- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03962543
MEK Inhibitor Mirdametinib (PD-0325901) in Patients With Neurofibromatosis Type 1 Associated Plexiform Neurofibromas (ReNeu)
A Phase 2b Trial of the MEK 1/2 Inhibitor (MEKi) PD-0325901 in Adult and Pediatric Patients With Neurofibromatosis Type 1 (NF1)-Associated Inoperable Plexiform Neurofibromas (PNs) That Are Causing Significant Morbidity
Study Overview
Status
Intervention / Treatment
Detailed Description
Neurofibromas are non-malignant peripheral nerve sheath tumors, which are classified as plexiform neurofibromas (PNs) if they extend longitudinally along a nerve and involve multiple fascicles. PNs are a major cause of morbidity and disfigurement in individuals with NF1, and as the tumor growth progresses, can cause a multitude of clinical problems including pain and impaired physical function. PNs have the potential to undergo malignant transformation to Malignant Peripheral Nerve Sheet Tumors (MPNST).
Mirdametinib (PD-0325901) is an orally delivered, highly selective small-molecule inhibitor of the dual specificity kinases, MEK1 and MEK2 (MAPK/ERK Kinase) which prevents the phosphorylation and subsequent activation of mitogen-activated protein kinase (MAPK).
Previous studies of mirdametinib (PD-0325901) demonstrated PN shrinkage and sustained inhibition of pERK. Reduced tumor volume indicated that cell proliferation or cell death may be altered in PNs with administration of mirdametinib (PD-0325901).
Study Type
Enrollment (Actual)
Phase
- Phase 2
Expanded Access
Contacts and Locations
Study Locations
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Alabama
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Birmingham, Alabama, United States, 35233
- University of Alabama at Birmingham/Children's of Alabama
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Arizona
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Phoenix, Arizona, United States, 98195
- Mayo Clinic Arizona
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Arkansas
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Little Rock, Arkansas, United States, 72202
- Arkansas Children's Hospital
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California
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Los Angeles, California, United States, 90027
- Children's Hospital Los Angeles
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Los Angeles, California, United States, 90095
- University of California, Los Angeles (UCLA)
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Orange, California, United States, 92868
- Children's Hospital of Orange County
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Orange, California, United States, 92868
- University of California - Irvine Health
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Palo Alto, California, United States, 94304
- Lucile Packard Children's Hospital Stanford
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Sacramento, California, United States, 95817
- University Of California - Davis
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Colorado
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Aurora, Colorado, United States, 80045
- Children's Hospital Colorado
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Delaware
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Wilmington, Delaware, United States, 19803
- Nemours A. I. duPont Hospital for Children
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District of Columbia
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Washington D.C., District of Columbia, United States, 20010
- Children's National Hospital
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Florida
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Gainesville, Florida, United States, 32610
- University of Florida Clinical Research Center
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Miami, Florida, United States, 33155
- Nicklaus Children's Hospital
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Orlando, Florida, United States, 32804
- Florida Hospital Cancer Institute
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Orlando, Florida, United States, 32806
- Arnold Palmer Hospital for Children
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St. Petersburg, Florida, United States, 33701
- Johns Hopkins All Children's Hospital
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Tampa, Florida, United States, 33612
- Moffitt
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Illinois
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Chicago, Illinois, United States, 60612
- University of Illinois Hospital and Health Systems
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Indiana
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Indianapolis, Indiana, United States, 46202
- Indiana University
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Iowa
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Iowa City, Iowa, United States, 52242
- University of Iowa Health Care
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Michigan
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Ann Arbor, Michigan, United States, 48109
- University of Michigan Comprehensive Cancer Center
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Detroit, Michigan, United States, 48202
- Henry Ford Hospital
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Minnesota
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Minneapolis, Minnesota, United States, 55455
- University of Minnesota/Masonic Cancer Center
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Rochester, Minnesota, United States, 55905
- Mayo Clinic
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Missouri
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St Louis, Missouri, United States, 63110
- Washington University
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New Jersey
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Paterson, New Jersey, United States, 07503
- Saint Joseph's Regional Medical Center
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New York
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Albany, New York, United States, 12208
- Albany Medical Center
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The Bronx, New York, United States, 10467
- Children's Hospital at Montefiore
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North Carolina
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Chapel Hill, North Carolina, United States, 27599
- UNC Medical Center
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Durham, North Carolina, United States, 27710
- Duke University Medical Center
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Ohio
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Cincinnati, Ohio, United States, 45219
- UC Health
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Columbus, Ohio, United States, 43205
- Nationwide Children's Hospital
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Oklahoma
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Oklahoma City, Oklahoma, United States, 73104
- University of Oklahoma - Health Sciences Center
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Oregon
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Portland, Oregon, United States, 97239
- Oregon Health and Science University
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Pennsylvania
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Pittsburgh, Pennsylvania, United States, 15219-2739
- Children's Hospital of Pittsburgh UPMC
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Tennessee
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Nashville, Tennessee, United States, 37232
- Vanderbilt Children's Hospital
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Texas
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Dallas, Texas, United States, 75244
- University of Texas Southwestern
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Fort Worth, Texas, United States, 76104
- Cook Children's Medical Center
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Houston, Texas, United States, 77030
- MD Anderson Cancer Center
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Utah
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Salt Lake City, Utah, United States, 84108
- The University of Utah Health Sciences Center
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Virginia
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Charlottesville, Virginia, United States, 22903
- University of Virginia - Emily Couric Cancer Center
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Norfolk, Virginia, United States, 23510
- Children's Hospital of The King's Daughters
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Key Inclusion Criteria:
- Participant has documented NF1 mutation or a diagnosis of neurofibromatosis type 1 (NF1) using National Institute of Health (NIH) Consensus Conference criteria inclusive of the presence of a plexiform neurofibroma (PN).
- Participant has a PN that is causing significant morbidity.
- Participant has a PN that cannot be completely surgically removed.
- Participant has a target tumor that is amenable to volumetric MRI analysis.
- Participant is willing to undergo a tumor biopsy pre and post treatment if ≥ 18 years of age.
- Participant has adequate organ and bone marrow function.
Key Exclusion Criteria:
- Participant has abnormal liver function or history of liver disease.
- Participant has lymphoma, leukemia or any malignancy within the past 5 years (except for resected basal/squamous skin carcinomas without metastases within 3 years).
- Participant has breast cancer within 10 years.
- Participant has active optic glioma or other low-grade glioma requiring treatment.
- Participant has abnormal QT interval corrected or other heart disease within 6 months.
- Participant has a history of retinal pathology, risk factors for retinal vein occlusion or has a history of glaucoma.
- Participant has known malabsorption syndrome or gastrointestinal conditions that would impair absorption of mirdametinib (PD-0325901).
- Participant has received NF1 PN-targeted therapy within 45 days.
- Participant previously received or is currently receiving therapy with mirdametinib (PD-0325901) or any other MEK1/2 inhibitor.
- Participant has received radiation therapy within 6 months or has received radiation to the orbit at any time.
- Participant is unable to undergo or tolerate MRI.
- Participant has active bacterial, fungal or viral infection.
- Participant has experienced other severe acute or chronic medical or psychiatric conditions within 1 year.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Mirdametinib (PD-0325901)
Mirdametinib (PD-0325901) capsule or dispersible tablet 2 mg/m^2 (maximum dose of 4 mg) by mouth twice daily
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Mirdametinib (PD-0325901) capsule or dispersible tablet
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Confirmed Objective Response Rate at the End of the Treatment Phase.
Time Frame: Up to 24 months
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Response will be determined by a blinded centralized review of volumetric MRI.
The confirmed objective response rate (complete or partial response) by the end of Treatment Phase (i.e., Cycle 24) is defined as the proportion of participants who have a confirmed ≥ 20% reduction in target tumor volume as compared to baseline as assessed by a BICR, and the response needs to be confirmed by BICR in a consecutive tumor assessment within 2 - 6 months.
Partial response is defined as a ≥ 20% reduction in target tumor volume from baseline.
Complete response is defined as the complete resolution of the target tumor.
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Up to 24 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Percentage of Patients With Treatment-Emergent Adverse Events.
Time Frame: All SAEs and AEs were collected from the time of signing ICF until 30 days after the last dose of study treatment, an average of 1 year and 10 months and up to 3 years and 10 months.
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All adverse events were coded using MedDRA Version 24.0.
Adverse events will be assessed according to toxicities graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0.
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All SAEs and AEs were collected from the time of signing ICF until 30 days after the last dose of study treatment, an average of 1 year and 10 months and up to 3 years and 10 months.
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Duration of Response (DOR) for Participants Who Meet Criteria for Confirmed Objective Response.
Time Frame: Starting on the onset of confirmed objective response in the Treatment Phase and afterwards on the 15th day of every 4 cycles (each cycle is 28 days) until disease progression or death, whichever comes first, assessed up to approximately 3 years
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Duration of response is defined as the time in months between the first instance of response that is subsequently confirmed, until the date of radiographic disease progression or death, whichever occurs first.
For participants who enter the LTFU Phase, all MRI assessments in both the Treatment Phase and LTFU Phase will be used to determine duration of response.
Participants without radiographic disease progression or death while on study will have their results censored to their most recent adequate (i.e.
evaluable) tumor assessment date.
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Starting on the onset of confirmed objective response in the Treatment Phase and afterwards on the 15th day of every 4 cycles (each cycle is 28 days) until disease progression or death, whichever comes first, assessed up to approximately 3 years
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Change From Baseline on Quality of Life (QOL) as Measured by the Pediatric Quality of Life Inventory (PedsQL) at Cycle 13, Acute Version.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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The PedsQL consists of a 23-item core measure of global QOL that can be completed in approximately 5 minutes.
There is a total score and four subscales: physical functioning, emotional functioning, social functioning and school/work functioning.
Participants ≥ 5 years of age complete an age-appropriate self-report; and parents/guardians of children ages 2-17 complete a parent proxy report of the age-specific QOL.
The recall period is 7 days.
PedsQL items are answered on a Likert scale with responses ranging from 0 to 4 (where 0 means it is never a problem and 4 means it is almost always a problem).
These items are then reverse scored and linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25, 4=0.
On this scale, higher scores indicate better outcomes.
Overall scale scores are calculated as the mean of the scores for the questions in said scale (or of all questions for the total score).
The change from baseline is modelled using a mixed-model for repeated measures.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Pain as Measured by the Numeric Rating Scale-11 (NRS-11) at Cycle 13.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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The NRS-11 is a self-reported 11-point numerical scale that assesses pain severity.
Participants ≥ 8 years of age are asked to select a number from 0 (no pain) to 10 (worst pain you can imagine) that best describes their worst pain.
The recall period is 24 hours.
The change from baseline is modelled using a mixed-model for repeated measures.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Pain as Measured by the Pain Interference Index (PII) at Cycle 13.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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The PII assesses relevant aspects of one's life, including pain interference with activities, spending time with family/friends, mood, sleep and attention.
Participants ≥ 6 years of age complete a self-report, and parents/guardians of children aged 6-17 complete a parent proxy report.
The recall period is 24 hours.
The PII consists of 6 questions, each asking the responder to select one number from 0 to 6 that best describes how their/their proxy's pain has impacted various items over the past 24 hours with 0 representing "Not at all" and 6 representing "Completely".
The mean of the completed items is taken as the PII score for a single assessment.
The PII score presented each visit will be taken as the average of the PII scores over the 7 consecutive days up to and including visit day, with no transformation applied.
The change from baseline is modelled using a mixed-model for repeated measures.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Change From Baseline in Localized Strength (Dynamometer) at Cycle 13.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Assessment of strength will be conducted only in the area affected by the target tumor.
Measurements will be obtained using Medical Research Council (MRC) grading followed by quantitative assessments using the sponsor provided MicroFET2 dynamometer.
Dynamometer assessment (in lbs) must be conducted in accordance with the study reference manual.
For each participant, the sum of the dynamometer scores for the muscle groups tested will be taken as an overall score for each visit with higher scores indicating better localized strength.
To assess the change from baseline at a visit, a participant will need assessments in which all the following categories, as assessed at baseline, match at that visit: side affected, position during assessment (sitting/supine/lateral decubitus), muscle group assessed.
The change from baseline in localized strength measured by the sum of the dynamometer scores for the muscle groups tested will be assessed at Cycle 13.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Range of Motion of PN-Associated Functional Impairment at Cycle 13.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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If motor dysfunction or weakness is evident, range of motion of the affected areas and/or joints will be measured by a goniometer.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Endurance at Cycle 13.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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If airway or lower extremity motor dysfunction is evident, endurance will be measured by completion of a 6-minute walking test.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Time to Response Defined as the Time Between First Dose and the First Date of Objective Response That is Subsequently Confirmed.
Time Frame: Up to 24 months
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Response will be determined by a blinded centralized review of volumetric MRI.
Time to response is defined as the time in months from the start of treatment to the date of first response that was subsequently confirmed.
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Up to 24 months
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Time to Progression, From the First Dose to the First Date of a ≥ 20% Increase in Tumor Volume From Baseline.
Time Frame: On the 15th day of every 4 cycles (each cycle is 28 days) until disease progression is observed, assessed up to approximately 3.5 years
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Evidence of progression or tumor growth will be determined by a blinded centralized review of volumetric MRI.
Time to progression is defined as the time in months between the first treatment date until the date of radiographic disease progression.
For participants who enter the LTFU Phase, all MRI assessments in both the Treatment Phase and LTFU Phase will be used to determine time to progression.
Participants without radiographic disease progression will have their results censored to their most recent adequate (i.e.
evaluable) tumor assessment date.
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On the 15th day of every 4 cycles (each cycle is 28 days) until disease progression is observed, assessed up to approximately 3.5 years
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Progression Free Survival, Defined as the Time in Months From the First Dose to the Date of the First ≥ 20% Increase in Tumor Volume From Baseline or Death.
Time Frame: On the 15th day of every 4 cycles (each cycle is 28 days) until disease progression is observed or death, whichever comes first, assessed up to approximately 3.5 years
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Evidence of progression or tumor growth will be determined by a blinded centralized review of volumetric MRI.
Progression free survival is defined as the time in months between the first treatment date, until the date of radiographic disease progression or death, whichever occurs first.
For participants who enter the LTFU Phase, all MRI assessments in both the Treatment Phase and LTFU Phase will be used to determine progression free survival.
Participants without radiographic disease progression or death while on study will have their results censored to their most recent adequate (i.e.
evaluable) tumor assessment date.
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On the 15th day of every 4 cycles (each cycle is 28 days) until disease progression is observed or death, whichever comes first, assessed up to approximately 3.5 years
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Change From Baseline in PN-Associated Disfigurement Using Standardized Photography, Centrally Reviewed.
Time Frame: Up to 24 months
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For participants with a PN that is visible and amenable to photography, changes in visible tumor aspects will be evaluated by a centralized reviewer.
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Up to 24 months
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Comparison of Tumor Response to Levels of pERK and Biomarkers Indicative of Inhibition of Downstream Targets of MEK (eg, ERK Phosphorylation).
Time Frame: Up to 24 months
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Measured in tumor biopsies in participants ≥ 18 years of age.
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Up to 24 months
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Acceptability of the Dispersible Tablet Formulation as Measured by the Pediatric Oral Medicine Acceptability Questionnaire (P-OMAQ)
Time Frame: Completed only once through study completion
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The Pediatric Oral Medicine Acceptability Questionnaire (P-OMAQ) uses a 5-point numerical rate scale to measure acceptability of use of the tablet formulation with questions related to taste, smell and administration of study medication.
Participants ≥ 8 years of age complete a 12-item self-report; adult parents/caregivers responsible for oversight of study drug administration for participants ages 6 months to 17 years complete a 19-item caregiver report.
Each questionnaire is provided with a "past 7 days" recall with all items using a 5-point Numerical Rate Scale (1 to 5) with higher item-scores reflecting greater oral treatment acceptability.
The overall P-OMAQ-P (pediatric self-report) and P-OMAQ-C (adult caregiver) scores for a participant in the study will be taken as the mean of all answered questions on the respective questionnaire.
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Completed only once through study completion
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Change From Baseline in Localized Strength (Medical Research Council (MRC) Scale Grading) at Cycle 13.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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If motor dysfunction or weakness is evident, strength of the affected muscle groups will be measured by dynamometer and assessed by a muscle grading scale.
Medical Research Council (MRC) Scale grading (0-5) must be conducted in accordance with the study reference manual.
MRC Grading is assessed on a scale of 0 to 5, with 0 representing no movement being observed, and 5 representing the muscle contracting normally against full resistance.
To assess the change from baseline at a visit, a participant will need assessments in which all the following categories, as assessed at baseline, match at that visit: side affected, position during assessment (sitting/supine/lateral decubitus), muscle group assessed.
The MRC Grade visit score is calculated for each participant separately, and these scores are then averaged.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Physical Function Status as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) at Cycle 13: Pediatric v2.0 Mobility 8a.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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PROMIS measures capability of physical functioning, with questions related to daily activities.
Participants 8-17 years complete a self-report of physical function in the upper extremity or lower extremity (mobility), depending on the location of the PN.
The recall period is 7 days.
All PROMIS items are answered on a Likert scale with responses ranging from 1 to 5, with higher scores representing higher reported mobility.
The total raw score will be calculated as the sum of the individual item responses at a given visit (total raw scale range 8-40).
The total raw scores for the measure will be converted to T-scores using the applicable score conversion table in the user manual and scoring instructions (PROMIS, 2023) ranging from 14 to 59 for self-report, and 14 to 56 for parent proxy with higher scores representing higher reported mobility and better outcomes.
A T-score of 50 indicates the population mean with a standard deviation of 10.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Physical Function Status as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) at Cycle 13: Pediatric v2.0 Upper Extremities 8a.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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PROMIS measures capability of physical functioning, with questions related to daily activities.
Participants 8-17 years complete a self-report of physical function in the upper extremity or lower extremity (mobility), depending on the location of the PN.
The recall period is 7 days.
All PROMIS items are answered on a Likert scale with responses ranging from 1 to 5, with higher scores representing higher physical functioning in the upper extremities.
The total raw score will be calculated as the sum of the individual item responses at a given visit (total raw scale range 8-40).
The total raw scores for the measure will be converted to T-scores using the applicable score conversion table in the user manual and scoring instructions (PROMIS, 2023) ranging from 10 to 57 for self-report, and 13 to 55 for parent proxy with higher scores representing higher reported physical functioning and better outcomes.
A T-score of 50 indicates the population mean with a standard deviation of 10.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Change From Baseline in Physical Function Status as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) at Cycle 13: Adult v2.0 Physical Function 8b.
Time Frame: Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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PROMIS measures capability of physical functioning, with questions related to daily activities.
Participants ≥ 18 years with a target PN impacting physical functioning complete a self-report of physical function.
The recall period is 7 days.
All PROMIS items are answered on a Likert scale with responses ranging from 1 to 5, with higher scores representing higher reported physical capability.
The total raw score will be calculated as the sum of the individual item responses at a given visit (total raw scale range 8-40).
The total raw scores for the measure will be converted to T-scores using the applicable score conversion table in the user manual and scoring instructions (PROMIS, 2023) ranging from 20.3 to 60.1 with higher scores representing higher reported physical functioning and better outcomes.
A T-score of 50 indicates the population mean with a standard deviation of 10.
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Baseline and Cycle 13 (1 cycle = 28 days), up to 12 months
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Collaborators and Investigators
Investigators
- Study Director: Medical Responsible, SpringWorks Therapeutics, Inc., a healthcare company of Merck KGaA, Darmstadt, Germany
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Nervous System Diseases
- Neoplasms
- Neuromuscular Diseases
- Genetic Diseases, Inborn
- Peripheral Nervous System Diseases
- Neoplasms by Histologic Type
- Neurodegenerative Diseases
- Neoplasms, Nerve Tissue
- Nervous System Neoplasms
- Heredodegenerative Disorders, Nervous System
- Nerve Sheath Neoplasms
- Neoplastic Syndromes, Hereditary
- Neurocutaneous Syndromes
- Peripheral Nervous System Neoplasms
- Congenital, Hereditary, and Neonatal Diseases and Abnormalities
- Neurofibromatoses
- Neurofibromatosis 1
- Neurofibroma
- Neurofibroma, Plexiform
- mirdametinib
Other Study ID Numbers
- MEK-NF-201
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD from completed trials will be publicly available within 6 months after all of the following events:
- Approval of a product/new indication by major authorities (FDA, EMA, PMDA if requested) with no pending submissions
- Public results via primary manuscript or trial registry disclosure
- Legal authority to share data
- Privacy protections are in place If approval is not sought or development is globally discontinued, data will be publicly available within 18 months after global trial completion. Further information on how to request data can be found on our website bit.ly/IPD21
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.