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    Summary
    EudraCT Number:2012-005170-65
    Sponsor's Protocol Code Number:MK-8109-004
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2013-07-12
    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 number2012-005170-65
    A.3Full title of the trial
    A Phase IIa Open Label, Randomized Clinical Trial to Study the Safety and Efficacy of Vintafolide and the Combination of Vintafolide and Paclitaxel Compared to Paclitaxel in Subjects with Advanced Triple Negative Breast Cancer Using Etarfolatide (EC20) Subject
    Selection
    Ensayo clínico de fase IIa abierto y aleatorizado para estudiar la seguridad y la eficacia de Vintafolide y la combinación de Vintafolide y paclitaxel, en comparación con paclitaxel, en pacientes con cáncer de mama triplemente negativo avanzado, con selección de pacientes mediante etarfolatide (EC20)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase IIa Open Label, Randomized Clinical Trial to Study Vintafolide and Paclitaxel in Subjects with Advanced Triple Negative Breast Cancer Using SPECT/CT scan with Etarfolatide (EC20) for Subject Selection
    Ensayo clínico de fase IIa abierto y aleatorizado para estudiar Vintafolide y paclitaxel en pacientes con cáncer de mama triplemente negativo avanzado, con selección de pacientes mediante etarfolatide (EC20)
    A.3.2Name or abbreviated title of the trial where available
    Vintafolide and vintafolide plus paclitaxel compared to paclitaxel alone in subjects with TNBC using
    Vintafolide y vintafolide más paclitaxel frente a paclitaxel solo en pac con este tipo de cáncer
    A.4.1Sponsor's protocol code numberMK-8109-004
    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 SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.5.2Functional name of contact pointGlobal Clinical Trials Operations
    B.5.3 Address:
    B.5.3.1Street AddressOne Merck Drive
    B.5.3.2Town/ cityWhitehouse Station
    B.5.3.3Post code08889-0100
    B.5.3.4CountryUnited States
    B.5.4Telephone number2673053326
    B.5.5Fax number2673051255
    B.5.6E-mailemmett.schmidt@merck.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 nameMK-8109
    D.3.2Product code MK-8109
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNmk-8109
    D.3.9.1CAS number 74209-03-1
    D.3.9.2Current sponsor codemk-8109
    D.3.9.3Other descriptive nameEC145, folic acid desacetylvinblastine hydrazine conjugate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2.8
    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 nameEC20
    D.3.2Product code EC20
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNEC20
    D.3.9.1CAS number 479578-27-3
    D.3.9.2Current sponsor codeEC20
    D.3.9.3Other descriptive name99mTc EC20, folic acid-technetium 99m conjugate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name PACLIT
    D.2.1.1.2Name of the Marketing Authorisation holderCancernova GmbH onkologische Arzneimittel
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    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 namePACLIT
    D.3.2Product code paclitaxel
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTaxol
    D.3.9.1CAS number 33069-62-4
    D.3.9.3Other descriptive nameTaxol
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    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
    Triple Negative Breast Cancer (advanced breast cancer that is metastatic or unresectable and for which standard curative or palliative measures do not exist or are no longer effective)
    Cáncer de mama triplemente negativo (Cancer de mama avanzado metastasico o localmente recurrente no susceptible de resección quirúrgica con intención curativa).
    E.1.1.1Medical condition in easily understood language
    Triple Negative (ER-, PR-, HER2-) Breast Cancer
    Cáncer de mama triplemente negativo (ER-, PR-, HER2-)
    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 10072737
    E.1.2Term Advanced breast cancer
    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 evaluate the progression-free survival of vintafolide monotherapy relative to paclitaxel and the progression-free survival of vintafolide + paclitaxel combination therapy relative to paclitaxel in subjects with advanced triple negative breast cancer whose target lesions are 100% positive for folate receptor expression using etarfolatide scans.
    Evaluar la supervivencia sin progresión de la Vintafolide en monoterapia en comparación con el paclitaxel y la supervivencia sin progresión del tratamiento combinado con Vintafolide + paclitaxel en comparación con paclitaxel en sujetos con cáncer de mama triplemente negativo avanzado cuyas lesiones diana son positivas en un 100 % respecto de la expresión del receptor de folato mediante exploraciones con Etarfolatide.
