E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
HER2 distal esophageal, Gastroesophageal (GE) junction or gastric carcinoma. |
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E.1.1.1 | Medical condition in easily understood language |
Cancer of the esophagus, gastroesophageal (GE) junction or stomach. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10017758 |
E.1.2 | Term | Gastric cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10015362 |
E.1.2 | Term | Esophageal cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10056267 |
E.1.2 | Term | Gastroesophageal cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of the study is to compare the Progression Free Survival (PFS) between the experimental and comparator arms within two distinct patient populations: Patients with ‘Traditional’ and ‘Non-Traditional’ HER2 expressing tumors.
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E.2.2 | Secondary objectives of the trial |
To compare the following measures between the two treatment arms within each group:
- Overall Survival (OS) - Time to treatment failure (TTF) - Objective response rate - Duration of Response (DOR) - Safety Profiles - Health-Related Quality of Life (HRQOL) scores
To evaluate the following in treatment arm regimens that include MM-111:
- Pharmacokinetic (PK) profile and pharmacodynamic activity of MM-111 in distal esophageal, GE junction, and gastric carcinoma - Immunogenicity of MM-111 when administered in combination with paclitaxel with/without trastuzumab |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients will be qualified for study participation based on the following inclusion criteria:
- Patients must have documentation of histologically or cytologically confirmed metastatic or locally advanced adenocarcinoma of the distal esophagus, GE junction or stomach - Patients must have documentation of histologically or cytologically confirmed HER2 expression as follows: o Traditional HER2 Group 1: Patients who are HER2 3+ by IHC OR HER 2 2+ by IHC and HER2 gene amplified by FISH or CISH o Non-Traditional HER2 Group 2: Patients who are HER2 2+ by IHC and HER2 gene nonamplified by FISH or CISH - For Traditional HER2 Group 1 o Patients must have received one prior systemic therapy for metastatic disease, which must be a standard fluoropyrimidine/platinum-based frontline therapy given with or without trastuzumab - Non-Traditional HER2 Group 2 o Patients must have received one prior systemic therapy for metastatic disease which must be a standard fluoropyrimidine/platinum-based frontline therapy given without trastuzumab - Patients must be ≥18 years of age - Patients or their legal representatives must be able to understand and sign an informed consent - Patients should have evaluable or measurable disease ≥1 cm per RECIST 1.1 - Patients must have ECOG PS of 0, 1, or 2 - Patients must have adequate hematologic status as evidenced by: o Absolute neutrophil count (ANC) ≥1500 cells/mm3 o Platelet count ≥100,000 platelets/mm3 o Hemoglobin ≥9 g/dL - Patients must have adequate hepatic function as evidenced by: o Serum total bilirubin ≤1.5 × the upper limit of normal (ULN) o Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase ≤2.5 x ULN (5 × ULN is acceptable if liver metastases are present) - Patients must have adequate renal function as evidenced by: o Serum creatinine ≤1.5 × ULN or calculated clearance 60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal - Patients must be recovered from the effects of any prior surgery, radiotherapy or other antineoplastic therapy. NCI CTCAE v.4.0 up to grade 1 is acceptable for patients with preexisting peripheral neuropathy - Women of childbearing potential as well as fertile men and their partners must agree to abstain from sexual intercourse or to use an effective form of contraception during the study and for 6 months following the last dose of assigned study drug(s) - Patients must have an archived formalin-fixed, paraffin-embedded (FFPE) tumor tissue sample - Patients must be willing and able to undergo a pre-treatment biopsy (this applies to the first 30 patients in each treatment group i.e. 30 for Traditional HER2 and 30 for Non-Traditional HER2) |
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E.4 | Principal exclusion criteria |
