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Pfizer announced longer-term follow-up results from the Phase 2 PHAROS trial evaluating BRAFTOVI® + MEKTOVI® for patients with BRAF V600E-mutant metastatic non-small cell lung cancer (NSCLC). After approximately three years of follow-up:
– In treatment-naïve patients: 75% objective response rate, 40 months median duration of response, and 30.2 months median progression-free survival
– In previously treated patients: 46% objective response rate, 16.7 months median duration of response, and 9.3 months median progression-free survival
These results support BRAFTOVI + MEKTOVI as a potential standard of care option for this patient population. The combination was approved by the FDA in October 2023 and by the European Commission in August 2024 for BRAF V600E-mutant metastatic NSCLC.
Pfizer ha annunciato i risultati di follow-up a lungo termine dello studio di Fase 2 PHAROS che valuta BRAFTOVI® + MEKTOVI® per pazienti affetti da carcinoma polmonare non a piccole cellule metastatico (NSCLC) con mutazione BRAF V600E. Dopo circa tre anni di follow-up:
– Nei pazienti naivi al trattamento: 75% tasso di risposta oggettiva, 40 mesi di durata mediana della risposta, e 30,2 mesi di sopravvivenza libera da progressione mediana
– Nei pazienti precedentemente trattati: 46% tasso di risposta oggettiva, 16,7 mesi di durata mediana della risposta, e 9,3 mesi di sopravvivenza libera da progressione mediana
Questi risultati supportano BRAFTOVI + MEKTOVI come un’opzione terapeutica potenziale standard per questa popolazione di pazienti. La combinazione è stata approvata dalla FDA nell’ottobre 2023 e dalla Commissione Europea nell’agosto 2024 per NSCLC metastatico con mutazione BRAF V600E.
Pfizer anunció los resultados de seguimiento a largo plazo del ensayo de Fase 2 PHAROS que evalúa BRAFTOVI® + MEKTOVI® para pacientes con cáncer de pulmón no microcítico metastásico (NSCLC) con mutación BRAF V600E. Después de aproximadamente tres años de seguimiento:
– En pacientes naïve al tratamiento: 75% tasa de respuesta objetiva, 40 meses de duración media de la respuesta, y 30,2 meses de supervivencia libre de progresión media
– En pacientes previamente tratados: 46% tasa de respuesta objetiva, 16,7 meses de duración media de la respuesta, y 9,3 meses de supervivencia libre de progresión media
Estos resultados apoyan a BRAFTOVI + MEKTOVI como una opción potencial de tratamiento estándar para esta población de pacientes. La combinación fue aprobada por la FDA en octubre de 2023 y por la Comisión Europea en agosto de 2024 para NSCLC metastásico con mutación BRAF V600E.
화이자는 BRAFTOVI® + MEKTOVI®를 평가하는 2상 PHAROS 시험의 장기 추적 결과를 발표했습니다. 이 치료는 BRAF V600E 변이 전이성 비소세포 폐암 (NSCLC) 환자를 대상으로 하고 있습니다. 약 3년의 추적 관찰 후:
– 치료 미경험 환자: 75%의 객관적 반응률, 반응 지속 시간의 중앙값 40개월, 무진행 생존시간의 중앙값 30.2개월
– 이전에 치료받은 환자: 46%의 객관적 반응률, 반응 지속 시간의 중앙값 16.7개월, 무진행 생존시간의 중앙값 9.3개월
이 결과는 BRAFTOVI + MEKTOVI가 이 환자 집단에 대한 잠재적인 표준 치료 옵션으로서의 가능성을 뒷받침합니다. 이 조합은 2023년 10월에 FDA, 2024년 8월에 유럽연합 집행위원회에 의해 BRAF V600E 변이 전이성 NSCLC에 대해 승인되었습니다.
Pfizer a annoncé les résultats de suivi à long terme de l’essai de Phase 2 PHAROS évaluant BRAFTOVI® + MEKTOVI® pour les patients atteints de cancer du poumon non à petites cellules métastatique (NSCLC) avec mutation BRAF V600E. Après environ trois ans de suivi :
– Chez les patients naïfs de traitement : 75 % de taux de réponse objective, 40 mois de durée médiane de réponse, et 30,2 mois de survie sans progression médiane
– Chez les patients préalablement traités : 46 % de taux de réponse objective, 16,7 mois de durée médiane de réponse, et 9,3 mois de survie sans progression médiane
Ces résultats soutiennent BRAFTOVI + MEKTOVI comme une option de traitement standard potentielle pour cette population de patients. La combinaison a été approuvée par la FDA en octobre 2023 et par la Commission européenne en août 2024 pour le NSCLC métastatique avec mutation BRAF V600E.
Pfizer hat die langfristigen Follow-up-Ergebnisse der Phase-2-Studie PHAROS bekannt gegeben, die BRAFTOVI® + MEKTOVI® für Patienten mit BRAF V600E-mutiertem metastasierendem nicht-kleinzelligem Lungenkrebs (NSCLC) bewertet. Nach etwa drei Jahren Follow-up:
– Bei behandlungsnaiven Patienten: 75% objektive Ansprechrate, 40 Monate mediane Ansprechdauer, und 30,2 Monate mediane progressionsfreie Überlebenszeit
– Bei zuvor behandelten Patienten: 46% objektive Ansprechrate, 16,7 Monate mediane Ansprechdauer, und 9,3 Monate mediane progressionsfreie Überlebenszeit
Diese Ergebnisse unterstützen BRAFTOVI + MEKTOVI als potenzielle Standardtherapieoption für diese Patientengruppe. Die Kombination wurde im Oktober 2023 von der FDA und im August 2024 von der Europäischen Kommission für BRAF V600E-mutiertes metastasierendes NSCLC genehmigt.
Positive
- 75% objective response rate and 40 months median duration of response in treatment-naïve patients
- 30.2 months median progression-free survival in treatment-naïve patients
- 46% objective response rate and 16.7 months median duration of response in previously treated patients
- FDA and European Commission approval for BRAF V600E-mutant metastatic NSCLC
- Potential to become a standard of care option for this patient population
Negative
- Treatment-related adverse events led to dose reduction in 26% of patients
- Permanent discontinuation due to adverse events in 16% of patients
The long-term follow-up results from the PHAROS trial for BRAFTOVI + MEKTOVI in BRAF V600E-mutant metastatic NSCLC are highly encouraging. The combination showed substantial antitumor activity after approximately three years, with impressive objective response rates of 75% in treatment-naïve patients and 46% in previously treated patients.
Notably, the median duration of response of 40 months in treatment-naïve patients is exceptional for this aggressive cancer type. The median progression-free survival of 30.2 months in treatment-naïve patients is also remarkable, potentially representing the longest observed for this mutation compared to historical outcomes.
These results support BRAFTOVI + MEKTOVI as a potential standard of care for BRAF V600E-mutant metastatic NSCLC, particularly in the first-line setting. The combination’s safety profile remains consistent with previous findings, which is important for long-term treatment.
As an oncologist, I find these results particularly significant for BRAF V600E-mutant NSCLC patients. The extended follow-up data validates the durability of response, which is important in metastatic settings. The median overall survival not yet reached at three years in treatment-naïve patients is especially promising, suggesting a potential for long-term survival benefit.
The safety profile remains manageable, with no new concerns identified. This is critical for maintaining quality of life during extended treatment periods. The 26% dose reduction and 16% discontinuation rates due to adverse events are acceptable for a targeted therapy in this setting.
These results could indeed change clinical practice, potentially making BRAFTOVI + MEKTOVI a preferred first-line option for BRAF V600E-mutant NSCLC patients. However, it’s important to note that this mutation occurs in only about 2% of NSCLC cases, underscoring the importance of molecular testing in lung cancer management.
From a financial perspective, these results are positive for Pfizer. The extended efficacy and manageable safety profile of BRAFTOVI + MEKTOVI in BRAF V600E-mutant NSCLC could lead to increased adoption and potentially longer duration of treatment, driving revenue growth.
The recent FDA approval (October 2023) and European Commission approval (August 2024) for this indication provide a solid foundation for market penetration. While the target population is relatively small (2% of NSCLC patients), the potential for first-line use and extended treatment duration could make this a valuable niche for Pfizer.
Investors should also note Pfizer’s ongoing investigation of BRAFTOVI in earlier settings of metastatic colorectal cancer and exploration of a next-generation brain-penetrant BRAF inhibitor. These efforts could expand the market potential of Pfizer’s BRAF-targeted therapies, potentially offsetting future patent expirations or competition in the oncology space.
