MEK Inhibitor 162 Relapsed and/or Refractory Acute Myeloid Leukemia (AML) and Poor Prognosis, Not Suitable for or Unwilling to Receive Standard Therapy

Phase I:

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a study
group based on when you join this study. Up to 2 groups of 3-6 participants will be enrolled
in Phase 1 of the study.

If you are enrolled in Phase 1, the dose of MEK162 you receive will depend on when you joined
this study. The first group of participants will receive the lowest dose level of MEK162. The
second group will receive a higher dose of MEK162 than the group before it, if no intolerable
side effects were seen. This is designed to find the highest tolerable dose of MEK 162.

Participants in Phase 2 will then receive the highest tolerated dose that was found in Phase
1.

Study Drug Administration:

You will take MEK162 tablets by mouth 2 times a day (about 12 hours apart) every day with a
full cup of water.

There are 4 weeks in each study cycle.

Study Visits:

On Day 1 of Cycle 1:

- You will have a physical exam.

- Blood (about 4 teaspoons) will be drawn for routine tests and blood sugar testing.

On Days 4 and 8 of Cycle 1, blood (about 4 teaspoons) will be drawn for routine tests and
blood sugar testing.

Sometime during Days 13-27 of each cycle and again on Day 28 of Cycles 2 and beyond, the
study staff will call you and ask about any drugs you may be taking and any side effects you
may be having. The calls should last less than 10 minutes each time.

On Day 28 of Cycle 1, you will have a bone marrow aspirate and/or biopsy to check the status
of the disease and for biomarker and cytogenetic testing. If bone marrow cannot be collected,
blood (about 1-2 teaspoons) will be drawn for these tests.

You will have an EKG and either an ECHO or MUGA scan to check your heart function.

On Day 1 of Cycle 2 and beyond:

- You will have a physical exam.

- Blood (about 4 teaspoons) will be drawn for routine tests and blood sugar testing.

- Urine will be collected for routine tests.

- You will have an eye exam by an eye doctor.

- If you can become pregnant, blood (about 1 teaspoon) or urine will be collected for a
pregnancy test.

On visits when you have blood sugar testing, you should fast for at least 8 hours before the
blood draw.

On visits when you have urine collected, you will be given containers to collect your urine
over 24 hours if the doctor thinks it is needed.

If it is more convenient to you, you may be able to have some of your blood draws done away
from MD Anderson. The study staff will discuss this with you.

Every two or three months during your treatment, you will have an echocardiogram (ECHO) or a
multigated acquisition (MUGA) scan to check your heart function.

Length of Study:

You may continue taking the study drug for as long as the doctor thinks it is in your best
interest. You will no longer be able to take the study drug if the disease gets worse, if
intolerable side effects occur, or if you are unable to follow study directions.

Your participation on the study will be over once you have completed the end-of-treatment
visit.

End-of-Treatment Visit:

After your last dose of study drug:

- You will have a physical exam.

- Blood (about 2 teaspoons) will be drawn for routine tests

- If the doctor thinks it is needed, you will have a bone marrow aspirate and/or biopsy to
check the status of the disease and for biomarker, PD, and/or cytogenetic testing. If
you have already had a bone marrow aspirate and/or biopsy recently and your doctor
thinks repeating it is not needed, leftover bone marrow will be used for these tests. If
bone marrow cannot be collected, blood (about 1-2 teaspoons) will be drawn for these
tests.

- You will have an EKG.

Phase II:

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a study
group based on when you join this study. Up to 42 participants will be enrolled in Phase 2 of
the study.

Participants in Phase 1 were given a dose of MEK162 based on when they joined the study.
Groups of participants were given different dose levels until the highest tolerable dose of
MEK162 was found.

If you are enrolled in Phase 2, you will receive MEK162 at the highest dose that was
tolerated in Phase 1.

Study Drug Administration:

You will take MEK162 tablets by mouth 2 times a day (about 12 hours apart) every day with a
full cup of water.

There are 4 weeks in each study cycle.

Study Visits:

On Day 1 of Cycle 1:

- You will have a physical exam.

- Blood (about 4 teaspoons) will be drawn for routine tests and blood sugar testing.

On Days 4 and 8 of Cycle 1, blood (about 4 teaspoons) will be drawn for routine tests and
blood sugar testing.

Sometime during Days 13-27 of each cycle and again on Day 28 of Cycles 2 and beyond, the
study staff will call you and ask about any drugs you may be taking and any side effects you
may be having. The calls should last less than 10 minutes each time.

On Day 28 of Cycle 1, you will have a bone marrow aspirate and/or biopsy to check the status
of the disease and for biomarker and cytogenetic testing. If bone marrow cannot be collected,
blood (about 1-2 teaspoons) will be drawn for these tests.

You will have an EKG and either an ECHO or MUGA scan to check your heart function.

On Day 1 of Cycle 2 and beyond:

- You will have a physical exam.

- Blood (about 4 teaspoons) will be drawn for routine tests and blood sugar testing.

- Urine will be collected for routine tests.

- You will have an eye exam by an eye doctor.

- If you can become pregnant, blood (about 1 teaspoon) or urine will be collected for a
pregnancy test.

On visits when you have blood sugar testing, you should fast for at least 8 hours before the
blood draw.

On visits when you have urine collected, you will be given containers to collect your urine
over 24 hours if the doctor thinks it is needed.

If it is more convenient to you, you may be able to have some of your blood draws done away
from MD Anderson. The study staff will discuss this with you.

Every two or three months during your treatment, you will have an echocardiogram (ECHO) or a
multigated acquisition (MUGA) scan to check your heart function.

Length of Study:

You may continue taking the study drug for as long as the doctor thinks it is in your best
interest. You will no longer be able to take the study drug if the disease gets worse, if
intolerable side effects occur, or if you are unable to follow study directions.

Your participation on the study will be over once you have completed the end-of-treatment
visit.

End-of-Treatment Visit:

After your last dose of study drug:

- You will have a physical exam.

- Blood (about 2 teaspoons) will be drawn for routine tests

- If the doctor thinks it is needed, you will have a bone marrow aspirate and/or biopsy to
check the status of the disease and for biomarker, PD, and/or cytogenetic testing. If
you have already had a bone marrow aspirate and/or biopsy recently and your doctor
thinks repeating it is not needed, leftover bone marrow will be used for these tests. If
bone marrow cannot be collected, blood (about 1-2 teaspoons) will be drawn for these
tests.

- You will have an EKG.

Inclusion Criteria:

1. PHASE I -- a. Primary or secondary AML according to 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; b. Subjects with MDS, IPSS
Int-2 or high risk (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; c. Subjects with ALL, relapsed, refractory or intolerant to standard
treatment and for whom no effective treatment options are available.

2. Age greater or equal to 18 years.

3. Patients should be willing and able to give informed consent.

4. Eastern Cooperative Group (ECOG) PS less than or equal to 2.

5. 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 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.

6. Patients must meet at least one of the following conditions: a. Age greater than or
equal to 75 years; b. Age greater or equal to 60 and less than 75 years with at least
one of the following poor prognostic factors: i. Secondary AML, as determined by known
and documented exposure to chemotherapy or radiation therapy; ii. antecedent history
of MDS or myeloproliferative disorder according to WHO criteria for at least 3 months
prior to trial entry; iii. unfavorable cytogenetic abnormalities including chromosome
5 and 7 as well as complex; iv. ECOG Performance status 2. (Phase II ONLY)

7. Patients are willing and able to give informed consent. (Phase II only)

8. Only patients with mutated RAS (KRAS and NRAS) mutations are eligible to participate.
(Phase II only)

9. Adequate cardiac function defined as: --left ventricular ejection fraction (LVEF)
greater than or equal to 50% as determined by a multigated acquisition (MUGA) scan or
echocardiogram; -- QTcF interval less than or equal to 480 ms. (Phase II only)

Exclusion Criteria:

1. 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.

2. Patients should not have received an investigational agent for at least 2 weeks prior
to the first study drug dose.

3. Clinical evidence of active CNS leukemia requiring active therapy; prior CNS leukemia
well-controlled by ongoing therapy is allowed.

4. Active and uncontrolled infection including but not limited to known infection with
HIV, active hepatitis B, or hepatitis C.

5. Major surgery within two weeks prior to trial entry.

6. Liver function tests above the following limits at the screening: total bilirubin >
1.5 x ULN unless related to Gilbert's syndrome or hemolysis, AST and/or ALT > 2.5 X
ULN, or for subjects with liver involvement AST and/or ALT > 5 x ULN.

7. Serum creatinine > 1.5 x ULN and/or Creatinine Clearance (CrCl) < 30 mL/min at
screening (calculation according to Cockcroft & Gault formula).

8. Pregnant or nursing (lactating) women;

9. Female patients of childbearing potential and male patients with partners of
childbearing potential who are not willing ot 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 (a+b or a+c or b+c);
a. Use of oral, injected, or implanted hormonal methods of contraception; b. Placement
of an intrauterine device (IUD) or intrauterine system (IUS); c. Barrier methods of
contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with
spermicidal foam/gel/film/cream/vaginal suppository.

10. Female patients with reproductive potential who do not have a negative blood or urine
pregnancy test at screening;

11. History of significant difficulty swallowing, malabsorption or other chronic
gastro-intestinal disease or conditions that may hamper compliance and/or absorption
of the tested product.

12. Has significant cardiac conduction abnormalities and/ or pacemaker or any of the
following criteria: -- History of acute coronary syndromes (including myocardial
infarction, unstable angina, 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 BP > 140/100 mmHg (average of 3
consecutive readings)

13. History or current evidence of central serous retinopathy (CSR), retinal vein
occlusion (RVO).

14. 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).

15. 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).

16. Patients who have neuromuscular disorders that are associated with elevated CK (e.g.,
inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal
muscular atrophy).

17. Patients who are planning on embarking on a new strenuous exercise regimen after first
dose of study treatment. NB: Muscular activities, such as strenuous exercise, that can
result in significant increases in plasma CK levels should be avoided while on MEK162
treatment.

18. Impairment of gastrointestinal function or gastrointestinal disease (e.g., ulcerative
disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, small bowel
resection).