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NCT01763164

Study Comparing the Efficacy of MEK162 Versus Dacarbazine in Unresectable or Metastatic NRAS Mutation-positive Melanoma

Completed Phase 3 Results posted Last updated 22 March 2021
What this trial tests

Phase 3 trial testing MEK162 in Metastatic or Unresectable Cutaneous Melanoma in 402 participants. Completed in 4 June 2019.

Timeline
12 July 2013
Primary endpoint
1 December 2015
4 June 2019

Quick facts

Lead sponsorPfizer
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment402
Start date12 July 2013
Primary completion1 December 2015
Estimated completion4 June 2019
Sites229 locations across Italy, Japan, Poland, South Korea, Netherlands, Russia, Belgium, Sweden

Drugs / interventions tested

Conditions studied

Sponsor

Pfizer — full company profile →

Who can join

18 and older, any sex, with Metastatic or Unresectable Cutaneous Melanoma. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Progression-Free Survival (PFS) by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 Primary · From the date of randomization to the date of the first documented PD or death, whichever occurred first (maximum up to 77 weeks for binimetinib arm; maximum up to 61 weeks for dacarbazine arm)

PFS: time from randomization to first documented PD or death due to any cause, whichever occurred first. RECIST 1.1, PD: \>=20% increase in sum of diameter of target lesions (TLs) taking as reference the smallest sum on study (including baseline sum), sum must also be an absolute increase of \>=5 mm; unequivocal progression of existing non-TLs; appearance of \>=1 lesion. Complete response (CR): disappearance of all lesions; any pathological lymph nodes (TLs) or non-pathological (non-TLs) must have reduction in short axis to \<10 mm; normalization of tumor marker level for non-TLs. Partial resp

GroupValue95% CI
Binimetinib (MEK162)2.832.76 – 3.55
Dacarbazine1.511.48 – 1.71
Overall Survival (OS) Secondary · From the date of randomization to the date of death (maximum up to 107 weeks for binimetinib arm; maximum up to 88 weeks for dacarbazine arm)

Overall survival was defined as the time from the date of randomization to the date of death due to any cause. If a participant was not known to have died, overall survival was censored at the date of last known date participant alive.

GroupValue95% CI
Binimetinib (MEK162)10.978.94 – 13.60
Dacarbazine10.097.03 – 16.46
Overall Response Rate (ORR) Secondary · From date of randomization until first documented response of CR or PR (maximum up to 77 weeks for binimetinib arm; maximum up to 61 weeks for dacarbazine arm)

ORR: percentage of participants with best overall response (BOR) of CR or PR. BOR: best response recorded from start of treatment until CR or PR. RECIST V1.1, a) CR: disappearance of all lesions; any pathological lymph nodes (TLs) or non-pathological (non-TLs) must have reduction in short axis to \<10 mm; normalization of tumor marker level for non-TLs; b) PR: \>=30% decrease in sum of diameter of all TLs, taking as reference baseline sum of diameters. ORR is reported for confirmed and unconfirmed responses. Confirmed CR or PR = at least 2 determinations of CR or PR at least 4 weeks apart befo

Confirmed ORR
GroupValue95% CI
Binimetinib (MEK162)15.211.2 – 20.1
Dacarbazine6.83.1 – 12.5
Confirmed + Unconfirmed: ORR
GroupValue95% CI
Binimetinib (MEK162)22.717.8 – 28.2
Dacarbazine9.85.3 – 16.1
Time to Response (TTR) Secondary · From date of randomization until first documented response of CR or PR (maximum up to 77 weeks for binimetinib arm; maximum up to 61 weeks for dacarbazine arm)

TTR: time between date of randomization until first documented response of CR or PR. RECIST V1.1, a) CR: disappearance of all lesions; any pathological lymph nodes (TLs) or non-pathological (non-TLs) must have reduction in short axis to \<10 mm; normalization of tumor marker level for non-TLs; b) PR: \>=30% decrease in sum of diameter (dia) of all TLs, referring baseline sum of dia; c) PD: \>=20% increase in sum of diameter of all measured TLs taking as reference smallest sum of diameter of all TLs recorded at or after baseline, sum must also be absolute increase of \>=5 mm. Unequivocal progre

GroupValue95% CI
Binimetinib (MEK162)1.451.45 – 1.48
Dacarbazine2.791.22 – 3.38
Duration of Objective Response (DOR) Secondary · From the date of first documented response (CR or PR) to the first documented progression or death (maximum up to 77 weeks for binimetinib arm; maximum up to 61 weeks for dacarbazine arm)

DOR: time from date of first documented response (CR or PR) to first documented progression or death due to underlying cancer. RECIST V1.1, a) CR: disappearance of all lesions; any pathological lymph nodes (TLs) or non-pathological (non-TLs) must have reduction in short axis to \<10 mm; normalization of tumor marker level for non-TLs; b) PR: \>=30% decrease in sum of diameter (dia) of all TLs, referring baseline sum of dia; c) PD: \>=20% increase in sum of diameter of all measured target lesions taking as reference smallest sum of diameter of all target lesions recorded at or after baseline, s

GroupValue95% CI
Binimetinib (MEK162)6.874.21 – 11.07
DacarbazineNA4.14 – NA
Disease Control Rate (DCR) Secondary · From date of randomization until first documented response of CR, PR, SD or non-CR/non-PD (maximum up to 77 weeks for binimetinib arm; maximum up to 61 weeks for dacarbazine arm)

DCR was calculated as the percentage of participants with a BOR of CR, PR, SD RECIST V1.1, a) CR: disappearance of all lesions; any pathological lymph nodes (TLs) or non-pathological (non-TLs) must have reduction in short axis to \<10 mm; normalization of tumor marker level for non-TLs; b) PR: \>=30% decrease in sum of diameter of all target lesions, taking as reference the baseline sum of diameters; c) SD: neither sufficient shrinkage to qualify for PR or CR nor an increase in lesions which would qualify for PD taking as reference the smallest sum diameters; d) PD: \>=20% increase in sum of d

GroupValue95% CI
Binimetinib (MEK162)58.452.2 – 64.3
Dacarbazine24.817.7 – 33.0
Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs) Secondary · From baseline up to 219.4 weeks for binimetinib arm; From baseline up to 123.9 weeks for dacarbazine arm

An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship with the study treatment. SAE was defined as one of the following: was fatal or life-threatening; resulted in persistent or significant disability/incapacity; constituted a congenital anomaly/birth defect; was medically significant; required inpatient hospitalization or prolongation of existing hospitalization. Treatment-emergent AE was defined as an AE with onset date occurring during the on-treatment period. AEs included all SAEs and non-SAEs.

AEs
GroupValue95% CI
Binimetinib (MEK162)269
Dacarbazine104
SAEs
GroupValue95% CI
Binimetinib (MEK162)95
Dacarbazine26
Number of Participants With Clinically Notable Hematology Shifts Based on National Cancer Institute Common Terminology Criteria (NCI-CTCAE) Grade, Version 4.03 Secondary · From baseline up to 77 weeks in binimetinib arm; From baseline up to 61 weeks for dacarbazine arm

Clinically notable shifts are defined as worsening by at least 2 grades or to \>= grade 3. Severity was graded as Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily life (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent in

Activated partial thromboplastin time prolonged
GroupValue95% CI
Binimetinib (MEK162)7
Dacarbazine2
Hemoglobin decreased
GroupValue95% CI
Binimetinib (MEK162)17
Dacarbazine13
Prothrombin international normalized ratio increased
GroupValue95% CI
Binimetinib (MEK162)9
Dacarbazine0
Lymphocytes increased
GroupValue95% CI
Binimetinib (MEK162)20
Dacarbazine0
Lymphocytes decreased
GroupValue95% CI
Binimetinib (MEK162)35
Dacarbazine19
Neutrophils decreased
GroupValue95% CI
Binimetinib (MEK162)8
Dacarbazine21
Platelets decreased
GroupValue95% CI
Binimetinib (MEK162)3
Dacarbazine17
Leukocytes increased
GroupValue95% CI
Binimetinib (MEK162)0
Dacarbazine0
Number of Participants With Clinically Notable Clinical Chemistry/Biochemistry Shifts Based on NCI-CTCAE Grade, Version 4.03 Secondary · From baseline up to 77 weeks in binimetinib arm; From baseline up to 61 weeks for dacarbazine arm