    E.2.2Secondary objectives of the trial
    1. To assess the frequency of triple negative breast cancer subjects whose target tumors express FR(100%) versus FR(10-90%) versus FR(0%) using etarfolatide scans. 2. To determine the correlation between FOLR1 mRNA expression in tumors in subjects with advanced triple negative breast cancer and subject etarfolatide target lesion scores (FR[100%], FR[10-90%], FR[0%]) measured by etarfolatide.
    3. To compare the clinical activity of vintafolide monotherapy versus paclitaxel and the clinical activity of vintafolide + paclitaxel combination therapy versus paclitaxel in subjects with advanced triple negative breast cancer as measured by Overall Response Rate, Clinical Benefit Rate, and Overall Survival.
    4. To assess the safety and tolerability of vintafolide monotherapy versus the combination of vintafolide and paclitaxel versus paclitaxel monotherapy in subjects with advanced triple negative breast cancer.
    -Eval. la frecuencia de pacs con cáncer de mama triplemente negativo cuyos tumores expresan RF(100 %) frente a RF(10-90 %) frente a RF(0 %) mediante exploraciones con Etarfolatide.
    -Determinar la correlación entre la expresión de ARNm de FOLR1 en los tumores de pacs con cáncer de mama triplemente negativo avanzado y puntuaciones de las lesiones diana del sujeto con Etarfolatide (RF[100 %], RF[10-90 %], RF[0 %]) medidas con Etarfolatide.
    -Comparar la actividad clínica de la Vintafolide en monoterapia frente al paclitaxel y la actividad clínica del tratamiento combinado con Vintafolide + paclitaxel en comparación con paclitaxel en pacs con cáncer de mama triplemente negativo avanzado medida por Tasa de respuesta objetiva, Tasa de beneficio clínico y Supervivencia global
    -Eval. la seguridad y la tolerabilidad de la Vintafolide en monoterapia frente a la combinación de Vintafolide y paclitaxel frente al paclitaxel en monoterapia en pacs con cáncer de mama triplemente negativo avanzado
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Be a female subject with histologically or cytologically confirmed estrogen receptor negative, progesterone receptor negative, HER-2 negative (<3+ by IHC or fluorescence in situ hybridization [FISH] ratio <2.0 or per local standards) advanced breast cancer that is metastatic or unresectable and for which standard curative or palliative measures do not exist or are no longer effective.
    a.Estrogen receptor negative as determined by local
    institutional laboratory criteria for estrogen receptor negativity. At a minimum, ER negative must be defined as <1 percent tumor cells positive by immunohistochemistry, irrespective of intensity [33].
    b.Progesterone receptor negative as determined by local institutional laboratory criteria for progesterone receptor negativity. At a minimum, PR negative must be defined as <1 percent tumor cells positive by immunohistochemistry, irrespective of intensity [33].
    2.Have developed progressive disease following at least one (and not more than four) prior chemotherapeutic regimens for breast cancer, which was administered for treatment of locally advanced, locally recurrent and/or metastatic disease.
    a.At least one regimen must have included a taxane (e.g., paclitaxel, docetaxel) in any combination or order. (Patients with a history of prior taxane allergy or hypersensitivity are not eligible ? see exclusion criterion 7).
    b.Prior taxane may have been administered during adjuvant and/or neoadjuvant therapy.
    3.Have at least a single (RECIST 1.1 defined) measurable target lesion on a radiological evaluation that is conducted no more than 4 weeks prior to beginning of study therapy (vintafolide or vintafolide + paclitaxel or paclitaxel).
    a.Measureable extranodal lesions are defined as those that can be accurately measured in at least one dimension, with longest diameter ? 10 mm by CT scan. Nodal lesions must be ? 15 mm on the short axis. Refer to the IIOM for further specifications.
    b.Measurable lesions should not have received prior radiation therapy.
    4.Have all tumor target lesions characterized as Folate Receptor positive using etarfolatide screening as assessed by a centralized radiology review.
    a.Liver lesions are considered folate receptor positive.
    5.Submit archival tumor tissue sample for analysis.
    6.Not have received chemotherapy for 4 weeks prior to the initiation of study treatment and must have recovered to ? CTCAE grade 1 toxicities related to prior chemotherapies. Note: Subjects who have residual drug-induced neuropathy of ? Grade 2 will be eligible if it has been stable, and not worsening, for at least 30 days (see exclusion criterion #8).
    7.Female subject of childbearing potential should have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
    8.Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 30 days after the last dose of study medication (See Section 5.7.2.2). Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for >1 year.
    9.Be ? 18 years of age on day of signing informed consent.
    10.Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
    11.Have voluntarily agreed to participate by giving written informed consent. The subject may also provide consent for Future Biomedical Research. However, the subject may participate in the main trial without participating in Future Biomedical Research.
    12.Have no history of a prior malignancy with the exception of cervical intraepithelial neoplasia; basal cell carcinoma of the skin or who has undergone potentially curative therapy with no evidence of that disease for five years.
    13.Have adequate organ function as defined by the following values. All screening labs should be performed within one week of drug administration. (Read in the protocol)
    1.Ser una mujer con cáncer de mama avanzado negativo para receptores estrogénicos, negativo para receptores progesterónicos y negativo para HER-2 (< 3+ mediante IHQ o cociente de hibridación in situ con sondas fluorescentes [FISH] < 2,0 o conforme a las normas locales), confirmado histológica o citológicamente, metastásico o irresecable y para el que no existan medidas curativas o paliativas convencionales o para el que estas hayan dejado de ser eficaces.
    a.Negatividad para receptores estrogénicos según los criterios del laboratorio local. La definición de RE? deberá incluir, como mínimo, < 1 % de células tumorales positivas por inmunohistoquímica, con independencia de la intensidad [33].
    b.Negatividad para receptores progesterónicos según los criterios del laboratorio local. La definición de RP? deberá incluir, como mínimo, < 1 % de células tumorales positivas por inmunohistoquímica, con independencia de la intensidad [33].
    2.La paciente ha presentado enfermedad progresiva después de al menos un tratamiento quimioterápico previo (y no más de cuatro tratamientos previos) para el cáncer de mama, que se administró para el tratamiento de un cáncer de mama localmente avanzado, localmente recurrente y/o metastásico.
    a.Al menos uno de los tratamientos debe haber incluido un taxano (por ejemplo, paclitaxel, docetaxel) en cualquier combinación u orden. (Las pacientes con antecedentes de alergia o hipersensibilidad a los taxanos no son aptas; véase el criterio de exclusión 7).
    b.Pueden haberse administrado previamente taxanos durante el tratamiento adyuvante o neoadyuvante.
    3.La paciente tiene al menos una lesión diana mensurable (conforme a los criterios RECIST 1.1) en una evaluación radiológica realizada no más de 4 semanas antes del comienzo del tratamiento del estudio (Vintafolide o Vintafolide + paclitaxel o paclitaxel).
    a.Las lesiones extraganglionares mensurables se definen como aquellas que pueden medirse con exactitud en al menos una dimensión, cuyo diámetro mayor es ? 10 mm mediante TC. Las lesiones ganglionares deben ser ? 15 mm en el eje menor. En el IIOM se presentan especificaciones adicionales.
    b.Las lesiones mensurables no deben haber recibido radioterapia previa.
    4.Todas las lesiones tumorales diana han sido caracterizadas como positivas para el receptor de folato mediante exploración selectiva con Etarfolatide conforme a una revisión radiológica centralizada.
    a. Las lesiones hepáticas se consideran positivas para el recepor de folato.
    5.Se han enviado muestras de tejido tumoral de archivo para su análisis.
    6.La paciente no ha recibido quimioterapia durante 4 semanas antes del inicio del tratamiento del estudio y las reacciones adversas relacionadas con los tratamientos quimioterápicos previos deben haberse recuperado a un grado ? 1 de los CTCAE. Nota: Las pacientes que presenten neuropatía inducida por fármacos residual de grado ? 2 serán aptas si el trastorno se ha mantenido estable y no ha empeorado durante al menos 30 días (véase el criterio de exclusión 8).
    7.Las pacientes con capacidad de procrear deberán dar negativo en una prueba de embarazo en orina o suero realizada en las 72 horas previas a la primera dosis de la medicación del estudio. Cuando el resultado de la prueba en orina sea positivo o no pueda confirmarse como negativo, será necesario hacer una prueba de embarazo en suero.
