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Arteriovenous MalformationsPhase 2NCT06098872

Pilot Study on Trametinib for Surgical Unruptured AVMs

A Phase 2 study testing Trametinib tablet in people with Arteriovenous Malformations, run by University Health Network, Toronto at 1 site in Canada.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Arteriovenous malformation (AVM) is a tangle of abnormal vessels that can progress through life and cause significant bleeding, deformity, pain, and deficits in day-to-day activities. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Arteriovenous Malformations
What is being tested?
Trametinib tablet
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
1 siteCanada
Study dates
30 Jan 2024to 26 Mar 2026
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years.
  • Confirmed diagnosis of an unruptured AVM Spetzler-Martin Lawton Young Grade equal to or less than 6 on magnetic resonance imaging (MRI), CT-angiogram (CTA) or angiogram, and clinical exam by a physician who is familiar with this condition at any time in patient's medical history.
  • Planned surgical resection of AVM at University Health Network within the acceptable window defined by the study calendar (i.e. after the indicated study drug dosing period and approximate week-long follow up).
  • Patients must not have received an investigational drug within the 4 weeks prior to study enrolment.
  • Patients who have previously received biologic therapy treatment must have completed therapy at least 14 days prior to study enrolment.
  • Patients who have previously received myelosuppressive chemotherapy must have completed therapy at least 28 days prior to study enrolment.
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  • Patients on anticoagulants must have stopped treatment within 7 days of starting Trametinib.
  • Patient is able to swallow oral medication and/or retain oral medication via G tube.
  • Patients of childbearing potential (as assessed by their local Investigator) and fertile men who are sexually active must agree to the use of 2 forms of contraception (as discussed with the overseeing physician) throughout the period of study treatment and for 16 weeks after last dose of study drug. They are not allowed to donate ova or sperm for up to 16 weeks after the last dose of study drug.

Who cannot join

  • AVM due to known germline mutation such as phosphatase and tensin homolog (PTEN) or known history of familial AVM syndromes.
  • Received prior map kinase (MEK) inhibitor therapy.
  • Known allergy or contraindication to MEK inhibitor treatment.
  • Patients who have undergone major surgery, as defined by the overseeing Investigator, within 28 days prior to study enrolment or who have not recovered from side effects of such a procedure.
  • Patients that are currently pregnant or breastfeeding.
  • A known history of coagulopathy and/or current use of anticoagulant therapy.
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  • International normalized ratio (INR) > 1.5 within 7 days of enrolment.
  • Left ventricular ejection fraction (LVEF) <50%, or any ECG abnormalities within 7 days of enrolment.
  • Retinal vein occlusion, serous retinopathy or glaucoma diagnosed within 1 month of enrolment.
  • Diagnosis of significant liver failure (Child-Pugh score 2+) within 7 days of enrolment.
  • Rhabdomyolysis (creatinine kinase (CK) >5x ULN) within 7 days of enrolment.
  • Patients with known risk factors for gastrointestinal perforation (prior perforation, diverticulitis, metastases to the gastrointestinal tract and concomitant use of medications with a recognized risk of gastrointestinal perforation
  • Positive covid-19 polymerase chain reaction (PCR) test within 7 days of enrolment.
  • Patient is unwilling or unable to comply with study requirements.
  • Unstable health status that may interfere with completing the study, as assessed by the overseeing Investigator.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • University Health Network

    Toronto, Ontario

Other trials in Canada

About this study

Official title: Pilot Study on the Efficacy of MEK1/MEK2 Inhibitor Trametinib in Patients With Surgical Unruptured Arteriovenous Malformations

Arteriovenous malformation (AVM) is a tangle of abnormal vessels that can progress through life and cause significant bleeding, deformity, pain, and deficits in day-to-day activities. Surgery is a common treatment option for patients with AVMs where the goal is to safely remove the entire AVM without causing complications. While any surgery has its potential risks, most of the potential modifiable risk factors relate to the AVM's structure, such as the AVM size or presence of high risk structural features seen on scans. The purpose of this pilot study is to see whether taking an oral medication called Trametinib can improve upon the AVM structure in adult patients before their scheduled surgery.

