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    Summary
    EudraCT Number:2012-003593-51
    Sponsor's Protocol Code Number:CMEK162A2301
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2013-03-06
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2012-003593-51
    A.3Full title of the trial
    The NEMO trial (NRAS melanoma and MEK inhibitor): A randomized Phase III, open label, multicenter, two-arm study comparing MEK162 versus dacarbazine in patients with advanced unresectable or metastatic NRAS mutation-positive melanoma
    Ensayo NEMO (melanoma NRAS e inhibidor MEK): Estudio aleatorizado de Fase III, abierto, multicéntrico, de dos brazos, que compara la eficacia de MEK162 frente a Dacarbazina en pacientes con melanoma avanzado no resecable o metástasico con mutación NRAS positiva
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study comparing the efficacy of MEK162 versus dacarbazine in unresectable or metastatic NRAS mutation-positive melanoma (NEMO)
    Estudio que compara la eficacia de MEK162 contra dacarbazina del melanoma no resecable o metastásico con mutación positiva NRAS (NEMO)
    A.3.2Name or abbreviated title of the trial where available
    NEMO
    NEMO
    A.4.1Sponsor's protocol code numberCMEK162A2301
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT01763164
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorArray Biopharma Inc
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportArray Biopharma Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationArray Biopharma Inc
    B.5.2Functional name of contact pointMargaret Vargo
    B.5.3 Address:
    B.5.3.1Street Address3200 Walmut Street
    B.5.3.2Town/ cityBoulder
    B.5.3.3Post codeCO80301
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1303 3861485
    B.5.5Fax number+1303 3861252
    B.5.6E-mailmargie.vargo@arraybiopharma.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.2Product code MEK162
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMEK162
    D.3.9.1CAS number 606143-89-9
    D.3.9.2Current sponsor codeMEK162
    D.3.9.3Other descriptive nameMEK162
    D.3.9.4EV Substance CodeSUB31901
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namedacarbacina
    D.3.4Pharmaceutical form Powder for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDACARBACINA
    D.3.9.1CAS number 4342-03-4
    D.3.9.4EV Substance CodeSUB06882MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDacarbacina
    D.3.4Pharmaceutical form Powder for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDACARBACINA
    D.3.9.1CAS number 4342-03-4
    D.3.9.4EV Substance CodeSUB06882MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1000
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    metastatic or unresectable cutaneous melanoma
    melanoma cutáneo metastásico o irresecable
    E.1.1.1Medical condition in easily understood language
    metastatic or inoperable melanoma of the skin
    melanoma metastásico o inoperable de la piel
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10053571
    E.1.2Term Melanoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To determine whether treatment with MEK162 prolongs PFS as compared to dacarbazine in patients with advanced unresectable, or metastatic NRAS mutation-positive CUTANEUS or unknown primary melanoma who are previously untreated or who have progressed on or after prior (first-line immunotherapy for metastatic disease) TREATMENT WITH ANY NUMBER OF LINES OF INMUNOTHERAPY FOR UNRESECABLE OR METASTATIC DISEASE.
    El objetivo principal del estudio es determinar si el tratamiento con MEK162 prolonga la PFS en comparación con dacarbazina en pacientes con melanoma CUTANEO avanzado no resecable o metastásico con mutación NRAS positiva o melanoma primario desconocido no tratados previamente o que hayan progresado durante o tras (inmunoterapia previa de primera línea para enfermedad metastásica) TRATAMIENTO PREVIO CON CUALQUIER NÚMERO DE LÍNEAS DE INMUNOTERAPIA PARA ENFERMEDAD NO RESECABLE O METASTÁSICA .
    PFS será analizada principalmente en base al Comité de Revisión Independiente Ciego (BIRC). Las evaluaciones del investigador local se utilizarán como un análisis de apoyo clave
    E.2.2Secondary objectives of the trial
    Key secondary:
    To compare Overall Survival (OS) between treatment arms

    Other secondary:
    - To compare the Overall Response Rate (ORR) between treatment arms
    - To describe the time to objective response (TTR) in the two treatment arms
    - To describe the duration of objective response (DOR) between treatment arms
    - To compare the disease control rate (DCR) between treatment arms
    - To assess assess the safety and tolerability of MEK162 in this patient population using NCI CTCAE v4.03
    Comparar la Supervivencia Global (SG) entre los brazos de tratamiento:
    ?Comparar la Tasa de Respuesta Global (TRG) entre los brazos de tratamiento
    ?Describir el tiempo hasta la respuesta del objetivo (TTR) en los 2 brazos de tratamiento
    ?Describir la duración de la respuesta objetivo (DRO) en los 2 brazos de tratamiento
    ?Comparar la tasa de control de la enfermedad (DCR) entre los 2 brazos de tratamiento
    ?Evaluar la seguridad y tolerabilidad de MEK162 en esta población de pacientes mediante CTCAE versión 4.03
    ?Caracterizar la farmacocinética de MEK162 en esta población de pacientes
    ?Comparar el estado de salud global entre los brazos de tratamiento utilizando el Cuestionario de Calidad de Vida EORTC 30 (EORTC QLQ-C30) y el EuroQoL-5D (EQ-5D)
    ?Comparar el ECOG OMS entre los brazos de tratamiento
    ?Evaluar la concordancia entre el estado de mutación NRAS obtenido mediante la prueba del ensayo clínico para registro y la prueba diagnóstica acompañante que se someterá a PMA
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Written informed consent must be obtained prior to any study procedures.
    1. Signed written informed consent;
    2. Male or female patient, age ? 18 years;
    3. Histologically confirmed diagnosis of locally advanced, unresectable or metastatic cutaneous OR UNKNOWN PRIMARY melanoma AJCC Stage IIIC or IV UVEAL AND MUCOSAL MELANOMA ARE EXCLUDED;
    4. Presence of NRAS Q61 mutation in tumor tissue prior to randomization, as determined by a Novartis designated central laboratory;
    5. Naïve untreated patients or patients who have progressed on or after prior (first-line) TREATMENT WITH ANY NUMBER OF LINES OF immunotherapy for metastatic melanoma;
    Note: Prior adjuvant therapy is permitted, except the administration of MEK inhibitors
    6. Evidence of at least one measurable lesion as documented by radiological or photographic methods according to Novartis guideline version 3.1 based on RECIST version 1.1 (Appendix 2);
    Note: A previously irradiated lesion is eligible to be considered as a measurable lesion provided that there is objective evidence of progression of the lesion since discontinuation of therapy and prior to starting study drug (see Appendix 2).
    7. ECOG performance status of 0-1 (Table 7-3);
    8. Adequate bone marrow, organ function and laboratory parameters:
    ? Absolute neutrophil count (ANC) ? 1.5 x 109/L,
    ? Hemoglobin (Hgb) ? 10 g/dL without transfusions,
    ? Platelets (PLT) ? 100 x 109/L without transfusions,
    ? AST and/or ALT ? 2.5 × upper limit of normal (ULN); patients with liver metastases ? 5 ×ULN,
    ? Total bilirubin ? 2 × ULN,
    ? Creatinine ? 1.5 mg/dL;
    9. Adequate cardiac function:
    ? left ventricular ejection fraction (LVEF) ? 50% as determined by a multigated acquisition (MUGA) scan or echocardiogram,
    ? QTcF interval ? 480 ms;
    10. Able to take oral medications;
    11. Patient is deemed by the Investigator to have the initiative and means to be compliant with the protocol (treatment and follow-up);
    12. Negative serum ? HCG test (female patient of childbearing potential only) performed locally within 72 hours prior to first dose.
