Dosing & Uses
Dosage Forms & Strengths
tablet
- 15mg
Melanoma
Indicated in combination with encorafenib for patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, as detected by an FDA-approved test
45 mg PO BID in combination with encorafenib until disease progression or unacceptable toxicity
See encorafenib drug monograph for recommended dosing information
Non-Small Cell Lung Cancer
Indicated in combination with encorafenib for patients with unresectable or metastatic non-small cell lung cancer (NSCLC) with a BRAF V600E mutation, as detected by an FDA-approved test
45 mg PO BID in combination with encorafenib until disease progression or unacceptable toxicity
See encorafenib drug monograph for recommended dosing information
Dosage Modifications
If encorafenib is permanently discontinued, discontinue binimetinib
Recommended dose reductions for binimetinib for adverse reactions
- First dose reduction: 30 mg PO BID
- Subsequent modifications: Permanently discontinue if unable to tolerate 30 mg/day
Cardiomyopathy
- Asymptomatic, absolute decrease in left ventricular ejection fraction (LVEF) of >10% from baseline that is also below lower limit of normal (LLN): Withhold for up to 4 weeks, evaluate LVEF q2Weeks
-
Resume at a reduced dose if the following are present
- LVEF is at or above the LLN and
- Absolute decrease from baseline is ≤10% and
- Patient is asymptomatic
- If the LVEF does not recover within 4 weeks permanently discontinue
- Symptomatic congestive heart failure or absolute decrease in LVEF of greater than >20% from baseline that is also below LLN: Permanently discontinue
Venous thromboembolism
-
Uncomplicated DVT or PE
- Withhold drug; if improves to Grade 0-1, resume at a reduced dose
- If no improvement, permanently discontinue
- Life-threatening PE: Permanently discontinue
Serous retinopathy
- Symptomatic serous retinopathy/retinal pigment epithelial detachments
-
Withhold drug for up to 10 days
- If improves and becomes asymptomatic, resume at same dose
- If not improved, resume at a lower dose or permanently discontinue
Retinal vein occlusion
- Any grade: Permanently discontinue
Uveitis
-
Grades 1-3
- If Grade 1 or 2 does not respond to specific ocular therapy, or for Grade 3 uveitis, withhold for up to 6 weeks; if improved, resume at same or reduced dose
- If not improved, permanently discontinue
- Grade 4: Permanently discontinue
Interstitial lung disease
-
Grade 2
- Withhold for up to 4 weeks; if improved to Grade 0-1, resume at a reduced dose
- If not resolved within 4 weeks, permanently discontinue
- Grades 3 or 4: Permanently discontinue
Hepatotoxicity
-
Grade 2 AST/ALT increased
- Maintain binimetinib dose; if no improvement within 2 weeks, withhold dose until improved to Grade 0-1 or to pretreatment/baseline levels and then resume at the same dose
-
Recurrent Grade 2 or first occurrence of any Grade 3 AST/ALT increased
- Withhold for up to 4 weeks; if improves to Grade 0-1 or to pretreatment/baseline level, resume at reduced dose
- If no improvement, permanently discontinue
-
First occurrence of any Grade 4 AST/ALT increased
- Permanently discontinue OR
- Withhold for up to 4 weeks; if improves to Grade 0-1 or to pretreatment/baseline level, resume at reduced dose; if no improvement, permanently discontinue
-
Recurrent Grade 3 AST/ALT increased
- Consider permanently discontinuing
-
Recurrent Grade 4 AST/ALT increased
- Permanently discontinue
Rhabdomyolysis or CPK elevations
- Grade 4 asymptomatic CPK elevation OR any Grade CPK elevation with symptoms or with renal impairment
- Withhold dose for up to 4 weeks; if improved to Grade 0-1 resume at a reduced dose
- If not resolved within 4 weeks, permanently discontinue
Dermatologic
- Grade 2: If no improvement within 2 weeks, withhold drug until Grade 0-1; resume at same dose if first occurrence or reduce dose if recurrent
- Grade 3: Withhold until Grade 0-1; resume at same dose if first occurrence or reduce dose if recurrent
- Grade 4: Permanently discontinue
Other adverse reactions, including hemorrhage
- Dose modification when administered with encorafenib is NOT recommended for palmarplantar erythrodysesthesia syndrome (PPES), noncutaneous RAS mutation-positive malignancies, and QTc prolongation
-
Recurrent Grade 2 or first occurrence of any Grade 3
- Withhold for up to 4 weeks; if improves to Grade 0-1 or to pretreatment/baseline level, resume at reduced dose
- If no improvement, permanently discontinue
-
First occurrence of any Grade 4
- Permanently discontinue OR
- Withhold for up to 4 weeks; if improves to Grade 0-1 or to pretreatment/baseline level, resume at reduced dose; if no improvement, permanently discontinue
