Arm, Arm A vs Arm B)
DOR by BICR and by Investigator
PFS by BICR (Arm A vs Control Arm, Arm A vs Arm B)
OS (Arm A vs Control Arm, Arm A vs Arm B)
PFS by Investigator
TTR (by BICR and by Investigator), defined as the time from the date of randomization to first radiographic evidence of response (CR or PR) per RECIST v1.1
PFS2, defined as the time from the date of randomization to the date of discontinuation of next-line treatment after first objective PD by investigator assessment, the second objective disease progression, or
death from any cause, whichever occurs first
Incidence and severity of AEs graded according to the NCI CTCAE v4.03 and changes in clinical laboratory parameters, vital signs, and ECGs PRO scores as measured by the EORTC QLQ-C30, EQ-5D-5L, and
anchoring instruments PGIS and PGIC.
Trough plasma concentrations of encorafenib and the metabolite LHY746 in Arm A and Arm B
PK parameters of encorafenib and its metabolite LHY746
Summarize MSI-status as determined by retrospective central testing of baseline tumor tissue
BRAF V600E variant allele fraction (VAF) and/or overall mean VAF from cfDNA analysis of plasma samples collected at baseline and on treatment
Cohort 3:
PFS by BICR, defined as the time from the date of randomization to the earliest documented disease progression per RECIST v1.1, or death due to any cause
ORR by Investigator
DOR by BICR and by Investigator, defined as the time from the date of first radiographic evidence of response (CR or PR) to the earliest documented disease progression per RECIST v1.1, or death due to any
cause
PFS by Investigator, defined as the time from the date of randomization to the earliest documented disease progression per RECIST v1.1, or death due to any cause
OS, defined as the time from the date of randomization to death due to any cause
TTR (by BICR and by Investigator), defined as the time from the date of randomization to first radiographic evidence of response (CR or PR) per RECIST v1.1
Incidence and severity of AEs graded according to the NCI CTCAE v4.03 and changes in clinical laboratory parameters, vital signs, and ECGs
PRO scores as measured by the EORTC QLQ-C30, EQ-5D-5L, and anchoring instruments PGIS and PGIC
Trough plasma concentrations of encorafenib and the metabolite LHY746 in Cohort 3 Arm D
Summarize MSI-status as determined by retrospective central testing of baseline tumor tissue
BRAF V600E variant allele fraction (VAF) and/or overall mean VAF from cfDNA analysis of plasma samples collected at baseline and on treatment |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
| Throughout the duration of the study as outlined in Protocol Section 1.3 Schedule of Activities |
|
| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | No |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | Yes |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | No |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | No |
| E.6.13 | Others | No |
| E.7 | Trial type and phase |
| E.7.1 | Human pharmacology (Phase I) | No |
| E.7.1.1 | First administration to humans | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | No |
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
| E.7.4 | Therapeutic use (Phase IV) | No |
| E.8 Design of the trial |
| E.8.1 | Controlled | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| E.8.1.5 | Parallel group | Yes |
| E.8.1.6 | Cross over | No |
| E.8.1.7 | Other | No |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | Yes |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 5 |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 126 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
| Argentina |
| New Zealand |
| Ukraine |
| Taiwan |
| Australia |
| Brazil |
| Canada |
| India |
| Japan |
| Korea, Republic of |
| Mexico |
| Russian Federation |
| South Africa |
| United Kingdom |
| United States |
| Belgium |
| Bulgaria |
| Czechia |
| Denmark |
| Finland |
| Germany |
| Italy |
| Netherlands |
| Norway |
| Poland |
| Portugal |
| Romania |
| Slovakia |
| Spain |
| Sweden |
|
| E.8.7 | Trial has a data monitoring committee | Yes |
| E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of study is defined as LPLV. LPLV is defined as the date of the last visit or
follow-up contact of the last participant in the study globally. |
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 5 |
| E.8.9.1 | In the Member State concerned months | 1 |
| E.8.9.1 | In the Member State concerned days | 15 |
| E.8.9.2 | In all countries concerned by the trial years | 6 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |
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