- BRAFTOVI + MEKTOVI continued to show substantial antitumor activity after a minimum follow up of approximately three years, corresponding to the longest duration of response and progression-free survival in treatment-naïve patients compared to historical outcomes
- Results support BRAFTOVI + MEKTOVI as a standard of care option for this population
NEW YORK–(BUSINESS WIRE)– Pfizer Inc. (NYSE: PFE) today announced longer-term follow-up results from the Phase 2 single-arm PHAROS clinical trial evaluating the efficacy and safety of BRAFTOVI® (encorafenib) in combination with MEKTOVI® (binimetinib) for patients with BRAF V600E–mutant metastatic non-small cell lung cancer (NSCLC). After an additional 18 months of follow-up, the objective response rate (ORR) and the median duration of response (DoR) as assessed by independent radiology review were 75% and 40 months in treatment-naïve patients and 46% and 16.7 months in previously treated patients, respectively. In addition, after approximately three years of follow-up in treatment-naïve patients, the median progression-free survival (PFS) with BRAFTOVI + MEKTOVI was 30.2 months (95% confidence interval [CI], 15.7-not estimable [NE]), while median overall survival (OS) was not yet reached (95% CI, 31.3-NE). These data will be presented today during a late-breaking oral session (Abstract LBA56) at the European Society for Medical Oncology (ESMO) Congress 2024 in Barcelona, Spain.
“BRAF V600E-mutant metastatic non-small cell lung cancer tends to be aggressive, and effective targeted first-line treatment options with manageable safety profiles are critical for the thousands of people who are diagnosed globally each year,” said Gregory Riely, M.D., Ph.D., Vice Chair, Clinical Research in the Department of Medicine at Memorial Sloan Kettering Cancer Center (MSK) and PHAROS investigator. “The longer-term follow-up results from the PHAROS trial represent an important step forward in the treatment of BRAF V600E-mutant metastatic NSCLC, especially for treatment-naïve patients. These compelling results support the BRAFTOVI + MEKTOVI combination as a standard of care option for these patients.”
Lung cancer is the number one cause of cancer-related death around the world.1 NSCLC accounts for approximately 80-85% of lung cancers,2 with BRAF V600E mutations occurring in about 2% of patients with NSCLC.3 Understanding the role of the mitogen-activated protein within the pathway including BRAF V600E-mutant metastatic NSCLC.
The Phase 2 PHAROS trial (NCT03915951) is an open-label, multicenter, single arm study examining BRAFTOVI + MEKTOVI combination therapy in treatment-naïve and previously treated patients with BRAF V600E-mutant metastatic NSCLC. Notably, upon longer-term follow-up in previously treated patients, BRAFTOVI + MEKTOVI showed a median PFS of 9.3 months (95% CI, 6.2-24.8) and a median OS of 22.7 months (95% CI, 14.1-32.2), with a safety profile that was consistent with previous findings; no new safety concerns were identified. In this analysis, treatment-related adverse events (AEs) led to dose reduction in 26% of patients, and to permanent discontinuation in 16% of patients. Nausea, diarrhea, and fatigue remained the most common treatment-related AEs.
“These potentially practice-changing results from the PHAROS trial show that the combination of BRAFTOVI + MEKTOVI is providing long-term compelling efficacy for patients, and although no definitive conclusions can be made across trials, the duration of response and progression-free survival in treatment naïve patients appear to be the longest observed for BRAF V600E–mutant metastatic NSCLC compared with historical outcomes,” said Roger Dansey, M.D., Chief Development Officer, Oncology, Pfizer. “These latest data reflect our deep understanding of the science behind biomarker-driven cancers and add to our legacy in developing innovative targeted treatments in NSCLC. We are continuing to build upon this strong foundation with a pipeline of targeted medicines and combinations across our tumor areas of focus, including the ongoing investigation of BRAFTOVI in earlier settings of metastatic colorectal cancer, and the exploration of a next-generation brain-penetrant BRAF inhibitor.”
BRAFTOVI + MEKTOVI was approved by the U.S. Food and Drug Administration (FDA) in October 2023, and by the European Commission in August 2024, for the treatment of BRAF V600E-mutant metastatic NSCLC based on the initial ORR (the primary endpoint) and DoR (key secondary endpoint) results from the PHAROS clinical trial.
In addition to PHAROS, safety lead-in data from the ongoing Phase 3 BREAKWATER study investigating BRAFTOVI in combination with cetuximab and FOLFIRI chemotherapy in previously untreated BRAF V600E-mutant metastatic colorectal cancer (CRC) will also be presented as a mini-oral session at ESMO (Abstract 515MO). BRAFTOVI in combination with cetuximab and FOLFIRI was found to be generally tolerable in this patient population, with no new safety concerns identified. These findings support the ongoing investigation of this combination regimen as a potential treatment option for BRAF V600E-mutant metastatic CRC. The Phase 3 BREAKWATER trial is ongoing, with updated data expected in 2025.
BRAF mutations can occur in a number of tumor types, including metastatic melanoma, metastatic CRC and metastatic NSCLC. Among different types of BRAF mutations, the BRAF V600E mutation is particularly important as it occurs in approximately half of patients with BRAF-mutant metastatic NSCLC.4 Further, this mutation represents up to 90% of BRAF mutations in melanoma5 and more than doubles the risk of mortality for patients with CRC.6 In addition to our continued investigation of BRAFTOVI + MEKTOVI for BRAF-mutant cancers, Pfizer is also exploring a next-generation BRAF inhibitor designed to selectively inhibit mutant BRAF monomers and mutant BRAF-containing dimers and be brain penetrant. The investigational drug is currently being evaluated in a Phase 1 clinical study.
Pfizer has exclusive rights to BRAFTOVI + MEKTOVI in the U.S., Canada, and all countries in Latin America, Africa and the Middle East. Ono Pharmaceutical Co., Ltd. has exclusive rights to commercialize both products in Japan and South Korea, Medison has exclusive rights in Israel, and Pierre Fabre Laboratories has exclusive rights in all other countries, including Europe and Asia-Pacific (excluding Japan and South Korea). The PHAROS trial is conducted with support from Pierre Fabre Laboratories.
INDICATION AND USAGE
BRAFTOVI® (encorafenib) and MEKTOVI® (binimetinib) are kinase inhibitors indicated for use in combination for the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, as detected by an FDA-approved test.
BRAFTOVI is indicated, in combination with cetuximab, for the treatment of adult patients with metastatic colorectal cancer (CRC) with a BRAF V600E mutation, as detected by an FDA-approved test, after prior therapy.
BRAFTOVI and MEKTOVI are kinase inhibitors indicated for use in combination for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) with a BRAF V600E mutation, as detected by an FDA-approved test.
Limitations of Use: BRAFTOVI is not indicated for treatment of patients with wild-type BRAF melanoma, wild-type BRAF CRC, or wild-type BRAF NSCLC.
IMPORTANT SAFETY INFORMATION
This information applies to the safety of BRAFTOVI when used in combination with either MEKTOVI or cetuximab.
WARNINGS AND PRECAUTIONS
New Primary Malignancies: New primary malignancies, cutaneous and non-cutaneous, can occur. BRAFTOVI may promote malignancies associated with activation of RAS through mutation or other mechanisms. Perform dermatopathologic evaluations prior to initiating treatment, every 2 months during treatment, and for up to 6 months following discontinuation of treatment. Manage suspicious skin lesions with excision and dermatopathologic evaluation. Dose modification is not recommended for new primary cutaneous malignancies. Monitor patients receiving BRAFTOVI for signs and symptoms of non-cutaneous malignancies. Discontinue BRAFTOVI for RAS mutation-positive non-cutaneous malignancies. Monitor patients for new malignancies prior to initiation of treatment, while on treatment, and after discontinuation of treatment.
- BRAF-mutant type (BRAF-mt) metastatic melanoma (COLUMBUS study): Cutaneous squamous cell carcinoma (cuSCC), including keratoacanthoma (KA), occurred in 2.6% and basal cell carcinoma occurred in 1.6% of patients receiving BRAFTOVI with MEKTOVI. Median time to first occurrence of cuSCC/KA was 5.8 months.
- BRAF-mt metastatic CRC (BEACON CRC study): cuSCC, including KA, occurred in 1.4% of patients with CRC, and a new primary melanoma occurred in 1.4% of patients who received BRAFTOVI with cetuximab.
- BRAF-mt metastatic NSCLC (PHAROS study): cuSCC and skin papilloma (SP), each occurred in 2% of patients.
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. Patients with cardiovascular risk factors should be monitored closely. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
- 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 50% or below the institutional lower limit of normal (LLN).
- BRAF-mt metastatic melanoma (COLUMBUS study): Evidence of cardiomyopathy occurred in 7% and Grade 3 left ventricular dysfunction occurred in 1.6% of patients receiving BRAFTOVI with MEKTOVI. The median time to first occurrence of left ventricular dysfunction (any grade) was 3.6 months. Cardiomyopathy resolved in 87% of patients.
