Description:
Background:
Most people with hairy cell leukemia have a BRAF gene mutation. They can be treated with BRAF
inhibitors, drugs that target this mutation. For people who do not have this mutation, BRAF
inhibitors are not a treatment option. We found that in hairy cell leukemia, when BRAF is not
mutated, the MEK gene frequently is. Binimetinib is a MEK inhibitor which targets MEK. It is
important to determine if this drug can be a good treatment option in those who cannot
benefit treatment with BRAF inhibitors.
Objective:
To see if binimetinib is an effective treatment for hairy cell leukemia that does not have a
BRAF mutation.
Eligibility:
People ages 18 and older with hairy cell leukemia without a mutation in the BRAF gene and
whose disease either did not respond to treatment or came back after treatment
Design:
Participants will be screened with:
- Medical history
- Physical exam
- Blood and urine tests
- Lung and heart tests
- Eye exam
- Bone marrow biopsy: A needle will be injected through the participant s skin into the
bone to remove a sample of marrow.
- CT or MRI scan: Participants will lie in a machine that takes pictures of the body. They
might receive a contrast agent by vein.
Before they start treatment, participants will have an abdominal ultrasound, pulmonary
function tests, and exercise stress tests.
Participants will take binimetinib by mouth twice daily in 28-day cycles. They will keep a
medication diary.
Participants will have at least one visit before every cycle. Visits will include repeats of
some screening tests.
Participants may continue treatment as long as their disease does not get worse and they do
not have bad side effects.
About a month after their last dose of treatment, participants will have a follow-up visit.
They will then have visits once a year.
...
Title
- Brief Title: Binimetinib for People With Relapsed/Refractory BRAF Wild Type Hairy Cell Leukemia and Variant
- Official Title: Phase 2 Trial for Binimetinib for Patients With Relapsed/Refractory BRAF Wild Type Hairy Cell Leukemia and Variant
Clinical Trial IDs
- ORG STUDY ID:
200075
- SECONDARY ID:
20-C-0075
- NCT ID:
NCT04322383
Conditions
Interventions
Drug | Synonyms | Arms |
---|
binimetinib | | Arm 1/Experimental therapy |
Purpose
Background:
Most people with hairy cell leukemia have a BRAF gene mutation. They can be treated with BRAF
inhibitors, drugs that target this mutation. For people who do not have this mutation, BRAF
inhibitors are not a treatment option. We found that in hairy cell leukemia, when BRAF is not
mutated, the MEK gene frequently is. Binimetinib is a MEK inhibitor which targets MEK. It is
important to determine if this drug can be a good treatment option in those who cannot
benefit treatment with BRAF inhibitors.
Objective:
To see if binimetinib is an effective treatment for hairy cell leukemia that does not have a
BRAF mutation.
Eligibility:
People ages 18 and older with hairy cell leukemia without a mutation in the BRAF gene and
whose disease either did not respond to treatment or came back after treatment
Design:
Participants will be screened with:
- Medical history
- Physical exam
- Blood and urine tests
- Lung and heart tests
- Eye exam
- Bone marrow biopsy: A needle will be injected through the participant s skin into the
bone to remove a sample of marrow.
- CT or MRI scan: Participants will lie in a machine that takes pictures of the body. They
might receive a contrast agent by vein.
Before they start treatment, participants will have an abdominal ultrasound, pulmonary
function tests, and exercise stress tests.
Participants will take binimetinib by mouth twice daily in 28-day cycles. They will keep a
medication diary.
Participants will have at least one visit before every cycle. Visits will include repeats of
some screening tests.
Participants may continue treatment as long as their disease does not get worse and they do
not have bad side effects.
About a month after their last dose of treatment, participants will have a follow-up visit.
They will then have visits once a year.
...
Detailed Description
Background:
- Hairy cell leukemia (HCL) is an indolent B-cell leukemia comprising 2% of all leukemias,
or approximately 1900 new cases per year in the US.
- BRAF V600E mutation is very common in classic HCL.
