U.S. FDA Approves Pfizer’s BRAFTOVI® Combination Regimen as First-Line Treatment of BRAF V600E-Mutant Metastatic Colorectal Cancer
Pfizer (PFE) has received FDA accelerated approval for BRAFTOVI® combination with cetuximab and mFOLFOX6 as the first-line treatment for metastatic colorectal cancer with BRAF V600E mutation. The approval is based on the Phase 3 BREAKWATER trial results, which showed a 61% overall response rate compared to 40% in the control arm. The median duration of response was 13.9 months versus 11.1 months for the control group.
This marks the first and only combination regimen with targeted therapy approved for first-line use in this patient population. The safety profile was consistent with known profiles of each agent, with common adverse reactions including peripheral neuropathy, nausea, and fatigue. The approval was granted under FDA's Project FrontRunner initiative.
Pfizer (PFE) ha ricevuto l'approvazione accelerata dalla FDA per BRAFTOVI® in combinazione con cetuximab e mFOLFOX6 come trattamento di prima linea per il cancro colorettale metastatico con mutazione BRAF V600E. L'approvazione si basa sui risultati della fase 3 dello studio BREAKWATER, che ha mostrato una percentuale di risposta globale del 61% rispetto al 40% nel gruppo di controllo. La durata mediana della risposta è stata di 13,9 mesi contro 11,1 mesi per il gruppo di controllo.
Questo segna il primo e unico regime combinato con terapia mirata approvato per l'uso in prima linea in questa popolazione di pazienti. Il profilo di sicurezza era coerente con i profili noti di ciascun agente, con reazioni avverse comuni tra cui neuropatia periferica, nausea e affaticamento. L'approvazione è stata concessa nell'ambito dell'iniziativa Project FrontRunner della FDA.
Pfizer (PFE) ha recibido la aprobación acelerada de la FDA para BRAFTOVI® en combinación con cetuximab y mFOLFOX6 como tratamiento de primera línea para el cáncer colorrectal metastásico con mutación BRAF V600E. La aprobación se basa en los resultados del estudio de fase 3 BREAKWATER, que mostró una tasa de respuesta global del 61% en comparación con el 40% en el grupo de control. La duración mediana de la respuesta fue de 13.9 meses frente a 11.1 meses para el grupo de control.
Esto marca el primer y único régimen de combinación con terapia dirigida aprobado para su uso en primera línea en esta población de pacientes. El perfil de seguridad fue coherente con los perfiles conocidos de cada agente, con reacciones adversas comunes que incluyen neuropatía periférica, náuseas y fatiga. La aprobación fue otorgada bajo la iniciativa Project FrontRunner de la FDA.
화이자 (PFE)는 BRAF V600E 변이를 가진 전이성 대장암의 1차 치료제로 BRAFTOVI®와 cetuximab 및 mFOLFOX6의 조합에 대해 FDA의 가속 승인을 받았습니다. 이 승인은 3상 BREAKWATER 시험 결과를 바탕으로 하며, 이는 대조군의 40%에 비해 전체 반응률 61%을 보여주었습니다. 반응의 중앙 지속 기간은 대조군의 11.1개월에 비해 13.9개월이었습니다.
이는 이 환자 집단에서 1차 사용을 위한 표적 치료와 조합된 첫 번째이자 유일한 요법입니다. 안전성 프로파일은 각 약제의 알려진 프로파일과 일치하며, 일반적인 부작용으로는 말초신경병증, 메스꺼움 및 피로가 포함됩니다. 이 승인은 FDA의 Project FrontRunner 이니셔티브 하에 부여되었습니다.
Pfizer (PFE) a reçu l'approbation accélérée de la FDA pour BRAFTOVI® en combinaison avec cetuximab et mFOLFOX6 en tant que traitement de première ligne pour le cancer colorectal métastatique avec mutation BRAF V600E. L'approbation repose sur les résultats de l'essai de phase 3 BREAKWATER, qui a montré un taux de réponse global de 61% contre 40% dans le groupe témoin. La durée médiane de la réponse était de 13,9 mois contre 11,1 mois pour le groupe témoin.
Ceci marque le premier et unique régime de combinaison avec thérapie ciblée approuvé pour une utilisation en première ligne dans cette population de patients. Le profil de sécurité était cohérent avec les profils connus de chaque agent, les réactions indésirables fréquentes comprenant une neuropathie périphérique, des nausées et de la fatigue. L'approbation a été accordée dans le cadre de l'initiative Project FrontRunner de la FDA.
Pfizer (PFE) hat von der FDA die beschleunigte Zulassung für die Kombination von BRAFTOVI® mit Cetuximab und mFOLFOX6 als Erstlinientherapie für metastasierten kolorektalen Krebs mit BRAF V600E Mutation erhalten. Die Zulassung basiert auf den Ergebnissen der Phase-3-Studie BREAKWATER, die eine Gesamtansprechrate von 61% im Vergleich zu 40% in der Kontrollgruppe zeigte. Die mediane Ansprechdauer betrug 13,9 Monate gegenüber 11,1 Monaten für die Kontrollgruppe.
Dies markiert das erste und einzige Kombinationstherapie-Regime mit zielgerichteter Therapie, das für den Erstlinieneinsatz in dieser Patientengruppe genehmigt wurde. Das Sicherheitsprofil stimmte mit den bekannten Profilen jedes Wirkstoffes überein, wobei häufige Nebenwirkungen periphere Neuropathie, Übelkeit und Erschöpfung umfassten. Die Genehmigung wurde im Rahmen der Initiative Project FrontRunner der FDA erteilt.
- First-line treatment approval provides early access to targeted therapy
- Significant improvement in overall response rate (61% vs 40%)
- Longer duration of response (13.9 months vs 11.1 months)
- Priority review status and accelerated approval pathway achieved
- Continued approval contingent upon verification of clinical benefit
- 12% of patients discontinued treatment due to adverse reactions
- Multiple adverse reactions reported in ≥25% of patients
Insights
- BRAFTOVI in combination with cetuximab and mFOLFOX6 is the first and only combination regimen with targeted therapy approved for use as early as first-line for patients with metastatic colorectal cancer with a BRAF V600E mutation
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Accelerated approval is based on
61% overall response rate compared to40% in control arm in the Phase 3 BREAKWATER trial
“Historically, treatment options have been limited and outcomes poor for patients diagnosed with metastatic colorectal cancer with BRAF mutations,” 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. “As the first and only combination regimen featuring a BRAF-targeted therapy for this patient population, usable even in first-line treatment, the encorafenib regimen has demonstrated high response rates that are rapid and durable. This represents an encouraging sign of continued disease control and a source of renewed hope for patients.”
The ongoing BREAKWATER trial is evaluating BRAFTOVI plus cetuximab with or without chemotherapy (mFOLFOX6) in previously untreated mCRC patients who harbor a BRAF V600E mutation. It is the only Phase 3 trial for a BRAF-targeted therapy regimen in first-line BRAF V600E-mutant mCRC. The trial met one of the dual primary endpoints of confirmed overall response rate (ORR), with a statistically significant improvement over standard of care: ORR
“For more than a decade, Pfizer has been a pioneer in delivering targeted therapies for molecular-driven cancers. With today’s accelerated approval of the BRAFTOVI regimen, patients with metastatic colorectal cancer with a BRAF V600E mutation now have a first-line treatment option, which contains a targeted therapy specifically for a mutation that is driving their cancer,” said Chris Boshoff, M.D., Ph.D., Chief Oncology Officer, Executive Vice President, Pfizer. “This milestone adds to our legacy of developing innovative medicines in BRAF tumors, some of the hardest-to-treat cancers. We look forward to continuing to expand our portfolio, including the exploration of a next-generation brain-penetrant BRAF inhibitor.”
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. The most common adverse reactions (≥
“Finding out that your cancer has spread can be a frightening time for those with colorectal cancer and their loved ones. The prognosis for those receiving a metastatic colorectal cancer diagnosis has improved slightly in recent years, but the same cannot be said for those with a BRAF mutation who unfortunately face an especially aggressive disease and worse outcomes,” said Michael Sapienza, Chief Executive Officer of the Colorectal Cancer Alliance. “Today’s approval of the first combination regimen including a BRAF-targeted therapy for BRAF V600E-mutant metastatic colorectal cancer, which can be used for previously untreated patients, offers new promise for the community and marks an important step forward in our collective mission to end this disease.”
This application was granted priority review, used the Real-Time Oncology Review (RTOR) pilot program, and was conducted under Project Orbis, with application reviews ongoing for Project Orbis partners, including
About Colorectal Cancer (CRC)
CRC is the third most common type of cancer in the world, with approximately 1.8 million new diagnoses in 2022.2 Overall, the lifetime risk of developing CRC is about 1 in 23 for men and 1 in 25 for women.3 In the
BRAF mutations are estimated to occur in 8
About BREAKWATER
BREAKWATER is a Phase 3, randomized, active-controlled, open-label, multicenter trial of BRAFTOVI with cetuximab, alone or in combination with chemotherapy, in participants with previously untreated BRAF V600E-mutant mCRC. In the Phase 3 portion of the study, 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 and progression-free survival (PFS), as assessed by blinded independent central review (BICR). Key secondary endpoints include DoR as assessed by BICR, time to response by BICR, overall survival, and safety.
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
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 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)
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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. There may be a delay as the document is updated with the latest information. It will be available as soon as possible. Please check back for the updated full information shortly.
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.
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Disclosure Notice
The information contained in this release is as of December 20, 2024. 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 a new 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
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1 BRAFTOVI (encorafenib) Prescribing Information. Array BioPharma, Inc.; December 2024
2 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: December 2024.
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7 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.
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