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    The EU Clinical Trials Register currently displays   43851   clinical trials with a EudraCT protocol, of which   7283   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

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    Summary
    EudraCT Number:2012-004977-23
    Sponsor's Protocol Code Number:DP312804
    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:2013-05-29
    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 number2012-004977-23
    A.3Full title of the trial
    ARCHER 1050: A RANDOMIZED, OPEN-LABEL, PHASE 3, EFFICACY AND SAFETY STUDY OF DACOMITINIB (PF 00299804) VERSUS GEFITINIB FOR THE FIRST LINE TREATMENT OF LOCALLY ADVANCED OR METASTATIC NON SMALL CELL LUNG CANCER IN SUBJECTS WITH EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) ACTIVATING MUTATION(S)
    ARCHER 1050: ESTUDIO EN FASE III, ALEATORIZADO, ABIERTO, SOBRE LA EFICACIA Y SEGURIDAD DE DACOMITINIB (PF 00299804) FRENTE A GEFITINIB, EN EL TRATAMIENTO DE PRIMERA LÍNEA DEL CÁNCER DE PULMÓN NO MICROCÍTICO LOCALMENTE AVANZADO O METASTÁSICO EN PACIENTES CON MUTACION(ES) ACTIVADORA(S) DEL RECEPTOR DEL FACTOR DE CRECIMIENTO EPIDÉRMICO (EGFR)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study of dacomitinib versus gefitinib in patients with Non-Small Cell Lung Cancer
    Se trata de un estudio con dacomitinib frente a gefitinib en pacientes con Cáncer de pulmón no microcítico
    A.3.2Name or abbreviated title of the trial where available
    ARCHER 1050
    ARCHER 1050
    A.4.1Sponsor's protocol code numberDP312804
    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 SponsorSFJ LungCancer, Ltd.
    B.1.3.4CountryCayman Islands
    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 supportSFJ LungCancer, Ltd
    B.4.2CountryCayman Islands
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPfizer Italia S.r.l.
    B.5.2Functional name of contact pointWRS Oncology Europe
    B.5.3 Address:
    B.5.3.1Street AddressVia Mozzoni 12
    B.5.3.2Town/ cityMilano
    B.5.3.3Post code20152
    B.5.3.4CountryItaly
    B.5.4Telephone number00390241498 636
    B.5.5Fax number00390241498 497
    B.5.6E-mailpaola.tozzi@pfizer.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.3.1Product nameDacomitinib
    D.3.2Product code PF-00299804
    D.3.4Pharmaceutical form 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 INNDacomitinib
    D.3.9.2Current sponsor codePF-00299804
    D.3.9.3Other descriptive nameDACOMITINIB
    D.3.9.4EV Substance CodeSUB81761
    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 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.3.1Product nameDacomitinib
    D.3.2Product code PF-00299804
    D.3.4Pharmaceutical form 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 INNDacomitinib
    D.3.9.2Current sponsor codePF-00299804
    D.3.9.3Other descriptive nameDACOMITINIB
    D.3.9.4EV Substance CodeSUB81761
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    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 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.3.1Product nameDacomitinib
    D.3.2Product code PF-00299804
    D.3.4Pharmaceutical form 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 INNDacomitinib
    D.3.9.2Current sponsor codePF-00299804
    D.3.9.3Other descriptive nameDACOMITINIB
    D.3.9.4EV Substance CodeSUB81761
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number45
    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: 4
    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.2.1.1.1Trade name IRESSA
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca AB
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 nameIRESSA
    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 INNIRESSA
    D.3.9.1CAS number 184475-35-2
    D.3.9.3Other descriptive nameGEFITINIB
    D.3.9.4EV Substance CodeSUB20637
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number250
    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
    Non-Small Cell Lung Cancer
    Cáncer de pulmón no microcítico
    E.1.1.1Medical condition in easily understood language
    Lung Cancer
    Cancer de pulmón
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.1
    E.1.2Level LLT
    E.1.2Classification code 10029514
    E.1.2Term Non-small cell lung cancer NOS
    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 demonstrate that dacomitinib treatment is superior to gefitinib treatment with respect to Progression-Free Survival (PFS) as determined by blinded independent radiologic central (IRC) review, in the study population.
    Demostrar que el tratamiento con dacomitinib es superior al tratamiento con gefitinib en lo que respecta a la supervivencia sin progresión (SSP) determinada mediante la revisión por parte de una CRI enmascarada, en la población del estudio
    E.2.2Secondary objectives of the trial
    ? To compare secondary measures of efficacy: Overall Survival (OS), PFS, Objective Response Rate (ORR) and Duration of Response (DR)
    ? To evaluate the safety and tolerability between the two treatment arms;
    ? To compare the Patient Reported Outcomes (PRO) of health-related quality of life (HRQOL), and disease/treatment-related symptoms between the two arms;
    ? To compare the PRO of health status between the two arms;
    ? To explore the relative effect of treatment between the two treatment arms on tumors harboring exon 19 deletion and the L858R mutation in exon 21;
    ? To characterize the multiple-dose PK of dacomitinib and its major circulating metabolite PF-05199265 in Chinese subjects currently residing in mainland China, who were born in China, and whose parents are both Chinese descent (Arm A only);
    ? To determine dacomitinib and its major circulating metabolite PF-05199265 trough concentrations (Ctrough) for the evaluation of steady-state PK (Arm A only, at selected sites).
    -Comparar criterios secundarios de valoración de eficacia: Supervivencia global (SG) y SSP,tasa de respuesta objetiva (TRO) y duración de respuesta (DR);
    -Evaluar seguridad y tolerabilidad entre los 2grupos;
    -Comparar resultados comunicados por pacientes (RCP) de calidad de vida relacionada con salud (CDVRS) y síntomas relacionados con enfermedad/tratamiento entre los 2grupos;
    -Comparar RCP del estado de salud entre los 2grupos;
    -Explorar efecto relativo del tratamiento entre los 2grupos sobre tumores con eliminación en exón 19 y mutación L858R en exón 21;
    -Caracterizar FC de dosis múltiples de dacomitinib y su principal metabolito circulante PF-05199265 en pacientes chinos que actualmente residan en China continental,nacidos en China,y cuyos padres sean de origen chino (Grupo A solo);
    -Determinar concentraciones valle (Cvalle) de dacomitinib y su metabolito principal en circulación PF 05199265 para la evaluación de la FC en equilibrio (Grupo A solo,en determinados centros).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Provision of a voluntarily given, personally signed and dated, written informed consent document;
    2. Age ?20 years in Japan and Korea, and ?18 years in other countries, male or female;
    3. The presence of EGFR activating mutation (exon 19 deletion or the L858R mutation in exon 21) confirmed by the local laboratory based on the Qiagen - Therascreen® EGFR Mutation Detection Kit RGQ (Scorpions ARMS) in ex-China, or similar test methods approved by the sponsor. It is acceptable for subjects with the presence of the exon 20 T790M mutation together with either EGFR activating mutation (exon 19 deletion or the L858R mutation in exon 21) to be included in this study;
    4. Evidence of stage IIIB/IV (based on Union for International Cancer Control (UICC) staging system version 77) NSCLC of adenocarcinoma histology or its pathologically accepted variants (assessed by a local laboratory in ex-China, by a central laboratory in China). For this purpose the World Health Organization/International Association of Study of Lung Cancer Histologic Classification of Lung Cancer Criteria will be used and the diagnosis of NSCLC NOS (not otherwise specified), squamous or mixed adeno-squamous lung carcinomas will not be allowed;
    5. Tissue must be available for central laboratory confirmation of adenocarcinoma histology and activating mutation (unstained 4-6 slides from formalin fixed paraffin embedded block or a formalin fixed paraffin embedded block is required);
    6. Have an ECOG PS of 0 or 1;
    7. No prior treatment with systemic therapy for NSCLC;
    8. Radiologically measurable disease by RECIST v1.1 criteria:
    a. At least one target lesion that has not previously been radiated, and is measurable according to RECIST v1.1;
    b. Acceptable radiologic procedures for disease assessment include contrast enhanced conventional or spiral computed tomography (CT), or magnetic resonance imaging (MRI); contrast enhanced scans are required in the absence of contrast-allergy and subject intolerance of MRI. The following are not allowed as sole documentation of target lesions: CT component of positron emission tomography (PET)/CT, ultrasound alone, nuclear scans (including bone or PET scans), chest X-ray or bone radiographs, and tumor markers;
    9. Adequate organ function, including:
    a. Estimated creatinine clearance ?30 mL/min (as determined by Cockcroft-Gault formula or the study site?s standard formula);
    b. Urinary protein <3+ by urine dipstick. If urine protein by dipstick is ?3+, then a urine protein/creatinine ratio (UPC) should be obtained. The subject may enter only if UPC is <2.0;
    c. Absolute neutrophil count (ANC) ?1500 cells/mm3;
    d. Platelets ?100,000 cells/mm3;
    e. Hemoglobin ?10.0 g/dL;
    f. Bilirubin ? 1.5 x ULN;
    g. AST (also known as SGOT) and ALT (also known as SGPT) ?2.5 x ULN (?5.0 x ULN if hepatic metastases).
    10. Female subjects must be postmenopausal (defined as 12 months of amenorrhea following last menses), or they or their partners must be surgically sterile, or must agree to use effective contraception while receiving study treatment and for at least 3 months thereafter. The definition of effective contraception will be based on the judgment of the investigator;
    11. All female subjects with reproductive potential must have a negative pregnancy test (serum or urine) within 72 hours prior to starting study treatment;
    12. Male subjects or their female partners must be surgically sterile or must agree to use effective contraception while receiving study treatment and for at least 3 months thereafter. The definition of effective contraception will be based on the judgment of the investigator. Or female partners must be postmenopausal (defined as 12 months of amenorrhea following last menses);
    13. Willing and able to comply with study scheduled visits, treatment plans, laboratory tests, and other study procedures.
    1.Proporcionar un documento de consentimiento informado por escrito, personalmente fechado y firmado, y que haya sido otorgado libremente;
    2.Pacientes de ambos sexos con una edad ? 20 años en Japón y Corea y ? 18 años en otros países;
    3.Presencia de la mutación activadora del EGFR (eliminación del exón 19 o la mutación L858R en el exón 21 confirmadas por el laboratorio local mediante el equipo RGQ para la detección de mutaciones del EGFR Therascreen® de Qiagen (Scorpions ARMS) fuera de China o métodos analíticos similares aprobados por el promotor. En China, la presencia de la mutación activadora del EGFR (eliminación del exón 19 o la mutación L858R en el exón 21) se confirmará en el laboratorio central mediante el equipo RGQ para la detección de mutaciones del EGFR Therascreen® de Qiagen o el equipo para el análisis de mutaciones del EGFR de AmoyDx. Se aceptan pacientes con la mutación T790M en el exón 20, junto con la mutación activadora del EGFR (eliminación del exón 19 o la mutación L858R en el exón 21);
    4.Signos de CPNM en estadios IIIB/IV (en base a la versión 7 del sistema de estadificación de la Unión para el Control Internacional del Cáncer (UICC)) de histología de adenocarcinoma o sus variantes patológicas aceptadas (evaluadas por un laboratorio local fuera de China y por un laboratorio central en China). Para ello, se utilizarán los Criterios de clasificación histológica del cáncer de pulmón de la Organización Mundial de la Salud/Asociación internacional para el estudio del cáncer de pulmón y no se permitirá el diagnóstico de un CPNM inespecífico, carcinomas de pulmón escamoso o adenoescamoso mixto;
    5.Deberá haber tejido disponible para la confirmación en el laboratorio central de la histología de adenocarcinoma y la mutación activadora (se precisan 4-6 extensiones sin teñir de un bloque incluido en parafina fijado en formalina o un bloque incluido en parafina fijado en formalina);
    6.Tener una puntuación de GA del ECOG de 0 ó 1;
    7.No haber recibido tratamiento sistémico previo para el CPNM;
    8.Tener una enfermedad radiológicamente cuantificable según la versión 1.1. de los criterios RECIST:
    a.Al menos una lesión diana que no haya recibido radiación previa y sea cuantificable según la versión 1.1. de los criterios RECIST;
    b.Los procedimientos radiológicos aceptables para la evaluación de la enfermedad incluyen tomografía computerizada (TC) convencional o helicoidal con contraste, o resonancia magnética (RM); las exploraciones con contraste se realizarán siempre que no haya alergia al medio de contraste y en caso de intolerancia del paciente a la RM. No se permitirán los siguientes como documentación única de lesiones diana: componente de TC de una tomografía por emisión de positrones (TEP)/TC, ecografía solo, exploraciones nucleares (incluidas TEP o gammagrafía ósea), radiografías torácicas u óseas y marcadores tumorales;
    9.Función orgánica adecuada, que incluya:
    a.Aclaramiento de la creatinina estimado ? 30 ml/min (determinado mediante la fórmula de Cockcroft-Gault o la fórmula de referencia del centro del estudio);
    b.Proteínas urinarias < 3+ mediante tira reactiva de orina. Si las proteínas urinarias mediante tira reactiva son ? 3+, deberá obtenerse un cociente de proteínas urinarias/creatinina (PUC). El paciente podrá participar solo si el cociente PUC es < 2,0.
    c.Recuento absoluto de neutrófilos (RAN) ? 1.500 células/mm3.
    d.Plaquetas ? 100.000 células/mm3.
    e.Hemoglobina ? 10,0 g/dl;
    f.Bilirrubina ? 1,5 veces el límite superior de la normalidad (LSN);
    g.Aspartato aminotransferasa (AST; también conocido como SGOT) y alanina aminotransferasa (ALT; también conocido como SGPT) ? 2,5 x LSN (? 5,0 x LSN en caso de metástasis hepática);
    10.Las pacientes deberán ser posmenopáusicas (definido como 12 meses de amenorrea después de la última menstruación) o ellas o sus parejas deberán estar quirúrgicamente esterilizadas, o deberán acceder a utilizar métodos anticonceptivos eficaces durante el tratamiento del estudio y durante al menos los 3 meses posteriores. La definición de anticoncepción eficaz se basará en el criterio del investigador;
    11.Todas las mujeres en edad fértil deberán tener una prueba de embarazo negativa (suero u orina) en las 72 horas previas al inicio del tratamiento del estudio;
    12.Los pacientes varones y sus parejas féminas deberán haberse sometido a esterilización quirúrgica o deberán acceder a utilizar métodos anticonceptivos eficaces durante el tratamiento del estudio y durante al menos los 3 meses posteriores. La definición de anticoncepción eficaz se basará en el criterio del investigador; O las parejas féminas deberán ser posmenopáusicas (definido como 12 meses de amenorrea después de la última menstruación);
    13.Voluntad y capacidad para cumplir con las visitas programadas del estudio, los planes de tratamiento, las pruebas analíticas y otros procedimientos del estudio.
    E.4Principal exclusion criteria
    1. Any evidence of mixed histology that includes elements of small cell or carcinoid lung cancer. Variations of adenocarcinoma are allowed, however no squamous element can be present;
    2. Any other mutation other than exon 19 deletion or L858R in exon 21, with or without the presence of the exon 20 T790M mutation;
    3. Any history of brain metastases or leptomeningeal metastases, even if treated with radiation or surgery in the past and now stable;
    4. Any previous anti-cancer systemic treatment of early, locally advanced, or metastatic NSCLC including but not limited to chemotherapy, targeted therapies, small molecules, EGFR-TKIs and other tyrosine-kinase-inhibitors, monoclonal antibodies, anti-cancer vaccines, radiotherapy (other than palliative radiotherapy to lesions that will not be followed for tumor assessment on this study, i.e., non target lesions);
    5. Any surgery (not including minor procedures such as lymph node biopsy), palliative radiotherapy or pleurodesis within 2 weeks of baseline assessments;
    6. Any clinically significant gastrointestinal abnormalities that may impair intake, transit or absorption of the study drug, such as the inability to take oral medication;
    7. Current enrollment in another therapeutic clinical study, or use of a product with known effects on metabolism of the study drugs within 4 weeks of baseline assessments;
    8. Any psychiatric or cognitive disorder that would limit the understanding or rendering of informed consent and/or compromise compliance with the requirements of this study; or known drug abuse/alcohol abuse;
    9. History of, or currently suspected, diffuse non-infectious pneumonitis or interstitial lung disease including:
    a. Past medical history of interstitial lung disease, drug-induced interstitial disease, radiation pneumonitis which required steroid treatment or any evidence of clinically active interstitial lung disease;
    b. Pre-existing idiopathic pulmonary fibrosis evidenced by CT scan at baseline;
    c. Insufficient lung function as determined by either clinical examination or an arterial oxygen tension of <70 Torr.
    10. Any history of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption
    11. Uncontrolled or significant cardiovascular disease, including:
    a. Myocardial infarction within the last 12 months;
    b. Uncontrolled angina within the last 6 months;
    c. Congestive heart failure within the last 6 months;
    d. Diagnosed or suspected congenital long QT syndrome;
    e. Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes);
    f. Prolonged QTc interval on ECG; QTc must be less than CTCAE v4.0 Grade 2 (?480 msec) using Fridericia?s or Bazett?s correction formula with a manual reading by the investigator if required. The ECG may be repeated for evaluation of eligibility after management of correctable causes for observed QTc prolongation;
    g. Any history of second or third degree heart block;
    h. Heart rate <50 beats per minute on ECG in the presence of clinical symptoms (e.g., hypotension, evidence of hypoperfusion);
    i. Uncontrolled hypertension.
    12. Prior malignancy: Subjects will not be eligible if they have history of, or evidence of another concurrent malignancy. Exception would be effectively treated past history of non-melanoma skin cancer or in-situ cervical cancer with no evidence of active disease;
    13. Other severe acute or chronic medical condition that may increase the risk associated with study participation or investigational drug administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study;
    14. For Arm A (dacomitinib) after randomization, concomitant administration of narrow therapeutic index drugs that are CYP2D6 substrates is prohibited. For Arm B (gefitinib), investigator to reference label when co-administering gefitinib with other medications.