    1. Consentimiento informado por escrito firmado;
    2. Paciente hombre o mujer, edad ? 18 años;
    3. Diagnóstico histológicamente confirmado de melanoma PRIMARIO DESCONOCIDO O cutáneo localmente avanzado, no resecable O metastásico, AJCC Estadio IIIC o IV (Apéndice 1) QUEDA EXCLUIDO EL MELANOMA UVEAL O DE LA MUCOSA;
    4. Presencia de mutación NRAS Q61 en tejido de tumor antes de la aleatorización, determinado por un laboratorio central designado por Novartis;
    5. Pacientes no tratados previamente o que hayan progresado durante o tras TRATAMIENTO PREVIO CON CUALQUIER NÚMERO DE LÍNEAS DE INMUNOTERAPIA PARA MELANOMA NO RESECABLE O METASTÁSICO (inmunoterapia previa de primera línea para melanoma metastásico);
    Nota: Terapia adyuvante está permitida, excepto la administración de inhibidores MEK
    6. Evidencia de al menos una lesión medible detectada mediante métodos radiológicos o fotográficos de acuerdo con la guía de Novartis versión 3.1 basada en RECIST versión 1.1 (Apéndice 2);
    Nota: Una lesión previamente irradiada es elegible para ser considerada como lesión medible siempre que haya evidencia objetiva de progresión de la lesión desde la retirada de la terapia y antes del inicio del fármaco del estudio (ver Apéndice 2).
    7. Estado funcional ECOG de 0-1 (Tabla 7-3);
    8. Médula ósea, función de órganos y parámetros analíticos adecuados:
    ? Recuento absoluto de neutrófilos (ANC) ? 1,5 x 109/L,
    ? Hemoglobina (Hb) ? 10 g/dL sin transfusiones,
    ? Plaquetas (PLT) ? 100 x 109/L sin transfusiones,
    ? AST y/o ALT ? 2,5 × límite superior de normalidad (LSN); paciente con metástasis hepática ? 5 ×LSN,
    ? Bilirrubina total ? 2 × LSN,
    ? Creatinina ? 1,5 mg/dL;
    9. Función cardiaca adecuada:
    ? Fracción de eyección ventricular izquierda (FEVI) ? 50% determinado mediante ventriculografía isotópica (MUGA) o ecocardiograma,
    ? Intervalo QTcF ? 480 ms;
    10. Capaz de tomar medicaciones orales;
    11. El paciente es considerado por el Investigador que tiene la iniciativa y medios para ser cumplidor con el protocolo (tratamiento y seguimiento);
    12. Prueba de ? HCG negativa en suero (paciente mujer en edad fértil solo) realizada localmente en un plazo de 72 horas antes de la primera dosis.
    E.4Principal exclusion criteria
    1. Any UNTREATED active central nervous system (CNS) lesion (i.e., those with radiographically unstable, symptomatic lesions). However, patient treated with radiotherapy or surgery are eligible if the patient remained without evidence of CNS disease progression ? 4 weeks. Patients must be off corticosteroid therapy for ? 3 weeks.
    2. UVEAL OR MUCOSAL MELANOMA(Non-cutaneous melanoma;)
    3. History of leptomeningeal metastases;
    4. History or current evidence of retinal vein occlusion (RVO) or current risk factors for RVO (e.g. uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability syndromes);
    6. History of allogeneic bone marrow transplantation or organ transplantation;
    7. History of Gilbert?s syndrome;
    8. Previous or concurrent malignancy with the following exceptions:
    ? adequately treated basal cell or squamous cell carcinoma of the skin (adequate wound healing is required prior to study entry),
    ? in situ carcinoma of the cervix, treated curatively and without evidence of recurrence for at least 3 years prior to the study,
    ? a primary malignancy which has been completely resected and in complete remission for ?5 years;
    9. Prior therapy with a MEK- inhibitor;
    10. Patients who have received more than one line of immunotherapy for metastatic melanoma;
    11. Patients with washout period < 6 weeks from the last dose of ipilimumab or other immunotherapy;
    Note: chemotherapy given as part of isolated limb perfusion, regional or intralesional treatment will not be considered systemic treatment
    12. Any previous systemic chemotherapy for unresectable locally advanced or metastatic melanoma;
    13. Impaired cardiovascular function or clinically significant cardiovascular diseases, including any of the following:
    ? History of acute coronary syndromes (including myocardial infarction, unstable angina, coronary artery bypass grafting, coronary angioplasty, or stenting) <6 months prior to screening,
    ? Symptomatic chronic heart failure, history or current evidence of clinically significant cardiac arrhythmia and/or conduction abnormality <6 months prior to screening except atrial fibrillation and paroxysmal supraventricular tachycardia;
    14. Uncontrolled arterial hypertension despite medical treatment;
    15. Known positive serology for HIV, active hepatitis B, and/or active hepatitis C infection
    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);
    19. Any other condition that would, in the Investigator?s judgment, contraindicate the patient?s participation in the clinical study due to safety concerns or compliance with clinical study procedures, e.g., infection/inflammation, intestinal obstruction, unable to swallow medication, social/ psychological issues, etc.;
    20. Patients who have undergone major surgery or radiotherapy ? 3 weeks prior to starting study drug or who have not recovered from side effects of such procedure;
    21. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test;
    22. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception throughout the study and for 30 days after study drug discontinuation.
    1.1. Cualquier lesión NO TRATADA del sistema nervioso central (SNC) (es decir, aquellas con lesiones sintomáticas inestables radiológicamente). No obstante, los pacientes tratados con radioterapia o cirugía son elegibles si el paciente permaneció sin evidencia de progresión de la enfermedad del SNC ? 4 semanas. Los pacientes deben haber suspendido la terapia con corticosteroides durante ? 3 semanas.
    2. Melanoma (no cutáneo) UVEAL O DE LA MUCOSA;
    3. Antecedentes de metástasis leptomeníngea;
    4. Antecedentes o evidencia actual de oclusión venosa retiniana (RVO) o factores de riesgo para RVO (p.e. glaucoma no controlado, antecedentes de síndromes de hiperviscosidad o hipercoagulabilidad);
    5. Antecedentes de trasplante de médula ósea alogénica o trasplante de órganos;
    6. Antecedentes de síndrome de Gilbert;
    7. Neoplasia previa o concurrente con las siguientes excepciones:
    ? Carcinoma cutáneo de células basales o células escamosas adecuadamente tratado (adecuada curación de las heridas es necesaria antes de la entrada en el estudio),
    ? Carcinoma in situ de cervix, tratado curativamente y sin evidencia de recurrencia durante al menos 3 años antes del estudio,
    ? Una neoplasia primaria que ha sido completamente resecada y en remisión completa durante ?5 años;
    8. Terapia previa con un inhibidor de MEK;
    9. Pacientes que hayan recibido más de una línea de inmunoterapia para melanoma metastásico:
    10. Pacientes con un periodo de levado < 6 semanas desde la última dosis de ipilimumab u otra inmunoterapia;
    11. Cualquier quimioterapia sistémica previa para melanoma localmente avanzado no resecable o metastásico;
    Nota: la quimioterapia administrada como parte de perfusión aislada de extremidades, tratamiento regional o intralesional no se considerará tratamiento sistémico
    12. Función cardiovascular alterada o enfermedades cardiovasculares clínicamente significativas, incluyendo alguna de las siguientes:
    ? Antecedentes de síndromes coronarios agudos (incluyendo infarto de miocardio, angina inestable, bypass arterial coronario con injerto, angioplastia coronaria, o colocación de stent) < 6 meses antes de la selección,
    ? Insuficiencia cardiaca crónica sintomática, antecedentes o evidencia actual de arritmia cardiaca clínicamente significativa y/o anomalía de conducción < 6 meses antes de la selección excepto fibrilación auricular y taquicardia supraventricular paroxísmica;
    13. Hipertensión arterial no controlada a pesar de tratamiento médico;
    14. Serología positiva conocida para VIH, infección por hepatitis B activa, y/o hepatitis C activa
    15. Pacientes con alteraciones neuromusculares que están asociadas con CK elevado (p.e., miopatías inflamatorias, distrofia muscular, esclerosis lateral amiotrófica, atrofia muscular espinal);
    16. Pacientes que prevean empezar un nuevo régimen de ejercicio extenuante después de la primera dosis de tratamiento del estudio. NB: actividades musculares, como ejercicio extenuante, que puede determinar aumentos significativos de los niveles de CK plasmáticos deben ser evitados durante el tratamiento con MEK162;
    17. Alteración de la función gastrointestinal o enfermedad gastrointestinal (p.e., enfermedad ulcerosa, nauseas no controladas, vómitos, diarrea, síndrome de malabsorción, resección del intestino delgado);
    18. Cualquier otra alteración que podría, a criterio del Investigador, contraindicar la participación del paciente en el estudio clínico por problemas de seguridad o cumplimiento con los procedimientos del estudio clínicos, p.e., infección/inflamación, obstrucción intestinal, incapaz de tragar medicación, cuestiones sociales/psicológicas, etc.;
