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    Summary
    EudraCT Number:2012-004977-23
    Sponsor's Protocol Code Number:DP312804
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2013-07-09
    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 ConcernedItaly - Italian Medicines Agency
    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: Studio randomizzato, in aperto, di fase III, per valutare l’efficacia e la sicurezza di dacomitinib (PF-00299804) rispetto a gefitinib per il trattamento di prima linea del tumore al polmone non a piccole cellule, localmente avanzato o metastatico in soggetti con mutazione/i attivante/i del recettore per il fattore di crescita epidermico (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
    studio di dacomitinib rispetto a gefitinib in pazienti con tumore al polmone non a piccole cellule
    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 organisationQuintiles Limited
    B.5.2Functional name of contact pointRSU-RA
    B.5.3 Address:
    B.5.3.1Street AddressAlba Campus, Rosebank
    B.5.3.2Town/ cityLivingston
    B.5.3.3Post codeEH54 7EG
    B.5.3.4CountryUnited Kingdom
    B.5.6E-mailkath.cresswell@quintiles.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
    tumore al polmone non a piccole cellule
    E.1.1.1Medical condition in easily understood language
    Lung Cancer
    Tumore al polmone
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 16.0
    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 IRC review, in the study population.
    Dimostrare che il trattamento con dacomitinib è superiore al trattamento con gefitinib riguardo alla Sopravvivenza libera da progressione (PFS) come determinato dalla revisione IRC in cieco, nella popolazione dello studio.
    E.2.2Secondary objectives of the trial
    To compare secondary measures of efficacy: Overall Survival and PFS as determined by investigators’ assessments, Objective Response Rate and Duration of Response (DR) both as determined by blinded IRC review and investigators’ assessments between the two treatment arms
    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 Patient Reported Outcomes (PRO) of health status between the two arms
    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).
    Mettere a confronto le misure di efficacia secondarie: OS e PFS come determinata dalle valutazioni dello sperimentatore, ORR e DR entrambe determinate dalla revisione IRC in cieco e dalle valutazioni dello sperimentatore tra i due bracci di trattamento;
    Valutare la sicurezza e la tollerabilità tra i due bracci di trattamento;
    Confrontare gli PRO sulla qualità della vita correlata alla salute e i sintomi correlati alla malattia/al trattamento tra i due bracci;
    Confrontare gli PRO sullo stato di salute tra i due bracci;
    Caratterizzare la PK di dosi multiple di dacomitinib e del suo principale metabolita circolante PF-05199265 nei soggetti cinesi attualmente residenti nella Cina continentale, nati in Cina e i cui genitori sono entrambi di discendenza cinese (solo Braccio A);
    Determinare le concentrazioni di valle di dacomitinib e del suo principale metabolita circolante PF-05199265 per la valutazione dello stato stazionario della PK (solo Braccio A, presso centri selezionati).
    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 an EGFR activating mutation (exon 19 deletion or the L858R mutation in exon 21) in tumor tissue determinedby 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. In China, the presence of EGFR activating mutation (exon 19 deletion or the L858R mutation in exon 21) determined by the central laboratory based on either the Qiagen - Therascreen® EGFR Mutation Detection Kit RGQ or the AmoyDx EGFR Mutation Test Kit. 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 7) NSCLC of adenocarcinoma histology or its pathologically accepted variants using tumor tissue (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. Tumor tissue must be available for central laboratory confirmation of adenocarcinoma histology and presence of activating mutation. Ten (10) unstained, 4-6 micron thick sections from a formalin fixed paraffin embedded (FFPE) block or a FFPE block is requested. If the site is unable to provide 10 sections as requested, 4-6 unstained, 4-6 micron thick sections from a FFPE block are 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 contrast enhanced magnetic resonance imaging (MRI); non contrast CT scan is acceptable only for subjects who are both allergic to intravenous contrast and unable to cooperate with MRI, or MRI is not available. The following are not allowed as sole documentation of target lesions: CT component of a 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 patient 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 upper limit of normal (ULN);
    g. Aspartate aminotransferase (AST; also known as SGOT) and Alanine aminotransferase (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 before 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.
