Patient case: 34-year-old female with melanoma; genetic feature: NRAS (Q61L)

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

Summary: 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


Eligibility: Inclusion Criteria:
  -  Diagnosis of locally advanced, unresectable or metastatic cutaneous or melanoma of unknown primary AJCC Stage IIIC or IV (uveal and mucosal melanoma are excluded)
  -  Presence of NRAS Q61 mutation in tumor tissue prior to randomization as determined by a Novartis designated central laboratory
  -  Naïve untreated patients or patients who have progressed on or after any number of prior lines of immunotherapy for unresectable locally advanced or metastatic melanoma
  -  Evidence of at least one measurable lesion as detected by radiological or photographic methods
  -  Adequate bone marrow, organ function, cardiac and laboratory parameters
  -  Normal functioning of daily living activities
  Exclusion Criteria:
  -  Any untreated CNS metastases
  -  Uveal or mucosal melanoma
  -  History of or current evidence of retinal vein occlusion (RVO) or risk factors of RVO
  -  Patients with washout period < 6 weeks from the last dose of ipilimumab or other immunotherapy.
  -  Previous systemic chemotherapy for unresectable locally advanced or metastatic melanoma.
  -  History of Gilbert's syndrome
  -  Prior therapy with a MEK- inhibitor
  -  Impaired cardiovascular function or clinically significant cardiovascular diseases
  -  Uncontrolled arterial hypertension despite medical treatment
  -  HIV positive or active Hepatitis A or B
  -  Impairment of gastrointestinal function
  -  Patients who have undergone major surgery or radiotherapy ≤ 3 weeks prior to starting study drug or who have not recovered from side effects of such procedure;
  -  Patients with neuromuscular disorders that are associated with elevated CK.
  -  Pregnant or nursing (lactating) women
  -  Medical, psychiatric, cognitive or other conditions that may compromise the patient's ability to understand the patient information, give informed consent, comply with the study protocol or complete the study
  Other protocol-defined inclusion/exclusion criteria may apply

Relevance to patient case: definitely relevant