Patients will be disqualified from study participation based on the following exclusion criteria: - Patients for whom potentially curative antineoplastic therapy is available - Patients who previously received paclitaxel or other taxane treatment in the frontline or locally advanced setting - Patients who are pregnant or lactating - Patients with an active infection or with an unexplained fever >38.5°C during screening visits or on the first scheduled day of dosing (at the discretion of the investigator, patients with tumor fever may be enrolled) - Patients with known brain metastasis - Patients with known hypersensitivity to any of the components of MM-111 or who have had hypersensitivity reactions to fully human monoclonal antibodies - Patients with a known history of hypersensitivity to paclitaxel or other drugs formulated in Cremophor® EL, unless a patient has been de-sensitized in accordance with institutional guidelines - Patients with a known history of hypersensitivity to trastuzumab or any of its components (for group 1 only) - Patients who have received other recent anti-tumor therapy. This includes the following: o Investigational therapy administered within the 28 days prior to the first scheduled day of dosing MM-111 - Dosing within <28 days since receiving investigational therapy is acceptable once a time interval equal to at least five half-lives of the investigational agent has passed - Patients in the Traditional HER2 group already receiving trastuzumab do not require a wash-out period from trastuzumab (for group 1 only) o Any standard chemotherapy or radiation or other therapy within 14 days prior to the first scheduled dose of MM-111 o Patients who have not recovered from clinically significant effects of any prior surgery, radiotherapy or any other antineoplastic therapies. Patients with a known peripheral neuropathy must present with a grade 1 severity or less according to NCI CTCAE 4.0 Patients with active or prior history of New York Heart Association (NYHA) congestive heart failure or left ventricular ejection fraction (LVEF) <50% - History of myocardial infarction within 12 months of enrollment - Uncontrolled hypertension (systolic blood pressure >180 mm Hg or diastolic blood pressure >100 mm Hg) - Known angina pectoris requiring medication - Known clinically significant heart valve disease - Known history of high-risk arrhythmias requiring medical attention (chronic stable well controlled atrial fibrillation is permissible) - Active gastrointestinal bleeding - Patients who have received prior maximum cumulative anthracycline doses: o Doxorubicin or liposomal doxorubicin doses >360 mg/m2 o Mitoxantrone >120 mg/m2 and idarubicin >90 mg/m2 o Epirubicin doses higher than 720 mg/m2 o Other (e.g., liposomal doxorubicin or other anthracycline equivalent of 360 mg/m2 of doxorubicin) o If more than 1 anthracycline has been used, the cumulative dose must not exceed the equivalent of 360mg/m2 of doxorubicin - Patients with known human immunodeficiency virus (HIV). Patients with Hepatitis B surface antigen (carriers) may be enrolled but must receive nucleoside/nucleotide analogue or other suitable treatment for Hepatitis B per institutional guidelines - Patients with any other medical or psychological condition, deemed by the investigator to likely interfere with a patient’s ability to sign informed consent or cooperate and participate in the study, or interfere with the interpretation of the study results |
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E.5 End points |
E.5.1 | Primary end point(s) |
Progression Free Survival (PFS) is the primary efficacy endpoint. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
PFS is defined as the number of months from the date of randomization to the date of death or progression, whichever occurred earlier. |
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E.5.2 | Secondary end point(s) |
Secondary efficacy endpoints that will be used to evaluate target and non-target lesion antitumor response of each treatment regimen using RECIST v1.1 criteria include: - Overall Survival (OS) - Time to treatment failure (TTF) - Objective response rate - Duration of Response (DOR) - Safety profiles will also be analyzed - Health-Related Quality of Life (HRQOL) scores
The following will be assessed in treatment arm regimens that include MM-111: - Pharmacokinetic (PK) concentrations and pharmacodynamic activity of MM-111 in distal esophageal, GE junction, and gastric carcinoma Immunogenicity of MM-111 when administered in combination with paclitaxel with/without trastuzumab. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Death (i.e. overall survival)
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 14 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Denmark |
France |
Korea, Republic of |
Spain |
South Africa |
Taiwan |
United Kingdom |
United States |
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E.8.7 | Trial 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
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Date when all subjects are deceased. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |