Melanoma: coBRIM trial

Abbreviations

No EU-CTR

  • coBRIM references
    2014-11-13
    James Larkin
    Combined Vemurafenib and Cobimetinib in BRAF-Mutated Melanoma
Investigated (inv)
Comparator (comp)

VEMR+COBI

VEMR+PLB

248

247

Phase:

3

Randomisation:

Double blind

Primary tumour:

Melanoma

Subtype (biomarker):

BRAF MT

Stage:

meta

Line of therapy:

L1

Primary
VEMR+COBI
VEMR+PLB
HR
p
PFS
9.9 mo
6.2 mo
0.51 (0.39-0.68)
<0.001
PFS (IRC)
11.3 mo
6.0 mo
0.60 (0.45–0.79)
<0.001
Secondaries
VEMR+COBI
VEMR+PLB
HR
p
ORR
68%
45%
<0.001
CR
10%
4%
OS @9mo
81%
73%
0.046
DoR
NR
7.3 mo
(all grades, %)
VEMR+COBI
VEMR+PLB
p
Diarrhea
56
28
NA
Nausea
40
24
NA
Vomiting
21
13
NA
Rash
39
35
NA
Hyperkeratosis
10
29
NA
ALT increase
34
19
NA
AST increase
22
13
NA
CK increase
21
4
NA
Cutaneous squamous-cell carcinoma
<3
11
NA
Retinal detachment
0
9
NA
QT-interval prolongation
<4
5
NA
  • Inclusion
  • Exclusion

- Participants with histologically confirmed melanoma, either unresectable stage IIIc or stage IV metastatic melanoma, as defined by the AJCC 7th edition. Unresectability of stage IIIc disease must have confirmation from a surgical oncologist - Participants must be naïve to treatment for locally advanced unresectable or metastatic disease (ie, no prior systemic anti-cancer therapy for advanced disease; stage IIIc and IV). Prior adjuvant immunotherapy (including ipilimumab) is allowed - Documentation of BRAF V600 mutation-positive status in melanoma tumor tissue (archival or newly obtained tumor samples) using the cobas 4800 BRAF V600 mutation test - Measurable disease per RECIST v1.1 - Eastern Clinical Oncology Group performance status of 0 or 1 - Consent to provide archival for biomarker analyses - Consent to undergo tumor biopsies for biomarker analyses - Life expectancy ≥12 weeks - Adequate hematologic and organ function.

- History of prior rapidly accelerated fibrosarcoma or mitogen-activated protein kinase pathway inhibitor treatment - Palliative radiotherapy within 14 days prior to the first dose of study treatment - Major surgery or traumatic injury within 14 days prior to first dose of study treatment - Active malignancy other than melanoma that could potentially interfere with the interpretation of efficacy measures. Participants with a previous malignancy within the past 3 years are excluded except for participants with resected basal cell carcinoma or squamous cell carcinoma of the skin, melanoma in-situ, carcinoma in-situ of the cervix, and carcinoma in-situ of the breast - History of or evidence of retinal pathology on ophthalmological examination that is considered a risk factor for neurosensory retinal detachment, retinal vein occlusion, or neovascular macular degeneration - Uncontrolled glaucoma with intraocular pressure - Serum cholesterol ≥ Grade 2 - Hypertriglyceridemia ≥ Grade 2 - Hyperglycemia (fasting) ≥ Grade 2 - History of clinically significant cardiac dysfunction - Participants with active central nervous system (CNS) lesions (including carcinomatous meningitis) are excluded. However, participants are eligible if: • All known CNS lesions have been treated with stereotactic therapy or surgery, AND • There has been no evidence of clinical and radiographic disease progression in the CNS for ≥ 3 weeks after radiotherapy or surgery - Current severe, uncontrolled systemic disease - History of malabsorption or other condition that would interfere with absorption of study drugs - Pregnant, lactating, or breastfeeding women.

Characteristics
VEMR+COBI
VEMR+PLB
Agedc-comma sexdc-comma race
Median age (range)dc-comma yr
56 (23-88)
55 (25-85)
Male
59%
56%
White race
92%
95%
Geographic region
Australiadc-comma New Zealanddc-comma or Israel
16%
15%
Europe
74%
74%
North America
10%
10%
ECOG PS score
0
76%
67%
1
24%
33%
2
<1%
0%
Metastatic status
Unresectable stage IIIC
9%
5%
M1a
16%
16%
M1b
16%
17%
M1c
59%
62%
BRAF-mutation genotype
V600E
69%
70%
V600K
10%
13%
Could not be evaluated
21%
17%
Other
Elevated LDH
46%
43%
History of brain metastases
<1%
1%
Ad-hoc:
no.pts inv.
no.pts comp.
VEMR+COBI
VEMR+PLB
HR
p
OS
247
248
NR
NR
0.65 (0.42–1.00)
0.046
  • PFS
  • PFS (IRC)
analisys of PFS
VEMR+COBI
VEMR+PLB
HR (95% CI)
Disease stage
M1c
9.1 mo
5.3 mo
0.46 (0.33–0.64)
Unresectable IIIcdc-comma M1adc-comma or M1b
NR
NR
0.69 (0.40–1.19)
Age
<65 yr
9.9 mo
6.5 mo
0.54 (0.39–0.75)
≥65 yr
NR
5.5 mo
0.45 (0.25–0.79)
Sex
Male
9.8 mo
5.6 mo
0.52 (0.36–0.74)
Female
NR
7.2 mo
0.49 (0.31–0.78)
ECOG
0
9.9 mo
7.5 mo
0.60 (0.42–0.85)
1
11.1 mo
5.5 mo
0.40 (0.24–0.67)
LDH level
≥ULN
7.7 mo
4.7 mo
0.55 (0.38–0.79)
<ULN
NR
7.5
0.45 (0.29–0.71)
Prior adjuvant therapy
Yes
NR
7.2 mo
0.50 (0.18–1.35)
No
9.9 mo
6.0 mo
0.51 (0.38–0.69)
BRAF V600 mutation
V600E
NR
6.5 mo
0.57 (0.41–0.80)
V600K
NR
5.3 mo
0.27 (0.09–0.81)
analisys of PFS (IRC)
VEMR+COBI
VEMR+PLB
HR (95% CI)