E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with metastatic or unresectable locally advanced malignancies harboring specific genomic alterations regarding the biological crizotinib targets, and who are no more amenable to curative treatment |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10007050 |
E.1.2 | Term | Cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10029260 |
E.1.2 | Term | Neuroblastoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10002227 |
E.1.2 | Term | Anaplastic large cell lymphoma T- and null-cell types |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067917 |
E.1.2 | Term | Inflammatory myofibroblastic tumour |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10008593 |
E.1.2 | Term | Cholangiocarcinoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067946 |
E.1.2 | Term | Renal cell carcinoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10039022 |
E.1.2 | Term | Rhabdomyosarcoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10017758 |
E.1.2 | Term | Gastric cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10024658 |
E.1.2 | Term | Liver carcinoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061873 |
E.1.2 | Term | Non-small cell lung cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10018336 |
E.1.2 | Term | Glioblastoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061451 |
E.1.2 | Term | Colorectal cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10066474 |
E.1.2 | Term | Thyroid cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10006187 |
E.1.2 | Term | Breast cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10033128 |
E.1.2 | Term | Ovarian cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The objective of this study is to explore the efficacy of crizotinib as a single agent across diverse type of tumors guided by the presence of identified activating molecular alterations in the crizotinib-target genes, per cohort, per pathology and per target. |
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E.2.2 | Secondary objectives of the trial |
- To assess the safety profile of crizotinib
- To explore whether molecularly driven, high quality multi-tumor screening Phase II trials are feasible in the French multiinstitutional, multidisciplinary setting.
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
To investigate the additional molecular mechanisms in patients with tumor response versus patients without tumor response within the same cohort. |
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E.3 | Principal inclusion criteria |
1. Male and female ≥ 1 year of age
2. Diagnosis of unresectable locally advanced or metastatic malignant tumor (solid tumor or hematological malignancy) of any histological type (but Non Small Cell Lung Cancer with an ALK derived translocation) and considered by the investigator as not amenable to any other validated therapeutic option
3. At least one proven specific alterations among ALK, MET, RON and ROS1 genes determined on the primary and/or the metastatic lesion such as
• Any type of ALK translocation in Anaplastic Large Cell Lymphoma (ALCL), breast cancer, colorectal cancer, myofibroblastic inflammatory tumor and renal cell carcinoma
• ALK amplification/copy number gain (CNG) in rhabdomyosarcoma, renal cell carcinoma, neuroblastoma
• ALK mutation in neuroblastoma and anaplastic thyroid cancer
• MET amplification/CNG in gastric cancer, ovarian cancer, colorectal cancer, glioblastoma, hepatocarcinoma and NSCLC
• MET mutation in thyroid cancer as well as papillary renal cell carcinoma and colorectal cancer
• ROS1 translocation in cholangiocarcinoma and NSCLC
• RON mutation and amplification/CNG in gastric cancer (in a secondary phase of the trial)
• Any other pathology, except CNS tumors, harbouring one of these alterations, including in genomic AXL gene
Patients included in pangenomic research programs harbouring specific alterations in at least one crizotinib target different from those listed above (i.e AXL, etc.) are also eligible
The list of alterations, oncogenic variants and other target genes may be upgraded during the progress of the study considering the level of proof
4. Measurable disease according to RECIST 1.1 guidelines with target lesion of at least 20 mm (or 10 mm on spiral CT scans) and presence of at least one RECIST-measurable lesion outside of a previously radiated field or potential palliative irradiation fields
5. Patients who had received any previous systemic anticancer treatment and/or radiotherapy should have recovered from any treatment related toxicity, i.e. ≤ grade1, with a mandatory free interval of at least 3 weeks for systemic treatments, and at least 5 half-lives for targeted drugs. ALCL patients receiving vincristine, vinblastine or non-hematologically toxic compounds can have a wash-out period shortened to 2 weeks
6. Patients who had received any investigational drug are eligible after a 4-week wash-out period or a wash-out period equivalent to 5 half-lifes of the product, depending on the longest period
7. Adequate hematologic function (ANC ≥ 1.0x109/L, platelets ≥ 75x109/L, platelets ≥ 50x109/L for ALCL with bone marrow involved ; Hb ≥ 8g/L), renal function (creatinine clearance ≥ 60mL/min using Cockroft and Gault formula) and hepatic function (serum bilirubin ≤ 1.5x ULN unless due to Gilbert’s syndrome ; ASAT and ALAT ≤ 5x ULN if documented liver metastasis or ≤ 3x ULN if documented liver metastasis associated with advanced fibrosis (FibroTest>0.48) or ≤ 3x ULN without liver metastasis)
8. Patients presenting strictly normal values for calcium and magnesium levels, measured within 14 days of the treatment initiation, and strictly normal values for potassium level measured within 72 hours of the treatment initiation
9. Patients able to swallow and retain oral medication
10. ECOG Performance Status of 0 to 2, or Karnofsky scale > 50 % or Lansky Play scale (< 12 years) > 50%
11. Life expectancy ≥ 3 months
12. Potentially reproductive patients must agree to use an effective contraceptive method, practice adequate methods of birth control or practice complete abstinence while on treatment, beginning 2 weeks before the first dose of investigational product and for at least 3 months after the last dose of study drug
13. Women of childbearing potential must have a negative serum pregnancy test within 14 days of enrollment and/or urine pregnancy test 72 hours prior to the administration of the study drug
14. Women who are breastfeeding should discontinue nursing prior to the first of study drug and until 3 months after the last dose
15. Patients must be affiliated to a Social Security System.
16. Patient information and written informed consent form signed. For patient under the age of 18, patient and parents information as well as written informed consent signed by parents
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E.4 | Principal exclusion criteria |
1. Non Small Cell Lung Cancer patients harbouring ALK derived translocations
2. Patient eligibile for a clinical trial with an anticancer drug (including crizotinib) targeting the same molecular alteration in the patient’s pathology open to accrual in France. Patients not eligible in this trial are still eligible for the AcSé study
3. Genomic alteration limited to an overexpression of ALK, MET, RON, ROS1 or any other crizotinib-target (i.e. without increased copy number or structural gene alteration) will not be sufficient for eligibility. Only patients with ALCL are eligible if their tumor is ALK positive as evidenced by immunohistochemistry
4. Patients with primary or secondary CNS disease
5. Previous treatment with crizotinib
6. Major surgery or tumor embolization within 4 weeks and minor surgery within 2 weeks prior to the initiation of the study drug
7. Patients with other concurrent severe and/or uncontrolled medical disease which could compromise participation in the study, such as, but not limited to :
a) Any of the following within the 3 months prior to starting study treatment: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, or cerebrovascular accident including transient ischemic attack
b) Ongoing congestive heart failure
c) Congenital long QT syndrome
d) Heart rate ≤ 45 beats/minute
e) Ongoing cardiac dysrhythmias of NCI CTCAE Grade ≥2, uncontrolled atrial fibrillation of any grade, or machine-read ECG with QTcF interval >470 msec
f) History of extensive disseminated/bilateral or known presence of Grade 3 or 4 interstitial fibrosis or interstitial lung disease, including a history of pneumonitis, hypersensitivity pneumonitis, interstitial pneumonia, interstitial lung disease, obliterative bronchiolitis, and pulmonary fibrosis, but not history of prior radiation pneumonitis
g) Spinal cord compression unless treated with the patient attaining good pain control and stable or recovered neurologic function
h) Carcinomatous meningitis or leptomeningeal disease
i) Known HIV-positive, known active hepatitis A, B or C, or latent hepatitis B or C, or any other uncontrolled infection
j) Other severe acute or chronic medical (including severe gastrointestinal conditions such as diarrhea or ulcer) or psychiatric conditions, or end stage renal disease on hemodialysis or laboratory abnormalities that would impart, in the judgment of the investigator and/or sponsor, excess risk associated with study participation or study drug administration, and which would, therefore, make the patient inappropriate for study entry
8. Patients using drugs that are known potent CYP3A4 inhibitors, (including but not limited to atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole), or potent CYP3A4 inducers (including but not limited to carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, and St. John’s Wort=millepertuis in French) are not eligible if those treatments can not be substituted
9. Patients using non-substitutable drugs that are CYP3A4 substrates with narrow therapeutic indices, including but not limited to dihydroergotamine, aripiprazole, ergotamine, halofantrine, pimozide, triazolam astemizole, cisapride, and terfenadine
10. Patients with significantly altered mental status prohibiting the understanding of the study or with psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
11. Individual deprived of liberty or placed under the authority of a tutor.
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E.5 End points |
E.5.1 | Primary end point(s) |
Anti-tumor activity of crizotinib, as the primary objective of the trial, will be carried out by the determination of the confirmed objective response rate (complete or partial response according to RECIST 1.1), assessed in each cohort defined by a pathology associated with a crizotinib target alteration. |
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E.5.2 | Secondary end point(s) |
- Disease control rate
- Response duration
- Progression-free survival
- Overall Survival
- Safety (CTCAE v4.0)
- Correlative research endpoints
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 200 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |