Binimetinib – Uses, Dosage, Side Effects, Interaction

Indications

Use in Cancer

Binimetinib is approved to be used with encorafenib to treat:

• Melanoma that cannot be removed by surgery or has spread to other parts of the body. It is used in patients whose cancer has a certain mutation in the BRAF gene.

Binimetinib is also being studied in the treatment of other types of cancer.

Contraindications

• chronic? heart failure?
• blood clot formation in vein?
• bleeding
• liver? problems
• a condition with muscle tissue breakdown called rhabdomyolysis
• pregnancy
• a patient who is producing milk and breastfeeding
• lung tissue problem

Dosage?

Strengths: 15 mg

Melanoma – Metastatic

• 45 mg orally every 12 hours in combination with encorafenib until disease progression? or unacceptable toxicity
• Refer to the encorafenib prescribing information for encorafenib dosing information.
• This drug may be taken with or without food.
• Do not take a missed dose within 6 hours of the next dose.
• Do not take an additional dose if vomiting? occurs after administration but continue with the next scheduled dose.

Liver Dose Adjustments

• Mild? hepatic impairment (total bilirubin? greater than 1 and less than or equal to 1.5 x the upper limit of normal (ULN) and any AST or total bilirubin less than or equal to ULN and AST greater than ULN: No adjustment recommended.
• Moderate? (total bilirubin greater than 1.5 and less than or equal to 3 × ULN and any AST) or severe? (total bilirubin levels greater than or equal to 3 × ULN and any AST) hepatic impairment: The recommended dose is 30 mg orally 2 times a day.

Dose Adjustments

If encorafenib is permanently discontinued, discontinue this drug.
Recommended Dose Reductions for Adverse Reactions:

• First dose reduction: 30 mg orally every 12 hours
• Subsequent modification: Permanently discontinue this drug if unable to tolerate 30 mg orally every 12 hours.

DOSE ADJUSTMENTS:
CARDIOMYOPATHY?:

• Asymptomatic?, absolute decrease in LVEF of greater than 10% from baseline? that is also below lower limit of normal (LLN): Withhold this drug for up to 4 weeks; evaluate LVEF every 2 weeks. Resume this drug at a reduced dose if LVEF is at or above the lower limit or normal AND absolute decrease from baseline is 10% or less AND patient is asymptomatic. If the LVEF does not recover within 4 weeks permanently discontinue this drug.
• Symptomatic congestive heart failure? or absolute decrease in LVEF or greater than 20% from baseline that is also below LLN: Permanently discontinue this drug.

VENOUS THROMBOEMBOLISM:

• Uncomplicated deep venous thrombosis? (DVT?) or pulmonary embolism? (PE?): Withhold this drug. If improves to Grade 0 or 1, resume at a reduced dose. If no improvement, permanently discontinue this drug.
• Life-threatening PE: Permanently discontinue this drug.

SEROUS RETINOPATHY:

• Symptomatic serous retinopathy/retinal pigment epithelial detachments: Withhold this drug for up to 10 days. If improves and becomes asymptomatic, resume at the same dose. If not improved, resume at a lower dose level or permanently discontinue this drug.

RETINAL VEIN OCCLUSION (RVO):

• Any grade: Permanently discontinue this drug.

UVEITIS:

• Grade 1, 2, or 3: If Grade 1 or 2 does not respond to specific ocular therapy, or for Grade 3 uveitis, withhold this drug for up to 6 weeks. If improved, resume at same or reduced dose. If not improved, permanently discontinue this drug.
• Grade 4: Permanently discontinue this drug.

INTERSTITIAL LUNG DISEASE?:

• Grade 2: Withhold this drug for up to 4 weeks. If improved to Grade 0 or 1, resume a reduced dose. If not resolved within 4 weeks, permanently discontinue this drug.
• Grade 3 or 4: Permanently discontinue this drug.

HEPATOTOXICITY:

• Grade 2 AST or ALT increased: Maintain the dose. If no improvement within 2 weeks, withhold this drug until improved to Grade 0 or 1 or to pretreatment/baseline levels and then resume at the same dose.
• First occurrence of Grade 3 AST or ALT increased: Withhold this drug for up to 4 weeks. If improves to Grade 0 or 1 or to pretreatment/baseline levels, resume at reduced dose. If no improvement, permanently discontinue this drug.
• Recurrent? Grade 3 AST or ALT increased: Consider permanently discontinuing this drug.
• First occurrence of Grade 4 AST or ALT increased: Permanently discontinue this drug OR withhold this drug for up to 4 weeks. If improves to Grade 0 or 1 or to pretreatment/baseline levels, then resume at a reduced dose. If no improvement, permanently discontinue this drug.
• Recurrent Grade 4 AST or ALT increased: Permanently discontinue this drug.

RHABDOMYOLYSIS OR CREATINE PHOSPHOKINASE (CPK) ELEVATIONS:

• Grade 4 asymptomatic CPK elevation OR any Grade CPK elevation with symptoms or with renal? impairment: Withhold this drug for up to 4 weeks. If improved to Grade 0 or 1 resume at a reduced dose. If not resolved within 4 weeks, permanently discontinue this drug.

DERMATOLOGIC:

• Grade 2: If no improvement within 2 weeks, withhold this drug until Grades 0 to 1. Resume at the same dose if the first occurrence or reduce the dose if recurrent.
• Grade 3: Withhold this drug until Grade 0 or 1. Resume at the same dose if the first occurrence or reduce dose if recurrent.
• Grade 4: Permanently discontinue this drug.

OTHER ADVERSE REACTIONS (INCLUDING HEMORRHAGE):

• Recurrent Grade 2 or first occurrence of any Grade 3: Withhold this drug for up to 4 weeks. If improved to Grade 0 or 1 resume at a reduced dose. If not resolved within 4 weeks, permanently discontinue this drug.
• The first occurrence of any Grade 4: Permanently discontinue this drug OR withhold this drug for up to 4 weeks. If improves to Grade 0 or 1 or to pretreatment/baseline levels, then resume at a reduced dose. If no improvement, permanently discontinue this drug.

Side Effects

The Most Common

• fatigue?, nausea?, diarrhea?, vomiting,
• abdominal pain, and arthralgia.
• hemorrhage and headache.
• Retinal hemorrhage, retinal detachment (6%),
• macular edema, serous retinopathy (20%)
• Hypertension,
• thromboembolic events such as DVT, resulting in pulmonary embolism (5.6%),
• peripheral edema or periorbital edema (43.5%),
• hemorrhage (11.2%)
• Pulmonary events
• Pneumonitis (1.9%),
• Pulmonary embolism
• Cardiovascular system QT interval prolongation (3.3%),
• Left ventricular dysfunction (7%)
• Gastrointestinal system
• Hepatotoxicity, diarrhea, nausea, vomiting,
• stomatitis, dry mouth
• Acneiform dermatitis

More Common

• fatigue
• nausea
• diarrhea
• vomiting
• abdominal pain
• constipation
• dizziness
• vision changes or eye pain, swelling, or redness
• fever, sore throat, chills, cough, or other signs of infection
• yellow eyes or skin, dark urine, loss of appetite, fatigue, or pain or discomfort in right upper stomach area
• unusual weakness, muscle pain, or dark red or brown urine
• unusual bleeding or bruising; black, tarry, or bloody stools; or coughing up blood
• shortness of breath or cough
• sudden onset of difficulty breathing; chest pain; swelling of the feet, ankles, or lower legs; or leg pain, warmth, or swelling
• fast, pounding heartbeat; shortness of breath; swelling of ankles and feet; or dizziness

Rare

• Anemia
• Vomiting
• Increased AST/ALT
• Abdominal pain
• Constipation
• Rash
• Increased alkaline phosphatase
• Visual impairment
• Serous retinopathy/retinal pigment epithelial dystrophy (RPED)
• Bleeding
• Low blood sodium (hyponatremia)
• Fever
• Dizziness
• Low white blood cell count (leukopenia, neutropenia)
• Low lymphocyte levels (lymphopenia)
• Swelling of extremities
• Increased GGT
• High blood pressure (hypertension)
• Colitis
• Panniculitis
• Drug hypersensitivity

Drug interaction

Pregnancy and Lactation

US FDA pregnancy category Not Assigned

Pregnancy

Drugs that have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help healthcare providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

Lactation

No information is available on the use of this drug during breastfeeding. Because it is highly bound to plasma proteins, and the half-life is 3.5 hours, the amount in milk is likely to be low; however, the manufacturer recommends that breastfeeding be discontinued during therapy and for at least 3 days after. For patients taking the combination with encorafenib, the manufacturer recommends that breastfeeding be discontinued during therapy and for at least 2 weeks after.

References