    Fornire un documento scritto di consenso informato, concesso volontariamente, personalmente firmato e datato;
    In Giappone e in Corea essere di età ≥ 20 anni e ≥ 18 anni negli altri Paesi, di sesso maschile o femminile;
    Al di fuori della Cina, presentare una mutazione attivante dell’EGFR (delezione dell’esone 19 o mutazione di L858R nell’esone 21) nel tessuto tumorale determinata dal laboratorio locale basandosi sul kit Qiagen - Therascreen® con RGQ per il rilevamento delle mutazioni dell’EGFR o test simili approvati dallo Sponsor. In Cina, presentare mutazione attivante dell’EGFR (delezione dell’esone 19 o mutazione di L858R nell’esone 21) determinata dal laboratorio locale basandosi sul kit Qiagen - Therascreen® con RGQ per il rilevamento delle mutazioni dell’EGFR o sul kit per il test di rilevazione della mutazione dell’EGFR AmoyDx. È accettabile l’inclusione nello studio di soggetti che presentano la mutazione T790M dell’esone 20 unitamente alla mutazione attivante EGFR (delezione dell’esone 19 o mutazione L858R nell’esone 21);
    Evidenza di NSCLC allo stadio IIIB/IV (basata sul sistema di stadiazione versione 7 dell’UICC)), prova istologica dell’adenocarcinoma o delle sue varianti accettate a livello patologico usando tessuto tumorale (laboratorio locale all’esterno alla Cina, laboratorio centrale in Cina). Per questo scopo saranno utilizzati i criteri per la classificazione istologica del cancro al polmone dell’OMS/IASLC e la diagnosi di NSCLC NOS , carcinoma polmonare a cellule squamose o carcinoma polmonare misto adenosquamoso non sarà consentita;
    Il tessuto tumorale deve essere disponibile per la conferma da parte del laboratorio centrale dell’istologia dell’adenocarcinoma e della presenza di mutazione attivante. Sono richieste dieci (10) sezioni spesse 4-6 micron, non colorate da un blocco FFPE oppure un blocco FFPE. Se il centro non è in grado di fornire 10 sezioni come richiesto, sono richieste 4-6 sezioni spesse 4-6 micron, non colorate da un blocco FFPE;
    Presentare un PS ECOG di 0 o 1;
    Assenza di precedente terapia sistemica per NSCLC;
    Malattia radiologicamente misurabile in base ai criteri RECIST v1.1;
    a.Almeno una lesione bersaglio non sottoposta in precedenza a radioterapia e misurabile in base ai criteri RECIST v1.1;
    b.Procedure radiologiche accettabili per la valutazione della malattia includono TC con mezzo di contrasto convenzionale o spirale, oppure RMI con contrasto; la TC senza contrasto è accettabile solo per i soggetti allergici al contrasto per via endovenosa e non cooperativi durante la RMI, oppure nel caso in cui la RMI non sia disponibile. Quanto segue non sarà consentita come unica documentazione delle lesioni bersaglio: Componente TC di una PET/TC, solo ecografia, scansioni nucleari (incluse scintigrafia ossea o PET), radiografia del torace o radiografie ossee e marcatori del tumore;
    Funzionalità organica adeguata che include:
    a.Clearance della creatinina stimata ≥ di 30 ml/min (come determinato utilizzando la formula di Cockcroft-Gault oppure la formula standard del centro dello studio);
    b.Proteina urinaria < 3+ allo stick urinario. Se la proteina urinaria allo stick urinario è 3+, allora si deve determinare il rapporto proteine/creatinina nelle urine (UPC). Il paziente può essere inserito soltanto se l’UPC è < 2,0;
    c.Conta assoluta dei neutrofili (ANC) ≥ 1500 cellule/mm3;
    d.Piastrine ≥ 100.000 cellule/mm3;
    e.Emoglobina ≥ 10,0 g/dl;
    f.Bilirubina 1,5 x il limite superiore della norma (LSN);
    g.AST; noto anche come SGOT e ALT, anche nota come SGPT 2,5 x LSN (5,0 x LSN se ci sono metastasi epatiche).
    I soggetti di sesso femminile devono essere in post-menopausa (definita come 12 mesi di amenorrea in seguito alle ultime mestruazioni) o i loro partner devono essere stati sottoposti a sterilizzazione chirurgica, oppure devono acconsentire ad usare metodi contraccettivi efficaci nel periodo in cui ricevono il trattamento sperimentale e per almeno i successivi 3 mesi. La definizione di contraccezione efficace sarà basata sull’opinione dello sperimentatore;
    Tutti i soggetti di sesso femminile potenzialmente fertili devono sottoporsi a un test di gravidanza (siero o urine), che deve dare un risultato negativo, nelle 72 ore che precedono l’inizio del trattamento dello studio;
    I soggetti di sesso maschile o le rispettive partner di sesso femminile devono essere stati sottoposti a sterilizzazione chirurgica, oppure devono acconsentire ad usare metodi contraccettivi efficaci nel periodo in cui ricevono il trattamento sperimentale e per almeno i successivi 3 mesi. La definizione di contraccezione efficace sarà basata sull’opinione dello sperimentatore. Oppure le partner di sesso femminile devono essere in post-menopausa (defi12 mesi di amenorrea in seguito alle ultime mestruazioni);
    Il soggetto deve essere disposto e in grado di rispettare le visite programmate dello studio, i piani di trattamento, gli esami di laboratorio e altre procedure dello studio.
    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. Both mutations (exon 19 deletion and L858R mutation in exon 21) within a tumor sample;
    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;
    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 electrocardiogram (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);
    12. Uncontrolled hypertension.Severely impaired (defined as Child-Pugh Class C) hepatic dysfunction;
    13. 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;
    14. Other severe acute or chronic medical condition that may increase the risk associated with study participation or study 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;
    15. Use of narrow therapeutic index drugs that are CYP2D6 substrates (procainamide, pimozide, and thioridazine etc.) from screening to randomization. Use of a product with known effects on pharmacokinetics of gefitinib in reference to package insert from screening to randomization.
    1. Qualsiasi evidenza di istologia mista che include elementi di tumore al polmone a piccole cellule o carcinoide. Sono ammesse varianti di adenocarcinoma, tuttavia, non può essere presente alcun elemento squamoso;
    2. Qualsiasi mutazione diversa dalla delezione dell’esone 19 o dalla mutazione L858R nell’esone 21, con o senza la presenza della mutazione T790M nell’esone 20. Entrambe le mutazioni (delezione dell’esone 19 e mutazione L858R nell’esone 21) in un campione di tumore;
    3. Eventuale anamnesi di metastasi cerebrali o leptomeningee, anche se trattate in passato con radiazione o chirurgia e ora stabili;
    4. Eventuale precedente trattamento sistemico antitumorale di NSCLC precoce, localmente avanzato o metastatico che include ma non si limita a chemioterapia, terapie mirate, con piccole molecole, TKI dell’EGFR e altri inibitori della tirosin-chinasi, anticorpi monoclonali, vaccini antitumorali, radioterapia (differente dalla radioterapia palliativa per lesioni che non saranno seguite per la valutazione del tumore in questo studio, ovvero non sono lesioni bersaglio);
    5. Eventuale intervento chirurgico (che non include procedure minori come la biopsia linfonodale), radioterapia palliativa o pleurodesi entro 2 settimane dalle valutazioni al basale;
    6. Eventuali anomalie gastrointestinali clinicamente significative che possono compromettere l’assunzione, il transito o l’assorbimento del farmaco dello studio, come l’incapacità di assumere farmaci per via orale;
    7. Attuale arruolamento in un altro studio clinico terapeutico;
    8. Eventuali disordini psichiatrici o cognitivi che potrebbero limitare la comprensione o l’interpretazione del consenso informato e/o compromettere la conformità ai requisiti di questo studio o noto abuso di alcool/farmaci;
    9. Anamnesi di, o attualmente sospetta, polmonite non infettiva diffusa o malattie polmonari interstiziali che includono:
    a. Precedente anamnesi medica di malattie polmonari interstiziali, malattie interstiziali indotte da farmaci, polmoniti da radiazioni che richiedono trattamento steroideo o qualsiasi evidenza di malattia polmonare interstiziale clinicamente attiva;
    b. Fibrosi polmonare idiopatica preesistente dimostrata da TAC al basale;
    c. Funzionalità polmonare insufficiente come determinato dal esame clinico o da una tensione dell’ossigeno arterioso < 70 Torr.
    10. Eventuale anamnesi d’intolleranza al galattosio, deficit di Lapp-lattasi o malassorbimento di glucosio-galattosio;
    11. Malattia cardiovascolare non controllata o significativa, come:
    a. Infarto del miocardio negli ultimi 12 mesi;
    b. Angina non controllata negli ultimi 6 mesi;
    c. Insufficienza cardiaca congestizia negli ultimi 6 mesi;
    d. Sindrome del QT lungo congenita diagnosticata o sospetta;
    e. Eventuale anamnesi di aritmie ventricolari clinicamente significative (come tachicardia ventricolare, fibrillazione ventricolare o torsioni di punta);
    f. Prolungamento dell’intervallo QTc sull’elettrocardiogramma (ECG); il QTc deve essere inferiore al Grado 2 (≤480 msec) dei criteri CTCAE v4.0, utilizzando la formula di correzione di Fridericia o di Bazett con lettura manuale da parte dello sperimentatore, se necessario. L’ECG può essere ripetuto per la valutazione dell’eleggibilità dopo la gestione delle cause correggibili del prolungamento del QTc osservato;
    g. Eventuale anamnesi di un blocco cardiaco di secondo o terzo grado;
    h. Battito cardiaco < 50 battiti al minuto sull’ECG in presenza di sintomi clinici (ad es. ipotensione, evidenza di ipoperfusione);
    i. Ipertensione non controllata.
