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    Summary
    EudraCT Number:2013-002095-40
    Sponsor's Protocol Code Number:B2151005
    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:2014-03-11
    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 number2013-002095-40
    A.3Full title of the trial
    A RANDOMIZED PHASE 2 STUDY OF PF-05212384 PLUS IRINOTECAN VERSUS CETUXIMAB PLUS IRINOTECAN IN PATIENTS WITH KRAS AND NRAS WILD TYPE METASTATIC COLORECTAL CANCER
    ESTUDIO DE FASE II ALEATORIZADO DE PF-05212384 MÁS IRINOTECÁN FRENTE A CETUXIMAB MÁS IRINOTECÁN EN PACIENTES CON CÁNCER COLORRECTAL METASTÁSICO CON KRAS Y NRAS DE TIPO NATURAL
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to assess safety and tolerability of PF-05212384 in combination with other anti-tumor agents
    Estudio para evaluar la seguridad y tolerabilidad de PF-05212384 en combinación con otros agentes antitumorales
    A.4.1Sponsor's protocol code numberB2151005
    A.5.4Other Identifiers
    Name:US IND NumberNumber:104846
    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 SponsorPfizer Inc.,235 East 42nd Street, New York, NY 10017
    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 supportPfizer Inc., 235 East 42nd Street, New York, NY 10017
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPfizer Inc
    B.5.2Functional name of contact pointClinical Trials.gov Call Center
    B.5.3 Address:
    B.5.3.1Street Address235 East 42nd Street
    B.5.3.2Town/ cityNew York
    B.5.3.3Post codeNY 10017
    B.5.3.4CountryUnited States
    B.5.4Telephone number+18007181021
    B.5.5Fax number+13037391119
    B.5.6E-mailClinicalTrials.govCallCenter@pfizer.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.2Product code PF-05212384
    D.3.4Pharmaceutical form Lyophilisate 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 INNnot available
    D.3.9.1CAS number 1197160-78-3
    D.3.9.2Current sponsor codePF-05212384
    D.3.9.4EV Substance CodeSUB31240
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 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.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCETUXIMAB
    D.3.4Pharmaceutical form 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 INNCETUXIMAB
    D.3.9.1CAS number 205923-56-4
    D.3.9.4EV Substance CodeSUB01178MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    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 Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameIRINOTECAN
    D.3.4Pharmaceutical form Concentrate 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 INNIRINOTECAN
    D.3.9.1CAS number 97682-44-5
    D.3.9.4EV Substance CodeSUB08295MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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
    Colorectal Cancer
    Cáncer Colorrectal
    E.1.1.1Medical condition in easily understood language
    Colorectal Cancer
    Cáncer Colorrectal
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 16.1
    E.1.2Level PT
    E.1.2Classification code 10069755
    E.1.2Term K-ras gene mutation
    E.1.2System Organ Class 10018065 - General disorders and administration site conditions
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 16.1
    E.1.2Level PT
    E.1.2Classification code 10071972
    E.1.2Term N-ras gene mutation
    E.1.2System Organ Class 10018065 - General disorders and administration site conditions
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 16.1
    E.1.2Level LLT
    E.1.2Classification code 10052362
    E.1.2Term Metastatic colorectal 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 investigate whether PF-05212384 in combination with irinotecan is superior to cetuximab in combination with irinotecan in prolonging PFS in patients with KRAS and NRAS wild type mCRC who have progressed following prior treatment with irinotecan, oxaliplatin, and fluoropyrimidine.
    Investigar si PF-05212384 en combinación con irinotecán es superior a cetuximab en combinación con irinotecán en prolongar la SLP en pacientes con CCRm con KRAS y NRAS de tipo natural cuya enfermedad ha progresado tras el tratamiento previo con irinotecán, oxaliplatino y fluoropirimidina.
    E.2.2Secondary objectives of the trial
    -To confirm the recommended Phase2 Dose (RP2D) of PF-05212384 in combination with irinotecan in Japanese patients (Japanese LIC only)
    -To further characterize the anti-tumor activity of PF-05212384 in combination with irinotecan vs cetuximab in combination with irinotecan in patients with KRAS and NRAS wild type mCRC(randomized portion only)
    -To characterize and compare the safety of PF-05212384 in combination with irinotecan and cetuximab in combination with irinotecan in patients with KRAS and NRAS wild type mCRC(randomized portion only)
    -To characterize the effects of the combination on the potential to prolong the QTc interval(randomized portion and Japanese LIC)
    -To assess the PK of PF-05212384 and irinotecan(randomized portion and Japanese LIC)
    -To correlate study drug efficacy to gene and proteomics biomarkers related to the EGFR, PI3K/mTOR, and other oncogenic pathways in tumor tissue(randomized portion and Japanese LIC)
    Refer to protocol for the rest of sec. objectives
    - Confirmar la dosis recomendada para la fase II de PF-05212384 en combinación con irinotecán en pacientes japoneses en centros de Japón (CPI de japoneses solo).
