Pfizer’s BRAFTOVI® Combination Regimen Demonstrates Improved Response in Patients with BRAF V600E-Mutant Metastatic Colorectal Cancer
Pfizer (PFE) announced positive Phase 3 BREAKWATER trial results for BRAFTOVI® combination therapy in treating BRAF V600E-mutant metastatic colorectal cancer (mCRC). The trial showed a significantly higher objective response rate of 60.9% compared to 40% with standard chemotherapy.
Key findings include a median duration of response of 13.9 months for the BRAFTOVI combination versus 11.1 months for chemotherapy. Additionally, 22.4% of BRAFTOVI-treated patients maintained response for 12+ months, compared to 11.4% in the chemotherapy group.
While overall survival data is not yet mature, early trends favor the BRAFTOVI combination. The safety profile aligned with known profiles of individual components, with serious treatment-emergent adverse events occurring in 37.7% of BRAFTOVI combination patients versus 34.6% in the chemotherapy group. The FDA granted accelerated approval for this treatment in December 2024.
Pfizer (PFE) ha annunciato risultati positivi della fase 3 dello studio BREAKWATER per la terapia combinata con BRAFTOVI® nel trattamento del carcinoma colorettale metastatico (mCRC) con mutazione BRAF V600E. Lo studio ha mostrato un tasso di risposta obiettiva significativamente più alto del 60,9% rispetto al 40% ottenuto con la chemioterapia standard.
I risultati chiave includono una durata mediana della risposta di 13,9 mesi per la combinazione con BRAFTOVI rispetto a 11,1 mesi per la chemioterapia. Inoltre, il 22,4% dei pazienti trattati con BRAFTOVI ha mantenuto la risposta per oltre 12 mesi, rispetto all'11,4% del gruppo chemioterapico.
Sebbene i dati di sopravvivenza globale non siano ancora maturi, le prime tendenze favoriscono la combinazione con BRAFTOVI. Il profilo di sicurezza è stato coerente con i profili conosciuti dei singoli componenti, con eventi avversi gravi emersi durante il trattamento che si sono verificati nel 37,7% dei pazienti in combinazione con BRAFTOVI, rispetto al 34,6% nel gruppo di chemioterapia. La FDA ha concesso l'approvazione accelerata per questo trattamento nel dicembre 2024.
Pfizer (PFE) anunció resultados positivos del ensayo de fase 3 BREAKWATER para la terapia combinada con BRAFTOVI® en el tratamiento del cáncer colorrectal metastásico (mCRC) con mutación BRAF V600E. El ensayo mostró un tasa de respuesta objetiva significativamente más alta del 60,9% en comparación con el 40% de la quimioterapia estándar.
Los hallazgos clave incluyen una duración mediana de respuesta de 13,9 meses para la combinación de BRAFTOVI frente a 11,1 meses para la quimioterapia. Además, el 22,4% de los pacientes tratados con BRAFTOVI mantuvieron la respuesta durante más de 12 meses, en comparación con el 11,4% en el grupo de quimioterapia.
Aunque los datos de supervivencia global aún no son completamente maduros, las tendencias iniciales favorecen la combinación de BRAFTOVI. El perfil de seguridad se alineó con los perfiles conocidos de los componentes individuales, presentándose eventos adversos graves emergentes del tratamiento en el 37,7% de los pacientes tratados con la combinación de BRAFTOVI frente al 34,6% en el grupo de quimioterapia. La FDA otorgó la aprobación acelerada para este tratamiento en diciembre de 2024.
화이자 (PFE)는 BRAFTOVI® 복합요법의 BRAF V600E 변이 전이성 대장암(mCRC) 치료에 대한 3상 BREAKWATER 시험의 긍정적인 결과를 발표했습니다. 이 시험은 객관적인 반응률이 60.9%로 표준 화학요법의 40%에 비해 유의미하게 높음을 나타냈습니다.
