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000287439 1001_ $$0P:(DE-He78)a6b5fcabf661bef95109dbee87dc5271$$avan Tilburg, Cornelis Martinus$$b0$$eFirst author$$udkfz
000287439 245__ $$aLOGGIC/FIREFLY-2: a phase 3, randomized trial of tovorafenib vs. chemotherapy in pediatric and young adult patients with newly diagnosed low-grade glioma harboring an activating RAF alteration.
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000287439 520__ $$aPediatric low-grade glioma (pLGG) is essentially a single pathway disease, with most tumors driven by genomic alterations affecting the mitogen-activated protein kinase/ERK (MAPK) pathway, predominantly KIAA1549::BRAF fusions and BRAF V600E mutations. This makes pLGG an ideal candidate for MAPK pathway-targeted treatments. The type I BRAF inhibitor, dabrafenib, in combination with the MEK inhibitor, trametinib, has been approved by the United States Food and Drug Administration for the systemic treatment of BRAF V600E-mutated pLGG. However, this combination is not approved for the treatment of patients with tumors harboring BRAF fusions as type I RAF inhibitors are ineffective in this setting and may paradoxically enhance tumor growth. The type II RAF inhibitor, tovorafenib (formerly DAY101, TAK-580, MLN2480), has shown promising activity and good tolerability in patients with BRAF-altered pLGG in the phase 2 FIREFLY-1 study, with an objective response rate (ORR) per Response Assessment in Neuro-Oncology high-grade glioma (RANO-HGG) criteria of 67%. Tumor response was independent of histologic subtype, BRAF alteration type (fusion vs. mutation), number of prior lines of therapy, and prior MAPK-pathway inhibitor use.LOGGIC/FIREFLY-2 is a two-arm, randomized, open-label, multicenter, global, phase 3 trial to evaluate the efficacy, safety, and tolerability of tovorafenib monotherapy vs. current standard of care (SoC) chemotherapy in patients < 25 years of age with pLGG harboring an activating RAF alteration who require first-line systemic therapy. Patients are randomized 1:1 to either tovorafenib, administered once weekly at 420 mg/m2 (not to exceed 600 mg), or investigator's choice of prespecified SoC chemotherapy regimens. The primary objective is to compare ORR between the two treatment arms, as assessed by independent review per RANO-LGG criteria. Secondary objectives include comparisons of progression-free survival, duration of response, safety, neurologic function, and clinical benefit rate.The promising tovorafenib activity data, CNS-penetration properties, strong scientific rationale combined with the manageable tolerability and safety profile seen in patients with pLGG led to the SIOPe-BTG-LGG working group to nominate tovorafenib for comparison with SoC chemotherapy in this first-line phase 3 trial. The efficacy, safety, and functional response data generated from the trial may define a new SoC treatment for newly diagnosed pLGG.ClinicalTrials.gov: NCT05566795. Registered on October 4, 2022.
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000287439 650_7 $$2Other$$aBRAF
000287439 650_7 $$2Other$$aChemotherapy
000287439 650_7 $$2Other$$aChild
000287439 650_7 $$2Other$$aFirst-line
000287439 650_7 $$2Other$$aMAPK
000287439 650_7 $$2Other$$aPediatric low-grade glioma
000287439 650_7 $$2Other$$aTovorafenib
000287439 650_7 $$2Other$$apLGG
000287439 7001_ $$aKilburn, Lindsay B$$b1
000287439 7001_ $$aPerreault, Sébastien$$b2
000287439 7001_ $$aSchmidt, Rene$$b3
000287439 7001_ $$aAzizi, Amedeo A$$b4
000287439 7001_ $$aCruz-Martínez, Ofelia$$b5
000287439 7001_ $$aZápotocký, Michal$$b6
000287439 7001_ $$aScheinemann, Katrin$$b7
000287439 7001_ $$aMeeteren, Antoinette Y N Schouten-van$$b8
000287439 7001_ $$aSehested, Astrid$$b9
000287439 7001_ $$aOpocher, Enrico$$b10
000287439 7001_ $$aDriever, Pablo Hernáiz$$b11
000287439 7001_ $$aAvula, Shivaram$$b12
000287439 7001_ $$aZiegler, David S$$b13
000287439 7001_ $$0P:(DE-He78)51bf9ae9cb5771b30c483e5597ef606c$$aCapper, David$$b14$$udkfz
000287439 7001_ $$aKoch, Arend$$b15
000287439 7001_ $$0P:(DE-He78)a1f4b408b9155beb2a8f7cba4d04fe88$$aSahm, Felix$$b16$$udkfz
000287439 7001_ $$aQiu, Jiaheng$$b17
000287439 7001_ $$aTsao, Li-Pen$$b18
000287439 7001_ $$aBlackman, Samuel C$$b19
000287439 7001_ $$aManley, Peter$$b20
000287439 7001_ $$0P:(DE-He78)0be2f86573954f87e97f8a4dbb05cb0f$$aMilde, Till$$b21$$udkfz
000287439 7001_ $$0P:(DE-He78)4ad08e18c452a1684b5437a2f9a1052a$$aWitt, Ruth$$b22$$udkfz
000287439 7001_ $$0P:(DE-He78)551bb92841f634070997aa168d818492$$aJones, David T W$$b23$$udkfz
000287439 7001_ $$aHargrave, Darren$$b24
000287439 7001_ $$0P:(DE-He78)143af26de9d57bf624771616318aaf7c$$aWitt, Olaf$$b25$$eLast author$$udkfz
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