Vemurafenib + Cobimetinib for Craniopharyngioma

Recruiting at 122 trial locations

Overseen By Priscilla K. Brastianos, MD

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Alliance for Clinical Trials in Oncology

Must not be taking: CYP3A4 inducers, CYP3A4 inhibitors

Disqualifiers: Congestive heart failure, Uncontrolled hypertension, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: 20 weeks

24 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

You may need to stop taking certain medications. If you are on medications that are strong CYP3A4 inducers or inhibitors, or CYP1A2 substrates, you must stop them at least 14 days before joining the study.

What data supports the effectiveness of the drug combination Vemurafenib and Cobimetinib for treating craniopharyngioma?

Research shows that the combination of Vemurafenib and Cobimetinib is effective in treating patients with BRAF-mutant papillary craniopharyngioma, leading to significant tumor reduction and improved neurological outcomes. ^{1 2 3 4 5}

How is the drug combination of Vemurafenib and Cobimetinib unique for treating craniopharyngioma?

The combination of Vemurafenib and Cobimetinib is unique for treating craniopharyngioma because it specifically targets the BRAF-V600E mutation found in the papillary variant of this tumor, offering a non-surgical option that avoids the serious risks associated with surgery and radiotherapy, such as blindness and cognitive impairment. ^{1 2 5 6 7}

What is the purpose of this trial?

This phase II trial studies how well vemurafenib and cobimetinib work in treating patients with BRAF V600E mutation positive craniopharyngioma. Vemurafenib and cobimetinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Research Team

Priscilla K. Brastianos, MD

Principal Investigator

Massachusetts General Hospital

Eligibility Criteria

This trial is for patients with a specific brain tumor called BRAF V600E mutation positive craniopharyngioma. Eligible participants must have measurable disease, may or may not have received prior surgery, and should not have had previous treatment with BRAF or MEK inhibitors. Women of childbearing potential need a negative pregnancy test to participate.

Inclusion Criteria

I don't have a history of prolonged QT syndrome.

My kidney function is normal or only slightly reduced.

Absolute neutrophil count >= 1500/mm^3

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive vemurafenib orally twice daily on days 1-28 and cobimetinib once daily on days 1-21. Treatment repeats every 28 days for up to 5 courses.

20 weeks

Follow-up

Participants are monitored for disease progression or unacceptable toxicity. Patients with disease progression are followed up every 16 weeks for 2 years, and all other patients are followed up every 6 months for 5 years.

5 years

Treatment Details

Interventions

• Cobimetinib
• Vemurafenib

Trial Overview The effectiveness of two drugs, vemurafenib and cobimetinib, is being tested on stopping the growth of this type of brain tumor by blocking enzymes needed for cell growth. The study will assess how well these drugs work together in treating this condition.

Participant Groups

Group I: Treatment (vemurafenib, cobimetinib) Experimental Treatment 4 Interventions

Patients receive vemurafenib PO BID on day 1-28 and cobimetinib PO QD on days 1-21. Treatment repeats every 28 days for up to 5 courses in the absence of disease progression or unacceptable toxicity. Patients may then receive radiation therapy, surgery, or continued treatment with vemurafenib and cobimetinib at the discretion of the treating physician.

Cobimetinib is already approved in European Union, United States, Canada, Switzerland, Japan for the following indications:

Approved in European Union as Cotellic for:

• Melanoma

Approved in United States as Cotellic for:

• Melanoma

Approved in Canada as Cotellic for:

• Melanoma

Approved in Switzerland as Cotellic for:

• Melanoma

Approved in Japan as Cotellic for:

• Melanoma

Who Is Running the Clinical Trial?

Alliance for Clinical Trials in Oncology

Lead Sponsor

Trials

521

Recruited

224,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

Vemurafenib combined with cobimetinib has shown effectiveness in treating patients with BRAF-mutant papillary craniopharyngioma, a type of brain tumor.

This combination therapy targets specific mutations, suggesting a tailored approach to treatment that could improve outcomes for affected patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

BRAF-MEK Inhibition Is Effective in BRAFV600E-Mutant Papillary Craniopharyngioma. [2023]

A patient with a BRAF-V600E mutant papillary craniopharyngioma showed significant tumor reduction and neurological improvement after treatment with a combination of BRAF and MEK inhibitors (dabrafenib and trametinib) following unsuccessful radiation therapy.

Despite the successful tumor response, the patient experienced permanent panhypopituitarism, highlighting the need to consider potential long-term side effects of this treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

BRAF-V600E mutant papillary craniopharyngioma dramatically responds to combination BRAF and MEK inhibitors. Roque, A., Odia, Y.[2018]

A 35-year-old man with a BRAF-V600E-positive papillary craniopharyngioma experienced a remarkable 95% reduction in tumor size over 21 months while being treated with the BRAF-V600 inhibitor dabrafenib and trametinib, indicating the efficacy of this targeted therapy.

The treatment was well-tolerated with no negative side effects reported, suggesting that BRAF-V600E inhibition could be a safe and effective non-invasive option for managing this type of tumor.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case report and literature review of BRAF-V600 inhibitors for treatment of papillary craniopharyngiomas: A potential treatment paradigm shift. Nussbaum, PE., Nussbaum, LA., Torok, CM., et al.[2022]

In a study of 666 adult patients with craniopharyngioma, factors such as older age, lack of insurance, and larger tumor size were linked to worse overall survival, highlighting the importance of these demographics in treatment outcomes.

Patients who underwent gross total resection (GTR) or subtotal resection (STR) with adjuvant radiotherapy experienced significantly improved overall survival, while endoscopic resection methods had lower GTR rates but did not affect overall survival outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prognostic Factors and Treatment Impact on Overall Survival in Adult Craniopharyngioma. Awad, M., Butterfield, JT., Dhawan, S., et al.[2023]

Recent advances in understanding the molecular mechanisms of craniopharyngiomas have led to promising medical therapies, particularly for adamantinomatous craniopharyngiomas (ACPs) and papillary craniopharyngiomas (PCPs), which are characterized by distinct genetic mutations.

Targeted treatments, such as MEK inhibitors for ACPs and BRAF inhibitors for PCPs, have shown favorable responses in patients, indicating a shift towards personalized medicine for managing these rare tumors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medical Therapy for Craniopharyngiomas. Alexandraki, KI., Xekouki, P.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

BRAF-MEK Inhibition Is Effective in BRAFV600E-Mutant Papillary Craniopharyngioma. [2023]

2. England pubmed.ncbi.nlm.nih.gov

BRAF-V600E mutant papillary craniopharyngioma dramatically responds to combination BRAF and MEK inhibitors. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Case report and literature review of BRAF-V600 inhibitors for treatment of papillary craniopharyngiomas: A potential treatment paradigm shift. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Prognostic Factors and Treatment Impact on Overall Survival in Adult Craniopharyngioma. [2023]

5. Austria pubmed.ncbi.nlm.nih.gov

Recurrent papillary craniopharyngioma with BRAFV600E mutation treated with neoadjuvant-targeted therapy. [2018]

6. Japan pubmed.ncbi.nlm.nih.gov

[Molecularly Targeted Therapy for Craniopharyngioma]. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Medical Therapy for Craniopharyngiomas. [2022]