Drug Trial Snapshot: MEKTOVI
HOW TO USE THIS SNAPSHOT
The information provided in Snapshots highlights who participated in the clinical trials that supported the FDA approval of this drug, and whether there were differences among sex, race and age groups. The “MORE INFO” bar shows more detailed, technical content for each section. The Snapshot is intended as one tool for consumers to use when discussing the risks and benefits of the drugs.
LIMITATIONS OF THIS SNAPSHOT:
Do not rely on Snapshots to make decisions regarding medical care. Always speak to your health provider about the risks and benefits of a drug. Refer to the MEKTOVI Prescribing Information for complete information.
MEKTOVI (binimetinib)
(mek-TOE-vee)
Array Biopharma
Approval date: June 27, 2018
DRUG TRIALS SNAPSHOT SUMMARY:
What is the drug for?
MEKTOVI is a drug which is used with another drug, encorafenib, to treat a type of skin cancer called melanoma.
MEKTOVI is only to be used in patients who have melanoma with a specific abnormal gene (called a BRAF V600E or V600K mutation) that has spread to other parts of the body (advanced melanoma) or cannot be removed by surgery.
How is this drug used?
MEKTOVI is a tablet. Three tablets (total of 45 mg) are taken by mouth twice daily with encorafenib.
What are the benefits of this drug?
MEKTOVI plus encorafenib delays disease worsening. In addition, 63% of patients taking
MEKTOVI plus encorafenib experienced complete or partial shrinkage of their tumors.
The table below summarizes efficacy results for the clinical trial. The major efficacy outcome was progression-free survival (PFS) per RECIST v1.1 as assessed by a blinded independent central review.
Table 2. Efficacy Results from the Clinical Trial
| MEKTOVI | Vemurafenib | ||
|---|---|---|---|---|
Progression-Free Survivala | ||||
Number of Events (%) | 98 (51) | 106 (55) | ||
Progressive Disease | 88 (46) | 104 (54) | ||
Death | 10 (5) | 2 (1) | ||
Median PFS in months (95% CI) | 14.9 (11, 18.5) | 7.3 (5.6, 8.2) | ||
HR (95% CI)b | 0.54 (0.41, 0.71) | |||
P valuec | ||||
Overall Response Rate | ||||
ORR (95% CI) | 63% (56%, 70%) | 40% (33%, 48%) | ||
CR | 8% | 6% | ||
PR | 55% | 35% | ||
Duration of Response |
|
| ||
Median DoR months (95% CI) | 16.6 (12.2, 20.4) | 12.3 (6.9, 16.9) | ||
CI = Confidence interval; CR = Complete response; HR = Hazard ratio; NE = Not estimable; PFS = Progression-free survival; PR = Partial response.
a Estimated with Cox proportional hazard model adjusted by the following stratification factors: American Joint Committee on Cancer (AJCC) Stage (IIIB, IIIC, IVM1a or IVM1b, versus IVM1c) and Eastern Cooperative Oncology Group (ECOG) performance status (0 versus 1).
b Log-rank test adjusted by the same stratification factors.
MEKTOVI Prescribing Information
Were there any differences in how well the drug worked in clinical trials among sex, race and age?
- Sex: MEKTOVI worked similarly in men and women.
- Race: The majority of patients were White. The number of patients in other races was limited; therefore, differences in how well the drug worked among races could not be determined.
- Age: MEKTOVI worked similarly in patients younger and older than 65 years of age.
Were there any differences in how well the drug worked in clinical trials among sex, race, and age groups?
The table below summarizes efficacy results by subgroup.
Table 3. Progression-Free Survival Results in Demographic Subgroups
Demographic Subgroup | MEKTOVI | Vemurafenib | HR (95% CI) |
|---|---|---|---|
Overall | 98/192 | 106/191 | 0.58 (0.44,0.77) |
Sex | |||
Men | 63/115 | 61/111 | 0.62 (0.44, 0.89) |
Women | 35/77 | 45/80 | 0.5 (0.32, 0.79) |
Race | |||
White | 93/181 | 91/166 | 0.59 (0.44, 0.79) |
All Other | 5/11 | 15/25 | 0.52 (0.19, 1.43) |
Age Category | |||
65> | 69/132 | 80/140 | 0.55 (0.4, 0.77) |
>=65 years | 29/60 | 26/51 | 0.66 (0.39, 1.12) |
HR=hazard ratio; CI=confidence interval
FDA Review
What are the possible side effects?