주요 발견으로는 BRAFTOVI 복합요법의 중위 반응 지속 기간이 13.9개월이고 화학요법은 11.1개월이었습니다. 또한 BRAFTOVI 치료를 받은 환자의 22.4%는 12개월 이상 반응을 유지한 반면, 화학요법 그룹은 11.4%였습니다.
전반적인 생존 데이터는 아직 성숙하지 않았지만 초기 추세는 BRAFTOVI 복합요법을 선호합니다. 안전성 프로필은 개별 구성 요소의 알려진 프로필과 일치했으며, 치료 중 심각한 이상 반응이 BRAFTOVI 복합요법 환자의 37.7%에서 발생한 반면, 화학요법 그룹에서는 34.6%로 나타났습니다. FDA는 2024년 12월에 이 치료법에 대해 신속 승인을 부여했습니다.
Pfizer (PFE) a annoncé des résultats positifs de l'essai clinique de phase 3 BREAKWATER sur la thérapie combinée avec BRAFTOVI® pour traiter le cancer colorectal métastatique (mCRC) avec mutation BRAF V600E. L'essai a montré un taux de réponse objective significativement plus élevé de 60,9% par rapport à 40% avec la chimiothérapie standard.
Les résultats clés incluent une durée médiane de réponse de 13,9 mois pour la combinaison BRAFTOVI contre 11,1 mois pour la chimiothérapie. De plus, 22,4% des patients traités par BRAFTOVI ont maintenu une réponse pendant plus de 12 mois, contre 11,4% dans le groupe de chimiothérapie.
Bien que les données de survie globale ne soient pas encore mûres, les tendances préliminaires favorisent la combinaison BRAFTOVI. Le profil de sécurité était en accord avec les profils connus des composants individuels, les événements indésirables graves survenant chez 37,7% des patients de la combinaison BRAFTOVI contre 34,6% dans le groupe de chimiothérapie. La FDA a accordé une approbation accélérée pour ce traitement en décembre 2024.
Pfizer (PFE) hat positive Ergebnisse der Phase-3-Studie BREAKWATER zur BRAFTOVI®-Kombinationstherapie zur Behandlung von BRAF V600E-mutanter metastasierendem kolorektalem Krebs (mCRC) bekannt gegeben. Die Studie zeigte eine deutlich höhere objektive Ansprechrate von 60,9% im Vergleich zu 40% mit der Standardchemotherapie.
Wichtige Ergebnisse umfassen eine medianen Dauer des Ansprechens von 13,9 Monaten für die BRAFTOVI-Kombination im Vergleich zu 11,1 Monaten für die Chemotherapie. Zudem erhielten 22,4% der mit BRAFTOVI behandelten Patienten eine Reaktion, die länger als 12 Monate anhielt, im Vergleich zu 11,4% in der Chemotherapie-Gruppe.
Obwohl die Daten zur Gesamtüberleben noch nicht ausgereift sind, sprechen frühe Trends für die BRAFTOVI-Kombination. Das Sicherheitsprofil stimmte mit den bekannten Profilen der einzelnen Komponenten überein, wobei schwerwiegende therapiebedingte unerwünschte Ereignisse bei 37,7% der Patienten mit BRAFTOVI-Kombination im Vergleich zu 34,6% in der Chemotherapie-Gruppe auftraten. Die FDA erteilte im Dezember 2024 eine beschleunigte Genehmigung für diese Behandlung.
- Significant improvement in objective response rate (60.9% vs 40%)
- Longer duration of response (13.9 months vs 11.1 months)
- Higher percentage of long-term responders (22.4% vs 11.4%)
- FDA accelerated approval already secured
- Promising early overall survival trends
- Overall survival data still immature
- Slightly higher rate of serious adverse events (37.7% vs 34.6%)
Insights
The BREAKWATER trial results represent a significant advancement in targeted therapy for BRAF V600E-mutant metastatic colorectal cancer (mCRC). The 60.9% objective response rate versus 40% in the control arm demonstrates compelling clinical efficacy, with the odds ratio of 2.443 (p=0.0008) indicating strong statistical significance.
