Phase II Study Investigating the Combination of Encorafenib and Binimetinib in BRAF V600E Mutated Chinese Patients With Metastatic Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer Clinical Trial

— OCEANII  

Official title:

Multicenter, Open-label, Phase II Study With a Safety Lead-in Part Investigating the Efficacy, Safety and Pharmacokinetics of Encorafenib and Binimetinib Combination in BRAF V600E Mutated Chinese Patients With Metastatic Non-Small Cell Lung Cancer Who Are BRAF- and MEK Inhibitor Treatment-naïve

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05195632
• Other study ID #: W00090GE203
• Secondary ID: CTR20212962CTR20
• Status: Active, not recruiting
• Phase: Phase 2
• Start date: June 2, 2022
• Est. completion date: May 2025

Study information

• Verified date: October 2023
• Source: Pierre Fabre Medicament
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a phase 2, multicenter, single-arm study with a safety lead-in to investigate the efficacy, safety and pharmacokinetics of encorafenib 450 mg once daily (QD) in combination with binimetinib 45 mg twice daily (BID) (Combo450) in adult Chinese participants with metastatic unresectable stage IV BRAF V600E mutant NSCLC, who are BRAF- and MEK-inhibitor treatment-naïve and are either previously untreated or have had one line of prior therapy in metastatic setting.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 63
• Est. completion date: May 2025
• Est. primary completion date: May 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

If a participant has a BRAF V600E mutational status confirmed as per local assessment, the participant might enter the main screening directly.

All the following inclusion criteria must be met for a participant to be eligible to be included in this study:

1. Provide a signed and dated screening Informed Consent Form (ICF).

2. Chinese male or female with age = 18 years old for China mainland and = 20 years old for Taiwan at the time of the screening informed consent.

3. Documented histology- and/or cytology-confirmed metastatic unresectable Non-small cell lung cancer (NSCLC (i.e. Adenocarcinoma (ADC), large cell carcinoma, squamous cell carcinoma (SCC)).

4. Presence of B-Raf Proto-Oncogene, Serine/Threonine Kinase (BRAF) V600E mutation in tumor tissue previously determined by a local assay at any time prior to screening or by the central laboratory.

5. Able to provide a sufficient amount of representative tumor specimen (primary or metastatic, archived or newly obtained) for central prospective laboratory testing of BRAF mutation status and comparison of central BRAF V600E testing in the clinical study to BRAF V600E testing with a candidate companion diagnostic.

6. BRAF- and Mitogen-activated protein kinase kinase (MEK)-inhibitor treatment-naïve participants and previously untreated or have had one line of prior therapy in metastatic setting.

7. At least one measurable disease as per investigator assessment, as defined by RECIST v1.1, which has neither been irradiated nor biopsied during the screening period.

8. Life expectancy = 3 months.

9. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1.

10. Adequate hematologic function at screening and baseline.

11. Adequate hepatic function at screening and baseline.

12. Adequate renal function at screening and baseline.

13. Able to comply with the study protocol as per investigator assessment including oral drug intake, complying scheduled visits, treatment plan, laboratory tests and other study procedures.

14. Women are either postmenopausal for at least 1 year, are surgically sterile for at least 6 weeks, or child-bearing potential women must agree to take appropriate precautions to avoid pregnancy.

15. Men must agree not to father child until 90 days after the last dose of the study treatment.

Exclusion Criteria:

Participants meeting any of the following criteria are not eligible to be included in this study:

1. Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the study drugs (encorafenib and binimetinib), or their excipients.

2. Documented Anaplastic lymphoma kinase (ALK) fusion oncogene, Reactive oxygen species (ROS) rearrangement or Epidermal growth factor receptor (EGFR) sensitizing or driver mutation.

3. Participants who have received more than one prior line of systemic therapy.

4. Receipt of anti-cancer medications or investigational drugs within the specified intervals before the first administration of study treatment.

5. Symptomatic brain metastases or other active Central nervous system (CNS) metastases.

6. Leptomeningeal disease.

7. Participant has not recovered to = Grade 1 from toxic effects of prior therapy and/or complications from prior surgical intervention before starting study treatment.

8. Current use of prohibited medication = 1 week prior to start of the study treatment and/or concomitantly.

9. Impairment of gastrointestinal function or disease which may significantly alter the absorption of oral study treatment.

10. Impaired cardiovascular function or clinically significant cardiovascular diseases

11. History of thromboembolic or cerebrovascular events within 3 months prior to starting the study treatments

12. History or evidence of retinal pathology considered as risk factor for Retinal vein occlusion (RVO) or neovascular macular degeneration.

13. Concurrent neuromuscular disorder associated with the potential of elevated Creatine phosphokinase (CPK)

14. Participants with active Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV) or any other severe viral active infection (e.g. SARS-CoV-2 infection)

15. Evidence of active, non-infectious pneumonitis, history of interstitial lung disease that required oral or intravenous glucocorticosteroids for management.

16. Known history of a positive test for Human immunodeficiency virus (HIV) or known Acquired Immunodeficiency Syndrome (AIDS). Testing for HIV must be performed at sites where mandated locally.

17. Participants who have had major surgery (e.g. inpatient procedure with regional or general anesthesia) within 6 weeks prior to start of study treatment.

18. Participants with concurrent or history of another malignancy within 2 years of study entry Except:

1. Bowen's disease

2. Cured basal cell or cutaneous squamous cell carcinoma (CuSCC)

3. Gleason 6 prostate cancer

4. Treated in-situ carcinoma of cervix

19. Participant's conditions that contraindicates the use of study treatments and may affect interpretation of results or may render the participant at high risk from treatment complications.

20. Pregnant (confirmed by positive serum beta-human chorionic gonadotropin (ß-HCG) test), lactating or breast-feeding women.

21. Is a family member of the investigator or any associate, colleague, and employee assisting in the conduct of the study (secretary, nurse, technician).

22. Is in a position likely to represent a conflict of interest.

Related Conditions & MeSH terms

• Carcinoma, Non-Small-Cell Lung
• Lung Neoplasms
• Non-Small Cell Lung Cancer

Intervention

Drug:
• Encorafenib
Hard capsule
• Binimetinib
Film-coated tablet

Locations

Country	Name	City	State
China	Beijing Cancer Hospital	Beijing
China	Beijing Chest Hospital, Capital Medical University	Beijing
China	Peking University First Hospital	Beijing
China	The First Hospital of Jilin University	Changchun
China	Xiangya Hospital Central South University	Changsha
China	Sichuan Cancer Hospital	Chengdu
China	Chongqing University Cancer Hospital	Chongqing
China	The Second Hospital of Dalian University	Dalian
China	Fujian Medical University Union Hospital	Fuzhou
China	Fuzhou Tuberculosis Prevention and Control Hospital of Fujian Province (Fuzhou Pulmonary Hospital of Fujian)	Fuzhou
China	Guangdong Provincial People's Hospital	Guangzhou
China	Sun Yat-sen University Cancer Center	Guangzhou
China	Hainan General Hospital	Haikou
China	First Affiliated Hospital, Zhejiang University School of Medicine	Hangzhou
China	Zhejiang Cancer Hospital	Hangzhou
China	Zhejiang University School of Medicine, Sir Run Run Shaw Hospital	Hangzhou
China	Harbin Medical University Cancer Hospital	Harbin
China	Shandong Cancer Hospital	Jinan
China	The First Affiliated Hospital of Jinzhou Medical University	Jinzhou
China	Linyi Cancer Hospital	Linyi
China	The First Affiliated Hospital of Nanchang University	Nanchang
China	Guangxi Medical University Affiliated Tumor Hospital	Nanning
China	Liaoning Cancer Hospital & Institute	Shenyang
China	The First Hospital of China Medical University	Shenyang
China	Peking University Shenzhen Hospital	Shenzhen
China	The Fourth Hospital of Hebei Medical University	Shijiazhuang
China	Shanxi Provincial Cancer Hospital	Taiyuan
China	Tianjin Cancer Hospital Airport Hospital	Tianjin
China	Tongji Hospital Tongji Medical College Huazhong University of Science and Technology	Wuhan
China	Union Hospital Tongji medical college Huazhong University of Science and Technology	Wuhan
China	The Northern Jiangsu People's Hospital	Yangzhou
China	Yantai Yuhuangding Hospital	Yantai
China	Henan Cancer Hospital	Zhengzhou
Taiwan	Taipei Veterans General Hospital	Taipei

Sponsors (1)

Lead Sponsor	Collaborator
Pierre Fabre Medicament

Countries where clinical trial is conducted

China,  Taiwan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety Lead-In (SLI) Part: Incidence of Dose-limiting toxicities (DLTs)	Incidence of DLTs experienced during the Cycle 1 (days 1 to 28) after the first dose of study treatment. DLT rate defined as the number of DLT-evaluable participants with DLTs in the first 28 days after first dose of study treatment in the SLI (DLT-evaluation period), divided by the number of DLT-evaluable participants.	Cycle 1; Each cycle is 28 days
Primary	Pivotal Part: Confirmed objective response rate (cORR)	cORR defined as the percentage of participants who have achieved a complete response (CR) or partial response (PR) as determined by Independent Central Review (ICR) of radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Proportion of patients who have achieved a confirmed Best Overall Response (cBOR) of CR or PR as determined by per RECIST v1.1 and corresponding exact two-sided binomial 95% Confidence interval (CI).	Cycle 1 Day 1 through safety follow-up visit (30 days after end of treatment (EOT) visit or 7 days after EOT visit/last dose if EOT not performed), approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of encorafenib: Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of encorafenib: Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of encorafenib: Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of binimetinib: Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of binimetinib: Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of binimetinib: Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of encorafenib metabolite (LHY746): Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of encorafenib metabolite (LHY746): Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of encorafenib metabolite (LHY746): Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of binimetinib metabolite (AR00426032): Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of binimetinib metabolite (AR00426032): Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Pharmacokinetic (PK) parameter of binimetinib metabolite (AR00426032): Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1; Each cycle is 28 days
Secondary	Safety Lead-In (SLI) Part: Incidence, nature and severity of treatment emergent adverse events (TEAEs)	Incidence, nature and severity of TEAEs graded as per NCI CTCAE v4.03, TEAEs leading to dose interruption, reduction and discontinuation, Treatment-emergent serious adverse events (SAEs), TEAEs leading to death.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline clinical laboratory parameter: Hematology	Hemoglobin, hematocrit, Red Blood Cells (RBC), White Blood Cells (WBC) with differential (absolutes values), platelet counts, neutrophils, lymphocytes, monocytes, basophils and eosinophils	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline clinical laboratory parameter: Chemistry	Albumin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin and direct bilirubin, gamma glutamyl transferase (GGT), urea or blood urea nitrogen (BUN), creatinine, sodium, potassium, calcium, phosphate, chloride, uric acid, magnesium, Creatinine kinase (CK) (if total CK = 3X upper limit of normal (ULN), then measure isoenzymes including Creatine Kinase BB, Creatine Kinase MB, Creatine Kinase MM), serum creatinine and myoglobin in blood and urinalysis test weekly; if there is no local capability to measure CK isoenzymes, then participants must be referred to a local hospital for appropriate management while central laboratory results are awaited. If a diagnosis of rhabdomyolysis is confirmed, then sites should liaise with their local hospitals regarding management of the participants and administration of study medication), total protein, glucose, lactate dehydrogenase (LDH), lipase and amylase.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline clinical laboratory parameter: Coagulation	Prothrombin time (PT), international normalized ratio (INR) and activated partial thromboplastin time (aPTT)	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline of dipstick urinalysis	Dipstick measurements for specific gravity, pH, protein, glucose, bilirubin, ketones, leukocytes, and blood will be performed. Any clinically significant findings on dipstick will be followed up with a microscopic evaluation.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment-emergent adverse events (TEAEs) related to notable or abnormal changes in vital signs from baseline of vital sign examinations.	Clinically notable elevated values: Systolic blood pressure (BP): = 160 mmHg and an increase = 20 mmHg from baseline; Diastolic BP: = 100 mmHg and an increase = 15 mmHg from baseline; Heart rate: = 120 beats/min (bpm) with increase from baseline of = 15 bpm; Weight (kg) increase from baseline of = 10%; Body temperature [°C] = 37.5°C). Clinically notable low values: Systolic BP: = 90 mmHg with decrease from baseline of = 20 mmHg; Diastolic BP: = 50 mmHg with decrease from baseline of = 15 mmHg; Heart rate: = 50 bpm with decrease from baseline of = 15 bpm; Weight: = 20% decrease from baseline; Body temperature [°C]: = 36 °C. Number of participants with TEAEs related to notable changes to the vital signs after the start of study drug will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment-emergent adverse events (TEAEs) related to notable or abnormal changes from baseline of 12-lead electrocardiograms (ECGs)	12-lead ECGs will be obtained using an internationally recognized 12-lead cardiograph. Clinically notable ECG values: QT [millisecond (ms)] and QT interval (ms) corrected for heart rate using Fridericia's formula (QTcF) intervals (ms): increase from baseline > 30 ms; increase from baseline > 60 ms, new > 450 ms, new > 480 ms, new > 500 ms. Heart rate (beats/min): increase from baseline > 25% to a value > 100 bpm, decrease from baseline > 25% and to a value < 50 bpm. Number of participants with TEAEs related to abnormal or notable changes to ECG parameters after the start of study drug will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Safety Lead-In (SLI) Part: Incidence of treatment-emergent adverse events (TEAEs) related to notable or abnormal changes from baseline of echocardiogram or multigated acquisition (ECHO/MUGA) scans.	ECHO/MUGA scan assess Left Ventricular Ejection Fraction (LVEF). Changes from baseline of LVEF measurements over time will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Confirmed Objective Response Rate (cORR)	cORR as determined by investigator review of the radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Objective Response Rate (ORR)	ORR as determined by investigator review and independent central review (ICR) of the radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Duration of Response (DOR)	DOR defined as the time from first documented response (i.e. complete response (CR) or partial response (PR)) to the earliest documented disease progression, as determined by investigator review and independent central review (ICR) of radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, or death from any cause, whichever occurs first.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Disease Control Rate (DCR)	DCR defined as the proportion of participants who have achieved a best overall response of complete response (CR), partial response (PR) or stable disease (SD) as determined by investigator review and independent central review (ICR) of radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Time to Progression (TTP)	TTP defined as the time from first study treatment dose to the earliest documented disease progression as per investigator review and independent central review (ICR) of radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Progression Free Survival (PFS)	PFS defined as the time from first study treatment dose to the earliest documented disease progression as per investigator review and independent central review (ICR) of radiographic disease assessments according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 or death from any cause, whichever occurs first.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Overall Survival (OS)	OS defined as the time from first study treatment dose to the date of death due to any cause.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence, nature and severity of treatment emergent adverse events (TEAEs)	Incidence, nature and severity of treatment emergent adverse events (TEAEs) graded as per National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v4.03.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Treatment emergent adverse events (TEAEs) leading to dose interruption, reduction and discontinuation.	Incidence, nature and severity of TEAEs leading to dose interruption, reduction and discontinuation will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment emergent serious adverse events (SAEs)	Incidence, nature and severity of SAE will be recorded and graded as per National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v4.03.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment emergent adverse events (TEAEs) leading to death	TEAEs leading to deaths will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline clinical laboratory parameter: Hematology	Hemoglobin, hematocrit, Red Blood Cells (RBC), White Blood Cells (WBC) with differential (absolutes values), platelet counts, neutrophils, lymphocytes, monocytes, basophil and eosinophils	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline clinical laboratory parameter: Chemistry	Albumin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin and direct bilirubin, gamma glutamyl transferase (GGT), urea or blood urea nitrogen (BUN), creatinine, sodium, potassium, calcium, phosphate, chloride, uric acid, magnesium, Creatinine kinase (CK) (if total CK = 3X upper limit of normal (ULN), then measure isoenzymes (including all fractions), serum creatinine and myoglobin in blood and urinalysis test weekly; if there is no local capability to measure CK isoenzymes, then subjects must be referred to a local hospital for appropriate management while central laboratory results are awaited. If a diagnosis of rhabdomyolysis is confirmed, then sites should liaise with their local hospitals regarding management of the subjects and administration of study medication), total protein, glucose, lactate dehydrogenase (LDH), lipase and amylase.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline clinical laboratory parameter: Coagulation	Prothrombin time (PT), international normalized ratio (INR) and activated partial thromboplastin time (aPTT)	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment emergent adverse events (TEAEs) related to notable change from baseline of dipstick urinalysis.	Dipstick measurements for specific gravity, pH, protein, glucose, bilirubin, ketones, leukocytes, and blood will be performed. Any clinically significant findings on dipstick will be followed up with a microscopic evaluation.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment-emergent adverse events (TEAEs) related to notable or abnormal changes in vital signs from baseline of vital sign examinations.	Clinically notable elevated values: Systolic blood pressure (BP): = 160 mmHg and an increase = 20 mmHg from baseline; Diastolic BP: = 100 mmHg and an increase = 15 mmHg from baseline; Heart rate: = 120 beats/min (bpm) with increase from baseline of = 15 bpm; Weight (kg) increase from baseline of = 10%; Body temperature [°C] = 37.5°C). Clinically notable low values: Systolic BP: = 90 mmHg with decrease from baseline of = 20 mmHg; Diastolic BP: = 50 mmHg with decrease from baseline of = 15 mmHg; Heart rate: = 50 bpm with decrease from baseline of = 15 bpm; Weight: = 20% decrease from baseline; Body temperature [°C]: = 36 °C. Number of participants with TEAEs related to notable changes to the vital signs after the start of study drug will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment-emergent adverse events (TEAEs) related to notable or abnormal changes from baseline of 12-lead electrocardiograms (ECGs)	12-lead ECGs will be obtained using an internationally recognized 12-lead cardiograph. Clinically notable ECG values: QT [millisecond (ms)] and QT interval (ms) corrected for heart rate using Fridericia's formula (QTcF) intervals (ms): increase from baseline > 30 ms; increase from baseline > 60 ms, new > 450 ms, new > 480 ms, new > 500 ms. Heart rate (beats/min): increase from baseline > 25% to a value > 100 bpm, decrease from baseline > 25% and to a value < 50 bpm. Number of participants with TEAEs related to abnormal or notable changes to ECG parameters after the start of study drug will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of treatment-emergent adverse events (TEAEs) related to notable or abnormal changes from baseline of echocardiogram or multigated acquisition (ECHO/MUGA) scans.	ECHO/MUGA scan assess Left Ventricular Ejection Fraction (LVEF). Changes from baseline of LVEF measurements over time will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Incidence of targeted treatment emergent adverse events (TEAEs) of special interest.	Number and percentage of participants with at least one event of adverse event (AE) of special interest (AESI) will be reported.	Cycle 1 Day 1 through safety follow-up visit (30 days (+/- 3 days)) after last study treatment dose or before the initiation of subsequent anticancer therapy, whichever occurs first, approximately up to 18 months. Each cycle is 28 days.
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of encorafenib: Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1 at pre-dose, and 1, 2, 4, 6 hours post-dose; Cycle 1 to Cycle 6 at pre-dose for sparse samples; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of encorafenib: Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of encorafenib: Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of binimetinib: Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of binimetinib: Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of binimetinib: Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of encorafenib metabolite (LHY746): Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of encorafenib metabolite (LHY746): Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of encorafenib metabolite (LHY746): Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of binimetinib metabolite (AR00426032): Area under the curve (AUC)	Area under the curve (AUC) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of binimetinib metabolite (AR00426032): Minimum serum concentration (Cmin)	Minimum serum concentration (Cmin) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days
Secondary	Pivotal Part: Pharmacokinetic (PK) parameter of binimetinib metabolite (AR00426032): Maximum serum concentration (Cmax)	Maximum serum concentration (Cmax) will be calculated and reported.	Cycle 1 Day 1 and Cycle 2 Day 1; Cycle 1 to Cycle 6 at pre-dose; Each cycle is 28 days