Trametinib Activity in Patients with Solid Tumors and Lymphomas Harboring BRAF Non-V600 Mutations or Fusions: Results from NCI-MATCH (EAY131).

Abstract

Substantial preclinical evidence and case reports suggest that MEK inhibition is an active approach in tumors with <i>BRAF</i> mutations outside the V600 locus, and in <i>BRAF</i> fusions. Thus, Subprotocol R of the NCI-MATCH study tested the MEK inhibitor trametinib in this population. The NCI-MATCH study performed genomic profiling on tumor samples from patients with solid tumors and lymphomas progressing on standard therapies or with no standard treatments. Patients with prespecified fusions and non-V600 mutations in <i>BRAF</i> were assigned to Subprotocol R using the NCI-MATCHBOX algorithm. The primary endpoint was objective response rate (ORR). Among 50 patients assigned, 32 were eligible and received therapy with trametinib. Of these, 1 had a <i>BRAF</i> fusion and 31 had <i>BRAF</i> mutations (13 and 19 with class 2 and 3 mutations, respectively). There were no complete responses; 1 patient (3%) had a confirmed partial response (patient with breast ductal adenocarcinoma with <i>BRAF</i> G469E mutation) and 10 patients had stable disease as best response (clinical benefit rate 34%). Median progression-free survival (PFS) was 1.8 months, and median overall survival was 5.7 months. Exploratory subgroup analyses showed that patients with colorectal adenocarcinoma (<i>n</i> = 8) had particularly poor PFS. No new toxicity signals were identified. Trametinib did not show promising clinical activity in patients with tumors harboring non-V600 <i>BRAF</i> mutations, and the subprotocol did not meet its primary endpoint.