    12. Insufficienza epatica grave (definita come Classe C secondo la classificazione Child-Pugh);
    13. Tumore maligno precedente: I soggetti non sono idonei se presentano anamnesi o evidenza di un altro tumore maligno concomitante. Un’eccezione può essere rappresentata dal precedente anamnesi di cancro della pelle non melanoma oppure cancro della cervice in situ già efficacemente trattati e senza evidenza di malattia attiva;
    14. Altra condizione medica acuta o cronica che potrebbe aumentare il rischio associato con la partecipazione allo studio o la somministrazione del farmaco dello studio o che potrebbe interferire con l’interpretazione dei risultati dello studio e, a giudizio dello sperimentatore, renderebbe il soggetto non idoneo a partecipare a questo studio;
    15. Uso di farmaci con un indice terapeutico ridotto che sono substrati di CYP2D6 (procainamide, pimozide e tioridazina, ecc.) dallo screening alla randomizzazione. Uso di un prodotto con effetti noti sulla farmacocinetica di gefitinib come riferito nel foglietto illustrativo della confezione dallo screening alla randomizzazione.
    E.5 End points
    E.5.1Primary end point(s)
    Progression Free Survival (PFS) per RECIST version 1.1, as determined by blinded IRC review.
    Sopravvivenza libera da progressione (PFS) in base ai criteri RECIST versione 1.1, come determinata dalla revisione IRC in cieco.
    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),
    Valutata al termine del Ciclo 1 e del Ciclo 2, poi ad ogni altro ciclo (entro 7 giorni dall'inizio del ciclo successivo compreso il Giorno 1 del ciclo successivo)
    E.5.2Secondary end point(s)
    • Overall Survival (OS) and OS at 30 months (OS30m);
    • PFS as determined by investigator (INV) assessment;
    • 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 pre-dose plasma samples (Arm A only, at selected sites).
    Sopravvivenza complessiva (OS) e OS a 30 mesi (OS30m);
    • PFS come determinata dalla valutazione dello sperimentatore (INV);
    • Migliore risposta complessiva (BOR) come determinata da entrambe le valutazioni IRC e INV;
    • Durata della risposta (DR) come determinata da entrambe le valutazioni IRC e INV;
    • Profilo di sicurezza generale: eventi avversi (EA) e anomalie di laboratorio in base ai criteri comuni di terminologia per gli eventi avversi del National Cancer Institute (Common Terminology Criteria for Adverse Events, CTCAE) v4.0 e frazione di eiezione ventricolare sinistra (FEVS);
    • Esiti riferiti dai pazienti (PRO) sulla qualità della vita correlata alla salute (HRQOL) e sui sintomi correlati alla malattia/al trattamento tra due bracci misurati utilizzando il questionario di base sulla qualità della vita dell’Organizzazione europea per la ricerca e il trattamento del cancro (EORTC-QLQ-C30), il suo modulo sul tumore polmonare (QLQ-LC13);
    • Esiti riferiti dal paziente (PRO) sullo stato di salute tra i due bracci misurati utilizzando il questionario EuroQol 5 Dimension (EQ-5D);
    • Valutazioni dei parametri della PK di dosi multiple di dacomitinib e del suo principale metabolita circolante PF-05199265 nei soggetti cinesi attualmente residenti nella Cina continentale, nati in Cina e i cui genitori sono entrambi di discendenza cinese (solo Braccio A);
    • Concentrazioni di valle (Ctrough) di dacomitinib e del suo principale metabolita circolante PF-05199265 determinate da campioni di plasma pre-dose (solo Braccio A, presso centri selezionati).
    E.5.2.1Timepoint(s) of evaluation of this end point
    Evaluated throughout the treatment phase
    durante tutta la fase di trattamento
    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 concerned4
    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
    Italy
    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
    LVLS
    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 state30
    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
    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 Decision2013-09-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-07-16
    P. End of Trial
    P.End of Trial StatusCompleted
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