MEKTOVI in combination with encorafenib may cause serious side effects including heart failure, blood clots, muscle, eye, and liver damage, bleeding and lung inflammation.
The most common side effects of treatment with MEKTOVI when given with encorafenib are fatigue, nausea, diarrhea, vomiting and abdominal pain.
What are the possible side effects (results of trials used to assess safety)?
The table below summarizes adverse drug reactions in the clinical trial.
Table 4. Adverse Reactions Occurring in ≥ 10% of Patients Receiving MEKTOVI in Combination with Encorafenib a
Adverse Reaction | MEKTOVI | Vemurafenib | ||
|---|---|---|---|---|
All | Grades | All | Grades | |
General Disorders and Administration Site Conditions | ||||
Fatigue c | 43 | 3 | 46 | 6 |
Pyrexiac | 18 | 4 | 30 | 0 |
Peripheral edemac | 13 | 1 | 15 | 1 |
Gastrointestinal Disorders | ||||
Nausea | 41 | 2 | 34 | 2 |
Diarrhea | 36 | 3 | 34 | 2 |
Vomitingc | 30 | 2 | 16 | 1 |
Abdominal painc | 28 | 4 | 16 | 1 |
Constipation | 22 | 0 | 6 | 1 |
Skin and Subcutaneous Tissue Disorders | ||||
Rashc | 22 | 1 | 53 | 13 |
Nervous System Disorders | ||||
Dizzinessc | 15 | 3 | 4 | 0 |
Visual Disorders | ||||
Visual impairmentc | 20 | 0 | 4 | 0 |
Serous | 20 | 3 | 2 | 0 |
Vascular Disorders | ||||
Hemorrhagec | 19 | 3 | 9 | 2 |
Hypertension c | 11 | 6 | 11 | 3 |
a Grades per National Cancer Institute CTCAE v4.03.
b Grade 4 adverse reactions limited to diarrhea (n=1) and hemorrhage (n=3) in the MEKTOVI plus encorafenib arm and constipation (n=1) in the vemurafenib arm.
c Represents a composite of multiple, related preferred terms.
MEKTOVI Prescribing Information
Were there any differences in side effects among sex, race and age?
- Sex: The occurrence of side effects was similar in men and women.
- Race: The majority of patients were White. The number of patients in other races was limited; therefore, differences in side effects among races could not be determined.
- Age: The occurrence of side effects was similar in patients younger and older than 65 years of age.
Were there any differences in side effects of the clinical trials among sex, race, and age groups?
Tables below summarize the incidence of treatment emergent adverse events (TEAE) and serious adverse events (SAE) by sex and age subgroups.
Table 5. Per-patient Incidence of Adverse Events by Sex (Safety Population)
Event | MEKTOVI | Vemurafenib | ||
|---|---|---|---|---|
Men | Women | Men | Women | |
Any TEAE | 112 (97.4) | 77 (100) | 107 99.1) | 78 (100) |
Grade 3-4 TEAE | 65 (56.6) | 46 (59.7) | 67 (62.0) | 51 (65.4) |
Any SAE | 42 (36.5) | 24 (31.2) | 41 (38.0) | 28 (35.9) |
Grade 3-4 SAE | 37 (32.3) | 20 (26.0) | 34 (31.5) | 26 (33.3) |
Adapted from FDA Review
Table 6. Per-patient Incidence of Adverse Events by Age (Safety Population)
Event | MEKTOVI | Vemurafenib | ||
|---|---|---|---|---|
65> | ≥65 years | 65> | ≥65 years | |
Any TEAE | 129 (97.7) | 60 (100) | 135 (99.3) | 50 (100) |
Grade 3-4 TEAE | 73 (55.3) | 38 (63.3) | 83 (61.0) | 35 (70) |
Any SAE | 42 (31.9) | 24 (40.0) | 53 (39.0) | 16 (32.0) |
Grade 3-4 SAE | 36 (27.3) | 21 (35.0) | 46 (33.8) | 14 (28.0) |
Adapted from FDA Review
WHO WAS IN THE STUDIES?
Who participated in the clinical trials?
The FDA approved MEKTOVI based primarily on evidence from one clinical trial (NCT01909453) of 383 patients with BRAF V600 mutation-positive melanoma that was advanced or could not be removed by surgery. The trial was conducted at 162 sites in Europe, North America, and various countries around the world.