Read the detailed description

The goal of this pilot clinical trial is to see whether an oral medication called Trametinib can be given to patients with arteriovenous malformations (AVMs) of the brain and body before surgery in order to make the AVM structure less risky for surgery.

The main questions it aims to answer are:

  1. does taking Trametinib make the structure of the AVM less risky for surgery? This will determined by comparing the size and structure of the AVM on repeat scans before and after taking the drug.
  2. does taking Trametinib reduce the blood flow to the AVM? This will be determined by quantifying the blood flow to the AVM with quantitative magnetic resonance imaging software.
  3. is the drug well tolerated in this patient population? This will be determined by following for any side effects of the medication
  4. how does the drug do what it is supposed to do clinically by looking at its effect at the cell level? This will be determined by taking a piece of the AVM that is removed at the time of surgery and running experiments in the lab to compare its structure and behaviour to other AVMs that were not treated with this medication.

Participants will first undergo screening tests to ensure they are candidates for the medication. They will take oral Trametinib once daily for a total of 60 days prior to their planned surgery. They will be monitored for side effects at days 15, 30 and 60. They will undergo routine scans prior to starting the drug and then again within 5 days of their last dose to see any changes made to the AVM structure after taking the drug. Lastly, at the time of surgery, a part of the AVM removed will be sent to our research lab to see what the drug is doing at the cell level to result in the changes we can see on the scans.

Being tested
Trametinib tablet
Keywords
Trametinib, Mitogen-activated-protein-kinase (MEK) inhibitor
Medical subject headings
Arteriovenous Malformations

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Trametinib tabletDrug

    Drug is supplied in 2mg and 0.5 mg tablets

Study groups in NCT06098872
Study groupRoleWhat they receive
Experimental: Oral TrametinibExperimentalParticipants will receive oral Trametinib once daily for up to 60 days prior to their elective surgery
Receives: Drug: Trametinib tablet

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Radiological response by independent central review at day 60 or 5 days after last dose, whichever comes first

    as defined by one or more of the following: (1) at least 20% reduction in the volume of the AVM confirmed on repeat imaging, (2) resolution of angiographic weak points, or (3) resolution of AVM induced parenchymal changes by independent central review.

    Measured: screening, Day 60 or 5 days after last dose (whichever comes first)

Secondary outcomes (4)
  1. Safety of Trametinib in surgical AVM population

    Participants will be followed serially for the presence of adverse events, including their type, severity, and need for dose modifications or interruptions

    Measured: screening, Day 15, 30, 60, within 1 week of surgery and up to 30 days after final dose

  2. Change from baseline in symptomatology and functional performance

    Participants will be followed serially for any changes in self-reported clinical symptoms or signs, and for any changes in functional outcome with the modified Rankin Scale (mRS) (scale from 0 to 6, with increasing score representing worse functional status)

    Measured: screening, day 15, 30, and 60

  3. Change from baseline in AVM blood flow

    The blood flow to the AVM will be objectively compared over time after Trametinib dosing with serial quantitative magnetic resonance angiography imaging

    Measured: screening, day 60 or 5 days after final dose (whichever comes first)

  4. Effect of Trametinib on AVM pathobiology

    The documentation of signaling pathways identified in AVM tissues after Trametinib drug administration

    Measured: time of surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Oct 2023
  2. Study start30 Jan 2024
  3. Primary completion26 Mar 2026
  4. Study completion26 Mar 2026

Why it stopped: No patients enrolled

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
This is an open-label pilot study assessing the potential efficacy of Trametinib in improving AVM angioarchitecture for patients who are already planned to undergo surgical resection as part of their standard of care.
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06098872
Sponsor's protocol ID
23-5463
Other IDs
OZUHN-017
Status last verified
Oct 2023
First submitted
17 Oct 2023
Last updated
22 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Mansur A, Radovanovic I. Vascular malformations: An overview of their molecular pathways, detection of mutational profiles and subsequent targets for drug therapy. Front Neurol. 2023 Feb 10;14:1099328. doi: 10.3389/fneur.2023.1099328. eCollection 2023.

