Dabrafenib/Trametinib, BRAF or BRAF AND MEK Pre-op With BRAF and MEK Post-op, Phase IIB, Melanoma With Brain Mets,Biomarkers and Metabolites
Condition: Melanoma and Brain Metastases
MeSH terms: Melanoma; Neoplasm Metastasis; Brain Neoplasms
Intervention: Dabrafenib 150 mg; Trametinib 2.0 mg
Intervention description: Dabrafenib will be provided for oral administration as 50 mg and 75 mg capsules. Dabrafenib will be dosed orally with approximately 200 mL of water, twice a day. Dabrafenib should be administered under fasting conditions.; Trametinib study treatment will be provided as 0.5 mg and 2.0 mg tablets. should be taken orally with approximately 200 mL of water under fasting conditions, either one hour before or two hours after a meal.
Intervention MeSH terms: Trametinib; Dabrafenib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 6.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: BRAF V600E mutation; brain metastases; BRAF V600K mutation; Metastatic melanoma; BRAF inhibitor; brain neoplasms; GSK2118436

Summary:

      This is a global, multi-centre, open-label, study of GSK2118436 conducted in up to 30
      evaluable subjects with resectable, BRAF V600E or V600K mutation-positive metastatic melanoma
      to the brain. All subjects in this study are required to have accessible extracranial
      metastases and are agreeable to undergo repetitive biopsies. The first cohort of 15 subjects
      will receive dabrafenib orally 150mg twice daily (BID) for 7 to 14 days prior to surgery
      (Cohort A); the second cohort of 15 subjects will receive the combination of dabrafenib 150
      mg BID and trametinib 2 mg once daily for 7 to 14 days prior to surgery (Cohort B). The
      primary purpose of this study is to determine levels and distribution of dabrafenib, its
      metabolites, and trametinib (Cohort B only) in parenchymal brain metastases, extracranial
      metastases, and peripheral blood (plasma) within two cohorts of subjects with BRAF V600E/K
      mutation-positive melanoma that has metastasized to the brain. All subjects will be followed
      for survival and new anti-cancer therapy for a total of two years or until death or the
      subject wishes to withdraw from further follow-up.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Signed written informed consent

          -  Histologically-confirmed metastatic melanoma (Stage IV), carrying BRAF V600E or V600K
             mutation as determined by testing certified for clinical diagnostic purposes.
             Previously performed certified BRAF testing is acceptable. If no prior BRAF mutation
             testing results are available, testing of a distant metastasis is preferred, but
             testing of a regional metastasis or primary tumor is also acceptable

          -  At least one intracranial lesion >=1.0 cm but <=4.0 cm that can be treated with
             surgical resection in the opinion of the treating physicians, and for which immediate
             local therapy is not clinically indicated

          -  At least two extracranial lesions that are easily accessible for biopsy, in the
             judgment of the treating physician. Easily accessible tumors may include cutaneous,
             subcutaneous, and superficial lymph node metastases.

          -  Age >18 years of age.

          -  Able to swallow and retain oral medication

          -  Women with child-bearing potential must be willing to practice acceptable methods of
             birth control during the study

          -  Women of childbearing potential must have a negative serum pregnancy test within 14
             days of first dose of study treatment.

          -  Must be able to understand and comply with protocol requirements and instructions

          -  Eastern Co-operative Oncology Group (ECOG) performance status of 0-2

          -  Must have adequate organ function as defined by the following screening values
             (Retesting of borderline screening organ function and treatment with blood
             transfusions, growth factors etc. will be allowed):

          -  Absolute neutrophil count (ANC) >=1.2x10^9/L

          -  Hemoglobin >=9 g/dL

          -  Platelets >=100x10^9/L

          -  Serum bilirubin <=1.5 x upper limit of normal (ULN)

          -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <=2.5xULN

          -  Serum creatinine <=1.5 mg/dL (If serum creatinine is >1.5 mg/dL, calculate creatinine
             clearance using standard Cockcroft and Gault Method Creatinine clearance must be >50
             mL/min)

          -  Prothrombin time (PT)/International normalized ratio (INR) and partial thromboplastin
             time (PTT) <=1.3xULN

          -  Left ventricular ejection fraction (LVEF) >= institutional lower limit of normal (LLN)

        Exclusion Criteria:

          -  Neurological symptoms related to brain metastasis that are not controlled with a
             stable or decreasing dose of oral steroids for at least 7 days prior to starting
             GSK2118436

          -  Prior Central Nervous System (CNS)-directed local therapies, including surgical
             resection, whole brain radiation (WBRT), Stereotactic radiosurgery (SRS), or gamma
             knife (GK)

          -  Previous treatment with a BRAF or MEK inhibitor

          -  Cancer therapy (chemotherapy with delayed toxicity, extensive radiation therapy,
             immunotherapy, biologic therapy, or major surgery) or investigational anti-cancer
             drugs within the last 3 weeks, or chemotherapy without delayed toxicity within the
             last 2 weeks, preceding the first dose of study treatment.

          -  Current or expected use of a prohibited medication, including enzyme-inducing
             antiepileptic drugs (EIAEDs) during treatment with GSK2118436.

          -  Presence of leptomeningeal disease or dural metastases.

          -  History of another active malignancy within the past 5 years, or any malignancy with a
             confirmed activating RAS mutation. The prospective RAS mutation testing is not
             required, however, if results of previous RAS testing are known, they must be used in
             assessing eligibility. Subjects with a history of completely resected non-melanoma
             skin cancer are eligible.

          -  Known allergies against contrast agents required for magnetic resonance imaging (MRI)
             of intracranial lesions, or other contraindications for MRI, i.e., pacemaker

          -  Current use of therapeutic warfarin. Low-molecular-weight heparin and prophylactic
             low-dose warfarin are permitted

          -  Unresolved toxicity of National Cancer Institute Common Terminology Criteria for
             Adverse Events, version 4.0 (CTCAE v4.0) Grade 2 or higher from previous anti-cancer
             therapy, except alopecia

          -  Presence of active gastrointestinal disease or other condition that will interfere
             significantly with the absorption of drugs.

          -  History of a prior symptomatic stroke, dementia, or other significant central
             neurologic condition (i.e. multiple sclerosis)

          -  A history of known Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), or
             Hepatitis C Virus (HCV) infection

          -  Current acute infection requiring intravenous antibiotics

          -  A history of known glucose-6-phosphate dehydrogenase (G6PD) deficiency

          -  The history or evidence of following cardiac abnormalities:

          -  Corrected QT (QTc) interval using Bazett's Formula; (QTcB) >= 480 msecs

          -  A history of acute coronary syndromes (including myocardial infarction or unstable
             angina), coronary angioplasty, or stenting within 6 months prior to randomization

          -  Coronary angioplasty or stenting within the past 12 weeks

          -  Class II, III, or IV heart failure as defined by the New York Heart Association (NYHA)
             functional classification system

          -  Abnormal cardiac valve morphology (>= Grade 2) documented by echocardiogram (ECHO)

          -  History of or evidence of clinically significant uncontrolled cardiac arrhythmias

          -  Treatment refractory hypertension defined as a blood pressure of systolic >140 mmHg
             and/or diastolic >90 mm Hg which cannot be controlled by anti-hypertensive therapy

          -  Subjects with intra-cardiac defibrillators or permanent pacemakers

          -  Pregnant, lactating or breastfeeding females

          -  Any serious and/or unstable pre-existing medical, psychiatric disorder or other
             conditions that could interfere with subject's safety, obtaining informed consent or
             compliance to the study procedures

          -  Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs
             chemically related to GSK2118436 or excipients that contraindicate their participation