- BRAF-mt metastatic NSCLC (PHAROS study): Evidence of cardiomyopathy occurred in 11% and Grade 3 left ventricular dysfunction occurred in 1% of patients. Cardiomyopathy resolved in 82% of patients.
Hepatotoxicity: Hepatotoxicity can occur. Monitor liver laboratory tests before initiation, monthly during treatment, and as clinically indicated. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
- BRAF-mt metastatic melanoma (COLUMBUS study): The incidence of Grade 3 or 4 increases in liver function laboratory tests in patients receiving MEKTOVI with BRAFTOVI was 6% for alanine aminotransferase (ALT), 2.6% for aspartate aminotransferase (AST), and 0.5% for alkaline phosphatase.
- BRAF-mt metastatic NSCLC (PHAROS study): The incidence of Grade 3 or 4 increases in liver function laboratory tests was 10% for AST, 9% for ALT, and 3.2% for alkaline phosphatase.
Hemorrhage: Hemorrhage can occur when BRAFTOVI is administered in combination with MEKTOVI or cetuximab. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
- BRAF-mt metastatic melanoma (COLUMBUS study): Hemorrhage occurred in 19% of patients receiving BRAFTOVI with MEKTOVI and Grade 3 or higher hemorrhage occurred in 3.2% of patients. The most frequent hemorrhagic events were gastrointestinal, including rectal hemorrhage (4.2%), hematochezia (3.1%), and hemorrhoidal hemorrhage (1%). Fatal intracranial hemorrhage in the setting of new or progressive brain metastases occurred in 1.6% of patients.
- BRAF-mt metastatic CRC (BEACON CRC study): Hemorrhage occurred in 19% of patients receiving BRAFTOVI with cetuximab; Grade 3 or higher hemorrhage occurred in 1.9% of patients, including fatal gastrointestinal hemorrhage in 0.5% of patients. The most frequent hemorrhagic events were epistaxis (6.9%), hematochezia (2.3%), and rectal hemorrhage (2.3%).
- BRAF-mt metastatic NSCLC (PHAROS study): Hemorrhage occurred in 12% of patients including fatal intracranial hemorrhage (1%); Grade 3 or 4 hemorrhage occurred in 4.1% of patients. The most frequent hemorrhagic events were anal hemorrhage and hemothorax (2% each).
Uveitis: Uveitis, including iritis and iridocyclitis, has been reported in patients treated with BRAFTOVI with MEKTOVI. 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.
- BRAF-mt metastatic melanoma (COLUMBUS study): The incidence of uveitis among patients treated with BRAFTOVI with MEKTOVI was 4%.
- BRAF-mt metastatic NSCLC (PHAROS study): The incidence of uveitis among patients treated with BRAFTOVI with MEKTOVI was 1%.
QT Prolongation: BRAFTOVI is associated with dose-dependent QTc interval prolongation in some patients. Monitor patients who already have or who are at significant risk of developing QTc prolongation, including patients with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medicinal products associated with QT prolongation. Correct hypokalemia and hypomagnesemia prior to and during BRAFTOVI administration. Withhold, reduce dose, or permanently discontinue for QTc >500 ms.
- BRAF-mt metastatic melanoma (COLUMBUS study): An increase in QTcF to >500 ms was measured in 0.5% (1/192) of patients who received BRAFTOVI with MEKTOVI.
- BRAF-mt metastatic NSCLC (PHAROS study): An increase in QTcF to >500 ms was measured in 2.1% (2/95) of patients who received BRAFTOVI with MEKTOVI.
Embryo-Fetal Toxicity: Both BRAFTOVI and MEKTOVI can cause fetal harm when administered to a pregnant woman. BRAFTOVI can render hormonal contraceptives ineffective.
- BRAF-mt metastatic melanoma (COLUMBUS study) and BRAF-mt metastatic NSCLC (PHAROS study): Effective, non-hormonal contraceptives should be used during treatment and for at least 30 days after the final dose for patients taking BRAFTOVI with MEKTOVI.
- BRAF-mt metastatic CRC (BEACON CRC study): Advise females of reproductive potential to use effective nonhormonal contraception during treatment with BRAFTOVI and for 2 weeks after the final dose.
BRAFTOVI as a Single Agent is associated with increased risk of certain adverse reactions compared to when BRAFTOVI is used with MEKTOVI.
- BRAF-mt metastatic melanoma (COLUMBUS study): Grades 3 or 4 dermatologic reactions occurred in 21% of patients receiving BRAFTOVI as a single agent compared to 2% in patients receiving the combination of BRAFTOVI with MEKTOVI.