Several aspects of the data are particularly noteworthy:
- The 13.9-month median duration of response and 22.4% of patients maintaining response for 12+ months suggest robust durability
- The rapid median time to response of 7.1 weeks indicates quick clinical benefit
- The interim overall survival data, while immature, shows a promising hazard ratio of 0.47, suggesting potential for significant survival benefit
This approval through FDA's Project FrontRunner initiative marks a pivotal shift in mCRC treatment paradigm, being the first biomarker-driven therapy approved for first-line treatment. The consistent safety profile and lack of new safety signals strengthen the therapy's clinical utility. For Pfizer, this represents a significant market opportunity in the targeted therapy space, particularly given the high unmet need in BRAF V600E-mutant mCRC patients.
This approval significantly strengthens Pfizer's position in the precision oncology market. As the first and only targeted therapy approved for treatment-naïve BRAF V600E-mutant mCRC patients, BRAFTOVI's combination regimen addresses a critical unmet need in a specific patient population. The robust efficacy data, particularly the doubled odds of achieving objective response, positions this therapy as a potential standard of care.
The market implications are substantial:
- First-mover advantage in the biomarker-driven first-line setting creates significant barriers to entry
- The therapy's demonstrated efficacy and safety profile support broad adoption in clinical practice
- Global expansion potential is evident from ongoing regulatory discussions worldwide
The approval through Project FrontRunner demonstrates Pfizer's ability to expedite breakthrough therapies to market, potentially setting a precedent for future oncology drug approvals. This success reinforces Pfizer's strategic focus on precision medicine and strengthens its competitive position in the targeted oncology therapeutics market.
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Clinically meaningful and statistically significant results from the Phase 3 BREAKWATER trial show objective response rate of
61% with Pfizer’s BRAFTOVI combination regimen compared to40% with investigator’s choice of chemotherapy, representing a doubling of the odds of achieving an objective response -
BRAFTOVI combination regimen is the first and only targeted therapy approved by the
U.S. FDA for treatment-naïve patients with metastatic colorectal cancer with a BRAF V600E mutation
“Despite the high unmet need in this patient population, prior to the recent encorafenib combination regimen approval, there were no approved biomarker-driven therapies indicated for people with previously untreated BRAF V600E-mutant metastatic colorectal cancer,” said Scott Kopetz, M.D., Ph.D., FACP, Professor and Deputy Chair of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center and co-principal investigator of the BREAKWATER trial. “These data from the BREAKWATER study show the potential for this targeted treatment regimen to become the new standard of care for people with BRAF V600E-mutant metastatic colorectal cancer, for whom long-term disease control is critical.”
The estimated median duration of response as assessed by BICR was 13.9 months (
Overall survival (OS) data were immature at the time of this analysis but demonstrated a promising trend in favor of BRAFTOVI plus cetuximab and mFOLFOX6 compared to patients receiving chemotherapy with or without bevacizumab. Median OS with BRAFTOVI plus cetuximab with chemotherapy was not estimable (
“These results of this first analysis were the basis for the first approval of a targeted therapy regimen for use in the first-line setting for patients with metastatic colorectal cancer with a BRAF V600E mutation,” said Roger Dansey, M.D., Chief Oncology Officer, Pfizer. “We are highly encouraged by these response results, which are indicative of the clinically meaningful benefit of BRAFTOVI in reducing tumor size or having no detectable cancer, along with the promising interim analysis of overall survival. We look forward to additional read-outs from the BREAKWATER trial this year.”
The safety profile of BRAFTOVI in combination with cetuximab and mFOLFOX6 in the BREAKWATER trial was consistent with the known safety profile of each respective agent. No new safety signals were identified. Serious treatment-emergent adverse events occurred in
BRAFTOVI in combination with cetuximab and mFOLFOX6 was granted accelerated approval by the
Pfizer is continuing its commitment to help non-scientists understand the latest findings with the development of abstract plain language summaries (APLS) for company-sponsored research being presented, which are written in non-technical language. Those interested in learning more can visit www.Pfizer.com/apls to access the summaries.
About BREAKWATER
BREAKWATER is a Phase 3, randomized, active-controlled, open-label, multicenter trial of BRAFTOVI with cetuximab, alone or in combination with mFOLFOX6 in participants with previously untreated BRAF V600E-mutant mCRC. Patients were randomized to receive BRAFTOVI 300 mg orally once daily in combination with cetuximab (discontinued after randomization of 158 patients), BRAFTOVI 300 mg orally once daily in combination with cetuximab and mFOLFOX6 (n=236) or mFOLFOX6, FOLFOXIRI, or CAPOX each with or without bevacizumab (control-arm) (n=243). The dual primary endpoints are ORR, which was met at the time of analysis, and PFS as assessed by BICR. OS is a key secondary endpoint.
About Colorectal Cancer (CRC)
CRC is the third most common type of cancer in the world, with approximately 1.8 million new diagnoses in 2022.1 It is the second leading cause of cancer-related deaths.2 Overall, the lifetime risk of developing CRC is about 1 in 24 for men and 1 in 26 for women.2 In the
BRAF mutations are estimated to occur in 8
About BRAFTOVI® (encorafenib)
BRAFTOVI is an oral small molecule kinase inhibitor that targets BRAF V600E. Inappropriate activation of proteins in the MAPK signaling pathway (RAS-RAF-MEK-ERK) has been shown to occur in certain cancers, including CRC.
Pfizer has exclusive rights to BRAFTOVI in the
INDICATION AND USAGE
BRAFTOVI® (encorafenib) is indicated, in combination with cetuximab and mFOLFOX6, for the treatment of patients with metastatic colorectal cancer (mCRC) with a BRAF V600E mutation, as detected by an FDA-approved test. This indication is approved under accelerated approval based on response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
BRAFTOVI is also indicated, in combination with cetuximab, for the treatment of adult patients with mCRC with a BRAF V600E mutation, as detected by an FDA-approved test, after prior therapy.
Limitations of Use: BRAFTOVI is not indicated for treatment of patients with wild-type BRAF CRC.
IMPORTANT SAFETY INFORMATION
Refer to the prescribing information for cetuximab and individual product components of mFOLFOX6 for recommended dosing and additional safety information.
WARNINGS AND PRECAUTIONS
New Primary Malignancies: New primary malignancies, cutaneous and non-cutaneous, can occur. In BEACON CRC (previously treated BRAF V600E mutation-positive mCRC), cutaneous squamous cell carcinoma (cuSCC), including keratoacanthoma (KA), occurred in
Tumor Promotion in BRAF Wild-Type Tumors: In vitro experiments have demonstrated paradoxical activation of MAP-kinase signaling and increased cell proliferation in BRAF wild-type cells exposed to BRAF inhibitors. Confirm evidence of BRAF V600E or V600K mutation using an FDA-approved test prior to initiating BRAFTOVI.
Cardiomyopathy: Cardiomyopathy manifesting as left ventricular dysfunction associated with symptomatic or asymptomatic decreases in ejection fraction, has been reported in patients. Assess left ventricular ejection fraction (LVEF) by echocardiogram or multi-gated acquisition (MUGA) scan prior to initiating treatment, 1 month after initiating treatment, and then every 2 to 3 months during treatment. The safety has not been established in patients with a baseline ejection fraction that is either below
Hepatotoxicity: Hepatotoxicity can occur. In BREAKWATER (previously untreated BRAF V600E mutation-positive mCRC), the incidence of Grade 3 or 4 increases in liver function laboratory tests in patients receiving BRAFTOVI in combination with cetuximab and mFOLFOX6 was
Hemorrhage: In BEACON CRC (previously treated BRAF V600E mutation-positive mCRC), hemorrhage occurred in
Uveitis: Uveitis, including iritis and iridocyclitis, has been reported in patients treated with BRAFTOVI. Assess for visual symptoms at each visit. Perform an ophthalmological evaluation at regular intervals and for new or worsening visual disturbances, and to follow new or persistent ophthalmologic findings. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
QT Prolongation: BRAFTOVI is associated with dose-dependent QTc interval prolongation in some patients. In BREAKWATER (previously untreated BRAF V600E mutation-positive mCRC), an increase of QTcF >500 ms was measured in
Embryo-Fetal Toxicity: BRAFTOVI can cause fetal harm when administered to pregnant women. BRAFTOVI can render hormonal contraceptives ineffective. Advise females of reproductive potential to use effective nonhormonal contraception during treatment with BRAFTOVI and for 2 weeks after the final dose.
Risks Associated with Combination Treatment: BRAFTOVI is indicated for use as part of a regimen in combination with cetuximab, or in combination with cetuximab and mFOLFOX6. Refer to the prescribing information for cetuximab and individual product components of mFOLFOX6 for additional risk information.
Lactation: Advise women not to breastfeed during treatment with BRAFTOVI and for 2 weeks after the final dose.
Infertility: Advise males of reproductive potential that BRAFTOVI may impair fertility.
ADVERSE REACTIONS
BREAKWATER Trial (previously untreated BRAF V600E mutation-positive mCRC)
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Serious adverse reactions occurred in
38% of patients who received BRAFTOVI in combination with cetuximab and mFOLFOX6. Serious adverse reactions in >3% of patients included intestinal obstruction (3.5% ) and pyrexia (3.5% ). -
Fatal gastrointestinal perforation occurred in
0.9% of patients who received BRAFTOVI in combination with cetuximab and mFOLFOX6. -
Most common adverse reactions (≥
25% , all grades) in the BRAFTOVI with cetuximab and mFOLFOX6 arm compared to the control arm (mFOLFOX6 ± bevacizumab or FOLFOXIRI ± bevacizumab or CAPOX ± bevacizumab) were peripheral neuropathy (62% vs53% ), nausea (51% vs48% ), fatigue (49% vs38% ), rash (31% vs4% ), diarrhea (34% vs47% ), decreased appetite (33% vs25% ), vomiting (33% vs21% ), hemorrhage (30% vs18% ), abdominal pain (26% vs27% ), and pyrexia (26% vs14% ). -
Most common laboratory abnormalities (≥
10% , grade 3 or 4) in the BRAFTOVI with cetuximab and mFOLFOX6 arm compared to the control arm (mFOLFOX6 ± bevacizumab or FOLFOXIRI ± bevacizumab or CAPOX ± bevacizumab) were: increased lipase (51% vs25% ), decreased neutrophil count (36% vs34% ), decreased hemoglobin (13% vs5% ), decreased white blood cell count (12% vs7% ), and increased glucose (11% vs2% ).
BEACON CRC Trial (previously treated BRAF V600E mutation-positive mCRC)
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Most common adverse reactions (≥
25% , all grades) in the BRAFTOVI with cetuximab arm compared to irinotecan with cetuximab or FOLFIRI with cetuximab (control) were: fatigue (51% vs50% ), nausea (34% vs41% ), diarrhea (33% vs48% ), dermatitis acneiform (32% vs43% ), abdominal pain (30% vs32% ), decreased appetite (27% vs27% ), arthralgia (27% vs3% ), and rash (26% vs26% ). -
Other clinically important adverse reactions occurring in <
10% of patients who received BRAFTOVI in combination with cetuximab was pancreatitis. -
Most common laboratory abnormalities (all grades) (≥
20% ) in the BRAFTOVI with cetuximab arm compared to irinotecan with cetuximab or FOLFIRI with cetuximab (control) were: anemia (34% vs48% ) and lymphopenia (24% vs35% ).
