Mirdametinib treatment
The present disclosure relates to methods for treating certain types of tumors or cancers, such as plexiform neurofibromas (PN), plexiform neurofibromas associated with neurofibromatosis type 1 (NF1-PN), by administering to a patient in need thereof mirdametinib or a pharmaceutically acceptable salt thereof, such as by a certain dosing scheme.
1. A method of administering mirdametinib to a human patient in need thereof comprising orally administering to the patient mirdametinib or a pharmaceutically acceptable salt thereof, wherein
(i) for a patient having a body surface area of 0.4 to 0.69 m 2 , the patient is initially administered 1 mg mirdametinib or a pharmaceutically acceptable salt thereof twice daily,
(ii) for a patient having a body surface area of 0.7 to 1.04 m 2 , the patient is initially administered 2 mg mirdametinib or a pharmaceutically acceptable salt thereof twice daily,
(iii) for a patient having a body surface area of 1.05 to 1.49 m 2 , the patient is initially administered 3 mg mirdametinib or a pharmaceutically acceptable salt thereof twice daily, and
(iv) for a patient having a body surface area of at least 1.5 m 2 , the patient is initially administered 4 mg mirdametinib or a pharmaceutically acceptable salt thereof twice daily, and wherein the method further comprises:
(a) upon the patient exhibiting an asymptomatic, absolute decrease in left ventricle ejection fraction (LVEF) of 10% or greater from baseline and is below the lower limit of normal (LLN), withholding the mirdametinib or pharmaceutically acceptable salt thereof until improvement and then restarting administration of the mirdametinib or pharmaceutically acceptable salt thereof at a reduced dose; and
wherein the reduced dose is:
(i) for a patient having a body surface area from 0.4 to 0.69 m 2 , 1 mg once daily,
(ii) for a patient having a body surface area from 0.7 to 1.04 m 2 , 2 mg in the morning, and 1 mg in the evening,
(iii) for a patient having a body surface area from 1.05 to 1.49 m 2 , 2 mg in the morning and 2 mg in the evening, and
(iv) for a patient having a body surface area greater than or equal to 1.5 m 2 , 3 mg in the morning and 3 mg in the evening.
2. The method of claim 1 , wherein the patient suffers from a tumor or cancer.
3. The method of claim 2 , where the tumor or cancer is selected from the group consisting of plexiform neurofibromas (PN), plexiform neurofibromas associated with neurofibromatosis type 1 (NF1-PN), high grade glioma (HGG), low grade ovarian cancer, Langerhans cell histiocytosis (LCH), brain cancer, and a cancer that has metastasized to a patient's brain.
4. The method of claim 1 , wherein (a) upon the patient exhibiting an asymptomatic, absolute decrease in LVEF of 10% or greater and no more than 20% from baseline and is below the LLN, withholding the mirdametinib or pharmaceutically acceptable salt thereof until the absolute decrease in LVEF is resolved and then restarting administration of the mirdametinib or pharmaceutically acceptable salt thereof at the reduced dose.
5. The method of claim 1 , wherein the mirdametinib or pharmaceutically acceptable salt thereof is administered with or without food.
6. The method of claim 1 , wherein if a patient misses a dose of mirdametinib, the patient skips that dose and resumes administration at the next scheduled dose.
7. The method of claim 1 , wherein if vomiting occurs after administering a dose of mirdametinib, the patient does not administer an additional dose of mirdametinib, but continues with administration at the next scheduled dose.
8. The method of claim 1 , wherein the mirdametinib or pharmaceutically acceptable salt thereof is administered for the first 21 days of each 28-day cycle.
9. The method of claim 1 , wherein the mirdametinib or pharmaceutically acceptable salt thereof is administered until plexiform neurofibromas progression or unacceptable toxicity.
10. The method of claim 1 , wherein the LVEF of the patient is assessed by echocardiogram prior to initiating treatment with mirdametinib and every 3 months during the first year of treatment with mirdametinib.
11. The method of claim 1 , wherein the patient has symptomatic plexiform neurofibromas.
12. The method of claim 1 , wherein the patient has progressive plexiform neurofibromas.
13. The method of claim 1 , wherein the patient has head and neck lesions that are compromising the airway or great vessels, brachial or lumbar plexus lesions that are causing nerve compression and loss of function, lesions causing major deformity or are significantly disfiguring, lesions of the extremity that cause limb hypertrophy or loss of function or painful lesions.
14. The method of claim 1 , wherein the patient has paraspinal lesions.
15. The method of claim 1 , wherein the patient exhibits, at steady state exposure from administration of mirdametinib or a pharmaceutically acceptable salt thereof, a C max of mirdametinib of from about 100 to about 500 ng/mL, prior to withholding the mirdametinib or pharmaceutically acceptable salt thereof.
16. The method of claim 1 , wherein the patient exhibits, at steady state exposure from administration of mirdametinib or a pharmaceutically acceptable salt thereof, a C max of mirdametinib of from about 130 to about 245 ng/ml, prior to withholding the mirdametinib or pharmaceutically acceptable salt thereof.
17. The method of claim 1 , wherein the patient exhibits, at steady state exposure from administration of mirdametinib or a pharmaceutically acceptable salt thereof, a AUC last of mirdametinib of from about 200 to about 720 ng h/mL, prior to withholding the mirdametinib or pharmaceutically acceptable salt thereof.
18. The method of claim 1 , wherein the patient exhibits, at steady state exposure from administration of mirdametinib or a pharmaceutically acceptable salt thereof, a AUC last of mirdametinib of from about 250 to about 610 ng h/mL, prior to withholding the mirdametinib or pharmaceutically acceptable salt thereof.