    8.Las pacientes con capacidad de procrear tendrán que estar dispuestas a utilizar dos métodos anticonceptivos o estar esterilizadas quirúrgicamente, o abstenerse de mantener relaciones heterosexuales durante todo el estudio y durante 30 días después de la administración de la última dosis de la medicación del estudio (véase la sección 5.7.2,2). Se consideran pacientes con capacidad de procrear las que no han sido esterilizadas por métodos quirúrgicos o llevan más de 1 año sin menstruación.
    9.Tener una edad mínima de 18 años el día de firma del consentimiento informado.
    10.Tener un estado funcional del Eastern Cooperative Oncology Group (ECOG) de 0 o 1.
    11.Haber accedido voluntariamente a participar dando su consentimiento informado por escrito. La paciente también podrá otorgar su consentimiento para participar en la investigación biomédica futura. No obstante, podrá participar en el ensayo principal sin necesidad de participar en la investigación biomédica futura.
    12.No tener antecedentes de un proceso maligno previo a excepción de la neoplasia intraepitelial cervicouterina, carcinoma basocelular de la piel o haberse sometido a un tratamiento potencialmente curativo sin que haya habido signos de esa enfermedad durante cinco años.
    13.Tener una función orgánica adecuada conforme a los siguientes valores. Todos los valores analíticos de selección se realizarán en la semana anterior a la administración del fármaco. (Leer en el Protocolo)
    E.4Principal exclusion criteria
    1.Has had chemotherapy, radiotherapy, or biological therapy (including monoclonal antibodies) within 4 weeks prior to drug administration or who has not recovered (?Grade 1 or baseline) from adverse experiences due to agents administered more than 4 weeks earlier.
    2.Is currently participating or has participated in a study with an investigational compound or device within 28 days of initial dosing on this study.
    3.Has received more than 4 prior cytotoxic regimens for metastatic disease. Adjuvant treatments provided to the subject would not count towards this criterion.
    4.Has a primary central nervous system (CNS) tumor.
    5.Has active CNS metastases and/or carcinomatous meningitis. However, subjects with CNS metastases who have completed a course of therapy would be eligible for the study provided they are clinically stable for 1 month prior to entry as defined as: (1) no evidence of new or enlarging CNS metastasis; and (2) off steroids or on a stable dose of steroids for at least 2 weeks.
    6.Has had prior therapy with vinorelbine (Navelbine®) or vinca-containing compounds.
    7.Has known hypersensitivity to paclitaxel, docetaxel, other taxane therapies, drugs formulated with polyoxyethylated castor oil (Cremphor EL), vinblastine, other vinca-derived therapies, or their components or analogs.
    8.Has pre-existing neuropathy > Grade 2.
    a.Subjects who have residual drug-induced neuropathy of 2 will be eligible if it has been stable, and not worsening, for at least 30 days.
    b.Data from an ongoing study with vintafolide and docetaxel suggest that neuropathy is not prohibitive with a vintafolide-taxane combination. Nonetheless, a theoretical concern exists because both classes of drugs are associated with neuropathy. If excessive neuropathy becomes evident with further clinical experience, patients with baseline grade 2 neuropathy may be excluded. The Sponsor will notify sites in writing if such action is necessary.
    9.Has a recent (i.e., ? 6 weeks) history of abdominal surgery or peritonitis.
    10.Has a bowel occlusion or sub-occlusion.
    11.Has had prior abdominal or pelvic radiation therapy, or radiation therapy to > 10% of the bone marrow at any time in the past, or prior radiation therapy within the last three years to the breast / sternum, dermal lesions, head, or neck.
    12.Requires anti-folate therapy for the management of co-morbid conditions (e.g., rheumatoid arthritis).
    13.Has known psychiatric or substance abuse disorders that, in the opinion of the investigator, would interfere with cooperation with the requirements of the trial.
    14.Is, at the time of signing the informed consent, a known regular user (including ?recreational use?) of any illicit drugs or had a recent history (within the last year) of drug or alcohol abuse.
    15.Is expecting to reproduce within the projected duration of the study, and women who are pregnant or breastfeeding.
    16.Is known to be Human Immunodeficiency Virus (HIV)-positive.
    17.Has known active Hepatitis B or C.
    18.Has symptomatic ascites or pleural effusion. However, a subject who is clinically stable following treatment for these conditions is eligible for the study.