- If MEKTOVI is temporarily interrupted or permanently discontinued, reduce the dose of BRAFTOVI as recommended.
Risks Associated with Combination Treatment
- In BRAF-mt metastatic melanoma (COLUMBUS study), BRAFTOVI is used in combination with MEKTOVI so refer to the prescribing information for MEKTOVI for additional risk information.
- In BRAF-mt metastatic CRC (BEACON CRC study), BRAFTOVI is used in combination with cetuximab so refer to the prescribing information for cetuximab for additional risk information.
- In BRAF-mt metastatic NSCLC (PHAROS study), BRAFTOVI is indicated for use as part of a regimen in combination with MEKTOVI, so refer to the prescribing information for MEKTOVI for additional risk information.
Additional WARNINGS AND PRECAUTIONS for MEKTOVI When Used With BRAFTOVI
Venous Thromboembolism (VTE): VTE occurred in 6% of patients with BRAF-mt metastatic melanoma (COLUMBUS study), including 3.1% of patients who developed pulmonary embolism. VTE occurred in 7% of patients with BRAF-mt metastatic NSCLC (PHAROS study), including 1% of patients who developed pulmonary embolism. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
Other Ocular Toxicities
- Serous retinopathy
- Assess for visual symptoms at each visit. Perform an ophthalmologic examination at regular intervals, 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.
- BRAF-mt metastatic melanoma (COLUMBUS study): serous retinopathy occurred in 20% of patients receiving MEKTOVI with BRAFTOVI; 8% were retinal detachment and 6% were macular edema. Symptomatic serous retinopathy occurred in 8% of patients with no cases of blindness. The median time to onset of the first event of serous retinopathy (all grades) was 1.2 months.
- BRAF-mt metastatic NSCLC (PHAROS study): serous retinopathy (retinal detachment) occurred in 2% of patients with no cases of blindness.
- Retinal vein occlusion (RVO) is a known class-related adverse reaction of MEK inhibitors and may occur in patients receiving MEKTOVI with BRAFTOVI. In BRAF-mt metastatic melanoma (COLUMBUS study), 1 patient experienced RVO (0.1%) in the MEKTOVI with BRAFTOVI group (n=690).
- The safety of MEKTOVI has not been established in patients with a history of RVO or current risk factors for RVO, including uncontrolled glaucoma or a history of hyperviscosity or hypercoagulability syndromes.
- Perform ophthalmological evaluation for patient-reported acute vision loss or other visual disturbance within 24 hours. Permanently discontinue MEKTOVI in patients with documented RVO.
Interstitial Lung Disease (ILD): ILD, including pneumonitis, occurred in 0.3% (2 of 690 patients) with BRAF-mt metastatic melanoma (COLUMBUS study) receiving MEKTOVI with BRAFTOVI. One patient (1%) with BRAF-mt metastatic NSCLC (PHAROS study) receiving MEKTOVI with BRAFTOVI developed pneumonitis. Assess new or progressive unexplained pulmonary symptoms or findings for possible ILD. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
Rhabdomyolysis: Rhabdomyolysis can occur when MEKTOVI is taken with BRAFTOVI. Monitor creatine phosphokinase (CPK) and creatinine levels prior to initiating MEKTOVI, periodically during treatment, and as clinically indicated. Withhold, reduce dose, or permanently discontinue based on severity of adverse reaction.
- BRAF-mt metastatic melanoma (COLUMBUS study): Elevation of laboratory values of serum CPK occurred in 58% of patients receiving MEKTOVI with BRAFTOVI. Rhabdomyolysis was reported in 0.1% (1 of 690 patients) with BRAF mutation-positive melanoma receiving MEKTOVI with BRAFTOVI.
- BRAF-mt metastatic NSCLC (PHAROS study): Elevation of laboratory values of serum creatine kinase (CK) occurred in 41% of patients. No patient experienced rhabdomyolysis.
ADVERSE REACTIONS
BRAF-mt Metastatic Melanoma (COLUMBUS study)
- Most common adverse reactions (≥20%, all grades) for patients receiving BRAFTOVI with MEKTOVI compared to vemurafenib were fatigue (43% vs 46%), nausea (41% vs 34%), diarrhea (36% vs 34%), vomiting (30% vs 16%), abdominal pain (28% vs 16%), arthralgia (26% vs 46%), myopathy (23% vs 22%), hyperkeratosis (23% vs 49%), rash (22% vs 53%), headache (22% vs 20%), constipation (22% vs 6%), visual impairment (20% vs 4%), serous retinopathy/RPED (20% vs 2%).
- Other clinically important adverse reactions occurring in <10% of patients who received BRAFTOVI with MEKTOVI were facial paresis, pancreatitis, panniculitis, drug hypersensitivity, and colitis.
- Most common laboratory abnormalities (≥20%, all grades) for BRAFTOVI with MEKTOVI compared to vemurafenib included increased creatinine (93% vs 92%), increased CPK (58% vs 3.8%), increased gamma glutamyl transferase (GGT) (45% vs 34%), anemia (36% vs 34%), increased ALT (29% vs 27%), hyperglycemia (28% vs 20%), increased AST (27% vs 24%), and increased alkaline phosphatase (21% vs 35%).
BRAF-mt Metastatic CRC (BEACON CRC study)
- Most common adverse reactions (≥25%, all grades) in patients receiving BRAFTOVI with cetuximab compared to irinotecan with cetuximab or FOLFIRI with cetuximab (control) were fatigue (51% vs 50%), nausea (34% vs 41%), diarrhea (33% vs 48%), dermatitis acneiform (32% vs 43%), abdominal pain (30% vs 32%), decreased appetite (27% vs 27%), arthralgia (27% vs 3%), and rash (26% vs 26%).
- Other clinically important adverse reactions occurring in <10% of patients who received BRAFTOVI with cetuximab was pancreatitis.
- Most common laboratory abnormalities (≥20%, all grades) in the BRAFTOVI with cetuximab arm compared to irinotecan with cetuximab or FOLFIRI with cetuximab (control) were: anemia (34% vs 48%) and lymphopenia (24% vs 35%).
BRAF-mt Metastatic NSCLC (PHAROS study)
- Most common adverse reactions (≥25%, all grades) in patients receiving BRAFTOVI with MEKTOVI were fatigue (61%), nausea (58%), diarrhea (52%), musculoskeletal pain (48%), vomiting (37%), abdominal pain (32%), visual impairment (29%), constipation (27%), dyspnea (27%), rash (27%), and cough (26%).
- Serious adverse reactions occurred in 38% of patients receiving BRAFTOVI with MEKTOVI. Serious adverse reactions occurring in ≥2% of patients were hemorrhage (6%), diarrhea (4.1%), anemia (3.1%), dyspnea (3.1%), pneumonia (3.1%), arrhythmia (2%), device related infection (2%), edema (2%), myocardial infarction (2%), and pleural effusion (2%).
- Fatal adverse reactions occurred in 2% of patients, including intracranial hemorrhage (1%) and myocardial infarction (1%).
- Other clinically important adverse reactions occurring in <10% of patients who received BRAFTOVI with MEKTOVI were peripheral neuropathy, dysgeusia, facial paresis, pancreatitis, hyperkeratosis, erythema, and drug hypersensitivity.
- Most common laboratory abnormalities (≥20%, all grades) for BRAFTOVI and MEKTOVI included increased creatinine (91%), hyperglycemia (48%), anemia (47%), increased creatine kinase (41%), lipase increased (40%), increased ALT (34%), hypoalbuminemia (32%), increased alkaline phosphatase (31%), increased AST (31%), hyperkalemia (31%), hyponatremia (26%), lymphopenia (24%), serum amylase increased (22%), and thrombocytopenia (20%).
DRUG INTERACTIONS With BRAFTOVI When Used in Combination With Either MEKTOVI or Cetuximab
- Avoid coadministration of BRAFTOVI with strong or moderate CYP3A4 inhibitors (including grapefruit juice) or CYP3A4 inducers and use caution with sensitive CYP3A4 substrates. Avoid coadministration of BRAFTOVI with hormonal contraceptives.
- Modify BRAFTOVI dose if coadministration with a strong or moderate CYP3A4 inhibitor cannot be avoided.
- Avoid coadministration of BRAFTOVI with drugs known to prolong QT/QTc interval.
- Dose reductions of drugs that are substrates of OATP1B1, OATP1B3, or BCRP may be required when used concomitantly with BRAFTOVI.
Lactation: Advise women not to breastfeed during treatment with BRAFTOVI and MEKTOVI and for 2 weeks after the final dose.
Infertility: Advise males of reproductive potential that BRAFTOVI may impair fertility.
For BRAF-mt metastatic melanoma and for BRAF-mt metastatic NSCLC, see full Prescribing Information and Medication Guide for BRAFTOVI and full Prescribing Information and Medication Guide for MEKTOVI. See full Prescribing Information for BRAFTOVI and for MEKTOVI for dose modifications for adverse reactions. There may be a delay as the documents are updated with the latest information. They will be available as soon as possible. Please check back for the updated full information shortly.
For BRAF-mt metastatic CRC, see full Prescribing Information and Medication Guide for BRAFTOVI. See full Prescribing Information for BRAFTOVI for dose modifications for adverse reactions. Refer to cetuximab prescribing information for recommended dosing and safety information.
About Pfizer Oncology
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Disclosure Notice
The information contained in this release is as of September 14, 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) and MEKTOVI® (binimetinib) combination for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) with a BRAF V600E mutation, other potential indications and a next-generation BRAF inhibitor, including their potential benefits, that involves substantial risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Risks and uncertainties include, among other things, uncertainties regarding the commercial success of BRAFTOVI plus MEKTOVI; the uncertainties inherent in research and development, including the ability to meet anticipated clinical endpoints, commencement and/or completion dates for our clinical trials, regulatory submission dates, regulatory approval dates and/or launch dates, as well as the possibility of unfavorable new clinical data and further analyses of existing clinical data; the risk that clinical trial data are subject to differing interpretations and assessments by regulatory authorities; whether regulatory authorities will be satisfied with the design of and results from our clinical studies; whether and when any drug applications may be filed in any additional jurisdictions for BRAFTOVI plus MEKTOVI for the treatment of patients with metastatic NSCLC with a BRAF V600E mutation or in any jurisdictions for any other potential indications for BRAFTOVI and MEKTOVI or any other product candidates; whether and when any such applications may be approved by regulatory authorities, which will depend on a myriad factors, including making a determination as to whether the product’s benefits outweigh its known risks and determination of the product’s efficacy and, if approved, whether BRAFTOVI plus MEKTOVI or any such other product candidates will be commercially successful; decisions by regulatory authorities impacting labeling, manufacturing processes, safety and/or other matters that could affect the availability or commercial potential of BRAFTOVI plus MEKTOVI or any other product candidates; uncertainties regarding the impact of COVID-19 on Pfizer’s business, operations and financial results; and competitive developments.
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 U.S. Securities and Exchange Commission and available at www.sec.gov and www.pfizer.com.
References
1 World Health Organization. International Agency for Research on Cancer. GLOBOCAN 2022: Global Population Fact sheet. Available at: https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf. Last accessed: September 2024.
2 American Cancer Society. What is lung cancer? Available at: https://www.cancer.org/cancer/lung-cancer/about/what-is.html. Last accessed: September 2024.
3 American Lung Association. BRAF and lung cancer. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/biomarker-testing/braf. Last accessed: September 2024.
4 Paik PK, Arcila ME, Fara M, et al. Clinical characteristics of patients with lung adenocarcinomas harboring BRAF mutations. J Clin Oncol. 2011;29(15):2046-51.
5 Cheng L, Lopez-Beltran A, Massari F, et al. Molecular testing for BRAF mutations to inform melanoma treatment decisions: a move toward precision medicine. Mod Pathol. 2018;31(1):24-38.
6 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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FAQ
What were the key results of Pfizer’s PHAROS trial for BRAFTOVI + MEKTOVI in BRAF V600E-mutant NSCLC?
The PHAROS trial showed a 75% objective response rate and 40 months median duration of response in treatment-naïve patients, with 30.2 months median progression-free survival. In previously treated patients, the objective response rate was 46% with 16.7 months median duration of response.
When did Pfizer (PFE) receive approval for BRAFTOVI + MEKTOVI in BRAF V600E-mutant metastatic NSCLC?
Pfizer received FDA approval for BRAFTOVI + MEKTOVI in BRAF V600E-mutant metastatic NSCLC in October 2023, and European Commission approval in August 2024.
What were the main adverse events reported in the PHAROS trial for BRAFTOVI + MEKTOVI?
The most common treatment-related adverse events were nausea, diarrhea, and fatigue. Treatment-related adverse events led to dose reduction in 26% of patients and permanent discontinuation in 16% of patients.
How does BRAFTOVI + MEKTOVI’s efficacy compare to historical outcomes in BRAF V600E-mutant NSCLC?
According to Pfizer, the duration of response and progression-free survival in treatment-naïve patients appear to be the longest observed for BRAF V600E-mutant metastatic NSCLC compared to historical outcomes, although no definitive conclusions can be made across trials.