-
Recurrent Grade 3
- Consider permanently discontinuing
-
Recurrent Grade 4
- Permanently discontinue
Hepatic impairment
- Moderate (total bilirubin >1.5 to ≤3 x ULN and any AST): 30 mg PO BID
- Severe (total bilirubin >3 x ULN and any AST): 30 mg PO BID
Renal impairment
- No clinically important changes in binimetinib exposure were observed with severe renal impairment as compared with patients with normal renal function
Dosing Considerations
Limitations of use: Not indicated for patient with wild-type BRAF melanoma
Patient selection
- Melanoma: Confirm the presence of a BRAF V600E or V600K mutation in tumor specimens before initiating
- NSCLC: Confirm the presence of a BRAF V600E mutation in tumor specimens before initiating
Safety and efficacy not established
Adverse Effects
All grades of severity are listed unless otherwise indicated
>10%
Increased creatinine (93%)
Increased creatine phosphokinase (58%)
Increased gamma glutamyl transferase (GGT) (45%)
Fatigue (43%)
Nausea (41%)
Diarrhea (36%)
Anemia (36%)
Vomiting (30%)
Increased AST/ALT (27-29%)
Abdominal pain (28%)
Constipation (22%)
Rash (22%)
Increased alkaline phosphatase (21%)
Visual impairment (20%)
Serous retinopathy/retinal pigment epithelial dystrophy (RPED) (20%)
Hemorrhage (19%)
Hyponatremia (18%)
Pyrexia (18%)
Dizziness (15%)
Leukopenia (13%)
Lymphopenia (13%)
Neutropenia (13%)
Peripheral edema (13%)
Increased GGT, Grades 3 and 4 (11%)
Hypertension (11%)
1-10%
Colitis (<10%)
Panniculitis (<10%)
Drug hypersensitivity (<10%)
Hypertension, Grades 3 and 4 (6%)
Increased AST/ALT (2.6-6%)
Increased creatine phosphokinase, Grades 3 and 4 (5%)
Pyrexia, Grades 3 and 4 (4%)
Anemia, Grades 3 and 4 (3.6%)
Increased creatinine, Grades 3 and 4 (3.6%)
Hyponatremia, Grades 3 and 4 (3.6%)
Neutropenia, Grades 3 or 4 (3.1%)
Fatigue, Grades 3 and 4 (3%)
Dizziness, Grades 3 and 4 (3%)
Peripheral edema, Grades 3 and 4 (3%)
Hemorrhage, Grades 3 and 4 (3%)
Diarrhea, Grades 3 and 4 (3%)
Serous retinopathy/RPED, Grades 3 and 4 (3%)
Lymphopenia, Grades 3 or 4 (2.1%)
Nausea, Grades 3 and 4 (2%)
Vomiting, Grades 3 and 4 (2%)
Abdominal pain, Grades 3 and 4 (2%)
Rash, Grades 3 and 4 (1%)
<1%
Increased alkaline phosphatase
Warnings
Contraindications
None
Cautions
Also see Dosage Modifications
In the COLUMBUS trial, venous thromboembolism (VTE) occurred in 6% of patients receiving binimetinib in combination with encorafenib, including 3.1% of patients who developed pulmonary embolism
In patients with BRAF mutation-positive melanoma receiving binimetinib with encorafenib (n=690), 2 patients (0.3%) developed interstitial lung disease (ILD), including pneumonitis; assess new or progressive unexplained pulmonary symptoms or findings for possible ILD
Hepatotoxicity can occur when binimetinib concomitantly used with encorafenib; monitor liver laboratory tests before initiating, monthly during treatment, and as clinically indicated
Rhabdomyolysis can occur when binimetinib is administered in combination with encorafenib; monitor CPK and creatinine levels prior to initiating treatment, periodically during treatment, and as clinically indicated; withhold, reduce dose, or permanently discontinue based on severity of adverse reaction
Hemorrhage can occur when encorafenib is administered in combination with binimetinib; hemorrhagic events include GI, hemorrhoidal, rectal, and intracranial hemorrhage, and hematochezia; withhold, reduce dose, or discontinue drug (see Dosage Modifications)
Based on findings from animal studies and its mechanism of action, fetal harm may occur when administered to a pregnant woman (see Pregnancy)
Risks associated with combination treatment; refer to the encorafenib prescribing information for additional risk information
Ocular toxicities
-
Serous retinopathy
- In the COLUMBUS trial, serous retinopathy occurred in 20% of patients, including retinal detachment (8%) and macular edema (6%)
- Assess for visual symptoms at each visit
- Perform an ophthalmologic examination at regular intervals for new or worsening visual disturbances, and to follow new or persistent ophthalmologic findings
-
Retinal vein occlusion
- Retinal vein occlusion (RVO) is a known class-related adverse reaction of MEK inhibitors and may occur
- Perform ophthalmologic evaluation for patient-reported acute vision loss or other visual disturbance within 24 hr
-
Uveitis
- Uveitis (eg, iritis and iridocyclitis) reported in patients treated with binimetinib in combination with encorafenib
- Perform an ophthalmologic evaluation at regular intervals and for new or worsening visual disturbances, and to follow new or persistent ophthalmologic findings
Cardiomyopathy
