Pfizer’s BRAFTOVI® Combination Regimen Significantly Improved Progression-Free Survival and Overall Survival in Phase 3 BREAKWATER Trial
Pfizer (PFE) announced positive topline results from the Phase 3 BREAKWATER study of BRAFTOVI® combination therapy for metastatic colorectal cancer (mCRC) with BRAF V600E mutation. The study demonstrated statistically significant and clinically meaningful improvements in both progression-free survival (PFS) and overall survival (OS) compared to standard chemotherapy.
The BRAFTOVI combination regimen, which includes cetuximab and mFOLFOX6, received accelerated FDA approval in December 2024 for treatment-naïve patients based on improved objective response rate (ORR). The safety profile remained consistent with known profiles of each agent, with no new safety signals identified.
These results will be shared with the FDA to support potential conversion to full approval and with other global regulatory authorities for additional license applications.
Pfizer (PFE) ha annunciato risultati positivi preliminari dallo studio di Fase 3 BREAKWATER sulla terapia combinata con BRAFTOVI® per il cancro colorettale metastatico (mCRC) con mutazione BRAF V600E. Lo studio ha dimostrato miglioramenti statisticamente significativi e clinicamente rilevanti sia nella sopravvivenza senza progressione (PFS) che nella sopravvivenza complessiva (OS) rispetto alla chemioterapia standard.
Il regime di combinazione BRAFTOVI, che include cetuximab e mFOLFOX6, ha ricevuto approvazione accelerata dalla FDA nel dicembre 2024 per pazienti mai trattati, basata su un miglioramento del tasso di risposta oggettiva (ORR). Il profilo di sicurezza è rimasto coerente con i profili noti di ciascun agente, senza nuovi segnali di sicurezza identificati.
Questi risultati saranno condivisi con la FDA per supportare una possibile conversione in approvazione completa e con altre autorità regolatorie globali per ulteriori richieste di licenza.
Pfizer (PFE) anunció resultados positivos preliminares del estudio de Fase 3 BREAKWATER sobre la terapia combinada con BRAFTOVI® para el cáncer colorrectal metastásico (mCRC) con mutación BRAF V600E. El estudio demostró mejoras estadísticamente significativas y clínicamente relevantes tanto en la supervivencia libre de progresión (PFS) como en la supervivencia global (OS) en comparación con la quimioterapia estándar.
El régimen de combinación de BRAFTOVI, que incluye cetuximab y mFOLFOX6, recibió aprobación acelerada de la FDA en diciembre de 2024 para pacientes nunca tratados, basado en una tasa de respuesta objetiva (ORR) mejorada. El perfil de seguridad se mantuvo consistente con los perfiles conocidos de cada agente, sin nuevos señales de seguridad identificadas.
Estos resultados serán compartidos con la FDA para apoyar una posible conversión a aprobación completa y con otras autoridades regulatorias globales para solicitudes de licencia adicionales.
화이자 (PFE)는 BRAF V600E 돌연변이를 가진 전이성 대장암(mCRC)을 위한 BRAFTOVI® 복합 요법의 3상 BREAKWATER 연구에서 긍정적인 최종 결과를 발표했습니다. 이 연구는 표준 화학요법에 비해 무진행 생존 기간(PFS)과 전체 생존 기간(OS) 모두에서 통계적으로 유의미하고 임상적으로 의미있는 개선을 보여주었습니다.
BRAFTOVI 복합 요법은 cetuximab과 mFOLFOX6를 포함하여, 향상된 객관적 반응률(ORR)을 바탕으로 2024년 12월 치료 경험이 없는 환자에 대해 FDA의 신속 승인을 받았습니다. 안전성 프로필은 각 약물의 알려진 프로필과 일관성을 유지하며 새로운 안전성 신호는 발견되지 않았습니다.
이 결과는 FDA와 공유되어 전체 승인의 전환을 지원하고, 글로벌 규제 당국과 추가 라이센스 신청을 위해 공유될 예정입니다.
Pfizer (PFE) a annoncé des résultats préliminaires positifs de l'étude de Phase 3 BREAKWATER sur la thérapie combinée avec BRAFTOVI® pour le cancer colorectal métastatique (mCRC) avec mutation BRAF V600E. L'étude a démontré des améliorations statistiquement significatives et cliniquement pertinentes tant en termes de survie sans progression (PFS) que de survie globale (OS) par rapport à la chimiothérapie standard.
Le régime de combinaison BRAFTOVI, qui comprend le cetuximab et le mFOLFOX6, a reçu l'approbation accélérée de la FDA en décembre 2024 pour des patients n'ayant jamais été traités, sur la base d'un taux de réponse objective (ORR) amélioré. Le profil de sécurité est resté cohérent avec les profils connus de chaque agent, sans nouveaux signaux de sécurité identifiés.
Ces résultats seront partagés avec la FDA pour soutenir une conversion potentielle en approbation complète et avec d'autres autorités réglementaires mondiales pour des demandes de licence supplémentaires.
Pfizer (PFE) hat positive vorläufige Ergebnisse aus der Phase-3-Studie BREAKWATER zur Kombinationsbehandlung mit BRAFTOVI® bei metastasiertem kolorektalem Krebs (mCRC) mit BRAF V600E-Mutation bekannt gegeben. Die Studie zeigte statistisch signifikante und klinisch relevante Verbesserungen sowohl in der progressionsfreien Überlebenszeit (PFS) als auch in der Gesamtüberlebenszeit (OS) im Vergleich zur Standardchemotherapie.
Das Kombinationstherapie-Regime BRAFTOVI, das Cetuximab und mFOLFOX6 umfasst, erhielt im Dezember 2024 eine beschleunigte FDA-Zulassung für Patienten ohne vorherige Behandlung, basierend auf einer verbesserten objektiven Ansprechraten (ORR). Das Sicherheitsprofil blieb konsistent mit den bekannten Profilen jedes Medikaments, ohne dass neue Sicherheitssignale identifiziert wurden.
Diese Ergebnisse werden der FDA mitgeteilt, um eine mögliche Umwandlung in eine volle Zulassung zu unterstützen, sowie anderen globalen Regulierungsbehörden für zusätzliche Lizenzanträge.
- Achieved statistically significant improvements in both progression-free survival and overall survival
- Received FDA accelerated approval in December 2024 for first-line treatment
- Safety profile consistent with known profiles, no new safety concerns
- Potential to become new standard of care for BRAF V600E-mutant mCRC patients
- None.
Insights
The BREAKWATER trial results represent a significant milestone in targeted therapy for colorectal cancer treatment. The study demonstrated dual success with both progression-free survival (PFS) and overall survival (OS) endpoints, which is particularly noteworthy in the challenging BRAF V600E-mutated metastatic colorectal cancer space.
This development is especially significant for several reasons:
- The BRAFTOVI combination represents the first targeted therapy approved for first-line treatment in this specific mutation type, potentially establishing a new standard of care
- The trial's inclusion in the FDA's Project FrontRunner initiative highlights its strategic importance in advancing cancer treatment options
- The combination's accelerated approval in December 2024, coupled with these positive survival data, strengthens Pfizer's position in the precision oncology market
From a commercial perspective, the potential conversion to full FDA approval could significantly expand market adoption and payer coverage. BRAF V600E mutations occur in approximately 8-10% of metastatic colorectal cancer cases, representing a substantial market opportunity for Pfizer. The positive survival data could lead to inclusion in treatment guidelines and establish the combination as the preferred first-line option for this patient population.
The consistent safety profile without new signals enhances the therapy's clinical utility and potential market acceptance. For Pfizer, this success bolsters their oncology portfolio and demonstrates their capability in developing targeted therapies for specific genetic mutations.
The BREAKWATER trial success positions Pfizer strategically in the precision oncology market, particularly in the specialized BRAF V600E-mutated colorectal cancer segment. The commercial implications are substantial:
- The potential for global regulatory approvals could significantly expand the addressable market beyond the US
- First-line treatment positioning provides a competitive advantage in capturing market share early in the treatment journey
- The combination therapy approach may support premium pricing strategies
- Integration with existing diagnostic infrastructure for BRAF testing could accelerate adoption
The therapy's inclusion in Project FrontRunner suggests an expedited pathway to full approval, potentially accelerating market penetration. This development strengthens Pfizer's oncology portfolio, which has been seeking growth drivers amid patent expirations in other areas. The combination therapy's efficacy profile and safety data provide a strong foundation for market acceptance and potential inclusion in treatment guidelines, which typically drives payer coverage decisions.
- BRAFTOVI in combination with cetuximab and mFOLFOX6 showed statistically significant and clinically meaningful improvement in progression-free survival and overall survival in patients with metastatic colorectal cancer with a BRAF V600E mutation
- BRAFTOVI combination regimen received accelerated approval for treatment-naïve patients in December 2024
-
Results to be shared with the
U.S. FDA to support potential conversion to full approval
“We are extremely pleased with the clinically meaningful progression-free survival and overall survival results from the BREAKWATER study, which have the potential to be practice-changing for this patient population that has historically had limited treatment options and poor outcomes,” said Roger Dansey, M.D., Chief Oncology Officer, Pfizer. “The BRAFTOVI regimen is emerging as a new standard of care as the first targeted therapy approved for use as early as first-line for patients with mCRC with a BRAF V600E mutation. We look forward to discussing these data with global health authorities to bring this treatment to more patients around the world, as soon as possible.”
The BRAFTOVI combination regimen received accelerated approval by the
At the time of the ORR analysis, the safety profile of BRAFTOVI in combination with cetuximab and mFOLFOX6 continued to be consistent with the known safety profile of each respective agent. No new safety signals were identified. Detailed results from this analysis will be submitted for presentation at an upcoming medical meeting.
The approval of the BRAFTOVI combination regimen was among the first in the industry to be conducted under the FDA’s Project FrontRunner, which seeks to support the development and approval of new cancer drugs for advanced or metastatic disease. Pfizer will share these latest results with the FDA to potentially support full approval for BRAFTOVI in combination with cetuximab and mFOLFOX6 in patients with mCRC with a BRAF V600E mutation. The BREAKWATER data are also being discussed with other regulatory authorities around the world to support potential additional license applications for the BRAFTOVI combination regimen in this indication.
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 metastatic CRC. 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 progression-free survival (PFS) as assessed by blinded independent central review (BICR). Overall survival 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)
-
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)
-
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 February 3, 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 owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.
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.
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