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Tester tillegget av anti-kreftmedisin, ZEN003694, til den vanlige kjemoterapibehandlingen, Cetuximab Plus Encorafenib, for tykktarmskreft

29. oktober 2026 oppdatert av: National Cancer Institute (NCI)

En fase 1-studie av ZEN003694 (ZEN-3694) i kombinasjon med Cetuximab og Encorafenib hos pasienter med refraktær BRAF V600E metastatisk tykktarmskreft

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.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

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.

Studietype

Intervensjonell

Registrering (Antatt)

30

Fase

  • Fase 1

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

    • California
      • Costa Mesa, California, Forente stater, 92627
        • Rekruttering
        • UC Irvine Health Cancer Center-Newport
        • Hovedetterforsker:
          • Farshid Dayyani
        • Ta kontakt med:
          • Site Public Contact
          • Telefonnummer: 877-827-8839
      • Irvine, California, Forente stater, 92612
        • Rekruttering
        • UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
        • Ta kontakt med:
        • Hovedetterforsker:
          • Farshid Dayyani
      • Los Angeles, California, Forente stater, 90033
        • Rekruttering
        • USC / Norris Comprehensive Cancer Center
        • Hovedetterforsker:
          • Heinz-Josef Lenz
        • Ta kontakt med:
          • Site Public Contact
          • Telefonnummer: 323-865-0451
      • Los Angeles, California, Forente stater, 90033
        • Suspendert
        • Los Angeles General Medical Center
      • Orange, California, Forente stater, 92868
        • Rekruttering
        • UC Irvine Health/Chao Family Comprehensive Cancer Center
        • Ta kontakt med:
        • Hovedetterforsker:
          • Farshid Dayyani
    • Colorado
      • Aurora, Colorado, Forente stater, 80045
        • Rekruttering
        • UCHealth University of Colorado Hospital
        • Ta kontakt med:
          • Site Public Contact
          • Telefonnummer: 720-848-0650
        • Hovedetterforsker:
          • Alexis D. Leal
    • Kansas
      • Fairway, Kansas, Forente stater, 66205
        • Aktiv, ikke rekrutterende
        • University of Kansas Clinical Research Center
      • Kansas City, Kansas, Forente stater, 66160
        • Aktiv, ikke rekrutterende
        • University of Kansas Cancer Center
      • Overland Park, Kansas, Forente stater, 66211
        • Aktiv, ikke rekrutterende
        • University of Kansas Hospital-Indian Creek Campus
      • Westwood, Kansas, Forente stater, 66205
        • Aktiv, ikke rekrutterende
        • University of Kansas Hospital-Westwood Cancer Center
    • Louisiana
      • New Orleans, Louisiana, Forente stater, 70121
        • Aktiv, ikke rekrutterende
        • Ochsner Medical Center Jefferson
    • Ohio
      • Columbus, Ohio, Forente stater, 43210
        • Rekruttering
        • Ohio State University Comprehensive Cancer Center
        • Hovedetterforsker:
          • Shafia Rahman
        • Ta kontakt med:
    • Oklahoma
      • Oklahoma City, Oklahoma, Forente stater, 73104
        • Rekruttering
        • University of Oklahoma Health Sciences Center
        • Ta kontakt med:
        • Hovedetterforsker:
          • Susanna V. Ulahannan
    • Texas
      • Houston, Texas, Forente stater, 77030
        • Rekruttering
        • UT MD Anderson Cancer Center
        • Ta kontakt med:
        • Hovedetterforsker:
          • Salvador Alonso Martinez
    • Virginia
      • Charlottesville, Virginia, Forente stater, 22908
      • Richmond, Virginia, Forente stater, 23298
        • Rekruttering
        • VCU Massey Comprehensive Cancer Center
        • Hovedetterforsker:
          • Khalid Matin
        • Ta kontakt med:

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

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

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: N/A
  • Intervensjonsmodell: Enkeltgruppeoppdrag
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: 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

