Binimetinib in Treating Patients with Relapsed, Refractory, or Poor Prognosis Acute Myeloid Leukemia, Myelodysplastic Syndrome, or Acute Lymphoblastic Leukemia

Inclusion Criteria

• PHASE I * Primary or secondary AML according to World Health Organization (WHO) classification, with relapsed or refractory disease or newly diagnosed older subjects (greater than or equal to 65 years of age), not candidates for intensive chemotherapy * Subjects with myelodysplastic syndrome (MDS), International Prognostic Scoring System (IPSS) intermediate (Int)-2 or high risk (refractory anemia with excess blasts [RAEB]-2 only, i.e. greater than or equal to 10% blast) who are resistant or intolerant to standard treatment and are not candidates for transplantation * Subjects with acute lymphoblastic leukemia (ALL), relapsed, refractory or intolerant to standard treatment and for whom no effective treatment options are available
• Patients should be willing and able to give informed consent
• Eastern Cooperative Group (ECOG) performance status (PS) less than or equal to 2
• PHASE II -- Patients aged 60 and older with newly diagnosed primary or secondary AML according to WHO classification, without any prior therapy for AML with the exception of (a) emergency leukapheresis and (b) emergency treatment for hyperleukocytosis with hydroxyurea that is allowed until 24 hours before start of the trial treatment; Note: prior therapy for preexisting hematological condition e.g. MDS or myeloproliferative disease (MPD), including but not limited to hypomethylating agents is allowed until at least 2 weeks have elapsed from completion of that agent before the first dose of MEK 162; patients with relapsed AML, and relapsed MDS and CMML, after prior hypomethylating therapy are also eligible to participate
• Patients with untreated AML must meet at least one of the following conditions: * Age greater than or equal to 75 years; * Age greater or equal to 60 and less than 75 years with at least one of the following poor prognostic factors: ** Secondary AML, as determined by known and documented exposure to chemotherapy or radiation therapy ** Antecedent history of MDS or myeloproliferative disorder according to WHO criteria for at least 3 months prior to trial entry; ** Unfavorable cytogenetic abnormalities including chromosome 5 and 7 as well as complex; ** ECOG performance status 2
• Patients are willing and able to give informed consent (Phase II only)
• Only patients with mutated rat sarcoma (RAS) (KRAS and NRAS) mutations are eligible to participate (Phase II only)
• Left ventricular ejection fraction (LVEF) greater than or equal to 50% as determined by a multigated acquisition (MUGA) scan or echocardiogram (Phase II only)
• Corrected QT interval using Fridericia's formula (QTcF) interval less than or equal to 480 ms (Phase II only)

Exclusion Criteria

• PHASE I and II -- Administration of any antineoplastic therapy within at least 4 weeks (cytotoxic chemotherapy) or 2 weeks (biological and targeted therapy; hypomethylating agents are considered to be biological therapy) of that therapy of the first MEK 162/MEK 162 dose; except the use of hydroxyurea which can be administered up to 5 g/day up to 24 hours before the initiation of the study drug
• Patients should not have received an investigational agent for at least 2 weeks prior to the first study drug dose
• Clinical evidence of active central nervous system (CNS) leukemia requiring active therapy; prior CNS leukemia well-controlled by ongoing therapy is allowed
• Active and uncontrolled infection including but not limited to known infection with human immunodeficiency virus (HIV), active hepatitis B, or hepatitis C
• Major surgery within two weeks prior to trial entry
• Total bilirubin > 1.5 x upper limit of normal (ULN) unless related to Gilbert's syndrome or hemolysis
• Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) > 2.5 X ULN, or for subjects with liver involvement AST and/or ALT > 5 x ULN
• Serum creatinine > 1.5 x ULN and/or creatinine clearance (CrCl) < 30 mL/min at screening (calculation according to Cockcroft & Gault formula)
• Pregnant or nursing (lactating) women
• Female patients of childbearing potential and male patients with partners of childbearing potential who are not willing to use highly effective methods of contraception throughout the study and for 1 month after study drug discontinuation; highly effective contraception methods include: * Total abstinence or * Male or female sterilization * Combination of any two of the following: ** Use of oral, injected, or implanted hormonal methods of contraception ** Placement of an intrauterine device (IUD) or intrauterine system (IUS) ** Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/vaginal suppository
• Female patients with reproductive potential who do not have a negative blood or urine pregnancy test at screening
• History of significant difficulty swallowing, malabsorption or other chronic gastrointestinal disease or conditions that may hamper compliance and/or absorption of the tested product
• Has significant cardiac conduction abnormalities and/ or pacemaker or any of the following criteria: * History of acute coronary syndromes (including myocardial infarction, unstable angina, coronary artery bypass graft [CABG], coronary angioplasty, or stenting) < 6 months prior to screening * Symptomatic chronic heart failure; evidence of clinically significant cardiac arrhythmias and/or conduction abnormalities < 6 months prior to screening * Uncontrolled arterial hypertension, defined as blood pressure (BP) > 140/100 mmHg (average of 3 consecutive readings)
• History or current evidence of central serous retinopathy (CSR), retinal vein occlusion (RVO)
• Any ophthalmopathy visible at screening that would be considered a risk factor for CSR or RVO by the ophthalmologist (e.g. uncontrolled glaucoma or ocular hypertension, uncontrolled diabetes mellitus, history of hyperviscosity or hypercoagulability syndromes)
• Subjects with active other tumors, except early stage squamous cell carcinoma of the skin, basal cell carcinoma of the skin, or cervical intraepithelial neoplasia (CIN)
• Patients who have neuromuscular disorders that are associated with elevated creatine kinase (CK) (e.g., inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy)
• Patients who are planning on embarking on a new strenuous exercise regimen after first dose of study treatment; nota bene (NB): muscular activities, such as strenuous exercise, that can result in significant increases in plasma CK levels should be avoided while on MEK162 treatment
• Impairment of gastrointestinal function or gastrointestinal disease (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, small bowel resection)