Dabrafenib + Trametinib for Melanoma

Not currently recruiting at 884 trial locations

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: National Cancer Institute (NCI)

Must not be taking: BRAF inhibitors, MEK inhibitors

Disqualifiers: Uncontrolled hypertension, Diabetes, Hepatitis B/C, 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

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Compensation: Varies

Number of Visits: 1

Duration: 56 days per cycle

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how two medications, dabrafenib (a BRAF inhibitor) and trametinib (a MEK inhibitor), treat advanced melanoma, a type of skin cancer that cannot be surgically removed and has a specific genetic mutation called BRAF. The researchers aim to compare continuous treatment (taking the medicine daily) with intermittent treatment (taking breaks from the medicine) to determine if both methods are equally effective. Individuals with advanced melanoma and the BRAF mutation who have not previously used similar medications might be suitable for this study. As a Phase 2 trial, this research focuses on measuring the treatment's effectiveness in an initial, smaller group of people, offering participants the chance to contribute to important advancements in melanoma treatment.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you must not have received any anti-cancer drugs, major surgery, or immunotherapy within 28 days before joining. Hormonal contraception is not allowed due to potential drug interactions.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that using dabrafenib and trametinib together is generally safe for patients with BRAF-mutant melanoma. Studies have found that this combination can extend patients' lives. Most people tolerate the treatments well, experiencing few serious issues.

The safety information comes from several studies, including long-term observations. While some individuals have experienced side effects, these are usually manageable. This suggests the treatment is relatively safe, especially since the FDA has approved it for certain types of melanoma.

Overall, dabrafenib and trametinib, whether taken continuously or with breaks, appear to be a good option for those with BRAF-mutant melanoma, supported by strong research evidence. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about dabrafenib and trametinib for melanoma because they target specific mutations in cancer cells, unlike traditional chemotherapy that attacks all rapidly dividing cells. Dabrafenib inhibits the BRAF V600 mutation, a common driver in melanoma, while trametinib blocks the MEK pathway, which is often activated in these cancers. This combination therapy can potentially improve outcomes by offering a more targeted approach, reducing damage to healthy cells, and possibly resulting in fewer side effects than standard treatments like dacarbazine or high-dose interleukin-2.

What evidence suggests that dabrafenib and trametinib might be effective treatments for melanoma?

Research has shown that the combination of dabrafenib and trametinib effectively treats melanoma with a BRAF mutation. In studies, patients taking these drugs showed promising results, with about 19% experiencing no disease progression after 5 years. This trial will compare two dosing schedules: continuous and intermittent. Both groups will receive dabrafenib and trametinib, which block proteins that cancer cells need to grow. Patients treated with this combination have experienced longer periods without cancer progression. These findings suggest that dabrafenib and trametinib could be a strong option for managing advanced melanoma. ^{3 6 7 8 9}

Who Is on the Research Team?

Alain P Algazi

Principal Investigator

SWOG Cancer Research Network

Are You a Good Fit for This Trial?

This trial is for adults with stage III-IV melanoma that can't be surgically removed and have a specific BRAF mutation. They must take pills, have no serious gut issues, controlled brain metastases if present, meet blood criteria, not be pregnant/nursing, and agree to use contraception. Prior cancer treatments should be completed within specified time frames.

Inclusion Criteria

As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system

Your blood tests must show specific levels of different components in your blood.

My cancer has a BRAF V600E or V600K mutation, confirmed by a certified lab.

Exclusion Criteria

Patients must not be pregnant or nursing because of the risk of fetal harm; women/men of reproductive potential must have agreed to use an effective contraceptive method

I haven't taken any cancer drugs in the last 28 days, nor nitrosoureas or mitomycin C in the last 42 days.

I don't have lasting side effects from cancer treatment, except for hair loss.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive dabrafenib and trametinib either continuously or intermittently in 56-day cycles

56 days per cycle

PET/CT or CT scans in week 1 of cycle 2, blood sample collection, ECHO or MUGA on study

Follow-up

Participants are monitored for safety and effectiveness after treatment completion

Every 6 months for 3 years, then yearly for 2 years

What Are the Treatments Tested in This Trial?

Interventions

• Dabrafenib Mesylate
• Trametinib Dimethyl Sulfoxide

Trial Overview The study tests how well dabrafenib and trametinib treat advanced melanoma with a BRAF mutation when surgery isn't an option. These drugs block enzymes that tumor cells need to grow. The trial includes imaging tests like CT scans or PET/CT scans for monitoring.

How Is the Trial Designed?

Group I: Arm II (intermittent dosing) Experimental Treatment 7 Interventions

Patients receive dabrafenib PO BID and trametinib PO QD on days 1-7 and 29-56 of each cycle. Cycles repeat every 56 days in the absence of disease progression or unacceptable toxicity. Patients also undergo PET/CT or CT scans in week 1 of cycle 2 and at off treatment follow up prior to progression. Additionally, patients undergo blood sample collection, ECHO or MUGA on study.

Group II: Arm I (continuous dosing) Experimental Treatment 7 Interventions

Patients receive dabrafenib PO BID and trametinib PO QD on days 1-56 of each cycle. Cycles repeat every 56 days in the absence of disease progression or unacceptable toxicity. Patients also undergo PET/CT or CT scans in week 1 of cycle 2 and at off treatment follow up prior to progression. Additionally, patients undergo blood sample collection, ECHO or MUGA on study.

Who Is Running the Clinical Trial?

National Cancer Institute (NCI)

Lead Sponsor

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

The combination of dabrafenib and trametinib significantly improves progression-free survival and overall survival in patients with unresectable or metastatic melanoma with a BRAF (V600E/K) mutation, compared to monotherapy with dabrafenib or vemurafenib, based on results from two large phase III studies.

This combination therapy is well-tolerated, showing no increase in overall toxicity compared to monotherapy, and results in fewer skin-related adverse events, likely due to reduced activation of the MAPK pathway.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dabrafenib plus Trametinib: a Review in Advanced Melanoma with a BRAF (V600) Mutation. Dhillon, S.[2022]

Trametinib, when combined with dabrafenib, significantly prolongs median survival by about 8 months compared to vemurafenib alone in patients with metastatic or inoperable melanoma, based on a study of 704 patients.

While trametinib can enhance treatment efficacy, it also carries serious adverse effects, including life-threatening conditions like heart failure and gastrointestinal perforation, making it essential for patients to weigh the benefits against the risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trametinib (MEKINIST°) Metastatic or inoperable BRAF V600-positive melanoma: a few extra months of life. [2019]

In a study of 140 melanoma patients, higher levels of trametinib (Cmin ≥ 15.6 ng/mL) were associated with significantly longer overall survival (22.8 months vs. 12.6 months), suggesting that monitoring trametinib levels could improve treatment outcomes.

Dabrafenib exposure did not correlate with patient survival, and neither drug exposure was linked to significant toxicities, indicating that while trametinib levels are crucial for efficacy, safety remains a concern with dose adjustments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exposure-response analyses of BRAF- and MEK-inhibitors dabrafenib plus trametinib in melanoma patients. Groenland, SL., Janssen, JM., Nijenhuis, CM., et al.[2023]

The combination of BRAF inhibitor dabrafenib and MEK inhibitor trametinib significantly improves outcomes for metastatic melanoma patients compared to single-agent therapies, with a manageable safety profile.

While 98% of patients experience at least one adverse event during combination therapy, these events are mostly mild to moderate and can be effectively managed, highlighting the importance of addressing even minor side effects to maintain patients' quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The safety and efficacy of dabrafenib and trametinib for the treatment of melanoma. Knispel, S., Zimmer, L., Kanaki, T., et al.[2017]

In a real-world study of 20 patients with resected stage III BRAF-mutant melanoma, 90% experienced treatment-related toxicities requiring at least one interruption, highlighting the need for careful monitoring during therapy.

The most common adverse events included recurrent fever and chills (85%) and liver abnormalities (50%), with 65% of patients permanently discontinuing treatment due to these side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment related toxicities with combination BRAF and MEK inhibitor therapy in resected stage III melanoma. Homan, M., Warrier, G., Lao, CD., et al.[2022]

The combination of dabrafenib and trametinib showed promising antitumor activity in Japanese patients with BRAF V600E/K mutant melanoma, with an overall response rate of 83% in both phase 1 and phase 2 of the study involving 12 patients.

The treatment was generally well-tolerated, with common adverse events including fever (75%) and increased liver enzymes (67%), indicating that while effective, monitoring for side effects is important.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase 1/2 study assessing the safety and efficacy of dabrafenib and trametinib combination therapy in Japanese patients with BRAF V600 mutation-positive advanced cutaneous melanoma. Yamazaki, N., Tsutsumida, A., Takahashi, A., et al.[2018]

In a phase II trial involving 21 patients with unresectable locally advanced melanoma, neoadjuvant treatment with dabrafenib and trametinib enabled radical surgical resection in 86% of participants, with 81% achieving complete (R0) resection.

The median recurrence-free survival for patients who underwent surgery was 9.9 months, indicating that this combination therapy is a promising option for patients with previously inoperable melanoma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neoadjuvant Cytoreductive Treatment With BRAF/MEK Inhibition of Prior Unresectable Regionally Advanced Melanoma to Allow Complete Surgical Resection, REDUCTOR: A Prospective, Single-arm, Open-label Phase II Trial. Blankenstein, SA., Rohaan, MW., Klop, WMC., et al.[2021]

In a study of 66 patients with metastatic BRAF-mutated melanoma treated with dabrafenib and trametinib, 15 patients achieved a complete response (CR), indicating a significant survival benefit from this treatment.

The likelihood of achieving a complete response was higher in patients with smaller lesions (39.3% CR rate) compared to those with larger lesions (10.5% CR rate), suggesting that lesion size and the number of metastatic sites are important factors in treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

BRAFi/MEKi in patients with metastatic melanoma: predictive factors of complete response. Ribero, S., Malavenda, O., Fava, P., et al.[2019]

Dabrafenib and trametinib, both targeting the MAPK pathway, have shown significant efficacy in treating BRAF-mutant metastatic melanoma, with dabrafenib achieving a 59% objective response rate and improved progression-free survival compared to traditional chemotherapy.

The combination of dabrafenib and trametinib resulted in higher response rates and longer median progression-free survival than dabrafenib alone, while also presenting less cutaneous toxicity, making it a promising treatment option for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dabrafenib and trametinib, alone and in combination for BRAF-mutant metastatic melanoma. Menzies, AM., Long, GV.[2022]

In a phase 3 trial involving 870 patients with resected stage III melanoma and BRAF V600 mutations, the combination of dabrafenib and trametinib significantly improved relapse-free survival, with a 3-year rate of 58% compared to 39% for the placebo group.

The combination therapy also showed a higher overall survival rate of 86% versus 77% in the placebo group, indicating its efficacy without introducing new safety concerns, as the safety profile was consistent with previous studies in metastatic melanoma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adjuvant Dabrafenib plus Trametinib in Stage III BRAF-Mutated Melanoma. Long, GV., Hauschild, A., Santinami, M., et al.[2023]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT04527549

NCT04527549 | Testing Dabrafenib and Trametinib With or ... This phase II trial investigates how well adding hydroxychloroquine to the standard treatment of dabrafenib and trametinib works to overcome resistance and ...

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/31166680/

Five-Year Outcomes with Dabrafenib plus Trametinib in ... The progression-free survival rates were 21% (95% confidence interval [CI], 17 to 24) at 4 years and 19% (95% CI, 15 to 22) at 5 years.

3. clinicaltrials.eu clinicaltrials.eu/trial/long-term-safety-study-of-dabrafenib-mesylate-and-trametinib-dimethyl-sulfoxide-for-patients-benefiting-from-previous-treatment-in-multiple-indications/

Long-Term Safety Study of Dabrafenib Mesylate and ... This study assesses the long-term safety of Dabrafenib Mesylate and Trametinib Dimethyl Sulfoxide in treating various types of cancer, ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT02224781

Study Details | NCT02224781 | Dabrafenib and Trametinib ... This phase III trial studies how well initial treatment with ipilimumab and nivolumab followed by dabrafenib and trametinib works and compares it to initial ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38899716/

Final Results for Adjuvant Dabrafenib plus Trametinib in ... Background: The 5-year results of this trial showed that adjuvant therapy with dabrafenib plus trametinib resulted in longer relapse-free ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5834102/

long-term survival and safety analysis of a phase 3 study These data demonstrate that durable (≥3 years) survival is achievable with dabrafenib plus trametinib in patients with BRAF V600-mutant metastatic melanoma and ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT02130466

NCT02130466 | A Study of the Safety and Efficacy ... A Phase I/II Study to Assess the Safety and Efficacy of MK-3475 in Combination With Trametinib and Dabrafenib in Subjects With Advanced Melanoma. Conditions.

8. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/28475671/

long-term survival and safety analysis of a phase 3 study These data demonstrate that durable (≥3 years) survival is achievable with dabrafenib plus trametinib in patients with BRAF V600-mutant metastatic melanoma.

9. accessdata.fda.gov accessdata.fda.gov/drugsatfda_docs/nda/2019/202806Orig1s002.pdf

Approval Package - accessdata.fda.gov The safety data to support the combination of dabrafenib and trametinib are derived from pooled data from trial BRF113220, Parts A, B, C, and D.