    19. Pacientes que han sido sometidos a cirugía mayor o radioterapia ? 3 semanas antes del inicio del fármaco del estudio o que no se han recuperado de los efectos secundarios de dicho procedimiento;
    20. Mujer embarazada o en periodo de lactancia, donde embarazo se define como el estado de una mujer después de la concepción y hasta la finalización de la gestación, confirmada por una prueba de laboratorio positiva a hCG;
    21. Mujer en edad fértil, definida como mujer fisiológicamente capaz de quedarse embarazada, a menos que esté utilizando métodos anticonceptivos altamente eficaces durante la dosificación y durante 30 días después de suspender el tratamiento del estudio.
    E.5 End points
    E.5.1Primary end point(s)
    Progression free survival (PFS)
    PFS is defined as the time from the date of randomization to the date of the first documented disease progression or death due to any cause, whichever occurs first. PFS will be determined by a Blinded Independent Review Committee (BIRC). The local Investigator's assessments will be used as supportive analyses.
    PFS, definido como el tiempo desde la fecha de la aleatorización a la fecha de la primera progresión documentada de la enfermedad o muerte debido a cualquier otra causa, lo que suceda primero. PFS se determinará en base a la evaluación del tumor (criterios RECIST V1.1) según el BIRC y la información de supervivencia.
    Las evaluaciones del Investigador local se utilizarán como análisis de soporte.
    E.5.1.1Timepoint(s) of evaluation of this end point
    The final PFS analysis is expected approximately 16 months after FPFV.
    El último análisis de PFS se espera aproximadamente 16 meses después de la Primera Visita del Primer Paciente (FPFV).
    E.5.2Secondary end point(s)
    1. Overall Survival (OS)
    To compare OS between treatment arms.

    2. Overall Response Rate (ORR)
    ORR calculated as the proportion of patient with a best overall response of complete response (CR) or partial response (PR). ORR will be calculated for confirmed and unconfirmed responses separately.

    3. Time to Objective Response (TTR)
    TTR calculated as the time from date of randomization until first documented complete response (CR) or partial response(PR).

    4. Duration of objective response (DOR)
    DOR calculated as the time from the date of first documented CR or PR to the first documented progression or death due to underlying cancer

    5. Disease control rate (DCR)
    DCR calculated as the proportion of patient with a best overall response of CR, PR or stable disease (SD)

    6. Number of patients with adverse events
    To assess the safety and tolerability of MEK162 in this patient, changes in hematology and chemistry values, vital signs, electrocardiograms (ECGs), MUGA(Multi Gated Acquisition Scan)/echocardiogram and assessment of physical and ocular examinations graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03

    7. Number of patients with serious adverse events
    To assess the safety and tolerability of MEK162 in this patient, changes in hematology and chemistry values, vital signs, ECGs, MUGA/echocardiogram and assessment of physical and ocular examinations graded according to the NCI CTCAE v4.03

    8. Time to definitive 10% deterioration in the global health status score of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30)
    To compare the global health status between the treatments.

    9. Change from baseline in the global health status score of the EORTC QLQ-C30
    To compare the global health status between the treatment.

