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    Clinical Trial Results:
    The NEMO trial (NRAS melanoma and MEK inhibitor): A randomized Phase III, open label, multicenter, two-arm study comparing MEK162 versus dacarbazine in patients with advanced unresectable or metastatic NRAS mutation-positive melanoma

    Summary
    EudraCT number
    2012-003593-51
    Trial protocol
    SK   AT   CZ   DE   ES   GB   NL   BE   IT   HU   GR   SE   PL   PT   FR  
    Global end of trial date
    04 Jun 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    10 May 2020
    First version publication date
    10 May 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CMEK162A2301
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01763164
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Array BioPharma Inc.
    Sponsor organisation address
    3200 Walnut Street, Boulder, Colorado, United States, 80301
    Public contact
    Abdu Nessralla, Array BioPharma Inc., +1 857 600 3719, abdu.nessralla@arraybiopharma.com
    Scientific contact
    Abdu Nessralla, Array BioPharma Inc., +1 857 600 3719, abdu.nessralla@arraybiopharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    29 Jan 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    04 Jun 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Jun 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine whether treatment with MEK162 prolongs PFS as compared to dacarbazine in patients with advanced unresectable, or metastatic NRAS mutation-positive cutaneous or unknown primary melanoma who are previously untreated or who have progressed on or after prior treatment with any number of lines of immunotherapy for unresectable or metastatic disease.
    Protection of trial subjects
    The study was conducted according to the ethical principles of the Declaration of Helsinki. Informed consent was obtained from each patient in writing before randomization. The study was described by the Investigator, who answered any questions, and written information was also provided. The patient first gave consent for a neuroblastoma RAS viral (v-ras) oncogene homolog (NRAS) mutation status test at a central laboratory designated by Novartis by signing the molecular prescreening informed consent form (ICF). Patients were also asked to participate in the optional biomarker sampling. A separate biomarker ICF was provided.
    Background therapy
    Patients taking concomitant medications chronically maintained the same dose and dose schedule throughout the study as medically feasible. On the days PK blood sampling was performed, the patient continued their consistent use of other concomitant medication. Intermittently concomitant therapy use during the study was avoided on PK days. All concomitant medications and/or therapies were recorded in the patient’s source documents and eCRFs. Concomitant medications of specific interest were summarized separately.
    Evidence for comparator
    Dacarbazine (or locally approved generics) - patients randomized to dacarbazine received an IV infusion of dacarbazine 1000 mg/m2 over the course of 1 hour on day 1 and then every three weeks.
    Actual start date of recruitment
    30 Apr 2013
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 14
    Country: Number of subjects enrolled
    Poland: 11
    Country: Number of subjects enrolled
    Portugal: 4
    Country: Number of subjects enrolled
    Slovakia: 1
    Country: Number of subjects enrolled
    Spain: 23
    Country: Number of subjects enrolled
    United Kingdom: 25
    Country: Number of subjects enrolled
    Austria: 11
    Country: Number of subjects enrolled
    Belgium: 8
    Country: Number of subjects enrolled
    Czech Republic: 7
    Country: Number of subjects enrolled
    France: 46
    Country: Number of subjects enrolled
    Germany: 89
    Country: Number of subjects enrolled
    Greece: 1
    Country: Number of subjects enrolled
    Hungary: 9
    Country: Number of subjects enrolled
    Italy: 58
    Country: Number of subjects enrolled
    Canada: 18
    Country: Number of subjects enrolled
    Israel: 5
    Country: Number of subjects enrolled
    Japan: 7
    Country: Number of subjects enrolled
    Korea, Republic of: 3
    Country: Number of subjects enrolled
    Russian Federation: 11
    Country: Number of subjects enrolled
    South Africa: 6
    Country: Number of subjects enrolled
    Switzerland: 15
    Country: Number of subjects enrolled
    Turkey: 1
    Country: Number of subjects enrolled
    Argentina: 2
    Country: Number of subjects enrolled
    Australia: 11
    Country: Number of subjects enrolled
    Brazil: 1
    Country: Number of subjects enrolled
    United States: 15
    Worldwide total number of subjects
    402
    EEA total number of subjects
    307
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    210
    From 65 to 84 years
    192
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 402 patients were randomized 2:1 to receive either MEK162 or dacarbazine. Patients were stratified according to AJCC stage (IIIC, IVM1a, and IVM1b versus IVM1c), ECOG Performance status (0 versus 1) and prior treatment with any number of lines of immunotherapy for unresectable or metastatic disease (yes versus no).