    1.Cualquier signo de histología mixta que incluya elementos de cáncer de pulmón microcrítico o carcinoide. Se permiten variaciones de adenocarcinoma, aunque no puede haber elementos escamosos presentes;
    2.Cualquier otra mutación distinta de la eliminación del exón 19 o L858R en el exón 21, con o sin la presencia de la mutación T790M en el exón 20;
    3.Cualquier antecedente de metástasis cerebral o leptomeníngea, incluso si se ha tratado con radiación o cirugía anteriormente y actualmente es estable;
    4.Cualquier tratamiento antineoplásico sistémico previo para el CPNM incipiente, localmente avanzado, o metastásico incluyendo, entre otros, quimioterapia, tratamientos dirigidos, moléculas pequeñas, ITC del EGFR y otros inhibidores de tirosina cinasa, anticuerpos monoclonales, vacunas contra el cáncer, radioterapia (distinta de la radioterapia paliativa para lesiones que no se seguirán para la evaluación tumoral en este estudio, es decir, lesiones no diana);
    5.Cualquier intervención quirúrgica (no se incluyen las intervenciones menores como biopsia de los ganglios linfáticos) radioterapia paliativa o pleurodesis en las 2 semanas previas a las evaluaciones iniciales;
    6.Cualquier anomalía digestiva clínicamente significativa que pueda alterar la toma, el tránsito o la absorción del fármaco del estudio, como la incapacidad para tomar medicación oral;
    7.Participación actual en otro estudio clínico terapéutico, o uso de un producto con efectos conocidos sobre el metabolismo de los fármacos del estudio en las 4 semanas previas a las evaluaciones iniciales;
    8.Cualquier trastorno psiquiátrico o cognitivo que pudiera limitar la comprensión o el otorgamiento del consentimiento informado y comprometer el cumplimiento de los requisitos de este estudio o alcoholismo/drogadicción conocidos;
    9.Antecedentes, o sospecha actual, de neumonitis no infecciosa difusa o enfermedad pulmonar intersticial, que incluya:
    a.Antecedentes médicos de enfermedad pulmonar intersticial, enfermedad intersticial inducida por fármacos, neumonitis por radiación que precisara tratamiento con corticoesteroides o cualquier signo de enfermedad pulmonar intersticial clínicamente activa;
    b.Fibrosis pulmonar idiopática preexistente observada en la TC inicial;
    c.Función pulmonar insuficiente determinada en la exploración clínica o presión de oxígeno arterial < 70 Torr;
    10.Cualquier antecedente de intolerancia a la galactosa, insuficiencia de lactasa de Lapp o problemas de absorción de glucosa o galactosa;
    11.Enfermedad cardiovascular no controlada o significativa, como:
    a.Infarto de miocardio en los últimos 12 meses;
    b.Angina no controlada en los últimos 6 meses;
    c.Insuficiencia cardíaca congestiva en los últimos 6 meses;
    d.Síndrome de QT largo congénito diagnosticado o sospechado;
    e.Cualquier antecedente de arritmia ventricular clínicamente significativa (como taquicardia ventricular, fibrilación ventricular o Torsades de pointes);
    f.Intervalo QTc prolongado en el electrocardiograma (ECG); el QTc deberá ser inferior a grado 2 de los CTCAE v4.0 (? 480 ms) según la fórmula con corrección de Fridericia o Bazett con una lectura manual por parte del investigador, si procede. El ECG podrá repetirse para la evaluación de la elegibilidad después del tratamiento de las causas corregibles de la prolongación del QTc observada;
    g.Cualquier antecedente de bloqueo cardíaco de segundo o tercer grados;
    h.Frecuencia cardíaca < 50 latidos por minuto en el ECG en presencia de síntomas clínicos (p. ej., hipotensión, signos de hipoperfusión);
    i.Hipertensión no controlada;
    12.Neoplasia previa: los pacientes no podrán participar si hay antecedentes o signos de otra neoplasia. Serían excepciones los antecedentes de cáncer de piel no melanomatoso tratado de forma eficaz o el cáncer de cuello uterino in situ sin evidencias de enfermedad activa;
    13.Otra enfermedad aguda o crónica grave que pueda aumentar el riesgo asociado a la participación en el estudio o a la administración del fármaco del estudio o que pueda interferir en la interpretación de los resultados del estudio y, a criterio del investigador, hiciera que el paciente no fuera adecuado para participar en el estudio;
    14.En el Grupo A (dacomitinib), después de la aleatorización está prohibida la administración concomitante de fármacos con estrecho índice terapéutico que sean sustratos de CYP2D6. En el Apartado 5.9.1 se incluyen las directrices sobre la administración de los sustratos de CYP2D6.
    En el Grupo B (gefitinib), el investigador deberá consultar la ficha técnica cuando administre gefitinib de forma concomitante con otros medicamentos.
    E.5 End points
    E.5.1Primary end point(s)
    Progression-Free Survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, as determined by blinded IRC review.