    19.Has had a prior stem cell or bone marrow transplant.
    20.Has a history or current evidence of any condition, therapy, or lab abnormality that, in the opinion of the investigator, might confound the results of the study, interfere with the subject?s participation for the full duration of the study, or is not in the best interest of the subject to participate.
    1.Ha recibido quimioterapia, radioterapia o tratamiento biológico (incluidos anticuerpos monoclonales) en las 4 semanas previas a la administración del fármaco o no se ha recuperado (grado ? 1 o nivel basal) de reacciones adversas por fármacos administrados más de 4 semanas antes.
    2.Participa actualmente o ha participado en los 28 días previos a la administración inicial del fármaco del estudio en un estudio con un compuesto o producto sanitario en investigación.
    3.Ha recibido más de 4 tratamientos citotóxicos para la enfermedad metastásica. Los tratamientos adyuvantes administrados al sujeto no contarían para este criterio.
    4.Tiene un tumor primario del sistema nervioso central (SNC).
    5.Tiene metástasis activas en el SNC y/o meningitis carcinomatosa. No obstante, serán elegibles para el estudio las pacientes con metástasis del SNC que hayan completado un ciclo de tratamiento, siempre que se mantengan clínicamente estables durante 1 meses antes de su entrada en el estudio, lo que se define como: (1) ausencia de signos de metástasis nuevas o crecientes en el SNC; y (2) no haber recibido o haber recibido una dosis estable de esteroides durante al menos 2 semanas
    6.Ha recibido tratamiento previo con vinorelbina (Navelbine®) o compuestos con alcaloides de la vinca.
    7.Tiene hipersensibilidad conocida al paclitaxel, docetaxel, otros taxanos, fármacos formulados con aceite de ricino polioxietilado (Cremphor EL), vinblastina, otros alcaloides derivados de la vinca o sus componentes o análogos.
    8.Tiene una neuropatía preexistente de grado > 2.
    a.Las pacientes con neuropatía inducida por fármacos residual ? 2 serán aptas si el trastorno se ha mantenido estable y no ha empeorado durante al menos 30 días.
    b.Los datos de un estudio en curso con Vintafolide y docetaxel indican que la neuropatía no es prohibitiva con una combinación de Vintafolide y taxano. No obstante, existe una preocupación teórica porque ambas clases de fármacos se asocian a neuropatía. Si se observara una neuropatía excesiva con la experiencia clínica futura, podría excluirse a las pacientes con neuropatía basal de grado 2. El promotor notificará a los centros por escrito si tal acción es necesaria.
    9.Tiene antecedentes recientes (es decir, ? 6 semanas) de cirugía abdominal o peritonitis.
    10.Tiene una oclusión o suboclusión intestinal.
    11.Ha recibido radioterapia abdominal o pélvica previa, o radioterapia en > 10 % de la médula ósea en cualquier momento pasado, o radioterapia previa en los tres años anteriores en la mama/esternón, lesiones cutáneas, la cabeza o el cuello.
    12.Requiere tratamiento antifolato para el tratamiento de enfermedades concomitantes (por ejemplo, artritis reumatoide).
    13.Presenta algún trastorno psiquiátrico o por abuso de sustancias que, en opinión del investigador, interferiría en su cooperación con los requisitos del ensayo.
    14.En el momento de firmar el consentimiento informado, la paciente consume drogas (incluidas las recreativas) o presenta antecedentes recientes (en el último año) de alcoholismo o drogadicción.
    15.Se prevé que la paciente dará a luz dentro del período previsto del estudio, así como mujeres embarazadas o lactantes.
    16.Presencia conocida del virus de la inmunodeficiencia humana (VIH).
    17.Tiene antecedentes de hepatitis B o C activa.
    18.Tiene ascitis o derrame pleural sintomáticos. No obstante, si la paciente se encuentra clínicamente estable tras recibir tratamiento para estos procesos, podrá participar en el estudio.
    19.Ha recibido un trasplante de células madre o de médula ósea previamente.
    20.Tiene antecedentes o indicios actuales de cualquier trastorno, tratamiento o anomalía analítica que, en opinión del investigador, podría confundir los resultados del ensayo, afectar a la participación del sujeto durante todo el ensayo o hacer que la participación no sea lo más conveniente para la paciente.
    E.5 End points
    E.5.1Primary end point(s)
    The primary analysis will be to evaluate PFS which is generally accepted as an endpoint (or the closely related time to progression [TTP] endpoint) for clinical trials in patients with breast cancer.
    El análisis principal será evaluar la Supervivencia sin progresión , que es generalmente aceptado como criterio de valoración (o el tiempo estrechamente relacionado con la progresión [PTT] y el punto final) para los ensayos clínicos en pacientes con cáncer de mama.
    E.5.1.1Timepoint(s) of evaluation of this end point
    PFS will be assessed throughout the study and measured as the time from randomization to the time of disease progression or death. Patients will receive imaging assessments at 8 week intervals throughout the study to assess response.
    La Supervivencia sin progresión se evaluará durante todo el estudio y se mide como el tiempo desde la aleatorización hasta el momento de la progresión de la enfermedad o la muerte. A los pacientes se les haran pruebas de imágen a intervalos de 8 semanas durante el estudio para evaluar la respuesta.
    E.5.2Secondary end point(s)
    1. Overall Response Rate (ORR): Disease response will be assessed throughout the study by anatomic imaging evaluation and physical exam of visible/palpable tumor. Overall tumor response will be assessed using Enhanced RECIST 1.1 at the designated time points. The portion of patients with tumor size reduction predefined by RECIST 1.1, including patients with complete response (CR) and partial response (PR), will be evaluated.
    2. Clinical Benefit Rate (CBR): Disease control rates (DCR), which include stable disase (SD) as a response measure offer additional advantages over ORRs, since they are also associated with overall survival (OS) in breast cancer. During clinical development of Eribulin, SD lasting > 6 months was used to assess CBR as CR + PR + SD (?6 months). Since the same criteria were used to assess vintafolide activity in initial monotherapy trials in ovarian cancer, the CBR for this trial will be defined as CR + PR + SD (?6 months).
    3.Overall Survival (OS): OS data defined as the time from randomization until death from any cause will be collected as a universally accepted direct measure of benefit.
    4. Safety: The study will use standard endpoints that allow one to see results in context for comparison with large historical databases. Safety and tolerability of vintafolide in multiple indications will be assessed in advanced cancer subjects. Monitoring will include complete blood counts, serum chemistry, vital signs, physical exam, ECGs, and ECOG performance status.
    5. Pharmackokinetic Endpoints: For the initial dose of vintafolide and paclitaxel for each subject, plasma concentration-time profiles will be determined following IV administration. The following PK parameters will be determined for vintafolide and paclitaxel: maximum observed plasma concentration (Cmax); area under the plasma concentration-time curve (AUC); and if feasible, half-life (t1/2); total body clearance (CL) and volume of distribution (Vd). In addition, descriptive statistics of plasma concentrations at designated time points will be provided.
    1.La respuesta de la enfermedad se evaluará durante todo el estudio mediante evaluación imaginológica anatómica y mediante la exploración física del tumor palpable/visible. La respuesta tumoral global se evaluará mediante los criterios RECIST 1.1 mejorados. Se evaluará la proporción de pacientes con una reducción del tamaño del tumor predefinida conforme a los criterios RECIST 1.1, incluidas las pacientes con respuesta completa (RC) y respuesta parcial (RP). Se asocia a supervivencia global en los ensayos sobre el cáncer de mama metastásico.
    2.Las tasas de control de la enfermedad (TCE), que incluye la enfermedad estable (EE), como criterio de valoración de la respuesta ofrece ventajas adicionales con respecto a las tasas de respuesta objetiva, ya que también se asocian a supervivencia global en el cáncer de mama [25]. Durante el desarrollo clínico de la eribulina, se utilizó la enfermedad estable durante ? 6 meses para evaluar la tasa de beneficio clínico como RC + RP + EE (? 6 meses). Dado que se utilizaron los mismos criterios para evaluar la actividad de la vintafolida en los ensayos iniciales en monoterapia en el cáncer de ovario (manual del investigador de la vintafolida), la tasa de beneficio clínico de este ensayo se definirá como RC + RP + EE (? 6 meses).
    3.Los datos de la supervivencia global definida como el tiempo transcurrido desde la aleatorización hasta la muerte por cualquier causa se recabarán como criterio de valoración directo universalmente aceptado del beneficio.