    PubMed 36846125
  • Nikolaev SI, Fish JE, Radovanovic I. Somatic Activating KRAS Mutations in Arteriovenous Malformations of the Brain. N Engl J Med. 2018 Apr 19;378(16):1561-1562. doi: 10.1056/NEJMc1802190. No abstract available.

    PubMed 29669234
  • Fish JE, Flores Suarez CP, Boudreau E, Herman AM, Gutierrez MC, Gustafson D, DiStefano PV, Cui M, Chen Z, De Ruiz KB, Schexnayder TS, Ward CS, Radovanovic I, Wythe JD. Somatic Gain of KRAS Function in the Endothelium Is Sufficient to Cause Vascular Malformations That Require MEK but Not PI3K Signaling. Circ Res. 2020 Aug 28;127(6):727-743. doi: 10.1161/CIRCRESAHA.119.316500. Epub 2020 Jun 17.

    PubMed 32552404
  • Hong T, Yan Y, Li J, Radovanovic I, Ma X, Shao YW, Yu J, Ma Y, Zhang P, Ling F, Huang S, Zhang H, Wang Y. High prevalence of KRAS/BRAF somatic mutations in brain and spinal cord arteriovenous malformations. Brain. 2019 Jan 1;142(1):23-34. doi: 10.1093/brain/awy307.

    PubMed 30544177
  • Nicholson CL, Flanagan S, Murati M, Boull C, McGough E, Ameduri R, Weigel B, Maguiness S. Successful management of an arteriovenous malformation with trametinib in a patient with capillary-malformation arteriovenous malformation syndrome and cardiac compromise. Pediatr Dermatol. 2022 Mar;39(2):316-319. doi: 10.1111/pde.14912. Epub 2022 Jan 10.

    PubMed 35014097
  • Lekwuttikarn R, Lim YH, Admani S, Choate KA, Teng JMC. Genotype-Guided Medical Treatment of an Arteriovenous Malformation in a Child. JAMA Dermatol. 2019 Feb 1;155(2):256-257. doi: 10.1001/jamadermatol.2018.4653.

    PubMed 30566190
  • Edwards EA, Phelps AS, Cooke D, Frieden IJ, Zapala MA, Fullerton HJ, Shimano KA. Monitoring Arteriovenous Malformation Response to Genotype-Targeted Therapy. Pediatrics. 2020 Sep;146(3):e20193206. doi: 10.1542/peds.2019-3206.

    PubMed 32859736
  • Wright CJ, McCormack PL. Trametinib: first global approval. Drugs. 2013 Jul;73(11):1245-54. doi: 10.1007/s40265-013-0096-1.

    PubMed 23846731
  • Couto JA, Huang AY, Konczyk DJ, Goss JA, Fishman SJ, Mulliken JB, Warman ML, Greene AK. Somatic MAP2K1 Mutations Are Associated with Extracranial Arteriovenous Malformation. Am J Hum Genet. 2017 Mar 2;100(3):546-554. doi: 10.1016/j.ajhg.2017.01.018. Epub 2017 Feb 9.

    PubMed 28190454
  • Avolio E, Bassani B, Campanile M, Mohammed KA, Muti P, Bruno A, Spinetti G, Madeddu P. Shared molecular, cellular, and environmental hallmarks in cardiovascular disease and cancer: Any place for drug repurposing? Pharmacol Rev. 2025 Mar;77(2):100033. doi: 10.1016/j.pharmr.2024.100033. Epub 2024 Dec 24.

    PubMed 40148035

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Trametinib tablet in people with Arteriovenous Malformations, run by University Health Network, Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 22 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Radiological response by independent central review at day 60 or 5 days after last dose, whichever comes first (time frame: screening, Day 60 or 5 days after last dose (whichever comes first)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06098872, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 May 2026.

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