- HCL variant (HCLv) is wild type for BRAF and is more aggressive compared to classic HCL
due to its lower response and shorter duration of response to standard purine analog
chemotherapy. The median survival is only ~6 years compared to >25 years for classic
HCL.
- CD25+ classic-appearing HCL-cells that express unmutated IGHV4-34+ immunoglobulin
rearrangement, are wild-type for BRAF, and confer a poor prognosis when treated with
standard purine analog chemotherapy.
- While BRAF and MEK combination inhibition is making an impact in the treatment of BRAF
V600E mutated HCL, this treatment is not applicable for patients with BRAF-WT HCL/HCLv.
Furthermore, with poor survival outcomes in this patient population, lack of targeted
therapy constitutes a clear unmet need.
- Recently, several BRAF WT HCL/HCLv patients have received MEK inhibitors by
compassionate use and have had lifesaving partial to complete remission, however the
response has not been assessed systematically in clinical trials.
- Binimetinib (also known as MEK162) is an orally bioavailable, selective and potent
mitogenactivated protein (MAP) kinase kinase (MEK1 and MEK2) inhibitor, which is
approved for use in combination with encorafenib for the treatment of patients with
BRAF-mutant melanoma
- We have described MAP2K1 (MEK) mutations which may drive the aggressive clinical
behavior of BRAF WT HCL/HCLv patients, but MEK inhibition may be clinically useful even
in these patients without known MAP2K1 (MEK) mutations.
Objective:
-To determine the overall response rate (ORR) to binimetinib, in patients with BRAF WT HCL
and HCLv.
Eligibility:
- BRAF WT HCL or HCLv with at least 1 prior purine analog treatment
- Need for treatment as evidenced by any one of the following: ANC <1 x10^3/mcL, Hgb
<10g/dL, Platelet count <100 x10^3/mcL, leukemia cell count >5 x10^3/mcL, symptomatic
splenomegaly, enlarging HCL mass > 2cm in short axis.
- Greater than or equal to 18 years of age
- No uncontrolled infection, cardiopulmonary dysfunction, or secondary malignancy
requiring treatment.
- No chemotherapy, immunotherapy, investigational agent or radiotherapy within 4 weeks
prior to the start of study treatment.
Design:
- Single arm phase 2 trial to determine ORR in patients with relapsed/refractory BRAF WT
HCL and HCLv.
- 2-phase minimax design will be used to rule out an unacceptable 10% in favor of an
improved 25% ORR.
- Initially 16 evaluable patients will be enrolled. If 2 or more achieve a major response,
then accrual will continue to a total of 31 evaluable patients.
- Binimetinib will be given at a dose of 45mg BID for as long as patients can continue
dosing chronically without significant toxicity.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm 1/Experimental therapy | Experimental | Treatment with binimetinib | |
Eligibility Criteria
- INCLUSION CRITERIA:
- Histologically confirmed diagnosis of HCL or HCLv according to morphological and
immunophenotypic criteria of WHO classification of lymphoid neoplasm. Patients should
have at least one of the following indications for therapy:
1. Absolute neutrophil count (ANC) <1 x10^3/mcL
2. Hemoglobin <10g/dL
3. Platelets<100 x10^3/mcL
4. Symptomatic splenomegaly
5. Enlarging HCL mass or bone lesion > 2cm in short axis
6. Leukemia cell count >5x10^3/mcL
Patients who have eligible blood counts within 4 weeks prior to initiation of study therapy
will not be considered ineligible if subsequent blood counts prior to initiation of study
therapy fluctuate and become ineligible up until the time of the initiation of study
therapy.
- Refractory or relapsed disease - defined as either:
- Refractory- no response or disease progression in less than or equal to 1 year
following first-line treatment with a purine analog, or
- Relapsed- having relapsed following treatment with at least 1 prior purine-analog
treatments
- Patients must be BRAF WT as confirmed from fresh bone marrow aspirate and/or
peripheral blood sample, or lymph node/mass by the Laboratory of Pathology, NCI
- Patients who are ineligible for, unable to obtain in a timely manner, cannot access,
unwilling to undergo or have failed Moxetumomab Pasudotox trial at NCI
- Age greater than or equal to 18 years
- ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to
60%).