    4.Se evaluarán la seguridad y la tolerabilidad de la vintafolida en diversas indicaciones en pacientes con cáncer avanzado. Se hará un seguimiento semanal del hemograma durante todo el estudio, ya que los cambios hematológicos son una anomalía frecuente. Otras determinaciones de la seguridad serán un análisis de bioquímica sanguínea en las semanas 1 y 3 de cada ciclo, las constantes vitales, la exploración física, ECG y el estado funcional conforme a los criterios del ECOG.
    5.Para la dosis inicial de vintafolida y paclitaxel para cada sujeto, se determinarán los perfiles de concentración plasmática-tiempo después de la administración intravenosa. Se determinarán los siguientes parámetros farmacocinéticos para la vintafolida y el paclitaxel: concentración plasmática máxima observada (Cmáx), área bajo la curva de concentración plasmática-tiempo (AUC) y, si es posible, la semivida (t1/2), el aclaramiento corporal total (CL) y el volumen de distribución (Vd). Además, se facilitarán estadísticos descriptivos de las concentraciones plasmáticas en los puntos temporales designados.
    E.5.2.1Timepoint(s) of evaluation of this end point
    ORR and CBR will be assessed throughout the study through physical exams performed at the beginning of each cycle and by anatomic imaging performed every 8 weeks throughout the study.
    Subjects will be followed for OS at 3 month intervals via telephone contact for a minimum of 24 months and a maximum of 60 months from randomization.
    Safety: Complete blood counts will be monitored weekly throughout the study, serum chemistry assessment at week 1 and week 3 of every cycle, vital signs (prior to each dose), physical examination,ECGs, and ECOG performance status (once per cycle) . "Refer to protocol for complete list."
    La respuesta tasa de control de la enfermedad se evaluará durante todo el estudio mediante eval. de imagen anatómica y mediante la exploración física del tumor palpable/visible cada 8 semanas a lo largo del estudio.Los pacs. se someterán a seguimiento para determinar la supervivencia global a intervalos de 3 meses por telef. durante un mín. de 24 meses y un máximo de 60 meses después de la aleatorización.Se hará un seguimiento semanal del hemograma durante todo el estudio, ya que los cambios hematológicos son una anomalía frecuente. Otras determinaciones de la seguridad serán un análisis de bioquímica sanguínea en las semanas 1 y 3 de cada ciclo, las constantes vitales, la exploración física, ECG y el estado funcional conforme a los criterios del ECOG. Ver protocolo para la lista completa.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    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 Yes
    E.8.2.3.1Comparator description
    Paclitaxel
    Paclitaxel
    E.8.2.4Number of treatment arms in the trial3
    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 EEA13
    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
    Denmark
    Spain
    Sweden
    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
    The overall trial ends when the last subject completes the last trial visit, a minimum of 6 months post initial study medication administration have elapsed, or the last subject either discontinues from the trial or is lost to follow-up (i.e., the subject is unable to be contacted by the investigator), whichever comes first.
    El ensayo en su conjunto finalizará cuando el último sujeto complete la última visita del ensayo, cuando al menos hayan transcurrido 6 meses después de la administración inicial de la medicación del estudio o cuando el último sujeto se retire del estudio o se pierda el contacto con él para el seguimiento (es decir, el investigador no puede ponerse en contacto con el sujeto), lo que ocurra antes.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months5
    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: 68
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 34
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    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 state16
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 37
    F.4.2.2In the whole clinical trial 102
    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)
    When a subject discontinues/withdraws from the study, all applicable activities scheduled for the final trial visit should be performed at the time of discontinuation. Any adverse events which are present at the time of discontinuation/withdrawal should be followed in accordance with the safety requirements outlined in the protocol (Section 7.2 - Assessing andRecording Adverse Events).
    Cuando un sujeto se retire antes de la finalización del ensayo, deberán realizarse todas las actividades aplicables programadas para la visita final del ensayo en el momento de la retirada. Se hará un seguimiento de todos los acontecimientos adversos que estén presentes en el momento de la retirada, conforme a los requisitos de seguridad que se describen en la sección 7.2, Evaluación y registro de los acontecimientos adversos.
    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 Decision2013-08-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-08-19
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2014-06-18
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