- Cardiomyopathy, manifesting as left ventricular dysfunction associated with symptomatic or asymptomatic decreases in ejection fraction, reported in patients treated with binimetinib in combination with encorafenib
- Assess ejection fraction by echocardiogram or MUGA scan prior to initiating treatment, one month after initiating treatment, and then every 2-3 months during treatment
- Safety of binimetinib in combination with encorafenib has not been established in patients with a baseline ejection fraction that is either below 50% or below the institutional lower limit of normal (LLN)
- Closely monitor patients with cardiovascular risk factors
New primary malignancies
- New primary malignancies, cutaneous and non-cutaneous, can occur when used in combination with encorafenib
- In PHAROS, cutaneous squamous cell carcinoma and skin papilloma reported in 2% of patients who received this drug in combination with encorafenib
- Monitor patients for new malignancies prior to initiation of treatment, while on treatment, and after discontinuation of treatment
Pregnancy
Pregnancy
Based on animal reproduction studies and its mechanism of action, fetal harm may occur when binimetinib is administered to a pregnant woman
There are no available clinical data on the use of binimetinib during pregnancy
Advise pregnant women of the potential risk to a fetus
Animal data
- In animal reproduction studies, oral administration of binimetinib during the period of organogenesis was embryotoxic and an abortifacient in rabbits at doses greater than or equal to those resulting in exposures ~5 times the human exposure at the clinical dose of 45 mg PO BID
Contraception
- Verify pregnancy status of females of reproductive potential prior to initiating treatment Advise females of reproductive potential to use effective contraception during treatment with binimetinib and for at least 30 days after the final dose
- Nonhormonal contraceptives should be used during treatment and for at least 30 days after the final dose for patients taking encorafenib and binimetinib
Lactation
There are no data on the presence of binimetinib or its active metabolite in human milk, the effects of binimetinib on the breastfed infant, or on milk production
Because of the potential for serous adverse reactions from binimetinib in breastfed infants, advise women not to breastfeed during treatment with binimetinib and for 3 days after the final dose
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibits mitogen-activated extracellular signal regulated kinase (MEK) 1 and MEK 2
MEK proteins are upstream regulators of the extracellular signal-related kinase (ERK)-related phosphorylation and MEK-dependent phosphorylation of BRAF-mutant human melanoma cell lines
Encorafenib and binimetinib target 2 different kinases in the RAS/RAF/MEK/ERK pathway; compared with either drug alone, coadministration resulted in greater antiproliferative activity in vitro in BRAF mutation-positive cell lines and greater antitumor activity with respect to tumor growth inhibition in BRAF V600E mutant human melanoma xenograft studies in mice
Additionally, the combination of encorafenib and binimetinib delayed the emergence of resistance in BRAF V600E mutant human melanoma xenografts in mice compared with either drug alone
Absorption
Peak plasma time: 1.6 hr
Effect of food
- Administration of a single 45-mg dose with a high-fat, high-calorie meal (consisting of ~150 calories from protein, 350 calories from carbohydrate, and 500 calories from fat) in healthy subjects had no effect on binimetinib exposure
Distribution
Protein bound: 97%
Vd: 92 L
Metabolism
Primary metabolic pathway is glucuronidation with UGT1A1 contributing up to 61% of the binimetinib metabolism
Other pathways of binimetinib metabolism include N-dealkylation, amide hydrolysis, and loss of ethane-diol from the side chain
The active metabolite M3 produced by CYP1A2 and CYP2C19 represents 8.6% of the binimetinib exposure
Elimination
Half-life: 3.5 hr
Clearance: 20.2 L/hr
Excretion: Feces 62% (32% unchanged); urine 31% (6.5% unchanged)
Administration
Oral Administration
Administer doses twice daily, ~12 hr apart
May take with or without food
Missed dose: Do not take a missed dose within 6 hr of the next scheduled dose
Vomited dose: Do not take an additional dose if vomiting occurs following administration, but continue with the next scheduled dose
Storage
Store tablets at 20-25°C (68-77°F); excursions permitted between 15-30°C (59-86°F)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Mektovi oral - | 15 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
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