    ?Supervivencia sin progresión (SSP) según la versión 1.1. de RECIST, determinado según revisión de la CRI enmascarada.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Evaluated at the end of Cycle 1 and Cycle 2, then every other cycle (within 7 days of the start of subsequent cycle including Day 1 of subsequent cycle),
    Se evalua al final de los ciclos 1 y 2 y, a partir de entonces, cada 2 ciclos (en los 7 días previos al inicio del ciclo posterior incluyendo el día 1 del ciclo posterior)
    E.5.2Secondary end point(s)
    ? Overall Survival (OS) and OS at 30 months (OS30m);
    ? PFS as determined by investigator assessment (INV);
    ? Best Overall Response (BOR) as determined by both IRC and INV assessments;
    ? Duration of Response (DR) as determined by both IRC and INV assessments;
    ? Overall safety profile: adverse events (AEs) and laboratory abnormalities by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v4.0, and left ventricular ejection fraction (LVEF);
    ? Patient Reported Outcomes (PRO) of health related quality of life (HRQOL), and disease/treatment-related symptoms between the two arms as measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30), its Lung Cancer module (QLQ-LC13);
    ? Patient Reported Outcomes (PRO) of health status between the two arms as measured by the EuroQol 5 Dimension (EQ-5D);
    ? Multiple dose PK parameter estimates of dacomitinib and its major circulating metabolite PF-05199265 in Chinese subjects currently residing in mainland China, who were born in China, and whose parents are both Chinese descent (Arm A only);
    ? Trough concentrations (Ctrough) of dacomitinib and its major circulating metabolite PF-05199265, as determined from trough plasma samples (Arm A only, at selected sites).
    ?Supervivencia global (SG) y SG a los 30 meses (SG30m);
    ?SSP determinada según la evaluación del investigador (INV);
    ?Mejor respuesta global (MRG) determinada mediante evaluaciones de la CRI y del INV;
    ?Duración de la respuesta (DR) determinada mediante evaluaciones de la CRI y del INV;
    ?Perfil global de seguridad de acontecimientos adversos (AA) y anomalías analíticas según la versión 4.0 de los Criterios Terminológicos Comunes para Acontecimientos Adversos (CTCAE) del Instituto Nacional del Cáncer, y la fracción de eyección del ventrículo izquierdo (FEVI);
    ?Resultados comunicados por el paciente (RCP) de calidad de vida relacionada con la salud (CDVRS) y síntomas relacionados con la enfermedad/el tratamiento entre los dos grupos determinados mediante el cuestionario sobre calidad de vida de la European Organization for Research and Treatment of Cancer (EORTC QLQ C30), su módulo de cáncer de pulmón (QLQ-LC13);
    ?Resultados comunicados por los pacientes (RCP) del estado de salud entre los dos grupos determinados por el cuestionario EuroQol de 5 dimensiones (EQ-5D);
    ?Los cálculos de los parámetros FC de dosis múltiples de dacomitinib y su principal metabolito circulante PF-05199265 en pacientes chinos que actualmente residen en la China continental, nacidos en China, y cuyos padres son de origen chino (Grupo A solo);
    ?Concentraciones valle (Cvalle.) de dacomitinib y su metabolito principal en circulación PF-05199265, determinado a partir de las muestras de plasma obtenidas en el momento de concentración mínima del fármaco (Grupo A solo, en centros seleccionados).
    E.5.2.1Timepoint(s) of evaluation of this end point
    Evaluated throughout the treatment phase
    Evaluado durante la fase de tratamiento
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    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 No
    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 concerned18
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA28
    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
    China
    Hong Kong
    Japan
    Korea, Democratic People's Republic of
    Taiwan
    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
    LVLS
    Ultima visita del último patient
    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 months11
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months11
    E.8.9.2In all countries concerned by the trial days0
    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: 198
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 242
    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 state70
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 140
    F.4.2.2In the whole clinical trial 440
    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)
    None
    Ninguno
    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 Decision2013-04-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-04-15
    P. End of Trial
    P.End of Trial StatusCompleted
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