Mekinist For Oral Solution

— THERAPEUTIC CATEGORIES —
  • CNS cancers
  • Solid tumors

Mekinist For Oral Solution Generic Name & Formulations

General Description

Trametinib 4.7mg; per bottle; pwd for oral soln after reconstitution; strawberry-flavored.

Pharmacological Class

Kinase inhibitor.

See Also

How Supplied

Tabs—30; Oral soln (4.7mg)—1 (w. adapter and syringe)

Generic Availability

NO

Mechanism of Action

Trametinib is a reversible inhibitor of mitogen-activated extracellular signal-regulated kinase 1 (MEK1) and MEK2 activation and of MEK1 and MEK2 kinase activity. Also, trametinib inhibits cell growth of various BRAF V600 mutation-positive tumors in vitro and in vivo.

Mekinist For Oral Solution Indications

Indications

In combination with dabrafenib for the treatment of pediatric patients with low-grade glioma (LGG) with a BRAF V600E mutation who require systemic therapy.

Limitations of Use

Not for treatment of colorectal cancer because of known intrinsic resistance to BRAF inhibition.

Mekinist For Oral Solution Dosage and Administration

Adult

≥18yrs: not established.

Children

<1yr or <8kg: not established. Confirm presence of BRAF V600E mutation prior to initiation. Use tabs or oral soln based on the ability to swallow and body weight. Swallow tabs whole (do not use tabs if <26kg). For oral soln: may administer via oral dosing syringe or feeding tube. Take at least 1hr before or 2hrs after a meal once daily (approx. 24hrs apart). In combination with dabrafenib (for tabs): 1–<18yrs (26–37kg): 1mg; (38–50kg): 1.5mg; (≥51kg): 2mg. In combination with dabrafenib (oral soln): 1–<18yrs (8kg): 6mL (0.3mg); (9–10kg): 7mL (0.35mg); (11kg): 8mL (0.4mg); (12–13kg): 9mL (0.45mg); (14–17kg): 11mL (0.55mg); (18–21mg): 14mL (0.7mg); (22–25kg): 17mL (0.85mg); (26–29kg): 18mL (0.9mg); (30–33kg): 20mL (1mg); (34–37kg): 23mL (1.15mg); (38–41kg): 25mL (1.25mg); (42–45kg): 28mL (1.4mg); (46–50kg): 32mL (1.6mg); (≥51kg): 40mL (2mg). Continue until disease progression or unacceptable toxicity. Dose modifications: see full labeling.

Mekinist For Oral Solution Contraindications

Not Applicable

Mekinist For Oral Solution Boxed Warnings

Not Applicable

Mekinist For Oral Solution Warnings/Precautions

Warnings/Precautions

See full labeling for dabrafenib prior to starting combination therapy. With dabrafenib: risk of new primary malignancies, cutaneous, and non-cutaneous; monitor and perform skin evaluation prior to initiation, every 2 months during therapy, and up to 6 months after discontinuation. Monitor for pulmonary embolism (permanently discontinue if life-threatening), colitis, GI perforations, skin toxicities and secondary infections. Withhold if uncomplicated deep vein thrombosis or pulmonary embolism occurs for up to 3wks. Permanently discontinue for all Grade 4 hemorrhagic events or any persistent Grade 3 events. Risk of cardiomyopathy; assess LVEF prior to initiation, after one month, and then at every 2–3 month intervals during treatment; withhold for up to 4wks if absolute LVEF decreases by ≥10% from baseline and is less than the lower limit of normal (LLN); permanently discontinue if symptomatic cardiomyopathy or absolute LVEF decrease of >20% from baseline that is below LLN. Perform eye exam periodically and at any time for visual disturbances; withhold for up to 3wks, if retinal pigment epithelial detachment is diagnosed. Permanently discontinue if documented retinal vein occlusion, interstitial lung disease or pneumonitis occurs. Withhold if fever ≥100.4°F, evaluate infection and assess renal function; prophylaxis with antipyretics when resuming or give steroids for subsequent pyrexia. Withhold if intolerable or severe skin toxicity occurs; permanently discontinue if unresolved after 3wks. Interrupt treatment if hemophagocytic lymphohistiocytosis (HLH) suspected; discontinue and manage appropriately if confirmed. Pre-existing diabetes or hyperglycemia; monitor serum glucose levels. Severe renal or moderate to severe hepatic impairment. Embryo-fetal toxicity. Advise to use effective non-hormonal contraception (females of reproductive potential) or use of condoms (males w. female partners) during and for 4 months after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 4 months after last dose).

Mekinist For Oral Solution Pharmacokinetics

Absorption

  • Median time to peak plasma concentration (Tmax): 1.5 hours.

  • Mean absolute bioavailability: 72% (tabs); 81% (oral soln).

Distribution

  • 97.4% human plasma protein bound.

  • Apparent volume of distribution: 214 L.

Metabolism

Predominantly via deacetylation alone or with mono-oxygenation or in combination with glucuronidation biotransformation pathways in vitro. 

Elimination

  • Fecal (>80%), renal (<20%).
  • Half-life: 3.9–4.8 days.

Mekinist For Oral Solution Interactions

Not Applicable

Mekinist For Oral Solution Adverse Reactions

Adverse Reactions

Rash, diarrhea, lymphedema. In combination with dabrafenib: also pyrexia, chills, fatigue, nausea, vomiting, hypertension, peripheral edema, headache, arthralgia, myalgia, dry skin, decreased appetite, hemorrhage, cough, dyspnea, constipation, dermatitis acneiform, abdominal pain, paronychia, musculoskeletal pain.

Mekinist For Oral Solution Clinical Trials

See Literature

Mekinist For Oral Solution Note

Not Applicable

Mekinist For Oral Solution Patient Counseling

See Literature

Mekinist For Oral Solution Generic Name & Formulations

General Description

Trametinib 4.7mg; per bottle; pwd for oral soln after reconstitution; strawberry-flavored.

Pharmacological Class

Kinase inhibitor.

See Also

How Supplied

Tabs—30; Oral soln (4.7mg)—1 (w. adapter and syringe)

Generic Availability

NO

Mechanism of Action

Trametinib is a reversible inhibitor of mitogen-activated extracellular signal-regulated kinase 1 (MEK1) and MEK2 activation and of MEK1 and MEK2 kinase activity. Also, trametinib inhibits cell growth of various BRAF V600 mutation-positive tumors in vitro and in vivo.

Mekinist For Oral Solution Indications

Indications

In combination with dabrafenib, for the treatment of unresectable or metastatic solid tumors in adult and pediatric patients with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options.

Limitations of Use

Not for treatment of colorectal cancer because of known intrinsic resistance to BRAF inhibition.

Mekinist For Oral Solution Dosage and Administration

Adult

≥18yrs: use tab form.

Children

<1yr or <8kg: not established. Confirm presence of BRAF V600E mutation prior to initiation. Use tabs or oral soln based on the ability to swallow and body weight. Swallow tabs whole (do not use tabs if <26kg). For oral soln: may administer via oral dosing syringe or feeding tube. Take at least 1hr before or 2hrs after a meal once daily (approx. 24hrs apart). In combination with dabrafenib (for tabs): 1–<18yrs (26–37kg): 1mg; (38–50kg): 1.5mg; (≥51kg): 2mg. In combination with dabrafenib (for oral soln): 1–<18yrs (8kg): 6mL (0.3mg); (9–10kg): 7mL (0.35mg); (11kg): 8mL (0.4mg); (12–13kg): 9mL (0.45mg); (14–17kg): 11mL (0.55mg); (18–21mg): 14mL (0.7mg); (22–25kg): 17mL (0.85mg); (26–29kg): 18mL (0.9mg); (30–33kg): 20mL (1mg); (34–37kg): 23mL (1.15mg); (38–41kg): 25mL (1.25mg); (42–45kg): 28mL (1.4mg); (46–50kg): 32mL (1.6mg); (≥51kg): 40mL (2mg). Continue until disease progression or unacceptable toxicity. Dose modifications: see full labeling.

Mekinist For Oral Solution Contraindications

Not Applicable

Mekinist For Oral Solution Boxed Warnings

Not Applicable

Mekinist For Oral Solution Warnings/Precautions

Warnings/Precautions

See full labeling for dabrafenib prior to starting combination therapy. With dabrafenib: risk of new primary malignancies, cutaneous, and non-cutaneous; monitor and perform skin evaluation prior to initiation, every 2 months during therapy, and up to 6 months after discontinuation. Monitor for pulmonary embolism (permanently discontinue if life-threatening), colitis, GI perforations, skin toxicities and secondary infections. Withhold if uncomplicated deep vein thrombosis or pulmonary embolism occurs for up to 3wks. Permanently discontinue for all Grade 4 hemorrhagic events or any persistent Grade 3 events. Risk of cardiomyopathy; assess LVEF prior to initiation, after one month, and then at every 2–3 month intervals during treatment; withhold for up to 4wks if absolute LVEF decreases by ≥10% from baseline and is less than the lower limit of normal (LLN); permanently discontinue if symptomatic cardiomyopathy or absolute LVEF decrease of >20% from baseline that is below LLN. Perform eye exam periodically and at any time for visual disturbances; withhold for up to 3wks, if retinal pigment epithelial detachment is diagnosed. Permanently discontinue if documented retinal vein occlusion, interstitial lung disease or pneumonitis occurs. Withhold if fever ≥100.4°F, evaluate infection and assess renal function; prophylaxis with antipyretics when resuming or give steroids for subsequent pyrexia. Withhold if intolerable or severe skin toxicity occurs; permanently discontinue if unresolved after 3wks. Interrupt treatment if hemophagocytic lymphohistiocytosis (HLH) suspected; discontinue and manage appropriately if confirmed. Pre-existing diabetes or hyperglycemia; monitor serum glucose levels. Severe renal or moderate to severe hepatic impairment. Embryo-fetal toxicity. Advise to use effective non-hormonal contraception (females of reproductive potential) or use of condoms (males w. female partners) during and for 4 months after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 4 months after last dose).

Mekinist For Oral Solution Pharmacokinetics

Absorption

  • Median time to peak plasma concentration (Tmax): 1.5 hours.

  • Mean absolute bioavailability: 72% (tabs); 81% (oral soln).

Distribution

  • 97.4% human plasma protein bound.

  • Apparent volume of distribution: 214 L.

Metabolism

Predominantly via deacetylation alone or with mono-oxygenation or in combination with glucuronidation biotransformation pathways in vitro. 

Elimination

  • Fecal (>80%), renal (<20%).
  • Half-life: 3.9–4.8 days.

Mekinist For Oral Solution Interactions

Not Applicable

Mekinist For Oral Solution Adverse Reactions

Adverse Reactions

Rash, diarrhea, lymphedema. In combination with dabrafenib: also pyrexia, chills, fatigue, nausea, vomiting, hypertension, peripheral edema, headache, arthralgia, myalgia, dry skin, decreased appetite, hemorrhage, cough, dyspnea, constipation, dermatitis acneiform, abdominal pain, paronychia, musculoskeletal pain.

Mekinist For Oral Solution Clinical Trials

See Literature

Mekinist For Oral Solution Note

Not Applicable

Mekinist For Oral Solution Patient Counseling

See Literature