- Patients must have adequate organ and marrow function as defined below:
- Total bilirubin less than or equal to 3x upper limit of normal (ULN), unless
consistent with Gilbert s (ratio between total and direct bilirubin > 5)
- AST and ALT less than or equal to 3x ULN
- Alkaline phosphatase < 2.5x ULN
- Serum creatinine less than or equal to 1.5 mg/dL or creatinine clearance greater than
or equal to 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional
normal calculated using eGFR
- Serum albumin greater than or equal to 2 g/dL
- Prothrombin time (PT)/International Normalized Ratio < 2.5x ULN (If on warfarin,
PT/INR < 3.5x ULN; If on any other anticoagulation, Prothrombin time (PT) < 2.5x ULN
- Fibrinogen greater than or equal to 0.5x lower limit of normal
- The effects of binimetinib on the developing human fetus are unknown therefore
participants must use effective methods of contraception as directed below.
- Females of childbearing potential (FOCBP) who are sexually active with a
nonsterilized male partner must use a highly effective method of contraception
and not donate ova prior to study entry and or the duration of study treatment
and until 30 days after the last dose of binimetinib. Periodic abstinence, the
rhythm method, and the withdrawal method are not acceptable methods of
contraception. Females of childbearing potential are defined as those who are not
surgically sterile (i.e., bilateral tubal ligation, bilateral oophorectomy, or
complete hysterectomy) or those who are premenarchal or postmenopausal (defined
as 12 months with no menses without an alternative medical cause). A highly
effective method of contraception is defined as one that results in a low failure
rate (i.e., less than 1% per year) when used consistently and correctly. Not all
methods of contraception are highly effective. Female subjects must use a
hormonal method in addition to a barrier method alone, to minimize the chance of
pregnancy. Should a woman become pregnant or suspect she is pregnant while she or
her partner is participating in this study, she should inform her treating
physician immediately.
- Non-sterilized male participants who are sexually active with a female partner of
childbearing potential must agree to use methods of contraception that are highly
effective or acceptable, and not donate sperm from study entry until 90 days
after the last dose of binimetinib.
- Ability of subject to understand and the willingness to sign a written informed
consent document.
- Must co-enroll in study 10-C-0066: Collection of Human Samples to Study Hairy Cell and
other Leukemias, and to Develop Recombinant Immunotoxins for Cancer Treatment
EXCLUSION CRITERIA:
- Patients who have had chemotherapy, immunotherapy or radiotherapy within 4 weeks prior
to the start of study treatment.
- Prior therapy with binimetinib.
- Patients who are receiving any other investigational agents or have received an
investigational agent within 14 days prior to the start of study treatment.
- Patients who have undergone major surgery less than or equal to 6 weeks prior to start
of study treatment or who have not recovered from side effects of such procedure.
- Known hypersensitivity or contraindication to any component of binimetinib or its
excipients.
- Inability to swallow and retain study drug.
- Is pregnant or breastfeeding or expecting to conceive within the projected duration of
the study treatment, starting with the screening visit . Pregnant women are excluded
from this study because binimetinib has the potential for teratogenic or abortifacient
effects. Because there is an unknown but potential risk for adverse events in nursing
infants secondary to treatment of the mother with binimetinib, breastfeeding should be
discontinued if the mother is treated.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, cardiac disfunction (details as below), uncontrolled pulmonary infection,
pulmonary edema or psychiatric illness/social situations that would limit compliance
with study requirements.
- Evidence of active Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV) infection.
Note: Patients with laboratory evidence of cleared HBV or HCV infection may be enrolled. If
positive for Hepatitis B core antibody or surface antigen the patient must be on Tenofovir
or Entecavir and Hepatitis B Viral deoxyribonucleic acid (DNA) load must be <2000 IU/mL
- Active second malignancy requiring treatment other than minor resection of indolent
cancers like basal cell and squamous skin cancers.
- Human immunodeficiency virus (HIV)-positive patients unless taking appropriate anti-
HIV medications with a CD4 count of > 200. Otherwise, there may be an increased risk
of infections.
- History of an allogeneic bone marrow or stem cell transplant.
- Known history of acute or chronic pancreatitis
- Impaired cardiovascular function or clinically significant cardiovascular disease
including, but not limited to, any of the following:
1. History of acute coronary syndromes (including myocardial infarction, unstable
angina, coronary artery bypass grafting, coronary angioplasty or stenting) < 3
months prior to initiation of study therapy
2. Congestive heart failure requiring treatment (New York Heart Association Grade
greater than or equal to 2);
3. Left ventricular ejection fraction (LVEF) < 50% as determined by Multigated
Acquisition Scan (MUGA) or Transthoracic echocardiogram (TTE);
4. Uncontrolled hypertension defined as persistent systolic blood pressure greater
than or equal to 160 mmHg or diastolic blood pressure greater than or equal to
100 mmHg despite current therapy;
5. History or presence of clinically significant cardiac arrhythmias (including
resting bradycardia, uncontrolled atrial fibrillation or uncontrolled paroxysmal
supraventricular tachycardia);
6. Triplicate average baseline QTcF interval greater than or equal to 480 ms.
- Impairment of gastrointestinal function or disease which may significantly alter the
absorption of study drug (e.g., active ulcerative disease, uncontrolled vomiting or
diarrhea, malabsorption syndrome, small bowel resection with decreased intestinal
absorption), or recent (less than or equal to 3 months) history of a partial or
complete bowel obstruction, or other conditions that will interfere significantly with
the absorption of oral drugs.
- Concurrent neuromuscular disorder that is associated with elevated CK (e.g.,
inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal
muscular atrophy).
- History or current evidence of RVO or current risk factors for RVO (e.g., uncontrolled
glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability
syndromes); history of retinal degenerative disease.
- History of thromboembolic or cerebrovascular events less than or equal to 12 weeks
prior to the first dose of study treatment. Examples include transient ischemic
attacks, cerebrovascular accidents, hemodynamically significant (i.e. massive or
sub-massive) deep vein thrombosis or pulmonary emboli.
Note: Patients with either deep vein thrombosis or pulmonary emboli that does not result in
hemodynamic instability are allowed to enroll as long as they are on a stable dose of
anticoagulants for at least 4 weeks.
Note: Patients with thromboembolic events related to indwelling catheters or other
procedures may be enrolled.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | overall response rate |
Time Frame: | every year |
Safety Issue: | |
Description: | Percentage of patients with the best overall response of CR or PR to therapy |
Secondary Outcome Measures
Measure: | CR rate |
Time Frame: | every year |
Safety Issue: | |
Description: | the time criteria are met for CR or PR (whichever is recorded first) until the first date that patient no longer qualifies as a PR |
Measure: | Progression free survival |
Time Frame: | every year |
Safety Issue: | |
Description: | duration of time from the start of the treatment until time of disease relapse from PR, disease progression, or death, whichever occurs first |
Measure: | Overall survival |
Time Frame: | every year |
Safety Issue: | |
Description: | the time from the start of the treatment until time of death from any cause |
Measure: | time to next treatment |
Time Frame: | every year |
Safety Issue: | |
Description: | duration of time from the start of the binimetinib to next line of treatment |
Measure: | safety |
Time Frame: | every 4 weeks |
Safety Issue: | |
Description: | The fraction of patients with toxicity noted will be reported by grade and type of toxicity identified. |
Measure: | different response relative to MAP2K1 mutations |
Time Frame: | every year |
Safety Issue: | |
Description: | determine whether the response to binimetinib is different in patients with and without MAP2K1 (MEK mutations), in patients for which MEK status is known |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
Last Updated
August 16, 2021