Clinically notable shifts are defined as worsening by at least 2 grades or to \>= grade 3. Severity was graded as Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental ADL; Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade

Albumin decreased
GroupValue95% CI
Binimetinib (MEK162)27
Dacarbazine5
Alkaline phosphatase
GroupValue95% CI
Binimetinib (MEK162)8
Dacarbazine2
Alanine aminotransferase
GroupValue95% CI
Binimetinib (MEK162)14
Dacarbazine4
Aspartate aminotransferase
GroupValue95% CI
Binimetinib (MEK162)20
Dacarbazine1
Bilirubin
GroupValue95% CI
Binimetinib (MEK162)1
Dacarbazine1
Corrected Calcium increased
GroupValue95% CI
Binimetinib (MEK162)2
Dacarbazine4
Corrected Calcium decreased
GroupValue95% CI
Binimetinib (MEK162)2
Dacarbazine0
Creatinine
GroupValue95% CI
Binimetinib (MEK162)9
Dacarbazine2
Number of Participants With Clinically Notable Vital Signs Secondary · From baseline up to 77 weeks in binimetinib arm; From baseline up to 61 weeks for dacarbazine arm

Abnormalities criteria included: low/high pulse rate (beats per minute \[bpm\]):\<=50bpm with decrease from baseline \>=15bpm/\>=120bpm with increase from baseline \>=15bpm; Low/high systolic blood pressure (millimeters of mercury \[mmHg\]): \<=90mmHg with decrease from baseline \>=20mmHg/\>=160mmHg with increase from baseline \>=20mmHg; Low/high diastolic blood pressure \[mmHg\]: \<=50mmHg with decrease from baseline \>=15mmHg/\>=100mmHg with increase from baseline \>=15mmHg; Low/high body weight (kilogram \[kg\]): \>=20% decrease from baseline / \>=10% increase from baseline; Low/high body t

Sitting Pulse Rate - High
GroupValue95% CI
Binimetinib (MEK162)4
Dacarbazine1
Sitting Pulse Rate - Low
GroupValue95% CI
Binimetinib (MEK162)3
Dacarbazine1
Sitting systolic blood pressure - High
GroupValue95% CI
Binimetinib (MEK162)43
Dacarbazine8
Sitting systolic blood pressure -Low
GroupValue95% CI
Binimetinib (MEK162)2
Dacarbazine4
Sitting diastolic blood pressure - High
GroupValue95% CI
Binimetinib (MEK162)28
Dacarbazine4
Sitting diastolic blood pressure - Low
GroupValue95% CI
Binimetinib (MEK162)2
Dacarbazine1
Weight - High
GroupValue95% CI
Binimetinib (MEK162)16
Dacarbazine1
Weight - Low
GroupValue95% CI
Binimetinib (MEK162)0
Dacarbazine0
Number of Participants With Notable Electrocardiogram (ECG) Values Secondary · From baseline up to 77 weeks in binimetinib arm; From baseline up to 61 weeks for dacarbazine arm

Criteria for notable ECG values were as follow: QT interval (in millisecond \[msec\]) new (newly occurring post-baseline value) greater than (\>) 450, 480, 500, increase from baseline \>30, increase from baseline \>60; corrected QT interval by Fredericia formula (QTcF) in msec new (newly occurring post-baseline value) \> 450, 480, 500, increase from baseline \>30, increase from baseline \>60; corrected QT interval by Bazett's formula (QTcB) in msec new (newly occurring post-baseline value) \> 450, 480, 500, increase from baseline \>30, increase from baseline \>60; heart rate in bpm new (newly

QT - New > 450 msec
GroupValue95% CI
Binimetinib (MEK162)32
Dacarbazine8
QT - New > 480 msec
GroupValue95% CI
Binimetinib (MEK162)7
Dacarbazine1
QT - New > 500 msec
GroupValue95% CI
Binimetinib (MEK162)5
Dacarbazine0
QT - Increase from baseline > 30 msec
GroupValue95% CI
Binimetinib (MEK162)109
Dacarbazine33
QT - Increase from baseline > 60 msec
GroupValue95% CI
Binimetinib (MEK162)28
Dacarbazine5
QTcF - New > 450 msec
GroupValue95% CI
Binimetinib (MEK162)29
Dacarbazine15
QTcF - New > 480 msec
GroupValue95% CI
Binimetinib (MEK162)10
Dacarbazine1
QTcF - New > 500 msec
GroupValue95% CI
Binimetinib (MEK162)5
Dacarbazine1
Number of Participants With Adverse Events of Special Interest: Cardiac Events Secondary · From baseline up to 77 weeks in binimetinib arm; From baseline up to 61 weeks for dacarbazine arm

An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship with the study treatment. Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily life (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL;

GroupValue95% CI
Binimetinib (MEK162)35
Dacarbazine2

Adverse events — posted to ClinicalTrials.gov

Time frame: From baseline up to 219.4 weeks for binimetinib arm; From baseline up to 123.9 weeks for dacarbazine arm. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Binimetinib (MEK162)
Serious: 95/269 (35%)
Deaths:
Dacarbazine
Serious: 26/114 (23%)
Deaths:

Serious adverse events (129 terms)

ReactionSystemBinimetinib (MEK162)Dacarbazine
GENERAL PHYSICAL HEALTH DETERIORATIONGeneral disorders
RETINAL VEIN OCCLUSIONEye disorders
PULMONARY EMBOLISMRespiratory, thoracic and mediastinal disorders
VOMITINGGastrointestinal disorders
PYREXIAGeneral disorders
SKIN INFECTIONInfections and infestations
BLOOD CREATINE PHOSPHOKINASE INCREASEDInvestigations
DYSPNOEARespiratory, thoracic and mediastinal disorders
PNEUMONITISRespiratory, thoracic and mediastinal disorders
ANAEMIABlood and lymphatic system disorders
PANCYTOPENIABlood and lymphatic system disorders
DIARRHOEAGastrointestinal disorders
MUSCULAR WEAKNESSMusculoskeletal and connective tissue disorders
RENAL FAILURERenal and urinary disorders
HYPERTENSIVE CRISISVascular disorders
RETINAL VEIN THROMBOSISEye disorders
CONSTIPATIONGastrointestinal disorders
NAUSEAGastrointestinal disorders
CELLULITISInfections and infestations
ERYSIPELASInfections and infestations
PYELONEPHRITIS ACUTEInfections and infestations
SEPSISInfections and infestations
SOFT TISSUE INFECTIONInfections and infestations
UROSEPSISInfections and infestations
INTERVERTEBRAL DISC PROTRUSIONMusculoskeletal and connective tissue disorders
Other adverse events (58 terms — click to expand)

ReactionSystemBinimetinib (MEK162)Dacarbazine
BLOOD CREATINE PHOSPHOKINASE INCREASEDInvestigations
DIARRHOEAGastrointestinal disorders
DERMATITIS ACNEIFORMSkin and subcutaneous tissue disorders
OEDEMA PERIPHERALGeneral disorders
RASHSkin and subcutaneous tissue disorders
NAUSEAGastrointestinal disorders
FATIGUEGeneral disorders
VOMITINGGastrointestinal disorders
ASTHENIAGeneral disorders
CONSTIPATIONGastrointestinal disorders
ASPARTATE AMINOTRANSFERASE INCREASEDInvestigations
DRY SKINSkin and subcutaneous tissue disorders
HYPERTENSIONVascular disorders
RETINAL DETACHMENTEye disorders
EJECTION FRACTION DECREASEDInvestigations
PYREXIAGeneral disorders
DECREASED APPETITEMetabolism and nutrition disorders
EYELID OEDEMAEye disorders
MYALGIAMusculoskeletal and connective tissue disorders
DYSPNOEARespiratory, thoracic and mediastinal disorders
PRURITUSSkin and subcutaneous tissue disorders
SKIN FISSURESSkin and subcutaneous tissue disorders
ABDOMINAL PAINGastrointestinal disorders
ALOPECIASkin and subcutaneous tissue disorders
ALANINE AMINOTRANSFERASE INCREASEDInvestigations
RASH MACULO-PAPULARSkin and subcutaneous tissue disorders
DRY MOUTHGastrointestinal disorders
NEUTROPENIABlood and lymphatic system disorders
DYSGEUSIANervous system disorders
VISION BLURREDEye disorders
COUGHRespiratory, thoracic and mediastinal disorders
ANAEMIABlood and lymphatic system disorders
SUBRETINAL FLUIDEye disorders
INTRAOCULAR PRESSURE INCREASEDInvestigations
BACK PAINMusculoskeletal and connective tissue disorders
ARTHRALGIAMusculoskeletal and connective tissue disorders
HEADACHENervous system disorders
RASH PUSTULARInfections and infestations
THROMBOCYTOPENIABlood and lymphatic system disorders
MACULAR OEDEMAEye disorders

Most-reported serious reactions: GENERAL PHYSICAL HEALTH DETERIORATION, RETINAL VEIN OCCLUSION, PULMONARY EMBOLISM, VOMITING, PYREXIA, SKIN INFECTION, BLOOD CREATINE PHOSPHOKINASE INCREASED, DYSPNOEA.

Data from ClinicalTrials.gov NCT01763164 adverse events section.

Sponsor's own description

Two-arm, randomized, prospective, open-label, multi-center, phase III study to compare the efficacy and safety of MEK162 (45 mg BID) versus dacarbazine (1000 mg/m2 IV every 3 weeks) in patients with advanced (Stage IIIC) unresectable or metastatic (Stage IV) NRAS Q61 mutation-positive cutaneous or unknown primary melanoma. The mutation analysis will be performed at a central laboratory. Only those patients with Q61 mutation per central laboratory and meet all eligibility criteria will be randomized. A total of 393 patients will be randomized 2:1 to receive either MEK162 or dacarbazine. Patients will be stratified according to AJCC stage (IIIC, IVM1a, and IVM1b versus IVM1c), ECOG Performance status (0 versus 1) and any prior number of lines of immunotherapy (immunotherapies versus none). This study will use an Interactive Response Technology (IRT). The primary end point of the study is progression-free survival. Key secondary end point is overall survival

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. RAS-targeted therapies: is the undruggable drugged?
    Moore AR, Rosenberg SC, McCormick F, Malek S. · · 2020 · cited 832× · PMID 32528145 · DOI 10.1038/s41573-020-0068-6
  2. Binimetinib versus dacarbazine in patients with advanced NRAS-mutant melanoma (NEMO): a multicentre, open-label, randomised, phase 3 trial.
    Dummer R, Schadendorf D, Ascierto PA, Arance A, et al · · 2017 · cited 357× · PMID 28284557 · DOI 10.1016/s1470-2045(17)30180-8
  3. Current Development Status of MEK Inhibitors.
    Cheng Y, Tian H. · · 2017 · cited 181× · PMID 28954413 · DOI 10.3390/molecules22101551
  4. Systemic treatments for metastatic cutaneous melanoma.
    Pasquali S, Hadjinicolaou AV, Chiarion Sileni V, Rossi CR, et al · · 2018 · cited 140× · PMID 29405038 · DOI 10.1002/14651858.cd011123.pub2
  5. Targeting the ERK Signaling Pathway in Melanoma.
    Savoia P, Fava P, Casoni F, Cremona O. · · 2019 · cited 137× · PMID 30934534 · DOI 10.3390/ijms20061483
  6. MEK1/2 Inhibitors: Molecular Activity and Resistance Mechanisms.
    Wu PK, Park JI. · · 2015 · cited 107× · PMID 26615130 · DOI 10.1053/j.seminoncol.2015.09.023
  7. Treatment of NRAS-mutant melanoma.
    Johnson DB, Puzanov I. · · 2015 · cited 103× · PMID 25796376 · DOI 10.1007/s11864-015-0330-z
  8. A phase 1 dose-escalation and expansion study of binimetinib (MEK162), a potent and selective oral MEK1/2 inhibitor.
    Bendell JC, Javle M, Bekaii-Saab TS, Finn RS, et al · · 2017 · cited 87× · PMID 28152546 · DOI 10.1038/bjc.2017.10

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