    Pre-assignment
    Screening details
    Patients signed a specific informed consent for NRAS mutation analysis at a central laboratory. Patients with documented NRAS Q61 mutation result were eligible for screening.

    Period 1
    Period 1 title
    Treatment Period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    The study was open label.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Binimetinib
    Arm description
    Patients were assigned to one of the following 2 treatment arms in a ratio of 2:1 in favor of the investigational treatment: - Binimetinib (MEK162) 45 mg orally bid (twice a day) - Dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks)
    Arm type
    Experimental

    Investigational medicinal product name
    Binimetinib
    Investigational medicinal product code
    MEK162
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    The investigational treatment was binimetinib (MEK162) 45 mg orally bid (twice a day) and the control treatment was dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks). Binimetinib 15-mg film-coated tablets were supplied to the Investigators by the Sponsor. MEK162 was administered as a fixed dose of 45 mg (3 x 15 mg tablets) BID, with a glass of water. Patients were fasted 1 hour before and after the dose. Patients were supplied with a sufficient number of tablets for the number of doses to be taken prior to the next scheduled visit. Prescribed doses were taken twice daily, approximately 12 ± 2 hrs apart. It was recommended to document whether each prescribed dose was taken or not in the MEK162 patient dosing diary. If a patient vomited at any time after dosing, the dose of study drug had not been re-administered. Doses of study drug omitted for AEs or any other reason had not made up later in the day, or at the end of the dosing period.

    Arm title
    Dacarbazine
    Arm description
    Patients were assigned to one of the following 2 treatment arms in a ratio of 2:1 in favor of the investigational treatment: - Binimetinib (MEK162) 45 mg orally bid (twice a day) - Dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks)
    Arm type
    Active comparator

    Investigational medicinal product name
    Dacarbazine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Patients randomized to dacarbazine (or locally approved generics) will receive an IV infusion of dacarbazine 1000 mg/m2 over the course of 1 hour on day 1 and then every three weeks. Body surface area (BSA), in m2, was calculated using the following formula, where weight (W) is in kilograms and height (H) is in centimeters (Dubois and Dubois 1916): BSA= (W0.425x H0.725) x 0.007184 Globally, dacarbazine was available in vials containing 100 mg, 200 mg, 500 mg and 1000 mg. Dacarbazine (vials of 100mg/200mg/500mg/ 1000mg) was reconstituted according to local practice and following the guidelines in the local labels. Dacarbazine should be reconstituted according to local practice and following the guidelines in the local labels.

    Number of subjects in period 1
    Binimetinib Dacarbazine
    Started
    269
    133
    Completed
    0
    0
    Not completed
    269
    133
         Physician decision
    24
    13
         Patient decision
    -
    19
         Death
    10
    1
         Other
    -
    1
         Adverse event
    66
    8
         Progressive disease
    142
    76
         Subject/guardian decision
    26
    14
         Protocol deviation
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Binimetinib
    Reporting group description
    Patients were assigned to one of the following 2 treatment arms in a ratio of 2:1 in favor of the investigational treatment: - Binimetinib (MEK162) 45 mg orally bid (twice a day) - Dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks)

    Reporting group title
    Dacarbazine
    Reporting group description
    Patients were assigned to one of the following 2 treatment arms in a ratio of 2:1 in favor of the investigational treatment: - Binimetinib (MEK162) 45 mg orally bid (twice a day) - Dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks)

    Reporting group values
    Binimetinib Dacarbazine Total
    Number of subjects
    269 133 402
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    130 80 210
        From 65-84 years
    139 53 192
        85 years and over
    0 0 0
    Gender categorical
    Units: Subjects
        Female
    103 48 151
        Male
    166 85 251

    End points

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    End points reporting groups
    Reporting group title
    Binimetinib
    Reporting group description
    Patients were assigned to one of the following 2 treatment arms in a ratio of 2:1 in favor of the investigational treatment: - Binimetinib (MEK162) 45 mg orally bid (twice a day) - Dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks)

    Reporting group title
    Dacarbazine
    Reporting group description
    Patients were assigned to one of the following 2 treatment arms in a ratio of 2:1 in favor of the investigational treatment: - Binimetinib (MEK162) 45 mg orally bid (twice a day) - Dacarbazine 1000 mg/m2 IV once q3w (every 3 weeks)

    Subject analysis set title
    Full Analysis Set
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Full analysis set included all patients randomized

    Primary: Progression-free survival (PFS)

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    End point title
    Progression-free survival (PFS)
    End point description
    Progression-free survival (PFS), defined as the time from the date of randomization to the date of the first documented disease progression or death due to any cause, whichever occurs first. PFS was determined based on tumor assessment (RECIST V1.1 criteria) as per BIRC and survival information. Disease progression was determined based on tumor assessment according to RECIST v1.1. The local Investigator’s assessments was used as supportive analyses. The median follow-up time for PFS per central review was 2.69 months for the binimetinib arm and 1.45 months for the dacarbazine arm. 38% risk reduction in disease progression or death (PFS) was observed for patients treated with binimetinib compared to those treated with dacarbazine.
    End point type
    Primary
    End point timeframe
    The time from the date of randomization to the date of the first documented disease progression or death due to any cause, whichever occurs first.
    End point values
    Binimetinib Dacarbazine
    Number of subjects analysed
    269
    133
    Units: months
        median (confidence interval 95%)
    2.83 (2.76 to 3.55)
    1.51 (1.48 to 1.71)
    Statistical analysis title
    Comparison of the distribution of PFS
    Statistical analysis description
    The primary efficacy analysis was the comparison of the distribution of PFS between the 2 treatment arms using a stratified log-rank test at one-sided 2.5% cumulative level of significance. The null and the alternative hypothesis were defined as follows: H01: S1T(t) ≤ S1C(t) vs. HA1: S1T(t) > S1C(t), t ≥ 0 where S1C(t) was the survival distribution function of PFS in the control arm (dacarbazine) and S1T(t) was the survival distribution function of PFS in the experimental arm (binimetinib).
    Comparison groups
    Binimetinib v Dacarbazine
    Number of subjects included in analysis
    402
    Analysis specification
    Post-hoc
    Analysis type
    superiority [1]
    P-value
    < 0.001 [2]
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.62
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.47
         upper limit
    0.8
    Variability estimate
    Standard deviation
    Notes
    [1] - The primary efficacy endpoint, PFS as per BIRC, was analyzed based on the data from the FAS (full analysis set) according to the treatment arm and the stratification factors patients were randomized to.
    [2] - P-value was obtained from the one-sided stratified log-rank test except in the comparison labeled “unstratified tests”.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From start of the treatment period until 30 days of the last study medication dose. An overview of AEs , which included Adverse events of special interest (AESIs) was summarized by SOC and PT.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Binimetinib
    Reporting group description
    -

    Reporting group title
    Dacarbazine
    Reporting group description
    -

    Serious adverse events
    Binimetinib Dacarbazine
    Total subjects affected by serious adverse events
         subjects affected / exposed
    95 / 269 (35.32%)
    26 / 114 (22.81%)
         number of deaths (all causes)
    24
    3
         number of deaths resulting from adverse events
    4
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Cancer pain
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malignant ascites
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumour haemorrhage
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Haemorrhage
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypertensive crisis
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Aortic dilatation
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Embolism
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    General disorders and administration site conditions
    General physical health deterioration
         subjects affected / exposed
    10 / 269 (3.72%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 10
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Axillary pain
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Multiple organ dysfunction syndrome
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Oedema peripheral
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 269 (0.37%)
    3 / 114 (2.63%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malaise
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pneumonia
         subjects affected / exposed
    1 / 269 (0.37%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    4 / 269 (1.49%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    2 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    3 / 269 (1.12%)
    2 / 114 (1.75%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Aspiration
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemoptysis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lung disorder
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory arrest
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumothorax
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Confusional state
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abnormal behaviour
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Blood creatine phosphokinase increased
         subjects affected / exposed
    3 / 269 (1.12%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood pressure increased
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eastern Cooperative Oncology Group performance status worsened
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ejection fraction decreased
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Electrocardiogram QT prolonged
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical condition abnormal
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemoglobin decreased
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intraocular pressure increased
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Femoral neck fracture
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Muscle injury
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subdural haematoma
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tibia fracture
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial flutter
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrioventricular block
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrioventricular block first degree
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Mitral valve disease
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tachyarrhythmia
         subjects affected / exposed
    1 / 269 (0.37%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Spinal cord compression
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dropped head syndrome
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Motor dysfunction
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myasthenic syndrome
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral sensorimotor neuropathy
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sciatica
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subarachnoid haemorrhage
         subjects affected / exposed
    1 / 269 (0.37%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Brain oedema
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dementia
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Encephalopathy
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lethargy
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Progressive supranuclear palsy
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Iron deficiency anaemia
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancytopenia
         subjects affected / exposed
    0 / 269 (0.00%)
    2 / 114 (1.75%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Retinal vein occlusion
         subjects affected / exposed
    4 / 269 (1.49%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    4 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Retinal vein thrombosis
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Retinal detachment
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    3 / 269 (1.12%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 269 (0.37%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain lower
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ascites
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Autoimmune pancreatitis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Colitis ischaemic
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Duodenal perforation
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhoids
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intussusception
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Large intestinal obstruction
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Mesenteric vein thrombosis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Mouth ulceration
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subileus
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic failure
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholestasis
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Dermatitis acneiform
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psoriasis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rash maculo-papular
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperhidrosis
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Acute kidney injury
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nephrolithiasis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Intervertebral disc protrusion
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Muscular weakness
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intervertebral disc compression
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteonecrosis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pathological fracture
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rhabdomyolysis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 269 (0.00%)
    2 / 114 (1.75%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Flank pain
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Skin infection
         subjects affected / exposed
    3 / 269 (1.12%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyelonephritis acute
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 269 (0.74%)
    2 / 114 (1.75%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    0 / 0
    Soft tissue infection
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abscess limb
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dermo-hypodermitis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Herpes zoster
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteomyelitis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumococcal sepsis
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lung infection
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Perineal abscess
         subjects affected / exposed
    0 / 269 (0.00%)
    1 / 114 (0.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    2 / 269 (0.74%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diabetic metabolic decompensation
         subjects affected / exposed
    1 / 269 (0.37%)
    0 / 114 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Binimetinib Dacarbazine
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    269 / 269 (100.00%)
    104 / 114 (91.23%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    36 / 269 (13.38%)
    4 / 114 (3.51%)
         occurrences all number
    36
    4
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    97 / 269 (36.06%)
    5 / 114 (4.39%)
         occurrences all number
    97
    5
    Fatigue
         subjects affected / exposed
    68 / 269 (25.28%)
    38 / 114 (33.33%)
         occurrences all number
    68
    38
    Asthenia
         subjects affected / exposed
    44 / 269 (16.36%)
    19 / 114 (16.67%)
         occurrences all number
    44
    19
    Pyrexia
         subjects affected / exposed
    34 / 269 (12.64%)
    16 / 114 (14.04%)
         occurrences all number
    34
    16
    Peripheral swelling
         subjects affected / exposed
    15 / 269 (5.58%)
    2 / 114 (1.75%)
         occurrences all number
    15
    2
    Face oedema
         subjects affected / exposed
    14 / 269 (5.20%)
    0 / 114 (0.00%)
         occurrences all number
    14
    0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    27 / 269 (10.04%)
    5 / 114 (4.39%)
         occurrences all number
    27
    5
    Cough
         subjects affected / exposed
    20 / 269 (7.43%)
    10 / 114 (8.77%)
         occurrences all number
    20
    10
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    17 / 269 (6.32%)
    8 / 114 (7.02%)
         occurrences all number
    17
    8
    Investigations
    Blood creatine phosphokinase increased
         subjects affected / exposed
    119 / 269 (44.24%)
    3 / 114 (2.63%)
         occurrences all number
    119
    3
    Aspartate aminotransferase increased
         subjects affected / exposed
    39 / 269 (14.50%)
    5 / 114 (4.39%)
         occurrences all number
    39
    5
    Ejection fraction decreased
         subjects affected / exposed
    39 / 269 (14.50%)
    2 / 114 (1.75%)
         occurrences all number
    39
    2
    Alanine aminotransferase increased
         subjects affected / exposed
    23 / 269 (8.55%)
    8 / 114 (7.02%)
         occurrences all number
    23
    8
    Intraocular pressure increased
         subjects affected / exposed
    19 / 269 (7.06%)
    0 / 114 (0.00%)
         occurrences all number
    19
    0
    Weight decreased
         subjects affected / exposed
    13 / 269 (4.83%)
    6 / 114 (5.26%)
         occurrences all number
    13
    6
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    8 / 269 (2.97%)
    7 / 114 (6.14%)
         occurrences all number
    8
    7
    Platelet count decreased
         subjects affected / exposed
    2 / 269 (0.74%)
    11 / 114 (9.65%)
         occurrences all number
    2
    11
    Neutrophil count decreased
         subjects affected / exposed
    1 / 269 (0.37%)
    8 / 114 (7.02%)
         occurrences all number
    1
    8
    Nervous system disorders
    Neck pain
         subjects affected / exposed
    17 / 269 (6.32%)
    2 / 114 (1.75%)
         occurrences all number
    17
    2
    Dysgeusia
         subjects affected / exposed
    21 / 269 (7.81%)
    2 / 114 (1.75%)
         occurrences all number
    21
    2
    Headache
         subjects affected / exposed
    18 / 269 (6.69%)
    9 / 114 (7.89%)
         occurrences all number
    18
    9
    Dizziness
         subjects affected / exposed
    17 / 269 (6.32%)
    3 / 114 (2.63%)
         occurrences all number
    17
    3
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    19 / 269 (7.06%)
    11 / 114 (9.65%)
         occurrences all number
    19
    11
    Lymphopenia
         subjects affected / exposed
    7 / 269 (2.60%)
    7 / 114 (6.14%)
         occurrences all number
    7
    7
    Neutropenia
         subjects affected / exposed
    4 / 269 (1.49%)
    21 / 114 (18.42%)
         occurrences all number
    4
    21
    Thrombocytopenia
         subjects affected / exposed
    2 / 269 (0.74%)
    17 / 114 (14.91%)
         occurrences all number
    2
    17
    Leukopenia
         subjects affected / exposed
    0 / 269 (0.00%)
    8 / 114 (7.02%)
         occurrences all number
    0
    8
    Eye disorders
    Retinal detachment
         subjects affected / exposed
    35 / 269 (13.01%)
    0 / 114 (0.00%)
         occurrences all number
    35
    0
    Eyelid oedema
         subjects affected / exposed
    28 / 269 (10.41%)
    0 / 114 (0.00%)
         occurrences all number
    28
    0
    Vision blurred
         subjects affected / exposed
    20 / 269 (7.43%)
    1 / 114 (0.88%)
         occurrences all number
    20
    1
    Subretinal fluid
         subjects affected / exposed
    19 / 269 (7.06%)
    0 / 114 (0.00%)
         occurrences all number
    19
    0
    Macular oedema
         subjects affected / exposed
    17 / 269 (6.32%)
    0 / 114 (0.00%)
         occurrences all number
    17
    0
    Periorbital oedema
         subjects affected / exposed
    14 / 269 (5.20%)
    0 / 114 (0.00%)
         occurrences all number
    14
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    109 / 269 (40.52%)
    15 / 114 (13.16%)
         occurrences all number
    109
    15
    Nausea
         subjects affected / exposed
    85 / 269 (31.60%)
    35 / 114 (30.70%)
         occurrences all number
    85
    35
    Vomiting
         subjects affected / exposed
    58 / 269 (21.56%)
    15 / 114 (13.16%)
         occurrences all number
    58
    15
    Constipation
         subjects affected / exposed
    39 / 269 (14.50%)
    22 / 114 (19.30%)
         occurrences all number
    39
    22
    Dry mouth
         subjects affected / exposed
    22 / 269 (8.18%)
    1 / 114 (0.88%)
         occurrences all number
    22
    1
    Abdominal pain
         subjects affected / exposed
    24 / 269 (8.92%)
    8 / 114 (7.02%)
         occurrences all number
    24
    8
    Abdominal pain upper
         subjects affected / exposed
    16 / 269 (5.95%)
    3 / 114 (2.63%)
         occurrences all number
    16
    3
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    96 / 269 (35.69%)
    2 / 114 (1.75%)
         occurrences all number
    96
    2
    Dry skin
         subjects affected / exposed
    37 / 269 (13.75%)
    2 / 114 (1.75%)
         occurrences all number
    37
    2
    Pruritus
         subjects affected / exposed
    27 / 269 (10.04%)
    2 / 114 (1.75%)
         occurrences all number
    27
    2
    Skin fissures
         subjects affected / exposed
    26 / 269 (9.67%)
    0 / 114 (0.00%)
         occurrences all number
    26
    0
    Alopecia
         subjects affected / exposed
    24 / 269 (8.92%)
    3 / 114 (2.63%)
         occurrences all number
    24
    3
    Rash maculo-papular
         subjects affected / exposed
    23 / 269 (8.55%)
    0 / 114 (0.00%)
         occurrences all number
    23
    0
    Erythema
         subjects affected / exposed
    17 / 269 (6.32%)
    2 / 114 (1.75%)
         occurrences all number
    17
    2
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    28 / 269 (10.41%)
    3 / 114 (2.63%)
         occurrences all number
    28
    3
    Back pain
         subjects affected / exposed
    19 / 269 (7.06%)
    6 / 114 (5.26%)
         occurrences all number
    19
    6
    Arthralgia
         subjects affected / exposed
    18 / 269 (6.69%)
    3 / 114 (2.63%)
         occurrences all number
    18
    3
    Muscular weakness
         subjects affected / exposed
    16 / 269 (5.95%)
    0 / 114 (0.00%)
         occurrences all number
    16
    0
    Pain in extremity
         subjects affected / exposed
    11 / 269 (4.09%)
    6 / 114 (5.26%)
         occurrences all number
    11
    6
    Infections and infestations
    Rash pustular
         subjects affected / exposed
    18 / 269 (6.69%)
    0 / 114 (0.00%)
         occurrences all number
    18
    0
    Nasopharyngitis
         subjects affected / exposed
    17 / 269 (6.32%)
    5 / 114 (4.39%)
         occurrences all number
    17
    5
    Erysipelas
         subjects affected / exposed
    15 / 269 (5.58%)
    0 / 114 (0.00%)
         occurrences all number
    15
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    34 / 269 (12.64%)
    19 / 114 (16.67%)
         occurrences all number
    34
    19
    Hypokalaemia
         subjects affected / exposed
    12 / 269 (4.46%)
    0 / 114 (0.00%)
         occurrences all number
    12
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Jan 2013
    Protocol amendment V 01 All sections of the protocol including the protocol title that describe the patient population: • Changed the patient population to reflect the inclusion of patients who had progressed on or after prior first-line immunotherapy for metastatic disease. • All section of the protocol were updated with the appropriate visit window exception for the visit occurring 6 weeks after randomization (Study Day 43). The appropriate window is now +3 days • Table 6-6 MEK162-Recommended dose modifications associated with treatment related adverse events •Synopsis, Sections 2.2, 4.1 and 6.6.2 added a stratification factor to stratify patients by first-line immunotherapy (yes versus no) • Synopsis and Section 5.2 added patients who had progressed on or after prior first-line immunotherapy for metastatic disease to inclusion #5 Synopsis and Section 5.3: • Added history of retinal degenerative disease as exclusion #5 • Added patients who have received more than one line of immunotherapy for metastatic melanoma as exclusion #10 • Added patients who have not met the minimal washout requirements for prior metastatic therapy as exclusion #11 • Revised exclusion criterion #12 to exclude prior chemotherapy treatment • Clarified exclusion criterion #13 to not include atrial fibrillation and paroxysmal supraventricular hypertension as exclusionary as significant cardiac arrhythmias • Updated the uncontrolled arterial hypertension exclusion criteria to make it less specific (criterion #14)
    03 Sep 2013
    Protocol amendment V 02 included: • Update the inclusion and exclusion criteria • New and modify existing safety monitoring • Improvement some operational aspects • Other (clarifications, administrative changes and corrections)
    07 Apr 2014
    Protocol amendment V 03 included the following updates: • Clarifications of the eligibility criteria • Improvement operational aspects of the trial • Other (clarifications and corrections) Section 1.2.1.2 • Added “For updated clinical safety and efficacy data please refer to the most recent version of the Investigator’s Brochure.” To clinical experience Section 1.2.1.3 • Added results from the food effect study CMEK162A2103 Section 4.1 • Added “using the same IDE test for prescreening that is used in this protocol, and who have consented to utilizing those results for this study” • Added “Regardless of whether additional tumor is needed for the required study analyses, all patients intending to participate in the CMEK162A2301 study must sign both the prescreening and main consents” Section 5.2: • Added “or unknown primary” and “(Uveal and mucosa melanoma are excluded)” to inclusion criterion # 3 • Remove the word “first-line” from inclusion criterion #5 • Reduced the hemoglobin value from 10g/dL to 9g/dL in inclusion criterion # 8 • Added a “triplicate average baseline” to QTcF reading at baseline to the inclusion criterion # 9 Section 5.3: • Removed the word “active” and “(i.e. those with radiographically unresectable, symptomatic lesions)”, “and”, “are eligible if the” from exclusion criterion # 1 • Added the words “untreated” “are eligible if a)” ,“all known CNS lesions have been”, “and b) after treatment” to exclusion criterion # 1 • Removed “non-cutaneous” and Added “Uveal or mucosal ” melanoma to exclusion criterion # 2 • Removed exclusion criterion # 10
    09 Oct 2014
    Protocol amendment V 04 - The main objectives of this amendment were: • To make mandatory ocular coherence tomography (OCT) assessments at each visit to better characterize retinal events Safety: • To modify the grading criteria and dose modification for retinal events • To clarify the dose modification table for left ventricular systolic dysfunction • To clarify the guidance for monitoring and dose modification for CK elevation • To update and clarify eligibility criteria • To improve operational aspects of the trial • Other (clarifications and corrections)
    26 Oct 2015
    Protocol amendment V 05 - the purpose of this amendment is to document a change in study sponsorship from Novartis to Array BioPharma. Study design and procedures are not affected.
    05 Dec 2018
    Protocol amendment V 06 - this protocol amendment decreases the frequency of assessments for those patients continuing to receive binimetinib. In addition, as no further analyses of progression-free survival (PFS) and overall survival (OS) were planned, post-treatment disease follow-up and survival follow-up assessments would not be performed and central review of tumor assessments would be discontinued. Section 4.1 • Efficacy assessments will be performed locally, per standard of care for patients with advanced/metastatic melanoma, and tumor imaging will no longer be sent to the blinded independent review committee (BIRC) • Treatment discontinuation due to disease progression will now be based on Investigator assessment rather than BIRC determination • At the safety follow-up visit, patients will only complete assessment for adverse events (AEs) and serious adverse events (SAEs) and no other follow-up assessments outlined in prior amendments will be completed (i.e. health-related quality of life,survival follow-up) • Definition of study completion was updated Section 4.3 • The definition for the end of study was updated Section 6.2 • The assessment of progressive disease (PD) and discontinuation of study treatment would be based on Investigator assessment Section 6.7.2 • Study drug would no longer be dispensed by Interactive Response Technology (IRT), but would be provided by Fisher and manually assigned to the patients by site personnel.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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