Andre navn:
  • CT
  • KATT
  • CAT-skanning
  • Beregnet aksial tomografi
  • Datastyrt aksialtomografi
  • Datastyrt tomografi
  • CT skann
  • tomografi
  • Datastyrt aksial tomografi (prosedyre)
  • Datastyrt tomografi (CT) skanning
  • Diagnostisk CAT -skanning
  • Diagnostisk CAT -skannertype

Undergo MRI

Andre navn:
  • MR
  • Magnetisk resonans
  • Magnetic Resonance Imaging Scan
  • Medisinsk bildebehandling, magnetisk resonans / kjernemagnetisk resonans
  • MR Imaging
  • MR-skanning
  • NMR-avbildning
  • NMRI
  • Kjernemagnetisk resonansavbildning
  • Magnetisk resonanstomografi (MR)
  • sMRI
  • Magnetisk resonansavbildning (prosedyre)
  • MR-er
  • Strukturell MR

Undergo ECHO

Andre navn:
  • Ekkokardiografi
  • EC

Undergo MUGA

Andre navn:
  • Skanning av blodbasseng
  • Likevektsradionuklidangiografi
  • Gated Blood Pool Imaging
  • MUGA
  • Radionuklid ventrikulografi
  • RNVG
  • SYMA-skanning
  • Synchronized Multigated Acquisition Scanning
  • MUGA Scan
  • Multi-Gated Acquisition Scan
  • Radionuklid ventrikulogramskanning
  • Gated Heart Pool Scan
  • RNV Scan

Undergo biopsy

Andre navn:
  • Bx
  • BIOPSY_TYPE
  • Biopsi

Undergo collection of blood samples

Andre navn:
  • Biologisk prøvesamling
  • Bioprøve samlet
  • Prøvesamling

Given IV

Andre navn:
  • C225
  • Erbitux
  • IMC-C225
  • Cetuximab Biosimilar CDP-1
  • Cetuximab Biosimilar CMAB009
  • Cetuximab Biosimilar KL 140
  • Kimerisk anti-EGFR monoklonalt antistoff
  • Kimerisk MoAb C225
  • Kimerisk monoklonalt antistoff C225
  • C-225
  • C 225
  • Cetuximab-cetu
  • Cetuxa
  • ENZ 124
  • ENZ-124
  • ENZ124

Given PO

Andre navn:
  • BETi ZEN-3694
  • ZEN 3694
  • ZEN-3694
  • ZEN003694

Given PO

Andre navn:
  • Braftovi
  • LGX 818
  • LGX-818
  • LGX818

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Maximum tolerated dose (dose escalation cohort)
Tidsramme: 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)
Tidsramme: 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

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Time to progression
Tidsramme: 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
Tidsramme: 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)
Tidsramme: Up to 3 years

Median OS will be estimated according to Kaplan-Meier analysis.

Up to 3 years
Progression-free survival (PFS)
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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

Andre resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Presence or absence of a given gene mutation
Tidsramme: 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

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Etterforskere

  • Hovedetterforsker: Salvador Alonso Martinez, University of Texas MD Anderson Cancer Center LAO

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

5. juni 2024

Primær fullføring (Antatt)

30. januar 2027

Studiet fullført (Antatt)

30. januar 2027

Datoer for studieregistrering

Først innsendt

25. oktober 2023

Først innsendt som oppfylte QC-kriteriene

25. oktober 2023

Først lagt ut (Faktiske)

26. oktober 2023

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

30. oktober 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

29. oktober 2026

Sist bekreftet

1. september 2026

Mer informasjon

Begreper knyttet til denne studien

Andre studie-ID-numre

  • NCI-2023-08787
  • UM1CA186688 (U.S. NIH-stipend/kontrakt)
  • 10605 (Annen identifikator: CTEP)
  • NCI-2023-08787 (Registeridentifikator: CTRP (Clinical Trial Reporting Program))
  • 2024-0120
  • 10605 (Annen identifikator: University of Texas MD Anderson Cancer Center LAO)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

JA

IPD-planbeskrivelse

NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Ja

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

produkt produsert i og eksportert fra USA

Nei

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .