Testen der Zugabe des Krebsmedikaments ZEN003694 zur üblichen Chemotherapie, Cetuximab plus Encorafenib, bei Darmkrebs
Eine Phase-1-Studie zu ZEN003694 (ZEN-3694) in Kombination mit Cetuximab und Encorafenib bei Patienten mit refraktärem metastasiertem BRAF V600E-Darmkrebs
This phase I trial tests the safety, best dose, and effectiveness of ZEN003694 in combination with cetuximab and encorafenib in treating patients with colorectal cancer that has not responded to previous treatment (refractory), that has come back after a period of improvement (relapsed), and that has spread from where it first started (primary site) to other places in the body (metastatic). ZEN003694 is a protein inhibitor that binds to BET proteins. When ZEN003694 binds to BET proteins, it disrupts gene expression. Preventing the expression of certain growth-promoting genes may inhibit proliferation of tumor cells that over-express BET proteins. Immunotherapy with monoclonal antibodies, such as cetuximab, may help the body's immune system attack the tumor, and may interfere with the ability of tumor cells to grow and spread. Encorafenib is an enzyme inhibitor. It inhibits pathways that are responsible for controlling cell proliferation and survival, which may lead to a decrease in tumor cell proliferation. Both cetuximab and encorafenib have been approved to treat cancer. Adding ZEN003694 to cetuximab and encorafenib may be more effective at treating patients with refractory metastatic colorectal cancer than giving the usual treatment (cetuximab and encorafenib) alone.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
PRIMARY OBJECTIVES:
I. To define the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of BET bromodomain inhibitor ZEN-3694 (ZEN003694) when used in combination with cetuximab and encorafenib.
II. To define the safety profile of combination of ZEN003694, encorafenib, and cetuximab.
SECONDARY OBJECTIVES:
I. To observe and record anti-tumor activity. II. To evaluate clinical response signals of the combination. III. To assess the pharmacodynamic (PD) profile of the combination as defined by MAPK inhibition.
IV. To assess the pharmacokinetics (PK) of ZEN003694 in combination with encorafenib.
EXPLORATORY OBJECTIVE:
I. To characterize pharmacodynamics and potential mechanisms of resistance to therapy via whole exome sequencing (WES), ribonucleic acid sequencing (RNAseq), and assay for transposase-accessible chromatin with sequencing (ATACseq)/HiSeq 4000 or NovaSeq following progression on treatment.
OUTLINE: This is a dose-escalation study of ZEN003694 followed by a dose-expansion study.
Patients receive ZEN003694 orally (PO) once daily (QD) on days 1-28 of each cycle, cetuximab intravenously (IV) over 120 minutes on days 1 and 15 of each cycle, and encorafenib PO QD on days 1-28 of each cycle. NOTE: In the dose-expansion study, patients receive encorafenib on days 2-28 of cycle 1 and then on days 1-28 of cycles thereafter. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo echocardiography (ECHO) or multi-gated acquisition scan (MUGA), computed tomography (CT) or magnetic resonance imaging (MRI), and collection of blood samples throughout the trial. Patients may also undergo biopsy at screening and on study.
After completion of study treatment, patients are followed up every 2 months.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 1
Kontakte und Standorte
Studienorte
-
-
California
-
Costa Mesa, California, Vereinigte Staaten, 92627
- Rekrutierung
- UC Irvine Health Cancer Center-Newport
-
Hauptermittler:
- Farshid Dayyani
-
Kontakt:
- Site Public Contact
- Telefonnummer: 877-827-8839
-
Irvine, California, Vereinigte Staaten, 92612
- Rekrutierung
- UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
-
Kontakt:
- Site Public Contact
- Telefonnummer: 877-827-8839
- E-Mail: ucstudy@uci.edu
-
Hauptermittler:
- Farshid Dayyani
-
Los Angeles, California, Vereinigte Staaten, 90033
- Rekrutierung
- USC / Norris Comprehensive Cancer Center
-
Hauptermittler:
- Heinz-Josef Lenz
-
Kontakt:
- Site Public Contact
- Telefonnummer: 323-865-0451
-
Los Angeles, California, Vereinigte Staaten, 90033
- Suspendiert
- Los Angeles General Medical Center
-
Orange, California, Vereinigte Staaten, 92868
- Rekrutierung
- UC Irvine Health/Chao Family Comprehensive Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonnummer: 877-827-8839
- E-Mail: ucstudy@uci.edu
-
Hauptermittler:
- Farshid Dayyani
-
-
Colorado
-
Aurora, Colorado, Vereinigte Staaten, 80045
- Rekrutierung
- UCHealth University of Colorado Hospital
-
Kontakt:
- Site Public Contact
- Telefonnummer: 720-848-0650
-
Hauptermittler:
- Alexis D. Leal
-
-
Kansas
-
Fairway, Kansas, Vereinigte Staaten, 66205
- Aktiv, nicht rekrutierend
- University of Kansas Clinical Research Center
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Kansas City, Kansas, Vereinigte Staaten, 66160
- Aktiv, nicht rekrutierend
- University of Kansas Cancer Center
-
Overland Park, Kansas, Vereinigte Staaten, 66211
- Aktiv, nicht rekrutierend
- University of Kansas Hospital-Indian Creek Campus
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Westwood, Kansas, Vereinigte Staaten, 66205
- Aktiv, nicht rekrutierend
- University of Kansas Hospital-Westwood Cancer Center
-
-
Louisiana
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New Orleans, Louisiana, Vereinigte Staaten, 70121
- Aktiv, nicht rekrutierend
- Ochsner Medical Center Jefferson
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-
Ohio
-
Columbus, Ohio, Vereinigte Staaten, 43210
- Rekrutierung
- Ohio State University Comprehensive Cancer Center
-
Hauptermittler:
- Shafia Rahman
-
Kontakt:
- Site Public Contact
- Telefonnummer: 800-293-5066
- E-Mail: Jamesline@osumc.edu
-
-
Oklahoma
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Oklahoma City, Oklahoma, Vereinigte Staaten, 73104
- Rekrutierung
- University of Oklahoma Health Sciences Center
-
Kontakt:
- Site Public Contact
- Telefonnummer: 405-271-8777
- E-Mail: ou-clinical-trials@ouhsc.edu
-
Hauptermittler:
- Susanna V. Ulahannan
-
-
Texas
-
Houston, Texas, Vereinigte Staaten, 77030
- Rekrutierung
- UT MD Anderson Cancer Center
-
Kontakt:
- Site Public Contact
- Telefonnummer: 866-632-6789
- E-Mail: askmdanderson@mdanderson.org
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Hauptermittler:
- Salvador Alonso Martinez
-
-
Virginia
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Charlottesville, Virginia, Vereinigte Staaten, 22908
- Rekrutierung
- University of Virginia Cancer Center
-
Hauptermittler:
- Paul Kunk
-
Kontakt:
- Site Public Contact
- Telefonnummer: 434-243-6303
- E-Mail: uvacancertrials@hscmail.mcc.virginia.edu
-
Richmond, Virginia, Vereinigte Staaten, 23298
- Rekrutierung
- VCU Massey Comprehensive Cancer Center
-
Hauptermittler:
- Khalid Matin
-
Kontakt:
- Site Public Contact
- Telefonnummer: 804-628-6430
- E-Mail: CTOclinops@vcu.edu
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
- Patients must have histologically confirmed and radiographically measurable metastatic colorectal adenocarcinoma with known BRAF V600E mutation, confirmed in a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory with at least one tumor measurable as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and for which standard curative or palliative measures do not exist or are no longer effective
- Age ≥ 18 years. Because no dosing or adverse event data are currently available on the use of ZEN003694 in combination with cetuximab and encorafenib in patients < 18 years of age, children are excluded from this study
- Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (Karnofsky ≥ 60%)
- Absolute neutrophil count ≥ 1,500/mcL
- Platelets ≥ 100,000/mcL
- Hemoglobin (Hb) ≥ 9 mg/dl
- Total bilirubin ≤ 1.5 mg/dl (excluding Gilbert's disease)
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) ≤ 3 x institutional upper limit of normal (ULN)
- Creatinine clearance (CrCL) glomerular filtration rate (GFR) ≥ 50 mL/min/1.73 m^2
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
- Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
- Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression
- Patients with new or progressive brain metastases (active brain metastases) or leptomeningeal disease are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first cycle of therapy
- Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. Patients should be New York Heart Association Functional Classification of class II or better
- Patients must have progressed after at least 1 prior systemic treatment for incurable advanced or metastatic disease
- Patients must have received prior treatment with the combination of encorafenib and cetuximab. They must have tolerated the combination at doses planned for the study
- For the dose expansion phase, patients must have discontinued encorafenib at least 2 weeks prior to starting study treatment
- The effects of ZEN003694 on the developing human fetus are unknown. For this reason and because BRD and BET inhibitor agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for at least 4 months following the last dose of study drug. Women must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 72 hours prior to the start of investigational product. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
- Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants
Exclusion Criteria:
- Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1) with the exception of alopecia
- Patients who are receiving any other investigational agents
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to ZEN003694 or other agents used in study
- Patients with uncontrolled intercurrent illness including, but not limited to, active bleeding diatheses, poorly controlled infection/disorders, or nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with the study therapy
- Patients receiving any medications or substances that are strong inhibitors or inducers of CYP3A4 or substrates of CYP1A2 with narrow therapeutic windows are ineligible. Strong inhibitors or inducers of CYP3A4 must be discontinued at least 7 days prior to the first dose of ZEN003694. As proton pump inhibitors (PPIs), H2 receptor antagonists, and antacids may alter the pharmacokinetics of ZEN003694 by reducing ZEN003694 exposure, patients receiving proton pump inhibitors are ineligible. If H2 blockers or other acid reducing agents are used concomitantly with ZEN003694, a staggered dosing schedule should be used, either dose ZEN003694 2 hours before the H2 blocker or 10-12 hours after an H2 blocker. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product
- Pregnant women are excluded from this study because ZEN003694 is BRD and BET inhibitor agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with ZEN003694, breastfeeding should be discontinued if the mother is treated with ZEN003694. These potential risks may also apply to other agents used in this study
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: N / A
- Interventionsmodell: Einzelgruppenzuweisung
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: Treatment (ZEN003694, cetuximab, encorafenib)
Patients receive ZEN003694 PO QD on days 1-28 of each cycle, cetuximab IV over 120 minutes on days 1 and 15 of each cycle, and encorafenib PO QD on days 1-28 of each cycle. NOTE: In the dose-expansion study, patients receive encorafenib on days 2-28 of cycle 1 and then on days 1-28 of cycles thereafter. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo ECHO or MUGA, CT or MRI, and collection of blood samples throughout the trial. Patients may also undergo biopsy at screening and on study. |
Undergo CT
Andere Namen:
Undergo MRI
Andere Namen:
Undergo ECHO
Andere Namen:
Undergo MUGA
Andere Namen:
Undergo biopsy
Andere Namen:
Undergo collection of blood samples
Andere Namen:
Given IV
Andere Namen:
Given PO
Andere Namen:
Given PO
Andere Namen:
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Maximum tolerated dose (dose escalation cohort)
Zeitfenster: Up to completion of dose escalation phase
|
Will be determined based on the number of grade 3 or 4 adverse events in patients who participate on the study. Toxicities will be graded according to Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v 5.0). |
Up to completion of dose escalation phase
|
|
Recommended phase 2 dose (dose escalation cohort)
Zeitfenster: Up to completion of dose escalation phase
|
Will be determined based on the number of grade 3 or 4 adverse events in patients who participate on the study. Toxicities will be graded according to CTCAE v 5.0. |
Up to completion of dose escalation phase
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Time to progression
Zeitfenster: Time between consent onto study and progression, withdraw, or death, assessed up to 3 years
|
Will be estimated according to Kaplan-Meier analysis. |
Time between consent onto study and progression, withdraw, or death, assessed up to 3 years
|
|
Time to death
Zeitfenster: Time between consent onto study and death, assessed up to 3 years
|
Will be estimated according to Kaplan-Meier analysis. |
Time between consent onto study and death, assessed up to 3 years
|
|
Overall survival (OS)
Zeitfenster: Up to 3 years
|
Median OS will be estimated according to Kaplan-Meier analysis. |
Up to 3 years
|
|
Progression-free survival (PFS)
Zeitfenster: From start of treatment to time of progression or death, whichever occurs first, assessed up to 3 years
|
Median PFS will be estimated according to Kaplan-Meier analysis. |
From start of treatment to time of progression or death, whichever occurs first, assessed up to 3 years
|
|
MAPK inhibition
Zeitfenster: Baseline and cycle 1 day 14 (C1D14)
|
MAPK inhibition, measured by phosphorylated ERK pharmacodynamic profiling, will be evaluated to determine efficacy of the combination. |
Baseline and cycle 1 day 14 (C1D14)
|
|
Pharmacokinetic profile of ZEN003694 when combined with encorafenib
Zeitfenster: Prior to ZEN003694 administration on C1D1, C1D2 and C1D15, as well as 0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours post ZEN003694 administration on C1D1 and C1D15
|
Plasma concentration-time curves will be analyzed by noncompartmental methods using routines supplied. |
Prior to ZEN003694 administration on C1D1, C1D2 and C1D15, as well as 0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours post ZEN003694 administration on C1D1 and C1D15
|
Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Presence or absence of a given gene mutation
Zeitfenster: At pre-treatment and post-progression
|
The presence or absence of a given gene mutation will be evaluated by next-generation sequencing. |
At pre-treatment and post-progression
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Salvador Alonso Martinez, University of Texas MD Anderson Cancer Center LAO
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Lee HM, Zheng Z, Sorokin A, Wong CW, Napolitano S, Chowdhury S, Kanikarla PM, Singh AK, Kochat V, Bristow CA, Srinivasan S, Peoples M, Arslan E, Alshenaifi JY, Villarreal OE, Morris VK, Shen JP, Meric-Bernstam F, Jain AK, Fowlkes NW, Anderson A, Menter DG, Saw AK, Rai K, Kopetz S. Reprogramming of Cellular Plasticity via ETS and MYC Core-regulatory Circuits During Response to MAPK Inhibition in BRAF-mutant Colorectal Cancer. bioRxiv [Preprint]. 2025 Jun 20:2025.06.15.659716. doi: 10.1101/2025.06.15.659716.
- Lee HM, Zheng Z, Sorokin A, Wong CW, Napolitano S, Chowdhury S, Kanikarla Marie P, Singh AK, Kochat V, Bristow CA, Srinivasan S, Peoples M, Arslan E, Alshenaifi JY, Villarreal OE, Morris VK, Shen JP, Meric-Bernstam F, Jain AK, Fowlkes NW, Anderson A, Menter DG, Saw AK, Rai K, Kopetz S. Reprogramming of Cellular Plasticity via ETS and MYC Core-Regulatory Circuits during Response to MAPK Inhibition in BRAF-Mutant Colorectal Cancer. Clin Cancer Res. 2026 Aug 3;32(15):3309-3324. doi: 10.1158/1078-0432.CCR-25-4370.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Zusätzliche relevante MeSH-Bedingungen
- Neubildungen nach Standort
- Neubildungen
- Darmerkrankungen
- Gastrointestinale Neubildungen
- Neoplasmen des Verdauungssystems
- Erkrankungen des Verdauungssystems
- Magen-Darm-Erkrankungen
- Darmtumoren
- Rektale Erkrankungen
- Darmerkrankungen
- Kolorektale Neubildungen
- Aminosäuren, Peptide und Proteine
- Proteine
- Untersuchungstechniken
- Klinische Labortechniken
- Diagnosetechniken und Verfahren
- Diagnose
- Chirurgische Eingriffe, operativ
- Zytologische Techniken
- Zytodiagnose
- Antikörper, monoklonal, humanisiert
- Antikörper, monoklonal
- Antikörper
- Immunglobuline
- Immunoproteine
- Blutproteine
- Serumglobuline
- Globuline
- Diagnosetechniken, chirurgisch
- Chemie -Techniken, analytisch
- Spektrumanalyse
- Cetuximab
- Biopsie
- Handhabung von Proben
- Magnetresonanzspektroskopie
- Encorafenib
- (225) AC-DOTA-C (RGDYK)
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- NCI-2023-08787
- UM1CA186688 (US NIH Stipendium/Vertrag)
- 10605 (Andere Kennung: CTEP)
- NCI-2023-08787 (Registrierungskennung: CTRP (Clinical Trial Reporting Program))
- 2024-0120
- 10605 (Andere Kennung: University of Texas MD Anderson Cancer Center LAO)
Plan für individuelle Teilnehmerdaten (IPD)
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Beschreibung des IPD-Plans
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Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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