A Phase 2 interventional study of Binimetinib and Palbociclib in Metastatic Colorectal Carcinoma, Stage IV Colorectal Cancer AJCC v8 and Stage IVA Colorectal Cancer AJCC v8, sponsored by Academic and Community Cancer Research United. Completed at 7 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-08-22.
Sponsored by Academic and Community Cancer Research United · Phase 2, Interventional, and Treatment
This phase II trial studies how well binimetinib and palbociclib work compared to TAS-102 in treating patients with KRAS and NRAS mutation positive colorectal cancer that has spread to other places in the body (metastatic) or cannot be removed by surgery (unresectable). Binimetinib and palbociclib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as TAS-102, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving binimetinib and palbociclib may work better compared to TAS-102 alone in treating patients with colorectal cancer.
PRIMARY OBJECTIVE:
I. The primary objective is to compare the progression-free survival (PFS) between those randomized to palbociclib/binimetinib and those randomized to trifluridine and tipiracil hydrochloride (TAS-102) in patients with refractory KRAS- or NRAS-mutant metastatic colorectal cancer (CRC).
SECONDARY OBJECTIVES:
I. To compare the overall response rate by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria between those randomized to palbociclib/binimetinib and those randomized to TAS-102 in patients with refractory KRAS- or NRAS-mutant metastatic CRC.
II. To compare the overall survival (OS) between those randomized to palbociclib/binimetinib and those randomized to TAS-102 in patients with refractory KRAS- or NRAS-mutant metastatic CRC.
III. To determine the safety and tolerability of the recommended phase II dose of palbociclib in combination with binimetinib in patients with refractory KRAS- or NRAS-mutant metastatic CRC.
CORRELATIVE RESEARCH OBJECTIVES:
I. To determine the tumor mutational profiles that characterize groups of patients that predict for response or resistance to combination of palbociclib/binimetinib.
II. To determine the correlation between circulating tumor deoxyribonucleic acid (DNA) and tumor response or resistance to therapy with palbociclib/binimetinib or TAS-102.
III. To determine the association between Consensus Molecular Subtype based on gene expression profiling and response or resistance to combination of palbociclib/binimetinib.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM A: Patients receive binimetinib orally (PO) twice daily (BID) on days 1-28 and palbociclib PO once daily (QD) on days 1-21. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive trifluridine and tipiracil hydrochloride PO BID on days 1-5 and 8-12. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. Patients with disease progression may optionally crossover to Arm A.
After completion of study treatment, patients are followed up within 30-37 days and then every 12 weeks for up to 24 months.
6,741 studies on the registry are indexed under Carcinoma; 1,161 are open to participants now.
This study's enrollment of 102 is above the median of 45 across 5,170 interventional studies indexed under Carcinoma.
Browse Carcinoma studies →Academic and Community Cancer Research United is the lead sponsor of 49 studies on the registry; 5 are open to participants now.
Of its 13 completed or terminated interventional studies of FDA-regulated products, 12 (92%) have results posted.
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Able and willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
CROSSOVER INCLUSION CRITERIA: Able and willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study)
Exclusion Criteria:
Prior treatment with drug targeting BRAF, MEK, ERK, or CDK family
Women of child-bearing potential
Sexually active males
Any symptomatic brain metastasis
Prior treatment =\< 21 days prior to registration/randomization with any other chemotherapy, small molecule inhibitor (e.g. regorafenib), monoclonal antibody, immunotherapy, or radiotherapy
Impaired cardiovascular function or clinically significant cardiac diseases, including any of the following:
History of thromboembolic or cerebrovascular events =\< 12 weeks prior registration/randomization. Examples include transient ischemic attacks, cerebrovascular accidents, hemodynamically significant (i.e. massive or submassive) deep vein thrombosis or pulmonary emboli
Previous or concurrent malignancy =\< 3 years prior to registration/randomization with the following exceptions:
Other solid tumors treated curatively without evidence of recurrence for >= 3 years prior to registration/randomization
CROSSOVER EXCLUSION CRITERIA: Prior treatment with drug targeting BRAF, MEK, ERK, or CDK family
CROSSOVER EXCLUSION CRITERIA: Women of child-bearing potential
CROSSOVER EXCLUSION CRITERIA: Sexually active males
CROSSOVER EXCLUSION CRITERIA: Any symptomatic brain metastasis
CROSSOVER EXCLUSION CRITERIA: Impaired cardiovascular function or clinically significant cardiac diseases, including any of the following:
CROSSOVER EXCLUSION CRITERIA: History of thromboembolic or cerebrovascular events =\< 12 weeks prior re-registration. Examples include transient ischemic attacks, cerebrovascular accidents, hemodynamically significant (i.e. massive or sub-massive) deep vein thrombosis or pulmonary emboli
Patients receive binimetinib PO BID on days 1-28 and palbociclib PO QD on days 1-21. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
Drug: Binimetinib · Drug: Palbociclib
Patients receive trifluridine and tipiracil hydrochloride PO BID on days 1-5 and 8-12. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. Patients with disease progression may optionally crossover to Arm A.
Drug: Trifluridine and Tipiracil Hydrochloride
Given PO
Also known as: ARRY-162, ARRY-438162, MEK162, Mektovi
Given PO
Also known as: 6-Acetyl-8-cyclopentyl-5-methyl-2-((5-(piperazin-1-yl)pyridin-2-yl)amino)-8h-pyrido(2,3-d)pyrimidin-7-one, Ibrance, PD 0332991, PD 332991, PD 991, PD-0332991
Given PO
Also known as: Lonsurf, TAS 102, TAS-102, Tipiracil Hydrochloride Mixture with Trifluridine, Trifluridine/Tipiracil, Trifluridine/Tipiracil Hydrochloride Combination Agent TAS-102
Progression Free Survival (PFS)
Disease progression will be determined based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and will be documented at each enrolling site with no central review planned. PFS will be compared between treatment arms using the stratified log rank test at one-sided level 0.05. Kaplan-Meier methodology will be used to estimate the median PFS for each treatment arm, and Kaplan-Meier curves will be produced.
Time frame: Time from randomization date to either disease progression or death from any cause, whichever occurs first, assessed for up to 16 months
Overall Response Rate
Assessment of response data will be performed on the basis of definitions of responses according to RECIST version (v)1.1. Objective response is defined as a complete or partial response by RECIST v1.1. This will be reported as the number of patients experiencing an objective response.
Time frame: Up to 16 months
Overall Survival (OS)
Will use Kaplan-Meier methods to evaluate time to event endpoints, and will report median OS and its 95% confidence interval.
Time frame: Time from first dose of study treatment to death from any cause, assessed for up to 24 months
Number of Participants With Adverse Events
The number of patients experiencing a grade 3+ adverse event, regardless of attribution, will be reported.
Time frame: Up to 24 months
| Milestone | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort |
|---|---|---|---|
| Started | 47 | 46 | 9 |
| Crossed over to arm a | 0 | 21 | 0 |
| Completed | 42 | 41 | 8 |
| Not completed | 5 | 5 | 1 |
| Withdrew: Patient withdrawn prior to treatment | 5 | 5 | 1 |
Disease progression will be determined based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and will be documented at each enrolling site with no central review planned. PFS will be compared between treatment arms using the stratified log rank test at one-sided level 0.05. Kaplan-Meier methodology will be used to estimate the median PFS for each treatment arm, and Kaplan-Meier curves will be produced.
| months | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) |
|---|---|---|
| Progression Free Survival (PFS) | 2.3 (2.0 to 3.0) | 2.2 (2.1 to 2.3) |
Assessment of response data will be performed on the basis of definitions of responses according to RECIST version (v)1.1. Objective response is defined as a complete or partial response by RECIST v1.1. This will be reported as the number of patients experiencing an objective response.
| Participants | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) |
|---|---|---|
| Overall Response Rate | 0 | 1 |
Will use Kaplan-Meier methods to evaluate time to event endpoints, and will report median OS and its 95% confidence interval.
| months | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) |
|---|---|---|
| Overall Survival (OS) | 7.7 (5.1 to 13.1) | 6.8 (5.5 to 8.4) |
The number of patients experiencing a grade 3+ adverse event, regardless of attribution, will be reported.
| Participants | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort |
|---|---|---|---|
| Number of Participants With Adverse Events | 25 | 28 | 6 |
Collected over 24 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Arm A (Binimetinib, Palbociclib) | 29/42 (69%) | 9/42 (21.4%) | 38/42 (90.5%) |
| Arm B (Trifluridine and Tipiracil Hydrochloride) | 18/41 (43.9%) | 12/41 (29.3%) | 39/41 (95.1%) |
| Crossover | 15/21 (71.4%) | 5/21 (23.8%) | 21/21 (100%) |
| Safety Run-In Cohort | 1/8 (12.5%) | 4/8 (50%) | 8/8 (100%) |
| Event | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Crossover | Safety Run-In Cohort |
|---|---|---|---|---|
| AnemiaBlood and lymphatic system disorders | 1/42 | 2/41 | 0/21 | 1/8 |
| Febrile neutropeniaBlood and lymphatic system disorders | 0/42 | 0/41 | 0/21 | 1/8 |
| SepsisInfections and infestations | 0/42 | 0/41 | 0/21 | 1/8 |
| Alkaline phosphatase increasedInvestigations | 0/42 | 0/41 | 0/21 | 1/8 |
| Aspartate aminotransferase increasedInvestigations | 0/42 | 0/41 | 0/21 | 1/8 |
| Lymphocyte count decreasedInvestigations | 0/42 | 0/41 | 0/21 | 1/8 |
| HypomagnesemiaMetabolism and nutrition disorders | 0/42 | 0/41 | 0/21 | 1/8 |
| ProteinuriaRenal and urinary disorders | 0/42 | 0/41 | 0/21 | 1/8 |
| Urinary tract obstructionRenal and urinary disorders | 0/42 | 0/41 | 0/21 | 1/8 |
| MenorrhagiaReproductive system and breast disorders | 0/42 | 0/41 | 0/21 | 1/8 |
| Event | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Crossover | Safety Run-In Cohort |
|---|---|---|---|---|
| Rash acneiformSkin and subcutaneous tissue disorders | 23/42 | 2/41 | 10/21 | 7/8 |
| AnemiaBlood and lymphatic system disorders | 17/42 | 26/41 | 17/21 | 6/8 |
| CPK increasedInvestigations | 15/42 | 0/41 | 7/21 | 6/8 |
| Platelet count decreasedInvestigations | 18/42 | 10/41 | 6/21 | 6/8 |
| DiarrheaGastrointestinal disorders | 13/42 | 10/41 | 8/21 | 5/8 |
| FatigueGeneral disorders | 18/42 | 13/41 | 13/21 | 5/8 |
| Alkaline phosphatase increasedInvestigations | 11/42 | 13/41 | 9/21 | 5/8 |
| Neutrophil count decreasedInvestigations | 15/42 | 22/41 | 8/21 | 2/8 |
| NauseaGastrointestinal disorders | 13/42 | 15/41 | 9/21 | 4/8 |
| Aspartate aminotransferase increasedInvestigations | 10/42 | 9/41 | 7/21 | 4/8 |
| Age, Continuous(years) | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort | Total |
|---|---|---|---|---|
| Median | 52 (32 to 73) | 52 (33 to 74) | 51.5 (43 to 68) | 52 (32 to 74) |
| Sex/Gender, Customized(Participants) | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort | Total |
|---|---|---|---|---|
| Gender — Male | 19 | 22 | 3 | 44 |
| Gender — Female | 23 | 19 | 4 | 46 |
| Gender — Unknown | 0 | 0 | 1 | 1 |
| Race (NIH/OMB)(Participants) | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 |
| Asian | 0 | 3 | 1 | 4 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 |
| Black or African American | 1 | 4 | 0 | 5 |
| White | 41 | 32 | 6 | 79 |
| More than one race | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 2 | 1 | 3 |
| Region of Enrollment(participants) | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort | Total |
|---|---|---|---|---|
| United States | 42 | 41 | 8 | 91 |
| ECOG Performance Status(Participants) | Arm A (Binimetinib, Palbociclib) | Arm B (Trifluridine and Tipiracil Hydrochloride) | Safety Run-In Cohort | Total |
|---|---|---|---|---|
| 0 | 19 | 19 | 5 | 43 |
| 1 | 23 | 22 | 3 | 48 |
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