Figure 1 summarizes how many men and women were in the clinical trial.
Figure 1. Baseline Demographics by Sex
Clinical Trial Data
Figure 2 and Table 1 summarize the percentage of patients by race in the clinical trial.
Figure 2. Baseline Demographics by Race
Clinical Trial Data
Table 1 Baseline Demographics by Age
Race | Number of Patients | Percentage |
|---|---|---|
White | 348 | 91 |
Asian | 13 | 3 |
American Indian or Alaska Native | 2 | 0.5 |
Other | 5 | 1 |
Unknown | 13 | 3 |
Missing data | 2 | 0.5 |
Clinical Trial Data
The figure below summarizes the percentage of patients by age in the clinical trial.
Figure 3. Baseline Demographics by Age
Clinical Trial Data
Who participated in the trials?
The table below summarizes baseline demographics for patients in the trial.
Table 7. Baseline Demographics for the Clinical Trial
Demographic Category |
MEKTOVI with Encorafenib |
Vemurafenib |
TOTAL |
|---|---|---|---|
Sex, n(%) | |||
Men | 115 (60) | 111 (58) | 226 (59) |
Women | 77 (40) | 80 (42) | 157 (41) |
Race, n(%) | |||
White | 181 (94) | 167 (87) | 348 (91) |
Asian | 5 (3) | 8 (4) | 13 (3) |
American Indian or Alaska | 0 (0) | 2 (1) | 2 (0.5) |
Other | 3 (2) | 2 (1) | 5 (1) |
Unknown | 2 (1) | 11 (6) | 13 (3) |
Missing | 1 (1) | 1 (1) | 2 (0.5) |
Age Category, n(%) | |||
65> | 132 (69) | 140 (73) | 272 (71) |
>=65 years | 60 (31) | 51 (27) | 111 (29) |
Ethnicity, n(%) | |||
Hispanic or Latino | 20 (10) | 14 (7) | 34 (9) |
Not Hispanic or Latino |
|
| 291 (88) |
Unknown | 17 (9) | 26 (14) | 43 (11) |
Missing | 6 (3) | 9 (5) | 15 (4) |
Region, n(%) | |||
North America | 17 (9) | 17 (9) | 34 (9) |
Europe | 156 (81) | 153 (81) | 309 (81) |
Australia | 5 (3) | 6 (3) | 11 (3) |
Other | 14 (7) | 15 (7) | 29 (7) |
Clinical Trial Data
How were the trials designed?
The benefits and side effects of MEKTOVI were evaluated in one clinical trial. Enrolled patients had melanoma with a certain type of abnormal gene (called BRAF V600E or V600K mutation) that spread to other parts of the body or that could not be removed by surgery.
All patients received either MEKTOVI together with encorafenib or vemurafenib (FDA approved drug to treat melanoma) twice daily. Both, patients and investigators new which treatment had been given. Treatment continued until disease progression or development of unacceptable side effects.
The benefit of MEKTOVI was assessed by measuring the length of time it took the disease to worsen in patients who received MEKTOVI given with encorafenib and comparing it to the time the disease took to worsen in patients treated with vemurafenib.
How were the trials designed?
The safety and efficacy of MEKTOVI was established in a multicenter, randomized, open-label, active-controlled trial conducted in patients with BRAF V600E or V600K mutation-positive, unresectable or metastatic melanoma. The presence of mutation was detected using an FDA-approved mutation test.
Patients received MEKOVI twice daily plus encorafenib 450 mg orally twice daily or vemurafenib 960 mg twice daily. Treatment continued until disease progression or unacceptable toxicity.
The major efficacy outcome was progression-free survival (PFS) per RECIST v1.1 as assessed by blinded independent central review. Additional efficacy outcomes were overall survival, objective response rate, and duration of response.
GLOSSARY
CLINICAL TRIAL: Voluntary research studies conducted in people and designed to answer specific questions about the safety or effectiveness of drugs, vaccines, other therapies, or new ways of using existing treatments.
COMPARATOR: A previously available treatment or placebo used in clinical trials that is compared to the actual drug being tested.
EFFICACY: How well the drug achieves the desired response when it is taken as described in a controlled clinical setting, such as during a clinical trial.
PLACEBO: An inactive substance or “sugar pill” that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.
SUBGROUP: A subset of the population studied in a clinical trial. Demographic subsets include sex, race, and age groups.
PRESCRIBING INFORMATION