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    Summary
    EudraCT Number:2012-005477-31
    Sponsor's Protocol Code Number:I4C-MC-JTBC
    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:2013-05-16
    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 number2012-005477-31
    A.3Full title of the trial
    A Randomized, Open-Label Phase 2 Study Evaluating LY2875358 Plus Erlotinib and LY2875358 Monotherapy in MET Diagnostic Positive NSCLC Patients with Acquired Resistance to Erlotinib
    Estudio de fase 2, aleatorizado y abierto, en el que se compara LY2875358 y erlotinib con LY2875358 en monoterapia, en pacientes con CPNM en el que se expresa MET y que presentan resistencia adquirida a erlotinib
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A medical research evaluating the efficacy of a new medicine (LY2875358), administered alone or in combination with a second drug named Erlotinib, in patients affected by a defined type of lung cancer (MET Biomarker-Positive Non-Small-Cell Lung Cancer) that experienced a disease progression during a previous treatment with Erlotinib.
    Investigacion Medica para evaluar la eficacia de una nueva medicacion (LY2875358), administrada sola o en combinacion con Erlotinib, en pacientes con Cancer de Pulmon No Microcitico en el que se expresa MET y que no hayan repondido a erlotinib
    A.4.1Sponsor's protocol code numberI4C-MC-JTBC
    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 SponsorLilly S.A.
    B.1.3.4CountrySpain
    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 supportLilly S.A.
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEli Lilly
    B.5.2Functional name of contact pointClinical Trial Information
    B.5.3 Address:
    B.5.3.1Street AddressAvda de la Industria 30
    B.5.3.2Town/ cityAlcobendas Madrid
    B.5.3.3Post code28108
    B.5.3.4CountrySpain
    B.5.4Telephone number+34916635354
    B.5.5Fax number+34916633481
    B.5.6E-mailEU_Lilly_Clinical_Trials@lilly.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 nameLY2875358
    D.3.2Product code LY2875358
    D.3.4Pharmaceutical form Powder for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNN/A
    D.3.9.1CAS number N/A
    D.3.9.2Current sponsor codeLY2875358
    D.3.9.3Other descriptive nameLY2875358
    D.3.9.4EV Substance CodeSUB119274
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number75
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Tarceva
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Ltd.
    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.3.4Pharmaceutical 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 INNERLOTINIB HYDROCHLORIDE
    D.3.9.1CAS number 183319-69-9
    D.3.9.4EV Substance CodeSUB21050
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    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 Pulmon
    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 PT
    E.1.2Classification code 10059515
    E.1.2Term Non-small cell lung cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of this study is to evaluate the overall response rate (ORR) of LY2875358 plus erlotinib therapy and LY2875358 monotherapy in patients with MET diagnostic positive (MET diagnostic [+]) NSCLC and acquired resistance to erlotinib.

    As a co-primary objective, this study will evaluate the ORR of LY2875358 plus erlotinib therapy
    and LY2875358 monotherapy in the subpopulation of patients with MET-high expression status
    based on their post-erlotinib progression NSCLC tumor sample.
    El objetivo principal de este estudio es evaluar la tasa global de respuesta (TGR) del tratamiento con LY2875358 y erlotinib y del tratamiento con LY2875358 en monoterapia, en pacientes con cáncer de pulmón no microcítico (CPNM) en el que se exprese el protooncogén met (receptor del factor de crecimiento de hepatocitos) (MET +) y que presenten resistencia adquirida a erlotinib.

    Como objetivo coprincipal de este estudio se evaluará la TGR al tratamiento con LY2875358 y erlotinib y al tratamiento con LY2875358 en monoterapia en la subpoblación de pacientes que presenten un alto grado de expresión del MET, basándose en una muestra tumoral del CPNM recogida con posterioridad a la progresión durante el tratamiento con erlotinib.
    E.2.2Secondary objectives of the trial
    The secondary objectives of the study are as follows:
    ? To evaluate efficacy variables:
    o Progression-free survival (PFS)
    o Time to progressive disease (TTPD)
    o Change in tumor size (CTS)
    o Disease control rate (DCR)
    o Duration of response (DoR)
    o Overall survival (OS)

    ? To evaluate patient-reported outcome (PRO) measures and quality of life

    ? To characterize the safety and tolerability of LY2875358 when administered in combination with erlotinib or as monotherapy
    ? To evaluate pharmacokinetics of LY2875358 when administered in combination with erlotinib and as monotherapy
    ? To evaluate incidence and serum levels of antitherapeutic antibodies against LY2875358
    ? Evaluar las variables de eficacia:
    o Supervivencia sin progresión (SSP).
    o Tiempo hasta la enfermedad progresiva (ThEP)
    o Cambio en el tamaño del tumor (CTT)
    o Tasa de control de la enfermedad (TCE)
    o Duración de la respuesta (DdR).
    o Supervivencia global (SG)
    ? Evaluar las medidas de los resultados notificados por los pacientes
    ? Caracterizar la seguridad y tolerabilidad de LY2875358 cuando se administra en combinación con erlotinib o en monoterapia.
    ? Evaluar la farmacocinética de LY2875358 cuando se administra en combinación con erlotinib o en monoterapia.
    ? Evaluar la incidencia y la concentración sérica de los anticuerpos antiterapéuticos frente a LY2875358
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    [1] Have a histologically or cytologically confirmed diagnosis of metastatic Stage IV NSCLC at the time of study entry (American Joint Committee on Cancer Staging Criteria for NSCLC, 7th edition; Edge et al. 2009) and must be, in the judgment of the investigator, an appropriate candidate for experimental therapy.
    [2] Have at least 1 measurable extra-CNS lesion whose presence is assessable using standard techniques by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) (Eisenhauer et al. 2009). For patients with prior radiation therapy, measurable lesions must be outside a previous radiotherapy field if they are the sole site of disease, unless disease progression has been documented at that site since radiation.
    [3] Have documented radiographic progression of disease (use RECIST version 1.1 as guidance for definition of progression) while on continuous treatment with erlotinib monotherapy within at least the last 28 days (minimum ?100 mg erlotinib/d). Patients may not have received any other intervening systemic therapy since most recent radiographic progression on erlotinib except erlotinib which is allowed to be continued at the investigator?s discretion until initiation of study treatment. Patients who stopped erlotinib treatment upon progression will need to initiate JTBC study treatment no later than 28 days after discontinuing erlotinib.
    NOTE: Patients whose disease progresses only in the central nervous system (CNS) are not eligible.
    [4] Have either one or both of the following:
    ? Molecular evidence of an activating EGFRmt known to be associated with EGFR TKI drug sensitivity (G719X, exon 19 deletion, L858R, L861Q; further activating EGFRmt may be included in the future if supported by scientific evidence after discussion with the sponsor) from a tumor sample based on testing with a validated EGFRmt assay.
    ? Objective clinical benefit from most recent erlotinib treatment as defined by either documented partial or complete response or stable disease ?6 months as defined by RECIST version 1.1 in absence of radiographic progression after initiation of erlotinib. Patients with only symptomatic improvement while on erlotinib but no corresponding evidence of radiographic stability of disease are not eligible.
    [5] Determined to be MET diagnostic (+) as determined by the Study JTBC central laboratory based upon testing of a NSCLC tumor sample obtained at any time (ie. time of diagnosis of NSCLC or any time beyond).
    [6] Availability of a tumor sample taken from an extra-CNS lesion, or patient willingness to undergo a tumor biopsy of an extra-CNS lesion, post-erlotinib progression. The tumor sample should be taken from a progressing lesion on erlotinib whenever possible.
    [7] Performance status of ?2 on the Eastern Cooperative Oncology Group (ECOG) scale.
    [8] Have adequate organ function, as demonstrated by:
    ? Hematologic: Absolute neutrophil count (ANC) ?1.5 × 109/L, platelets ?100 × 109/L, and hemoglobin ?8 g/dL. Patients may receive erythrocyte transfusions to achieve this hemoglobin level at the discretion of the investigator. Initial treatment must not begin until 14 days after the erythrocyte transfusion.
    ? Hepatic: bilirubin ?1.5 times upper limits of normal (ULN), albumin ?25 g/L alkaline phosphatase (ALP), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ?2.5 times ULN or ?5 times ULN in patients with hepatic metastases.
    ? Renal: Serum creatinine level ?1.5 × ULN or calculated serum creatinine clearance ?50 mL/min, according to the method of Cockcroft and Gault.
    [9] Patients who require oral anticoagulants (eg. warfarin) are eligible provided there is increased vigilance with respect to the monitoring of INR, according to investigator judgment. If medically appropriate and the treatment is available, the investigator may also consider switching these patients to low-molecular-weight heparin, with which an interaction with LY2875358 or erlotinib is not expected.
    [10] Are male or female and at least 18 years old (or older if required by local law or regulations) at the time of screening.
    [11] Eligible patients of reproductive potential (both sexes) must agree to use adequate contraceptive methods (hormonal or barrier methods) during the study period and at least 12 weeks after the last dose of study therapy, or longer if required by local regulations.
    Women of child-bearing potential must test negative for pregnancy within 7 days prior to enrollment based on a serum pregnancy test and must also not be breastfeeding.
    [12] Are able to swallow tablets.
    [13] Have an estimated life expectancy of at least 12 weeks in the judgment of the investigator.
    [14] Have given written informed consent/assent prior to any study-specific procedures and are willing to make themselves available for the duration of the study and are willing to follow study procedures.
    [1] Presentar diagnóstico de CPNM metastásico (estadio IV), confirmado histológica o citológicamente, en el momento de inclusión en el estudio y ser candidatos apropiados para recibir tratamiento experimental, de acuerdo con el criterio del investigador.
    [2] Presentar al menos 1 lesión mensurable en una localización distinta al SNC, cuya presencia pueda evaluarse mediante las técnicas habituales, de acuerdo con los Criterios de Evaluación de la Respuesta de los Tumores Sólidos.
    [3] Haber experimentado progresión radiológica documentada de la enfermedad mientras recibían tratamiento continuado con erlotinib en monoterapia (al menos en el transcurso de los últimos 28 días y habiendo recibido al menos ?100 mg de erlotinib/d). Los pacientes no deberán haber recibido ningún otro tratamiento sistémico desde la progresión radiológica más reciente mientras recibían tratamiento con erlotinib (excepto erlotinib, que puede continuar administrándose a discreción del investigador, hasta el inicio del tratamiento del estudio). Los pacientes que hayan dejado de recibir tratamiento con erlotinib tras la progresión de la enfermedad deberán iniciar el tratamiento del estudio JTBC como máximo 28 días después de haber interrumpido la administración de erlotinib.
    [4] Presentar uno de los siguientes criterios o ambos:
    ? Presentar indicios moleculares de una mutación activadora del EGFR que esté asociada con sensibilidad a los inhibidores de la tirosina cinasa del EGFR. Dichos indicios deberán haberse determinado en una muestra del tumor, mediante un ensayo de EGFRmt validado.
    ? Haber obtenido un beneficio clínico objetivo con el tratamiento más reciente con erlotinib, esto es, haber alcanzado una respuesta parcial o completa documentadas o presentar enfermedad estable ? 6 meses, de acuerdo con los criterios RECIST (versión 1.1), en ausencia de progresión radiológica tras el inicio del tratamiento con erlotinib.
    [5] Presentar CPNM en el que se exprese el MET [MET (+)], de acuerdo con el análisis de una muestra de tumor que se llevará a cabo en el laboratorio central del estudio JTBC. Dicha muestra de tumor podrá obtenerse en cualquier momento (esto es, en el momento del diagnóstico del CPNM o en cualquier momento posterior).
    [6] Disponer de una muestra de tumor procedente de una lesión localizada fuera del SNC o que el paciente esté dispuesto a someterse a una biopsia tumoral de una lesión localizada fuera del SNC, con posterioridad a la progresión de la enfermedad experimentada durante el tratamiento con erlotinib.
    [7] Presentar una categoría funcional ? 2 en la Escala del Eastern Cooperative Oncology Group (ECOG).
    [8] Presentar una función orgánica adecuada, de acuerdo con los siguientes parámetros:
    ? Hematológicos: recuento absoluto de neutrófilos (RAN) ? 1,5 x 109/l, plaquetas ? 100 x 109/l y hemoglobina ? 8 g/dl.
    ? Hepáticos: bilirrubina ? 1,5 × límite superior de la normalidad (LSN); albúmina ? 25 g/l; fosfatasa alcalina (ALP), alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST) ? 2,5 × LSN o ? 5 × LSN en pacientes con metástasis hepáticas.
    ? Renales: concentración de creatinina sérica ? 1,5 × LSN; o aclaramiento calculado de creatinina sérica ? 50 ml/min, de acuerdo con el método de Cockcroft y Gault (anexo 5).
    [9] Los pacientes que requieran la administración de anticoagulantes orales se considerarán idóneos siempre que se realice un mayor seguimiento del índice internacional normalizado (INR) del paciente, de acuerdo con el criterio del investigador. Si es adecuado desde un punto de vista médico y se dispone del tratamiento, el investigador podrá considerar la posibilidad de cambiar a estos pacientes a un tratamiento con heparina de bajo peso molecular, con el que no se espera que LY2875358 o erlotinib interaccionen.
    [10] Pacientes de ambos sexos, que tengan al menos 18 años en el momento de la selección.
    [11] Los pacientes que se consideren idóneos y estén en edad fértil deberán estar de acuerdo en utilizar métodos anticonceptivos adecuados (hormonales o de barrera), tanto durante el período del estudio como al menos durante las 12 semanas posteriores a la última dosis del tratamiento del estudio, o durante un período más prolongado si así lo requieren las regulaciones locales.
    Las mujeres en edad fértil deben presentar un resultado negativo en una prueba de embarazo en suero realizada en el transcurso de los 7 días previos al reclutamiento, y no deberán estar en período de lactancia.
    [12] Ser capaz de ingerir comprimidos.
    [13] Tener una esperanza de vida estimada de al menos 12 semanas, de acuerdo con el criterio del investigador.
    [14] Haber proporcionado su consentimiento / asentimiento informado antes de realizar cualquiera de los procedimientos específicos del estudio, y estar disponibles durante la duración del estudio y dispuestos a seguir los procedimientos del mismo.
    E.4Principal exclusion criteria
    [15] Are currently enrolled in, or discontinued within the last 30 days from, a clinical trial involving an investigational product or nonapproved use of a drug or device, or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study.
    [16] Have previously completed or withdrawn from this study (exclusive patients who are rescreened prior to enrollment) or have been treated previously with LY2875358 or any other MET-targeting experimental therapeutic (including but not limited to: XL184, ARQ197, MetMab, crizotinib). There are no limitations to systemic therapies regimens (including any EGFR-directed therapies) prior to the most recent progression on erlotinib monotherapy.
    [17] Have a serious concomitant systemic disorder (eg, active infection including human immunodeficiency virus), or significant cardiac disease (eg, history of New York Heart Association class ?3, unstable angina, myocardial infarction) in 6 months prior to study drug administration that, in the opinion of the investigator, would compromise the patient?s ability to adhere to the protocol.
    [18] Have interstitial pneumonia or interstitial fibrosis of the lung, which, in the opinion of the investigator, could compromise the patient or the study treatment with erlotinib.
    [19] Have pleural effusion, pericardial fluid, or ascites requiring drainage every other week or more frequently.
    [20] have a history of another malignancy except for basal or squamous cell skin cancer and/or in situ carcinoma of the cervix, or other solid tumors treated curatively and without evidence of recurrence for at least 3 years prior to the study.
    [21] Have major surgery less than 2 weeks prior initiation of study treatment therapy.
    [22] Have any condition (eg, psychological, geographical) that does not permit compliance with study and follow-up procedures, or patient is, in the investigator?s opinion, not an appropriate candidate for the study.
    [23] Pregnant or lactating women.
    [24] Have symptomatic CNS metastasis (baseline computer tomography [CT] or magnetic resonance imaging [MRI] of the brain required in all patients. For those patients with known CNS metastases ongoing CNS surveillance using the same modality is required at half the frequency as extra-CNS imaging).

    Patients with asymptomatic CNS metastases are eligible if they are clinically stable with regard to neurologic function and either untreated and not requiring steroids or anticonvulsants to control CNS metastases related symptoms or are off steroids after cranial irradiation (whole-brain radiation therapy, focal radiation therapy, and stereotactic radiosurgery) at least 2 weeks prior to randomization, or after surgical resection performed at least 28 days prior to randomization. The patient may have no evidence of Grade ?1 CNS hemorrhage based on pretreatment or IV contrast-enhanced CT (performed within 2 weeks prior to randomization).
    [15] Estar participando en la actualidad o haber abandonado en el transcurso de los 30 días previos un ensayo clínico, en el que se administre un fármaco en fase de investigación, o se haga un uso no recogido en ficha técnica de un fármaco o dispositivo, o estar participando en la actualidad en cualquier otro tipo de investigación médica que se considere que no es compatible con el estudio, desde un punto de vista científico o médico.
    [16] Haber finalizado o haber interrumpido previamente la participación en este estudio (se excluye a aquellos pacientes que se hayan vuelto a someter al proceso de selección previamente al reclutamiento) o haber recibido tratamiento previo con LY2875358 o con cualquier otro tratamiento experimental dirigido al MET (entre otros, XL184, ARQ197, MetMab, crizotinib). No existe ninguna limitación en relación con el número de tratamientos sistémicos (incluido cualquier tratamiento dirigido al EGFR) que un paciente pueda haber recibido antes de la progresión más reciente que el paciente haya experimentado durante el tratamiento monoterápico con erlotinib.
    [17] Presentar un trastorno sistémico concomitante de carácter grave (por ejemplo, infección activa ?entre otras, debida al virus de la inmunodeficiencia humana (VIH)?), o cardiopatía significativa (por ejemplo, antecedentes de cardiopatía de clase ? 3, de acuerdo con los criterios de la New York Heart Association, angina inestable o infarto de miocardio) en el transcurso de los 6 meses previos a la administración del fármaco del estudio que, en opinión del investigador, puedan comprometer la capacidad del paciente para cumplir el protocolo.
    [18] Presentar neumonía intersticial o fibrosis pulmonar intersticial que, en opinión del investigador, podría comprometer al paciente o al tratamiento del estudio con erlotinib.
    [19] Presentar derrame pleural, fluido pericárdico o ascitis que requiera drenaje cada dos semanas o con mayor frecuencia.
    [20] Presentar antecedentes de otra neoplasia maligna, excepto los carcinomas basocelulares o escamosos de la piel y/o los carcinomas in situ del cuello uterino u otros tumores sólidos que se hayan tratado con intención curativa y que no presenten indicios de recurrencia al menos durante los 3 años previos al estudio.
    [21] Haberse sometido a cirugía mayor menos de 2 semanas antes del inicio del tratamiento del estudio.
    [22] Presentar cualquier circunstancia (por ejemplo, psicológica o geográfica) que no permita cumplir el estudio y los procedimientos de seguimiento de este, o que indique que el paciente no es un candidato adecuado para el estudio, en opinión del investigador.
    [23] Mujeres embarazadas o en período de lactancia.
    [24] Presentar metástasis sintomáticas en el CNS (se requiere que todos los pacientes se sometan en el momento basal a una tomografía computarizada [TC] de la cabeza o a una resonancia magnética nuclear [RMN] del cerebro. En relación con aquellos pacientes con metástatis conocidas en el SNC, la monitorización continua del SNC [mediante la misma modalidad utilizada anteriormente] deberá realizarse a la mitad de la frecuencia con la que se realicen las pruebas de imagen que se lleven a cabo para realizar seguimiento de las localizaciones de la enfermedad situadas fuera del SNC).

    Los pacientes que presenten metástasis asintomáticas en el SNC se considerarán idóneos si presentan estabilidad clínica en relación con la función neurológica, y bien no han recibido tratamiento y no requieren la administración de esteroides o anticonvulsivos para controlar los síntomas relacionados con las metástasis en el SNC, o no están recibiendo esteroides tras haber recibido irradiación craneal (radioterapia holocraneal, radioterapia focal o radiocirugía estereotáctica), al menos 2 semanas antes de la aleatorización, o tras haberse sometido a resección quirúrgica al menos 28 días antes de la aleatorización. El paciente no deberá presentar indicios de hemorragia en el SNC de grado ? 1, de acuerdo con los resultados de una resonancia magnética (RM) o una tomografía computarizada (TC) con contraste intravenoso previas al tratamiento, que deberán haberse realizado en el transcurso de las 2 semanas previas a la aleatorización
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint of the study is the Overall Response Rate (ORR). A responder is defined as any patient who exhibits a confirmed complete response (CR) or partial response (PR) relative to baseline as defined by RECIST 1.1 (Eisenhauer et al. 2009).
    Los criterios principal y coprincipal de valoración de la eficacia son la TGR, que se define como la proporción de pacientes que muestren una RC o RP confirmada, en relación con la evaluación basal, de acuerdo con los criterios RECIST 1.1 (Eisenhauer et al. 2009).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Database lock for the final analysis of the primary endpoint of ORR will occur after last patient enrolled has been followed for at least five months and investigator-assessed best response assessments have been completed for all patients.
    El cierre de la base de datos para el analisis del objetivo primario (TGR) ocurrira despues de que el ultimo paciente reclutado haya cumplido como minimo 5 meses de seguimiento y los investigadores hayan evaluado la mejor respuesta para cada uno de los cada uno de los pacientes
    E.5.2Secondary end point(s)
    Secondary endpoints:
    - Progression-free survival (PFS): The time from the date of study enrollment (randomization) to the date of first observation of objective progression or death from any cause as defined by RECIST 1.1 (Eisenhauer et al. 2009).
    - Time to progressive disease (TTPD): The time from the date of study enrollment (randomization) to the date of first observation of objective progression
    - Change in tumor size (CTS): The change in tumor size from baseline measurement to the measurement with the smallest tumor size during the study
    - Disease control rate (DCR): The proportion of patients in the analysis population who exhibit a SD or confirmed CR or PR relative to baseline during the study; response is defined by RECIST 1.1 (Eisenhauer et al. 2009)
    - Duration of response (DoR): The time from the date of first evidence of a CR or PR to the first date of objective recurrent or progressive disease or the date of death due to any cause, whichever is earlier.
    - Overall survival (OS): The time from the date of study enrollment to the date of death from any cause

    Health Outcomes:
    Patient symptoms, QoL, and health status will be assessed using the European Organisation for the Research and
    Treatment of Cancer (EORTC) questionnaires QLQ-C30, QLQ-LC13, and EuroQol EQ-5D.

    Safety and tolerability:
    The NCI-CTCAE version 4.0 will serve as the reference document for choosing appropriate terminology for, and grading the severity of, all AEs and other symptoms.

    Pharmacokinetic:
    The parameters for erlotinib will include steady-state maximum and minimum concentrations (Css,max and
    Css,min) and area under the concentration-time curve during the dosing interval at steady state (AUC?,ss). The parameters for LY2875358 may include systemic clearance (CL), volume of distribution (V), Css, min, and target mediated drug disposition (TMDD) model parameters, such as receptor-mediated clearance, non?receptor mediated
    clearance, volume of the central compartment, and volume of the peripheral compartment.

    Immunogenicity
    Immunogenicity will be assessed by a validated assay designed to detect ATAs in the presence of the investigational product.
    - Supervivencia sin progresión: período comprendido entre la fecha de reclutamiento (aleatorización) en el estudio y la fecha en la que se constate por primera vez la progresión objetiva de la enfermedad o la fecha de fallecimiento por cualquier causa.
    - Tiempo hasta la enfermedad progresiva período comprendido entre la fecha de reclutamiento (aleatorización) en el estudio y la fecha en la que se constate por primera vez la progresión objetiva de la enfermedad.
    - Cambio en el tamaño tumoral cambio observado en el tamaño del tumor, desde la medición basal a la medición que se corresponda con el menor tamaño tumoral determinado durante el estudio.
    - Tasa de control de la enfermedad proporción de pacientes de la población de análisis que durante el estudio muestren EE o una RC o RP confirmada, en relación con la evaluación basal; la respuesta viene definida por los criterios RECIST 1.1 (Eisenhauer et al. 2009)
    - Duración de la respuesta Período de tiempo comprendido entre el día en el que se observan por primera vez indicios de RP o RC y la fecha en la que se determine por primera vez la progresión objetiva de la enfermedad, o el paciente fallezca por cualquier causa (lo que acontezca en primer lugar); la respuesta viene definida por los criterios RECIST 1.1 (Eisenhauer et al. 2009)
    - Supervivencia global Período comprendido entre la fecha de reclutamiento en el estudio y la fecha de fallecimiento por cualquier causa.
    - Resultados notificados por el paciente
    Los resultados notificados por los pacientes, entre otros, los síntomas específicos de la enfermedad, la calidad de vida relacionada con la salud (CdV) y el estado de salud, se evaluarán mediante los cuestionarios EORTC QLQ-C30, QLQ-LC13 y EuroQol EQ 5D.
    - Seguridad y Tolerabilidad: Los CTCAE (versión 4.0) del National Cancer Institute constituirán los criterios de referencia a la hora de seleccionar la terminología apropiada para los AA y otros síntomas, así como para determinar la intensidad de los mismos
    - Farmacocinetica: Los parámetros relativos a erlotinib incluirán la concentración máxima y la concentración mínima en el estado estacionario (Cee,máx y Cee,min) y el área bajo la curva concentración-tiempo durante el intervalo de dosis, en el estado estacionario (ABC?,ee).
    Los parámetros relativos a LY2875358 podrán incluir el aclaramiento sistémico (CL), el volumen de distribución (V), la Cee,mín o los parámetros del modelo de distribución del fármaco en función de la diana (target mediated drug disposition, TMDD), como el aclaramiento mediado por receptores, el aclaramiento no mediado por receptores, el volumen del compartimento central y el volumen del compartimento periférico.
    - Inmunogenia: La inmunogenia se determinará mediante un ensayo validado, diseñado para detectar anticuerpos antifármaco, en presencia del producto en fase de investigación
    E.5.2.1Timepoint(s) of evaluation of this end point
    Database lock for an updated safety and efficacy analysis is estimated to occur after at least 75 OS events or 2 years after LPET, whichever occurs first.
    El cierre de la base de datos para el analisis actualizado de eficacia y seguridad se estima que ocurra tras al menos 75 evento de supervivencia global o 2 años despues de la ultimo paciente incluido en tratamiento (cualqueira que ocurra primero)
    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 Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Health outcome/quality of life
    Resultados en Salud / Calidad de vida
    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 Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA24
    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
    Israel
    Korea, Republic of
    United States
    E.8.7Trial has a data monitoring committee No
    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 ultimo paciente
    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 months10
    E.8.9.1In the Member State concerned days21
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months10
    E.8.9.2In all countries concerned by the trial days21
    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: 66
    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 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 state6
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 39
    F.4.2.2In the whole clinical trial 100
    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)
    Treatment is left at investigator's discretion once a patient has ended his/her participation in the trial. Patients receiving study treatment and experiencing ongoing clinical benefit may continue to
    receive study treatment in the extension period until one of the criteria for discontinuation is met.
    El tratamiento que seguiran los pacientes una vez discontinuados del estudio quedan a discreccion del investigador. Los pacientes que estén recibiendo el tratamiento del estudio y continúen experimentando beneficio clínico podrán continuar recibiendo el tratamiento del estudio en el período de extensión, hasta que se constate 1 de los criterios de interrupción
    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 Decision2013-08-02
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-06-24
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2016-03-24
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