    10. Change from baseline in the EQ-5D (EuroQol Group standardised instrument for use as a measure of health outcome)
    To compare the global health status between the treatment.
    -SG, calculado como el tiempo desde la fecha de aleatorización hasta la fecha de muerte debida a cualquier causa
    -TRG, calculada como la proporción de pacientes con mejor respuesta global de respuesta completa (RC) o respuesta parcial (RP). ORR se calculará para las respuestas confirmadas y sin confirmar por separado.
    - TTR, calculado como el tiempo desde la fecha de aleatorización hasta la primera RC o RP documentada
    - DRO, calculada como el tiempo desde la fecha de la primera RC o RP documentada a la primera progresión documentada o muerte debida a cáncer subyacente
    - DCR, calculada como la proporción de pacientes con una mejor respuesta global de RC, RP o enfermedad estable (EE)
    - Seguridad: Acontecimientos adversos y acontecimientos adversos graves, cambios en los valores de hematología y bioquímica, constantes vitales, ECGs, MUGA/ecocardiograma y evaluación de las exploraciones física y ocular puntuada de acuerdo con el NCI CTCAE v4.03
    - Perfiles plasmáticos concentración-tiempo de MEK162 y parámetros de PK basados en el modelo fecha de muerte debida a cualquier causa
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Final analysis is expected to occur 21 m after FPFV
    2. Time from date of randomization to date of death due to any cause
    3. Approximately 16 months after the FPFV
    4. Approximately 16 months after the FPFV
    5. Approximately 16 months after the FPFV
    6. Approximately 16 months after the FPFV
    7. Approximately 16 months after the FPFV
    8. Approximately 16 months after the FPFV
    9. Approximately 16 months after the FPFV
    10. Approximately 16 months after the FPFV
    1. El análisis final se espera que ocurra después de 21 meses desde la primera vista del primer paciente (FPFV)
    2. Tiempo desde la fecha de la asignación al azar hasta la fecha de la muerte por cualquier causa
    3. Aproximadamente 16 meses después de la FPFV
    4. Aproximadamente 16 meses después de la FPFV
    5. Aproximadamente 16 meses después de la FPFV
    6. Aproximadamente 16 meses después de la FPFV
    7. Aproximadamente 16 meses después de la FPFV
    8. Aproximadamente 16 meses después de la FPFV
    9. Aproximadamente 16 meses después de la FPFV
    10. Aproximadamente 16 meses después de la FPFV
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned16
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA72
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Australia
    Austria
    Belgium
    Brazil
    Canada
    Czech Republic
    France
    Germany
    Greece
    Hungary
    Iceland
    Israel
    Italy
    Japan
    Korea, Republic of
    Netherlands
    Poland
    Portugal
    Russian Federation
    Slovakia
    South Africa
    Spain
    Sweden
    Switzerland
    Turkey
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    final PFS analysis will take place when approximately 260 PFS events as per BIRC have been observed. This is estimated to occur around 16 months following the first patient first visit (FPFV). Subsequently, the study will remain open to collect additional survival and safety data until approximately 80% of the patients on the study (~314 patients) have died.
    El análisis final de PFS se realizará cuando se hayan observado aproximadamente 260acontecimientos de PFS según el BIRC.Se estima que ello ocurrirá alrededor de 16 meses después que el primer paciente primera visita(FPFV)(ver Sección10.8).Posteriormente,el estudio permanecerá abierto para obtener datos adicionales de supervivencia y seguridad hasta que aproximadamente el 80%de los pacientes del estudio(~314 pacientes)hayan muerto.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months7
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 295
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 98
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state26
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 190
    F.4.2.2In the whole clinical trial 393
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    after study completion, study drug will be made available to patients who continue to derive benefit from MEK162 study treatment.
    después de la finalización del estudio, el medicamento del estudio se pondrá a disposición de los pacientes para que puedan seguir beneficiándose del tratamiento con MEK162.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2013-06-18
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-04-16
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-06-04
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