DRUG INTERACTIONS
Strong or moderate CYP3A4 inhibitors: Avoid coadministration of BRAFTOVI with strong or moderate CYP3A4 inhibitors, including grapefruit juice. If coadministration is unavoidable, reduce the BRAFTOVI dose.
Strong CYP3A4 inducers: Avoid coadministration of BRAFTOVI with strong CYP3A4 inducers.
Sensitive CYP3A4 substrates: Avoid the coadministration of BRAFTOVI with CYP3A4 substrates (including hormonal contraceptives) for which a decrease in plasma concentration may lead to reduced efficacy of the substrate. If the coadministration cannot be avoided, see the CYP3A4 substrate product labeling for recommendations.
Dose reductions of drugs that are substrates of OATP1B1, OATP1B3, or BCRP may be required when used concomitantly with BRAFTOVI.
Avoid coadministration of BRAFTOVI with drugs known to prolong QT/QTc interval.
View the full Prescribing Information.
About Pfizer Oncology
At Pfizer Oncology, we are at the forefront of a new era in cancer care. Our industry-leading portfolio and extensive pipeline includes three core mechanisms of action to attack cancer from multiple angles, including small molecules, antibody-drug conjugates (ADCs), and bispecific antibodies, including other immune-oncology biologics. We are focused on delivering transformative therapies in some of the world’s most common cancers, including breast cancer, genitourinary cancer, hematology-oncology, and thoracic cancers, which includes lung cancer. Driven by science, we are committed to accelerating breakthroughs to help people with cancer live better and longer lives.
About Pfizer: Breakthroughs That Change Patients’ Lives
At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products, including innovative medicines and vaccines. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world’s premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For 175 years, we have worked to make a difference for all who rely on us. We routinely post information that may be important to investors on our website at www.Pfizer.com. In addition, to learn more, please visit us on www.Pfizer.com and follow us on X at @Pfizer and @Pfizer News, LinkedIn, YouTube and like us on Facebook at Facebook.com/Pfizer.
Disclosure Notice
The information contained in this release is as of January 25, 2025. Pfizer assumes no obligation to update forward-looking statements contained in this release as the result of new information or future events or developments.
This release contains forward-looking information about the BRAFTOVI® (encorafenib) plus cetuximab and mFOLFOX6 combination and an indication in the
A further description of risks and uncertainties can be found in Pfizer’s Annual Report on Form 10-K for the fiscal year ended December 31, 2023, and in its subsequent reports on Form 10-Q, including in the sections thereof captioned “Risk Factors” and “Forward-Looking Information and Factors That May Affect Future Results”, as well as in its subsequent reports on Form 8-K, all of which are filed with the
Erbitux® is a registered trademark of Eli Lilly and Company and Merck KGaA, Darmstadt,
References
- American Cancer Society. Global Cancer Facts & Figures 5th Edition. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-2024.pdf. Last accessed: January 2025.
- American Cancer Society. Key Statistics for Colorectal Cancer. Available at: https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html. Last accessed: January 2025.
- American Cancer Society. Cancer Facts & Figures 2025. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2025/2025-cancer-facts-and-figures-acs.pdf. Last accessed: January 2025.
- Ciardiello F, Ciardiello D, Martini G, et al. Clinical management of metastatic colorectal cancer in the era of precision medicine. CA Cancer J Clin. 2022;72:372–40.
- Josep Tabernero et al., The Evolving Treatment Landscape in BRAF-V600E–Mutated Metastatic Colorectal Cancer. Am Soc Clin Oncol Educ Book 42, 254-263(2022). DOI:10.1200/EDBK_349561
- Safaee Ardekani G, Jafarnejad SM, Tan L, et al. The prognostic value of BRAF mutation in colorectal cancer and melanoma: a systematic review and meta-analysis. PloS ONE. 2012;7(10):e47054.
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer. V.5.2024 © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed December 2024. To view the most recent and complete version of the guideline, go online to NCCN.org.
- Cervantes A, Adam R, Roselló S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023;34(1):10–32.
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FAQ
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