    - Caracterizar más la actividad antitumoral de PF-05212384 en combinación con irinotecán frente a cetuximab en combinación con irinotecán en pacientes con CCRm con KRAS y NRAS de tipo natural (parte aleatorizada solo).
    - Documentar cualquier actividad antitumoral de la combinación de PF-05212384 más irinotecán en la CPI de japoneses.
    - Caracterizar y comparar la seguridad de PF-05212384 en combinación con irinotecán y cetuximab en combinación con irinotecán en pacientes con CCRm con KRAS y NRAS de tipo natural (parte aleatorizada solo).
    - Caracterizar los efectos de las combinaciones sobre el potencial de prolongar el intervalo QTc (parte aleatorizada y CPI de japoneses).
    Para la lista completa de objetivos secundarios, por favor refiéranse al protocolo.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Men or women >=18 years of age (or >=20 years of age if required by local regulation).
    2. Patients with histologically confirmed diagnosis of colorectal cancer.
    3. RAS (KRAS and NRAS) wild type colorectal cancer. RAS (KRAS and NRAS) wild type status must be known prior to randomization. If results are available from local testing performed prior to entry into this study, they may be used as documentation of RAS (KRAS and NRAS) wild type status, as long as the test was performed using an acceptable test method (approved by the local regulatory health authority in the country in which the patient is enrolled for KRAS). If RAS mutation status is unavailable, then RAS (KRAS and NRAS) testing must be done locally (using an acceptable test method) or by the central vendor during screening, using an archived or fresh biopsy. Patients enrolled in the Japanese lead in cohort may be KRAS wild type only.
    4. Availability of archival tumor biopsy specimens, either formalin-fixed paraffin-embedded (FFPE) tumor tissue block or 20 unstained slides, for KRAS and NRAS and other biomarker analysis. Patients will need to provide a fresh biopsy for FFPE if archival material is not available.
    5. The first 25 patients in each arm of the study must be willing to provide matched fresh tumor biopsies (if clinically feasible [see Section 7.2 of protocol]) for pharmacodynamic biomarker studies.
    6. Documented progression of colorectal cancer following treatment with irinotecan, oxaliplatin, and fluoropyrimidine therapy in the metastatic setting.
    7. At least 1 measurable lesion as defined by Response Evaluation Criteria in Solid Tumors (RECIST) criteria, V 1.1. Lesion must not have been previously irradiated.
    8.Eastern Cooperative Oncology Group (ECOG) status of 0, 1 or 2 (not declining within 2 weeks prior to signing of informed consent); see Appendix 2 of protocol.
    9. Adequate bone marrow function as defined by:
    -Absolute neutrophil count (ANC) ?1500/mm3 or ?1.5 x 109/L;
    -Platelets ?100 x 109/L; and
    -Hemoglobin ?9 g/dL.
    10. Adequate renal function as defined by:
    -Serum creatinine ?1.5 x upper limit of normal (ULN) or
    -Estimated creatinine clearance ? 60 ml/min per institutional standard method of calculation
    11.Adequate hepatic function as defined by:
    -Total serum bilirubin ? 1.5 mg/dL;
    -Aspartate and alanine aminotransferase ?2.5 x ULN (? 5.0x ULN in presence of hepatic metastases); and
    -Alkaline phosphatase ? 2.5 x ULN (?5.0x ULN in presence of bone metastases).
    12.Adequate blood glucose control as defined by:
    -Fasting blood glucose ?126 mg/dL; and
    -HbA1c <7%.
    13. Adequate cardiac functioning as defined by:
    -12-Lead electrocardiogram (ECG) with normal tracing or clinically insignificant changes that do not require medical intervention; and
    -Patients with QTc interval <480 msec and no known history of QT/QTc prolongation.
    14. Resolved acute effects of any prior therapy to baseline severity or Grade ?1 CTCAE except for AEs not constituting a safety risk according to the Investigator?s judgement.
    15. Evidence of a personally signed and dated informed consent document indicating that the patient (or a legal representative) has been informed of all pertinent aspects of the study.
    16. Patients who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
    17. Male and female patients of childbearing potential must agree to use 2 highly effective method of contraception throughout the study and for at least 90 (180 days if required by local regulation) days after the last dose of assigned treatment. A patient is of childbearing potential if, in the opinion of the Investigator, he/she is biologically capable of having children and is sexually active.
    1. Hombres y mujeres >=18 años (o >=20 años si lo requiere la normativa local).
    2. Pacientes con diagnóstico de cáncer colorrectal histológicamente confirmado.
    3. Cáncer colorrectal con RAS (KRAS y NRAS) de tipo natural. El estado de RAS (KRAS y NRAS) de tipo natural se debe conocer antes de la aleatorización. Si se dispone de los resultados de las pruebas locales realizadas antes de entrar en este estudio, se podrán utilizar como documentación del estado de RAS (KRAS y NRAS) de tipo natural, siempre que la prueba se realizara utilizando un método de prueba aceptable (autorizado por la autoridad sanitaria reguladora local del país donde se inscribe el paciente para KRAS). Si no se dispone del estado de mutación de RAS (KRAS y NRAS), entonces se hará dicha prueba en el laboratorio local (utilizando un método de prueba aceptable) o en el laboratorio central durante la selección, utilizando una biopsia de archivo o nueva. Los pacientes incluidos en la cohorte de preinclusión japonesa solamente pueden ser de tipo KRAS natural.
    4. Disponibilidad de muestras de biopsias tumorales de archivo, ya sea un bloque de tejido tumoral fijado en formalina y embebido en parafina (FFPE) o aproximadamente 20 cortes sin tinción, para el análisis de KRAS y NRAS y de otros biomarcadores. Los pacientes tendrán que facilitar una biopsia nueva para FFPE si no cuentan con muestras de archivo.
    5. Los primeros 25 pacientes de cada grupo del estudio deben estar dispuestos a proporcionar biopsias tumorales nuevas pareadas (si es clínicamente factible [ver la sección 7.2]) para los estudios de biomarcadores farmacodinámicos.
    6. Progresión documentada del cáncer colorrectal tras el tratamiento con irinotecán, oxaliplatino y fluoropirimidina en el ámbito metastásico.
    7. Al menos una lesión medible como se define en los criterios de evaluación de la respuesta en tumores sólidos (RECIST), V 1.1. La lesión no debe haber sido previamente irradiada.
    8. Estado del grupo oncológico cooperativo del Este (ECOG) de 0, 1 o 2 (sin empeoramiento en las 2 semanas anteriores a la firma del consentimiento informado); ver Anexo 2 del protocolo completo.
    9. Función de la médula ósea adecuada como se define mediante:
    - recuento absoluto de neutrófilos (RAN) ?1500/mm3 o ?1,5 x 109/l;
    - plaquetas ?100 x 109/l; y
    - hemoglobina ?9 g/dl.
    10. Función renal adecuada como se define mediante:
    - creatinina sérica ?1,5 x límite superior de la normalidad (LSN); o
    - aclaramiento de la creatinina estimado ?60 ml/min mediante método de cálculo estándar del centro.
    11. Función hepática adecuada como se define mediante:
    - bilirrubina sérica total ?1,5 mg/dl;
    - aspartato y alanina aminotransferasa ?2,5 x LSN (?5,0 x LSN en presencia de metástasis hepáticas); y
    - fosfatasa alcalina ?2,5 x LSN (?5,0 x LSN en presencia de metástasis óseas).
    12. Control adecuado de la glucosa en sangre como se define mediante:
    - glucosa en sangre en ayunas ?126 mg/dl; y
    - HbA1c <7 %.
    13. Función cardiaca adecuada como se define mediante:
    - electrocardiograma (ECG) de 12 derivaciones con trazado normal o cambios clínicamente insignificantes que no requieren intervención médica; y
    - pacientes con intervalo QTc <480 ms y sin historia conocida de prolongación del intervalo QT/QTc.
    14. Remisión de los efectos agudos de cualquier otro tratamiento previo a la intensidad basal o a grado ?1 CTCAE a excepción de los AA que no representen un riesgo de seguridad conforme al criterio del investigador.
    15. Constancia de un documento de consentimiento informado firmado y fechado en persona que indique que el paciente (o su representante legal) ha sido informado de todos los aspectos pertinentes del estudio.
    16. Pacientes que deseen y que sean capaces de cumplir con las visitas programadas, los planes de tratamiento, los análisis de laboratorio y demás procedimientos del estudio.
    17. Los hombres potencialmente fértiles y las mujeres con capacidad de gestación deben aceptar utilizar 2 métodos anticonceptivos altamente eficaces durante todo el estudio y durante al menos 90 (180 días si así lo requiere la normativa local) después de la última dosis del tratamiento asignado. Un paciente es potencialmente fértil/tiene
    capacidad de gestación si, en opinión del investigador, es biológicamente capaz de tener hijos y es sexualmente activo.
    E.4Principal exclusion criteria
    1. Patients who are investigational site staff members directly involved in the conduct of the trial and their family members, site staff members otherwise supervised by the Investigator, or patients who are Pfizer employees directly involved in the conduct of the trial.
    2. More than 2 prior cytotoxic chemotherapy regimens for colorectal cancer in the metastatic setting.
    3. Patients who are known to be homozygous for the UGT1A1*28 or
    UGT1A1*6 allele or heterozygous for both.
    4. Concurrent administration of herbal preparations and current or anticipated need for food or drugs that are known substrates of UGT1A9 (e.g. propofol, propanolol). PF-05212384 is a strong UGT1A9 inhibitor.
    5. Acetaminophen use within 24 hours of the first dose of PF-05212384 (see Section 5.4).
    6. Prior therapy with an agent that is known or proposed to be active by inhibition of PI3K, and/or mTOR, and/or AKT, and/or EGFR including cetuximab or panitumumab.
    7. Patients who have discontinued prior irinotecan treatment due to toxicity or have experienced a severe hypersensitivity reaction to irinotecan or to one of its excipients.
    8. Patients with prior radiation to the pelvis or abdomen in the metastatic or locally advanced setting.
    9. Patients with a history of Gilbert's syndrome.
    10. Patients with unresolved chronic inflammatory bowel disease and/or current unresolved bowel obstruction
    11. Patients with clinically significant active bacterial, fungal, or viral infection.
    12. Uncontrolled or significant cardiovascular disease as defined by:
    -Myocardial infarction within the prior 6 months.
    -Uncontrolled angina within the prior 6 months.
    -Congestive heart failure within the prior 6 months.
    -Diagnosed or suspected congenital long QT syndrome.
    -Any history or second or third degree heart block unless with current pacemaker.
    -History or clinically significant ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, or Torsades de Pointes.
    -Heart rate <50 beats per minute on pre-entry electrocardiogram.
    -Uncontrolled hypertension.
    13. Patients with a history of interstitial lung disease.
    14. Patients with a history of allergic or anaphylactic reaction to any therapeutic or diagnostic monoclonal antibody or IgG-fusion protein.
    15. Patients with other malignancies except those for which the patient has been disease-free for at least 5 years, or adequately treated cervical carcinoma in situ, or adequately treated basal or squamous cell carcinoma of the skin.
    16. Patients with known active brain metastases. Patients with previously diagnosed brain metastases are eligible if they have completed their treatment for CNS metastases and have recovered from the acute effects of radiation therapy or surgery, have been off of corticosteroid treatment for at least 4 weeks and neurologically stable prior to joining the study.
    17. Patients who have undergone any surgery (not including minor procedures such as lymph node biopsy, needle biopsy, or placement of port a cath) within 4 weeks of first dose of study drug; or not fully recovered from any side effects of previous procedures.
    18. Patients who have undergone chemotherapy, radiotherapy (other than palliative radiotherapy to lesions that will not be followed for tumor assessment on this study, ie, non target lesions) within 4 weeks or hormonal, biological or investigational agents within 2 weeks of first dose of study drug (or within 5 times the half life of the agent or 6 weeks for mitomycin C or nitrosoureas).
    19. Current use or anticipated need for food or drugs that are known strong or moderate CYP3A4 inhibitors. Because inhibition of CYP3A4 isoenzymes may increase study drug exposure leading to a potential increases in toxicities, the use of known strong inhibitors (e.g. strong CYP3A4 inhibitors: grapefruit juice or grapefruit/grapefruit related citrus fruits (eg, Seville oranges, pomelos), ketoconazole, miconazole, itraconazole, voriconazole, posaconazole, erythromycin, clarithromycin, telithromycin, varapamil, indinavir, saquinavir, ritonavir, nelfinavir, nefazodone, lopinavir, atazanavir, amprenavir, fosamprenavir and delavirdine, troleandomycin, mibefradil, conivaptan) are not permitted from 14 days prior to the first dose of study drug until 14 days after study treatment discontinuation.
    20. Current or anticipated need for food or drugs that are known potent CYP3A4 inducers. Study drug metabolism may be induced when taking strong CYP3A4 inducers (e.g. strong CYP3A4 inducers: phenobarbital, rifampin, phenytoin, carbamazepine, rifabutin, rifapentin, clevidipine, St. John?s Wort) resulting in reduced plasma concentrations. Therefore co administration of study drug in combination with these and other strong CYP3A4 inducers is not permitted from 14 days prior to the first dose of study drug until 14 days after study treatment discontinuation.

    For more exclusion criteria refer to the protocol.
    1. Pacientes que sean miembros del personal del centro de investigación directamente implicados en la realización del ensayo y sus familiares, miembros del personal del centro que sean supervisados por el investigador o pacientes que sean empleados de Pfizer directamente implicados en la realización del ensayo.
    2. Más de 2 regímenes de quimioterapia citotóxica anteriores para el cáncer colorrectal en el ámbito metastásico.
    3. Pacientes homocigotos para el alelo UGT1A1*28 o UGT1A1*6 o heterocigotos para ambos.
    4. Administración concurrente de preparados fitoterapéuticos y necesidad actual o anticipada de alimentos o medicamentos que sean sustratos conocidos de UGT1A9 (p. ej.: propofol y propanolol). PF-05212384 es un inhibidor potente de UGT1A9.
    5. Uso de paracetamol (acetaminofeno) en las 24 horas previas a la primera dosis de PF-05212384 (ver sección 5.4)
    6. Terapia previa con un compuesto que se sepa o se crea que su acción se deba a la inhibición de PI3K, y/o mTOR, y/o AKT y/o EGFR, incluidos cetuximab o panitumumab.
    7. Pacientes que hayan suspendido el tratamiento anterior con irinotecán por la toxicidad o hayan presentado una reacción de hipersensibilidad grave al irinotecán o a alguno de sus excipientes.
    8. Pacientes con radiación previa en la pelvis o en el abdomen en el contexto de enfermedad metastásica o localmente avanzada.
    9. Pacientes con historia de síndrome de Gilbert.
    10. Pacientes con enfermedad intestinal inflamatoria sin resolver y/o obstrucción intestinal sin resolver actual.
    11. Pacientes con infección bacteriana, fúngica o vírica activa clínicamente significativa.
    12. Enfermedad cardiovascular no controlada o significativa según se define por:
    - Infarto de miocardio en los 6 meses anteriores.
    - Angina no controlada en los 6 meses anteriores.
    - Insuficiencia cardiaca congestiva en los 6 meses anteriores.
    - Diagnóstico o sospecha de síndrome congénito de QT largo.
    - Historia o bloqueo cardiaco de segundo o tercer grado a menos que lleve actualmente marcapasos.
    - Historia o arritmias ventriculares clínicamente significativas tales como taquicardia ventricular, fibrilación ventricular o Torsades de Pointes.
    - Frecuencia cardiaca <50 latidos por minuto en el electrocardiograma antes de la inclusión.
    - Hipertensión no controlada.
    13. Pacientes con historia de enfermedad pulmonar intersticial.
    14. Pacientes con historia de reacción alérgica o anafiláctica a cualquier anticuerpo monoclonal terapéutico o diagnóstico o a la proteína de fusión IgG.
    15. Pacientes con otras neoplasias malignas excepto aquellas que el paciente lleve al menos 5 años libre de enfermedad, o carcinoma cervical in situ adecuadamente tratado, o carcinoma de piel de células basales o escamosas adecuadamente tratado.
    16. Pacientes con metástasis cerebrales activas conocidas. Los pacientes con metástasis cerebrales previamente diagnosticadas son elegibles si han finalizado el tratamiento para la metástasis de SNC y se han recuperado de los efectos agudos de la radioterapia o la cirugía, llevan al menos 4 semanas sin tratamiento con corticoesteroides y están neurológicamente estables antes de entrar en el estudio.
    17. Pacientes que se hayan sometido a cualquier cirugía (no incluye intervenciones menores tales como biopsia de los ganglios linfáticos, biopsia por punción con aguja o colocación de un port-a-cath) en las 4 semanas anteriores a la primera dosis del medicamento del estudio; o que no se hayan recuperado del todo de cualquier efecto adverso de intervenciones anteriores.
    18. Pacientes que hayan recibido quimioterapia, radioterapia (que no sea radioterapia paliativa en lesiones que no recibirán un seguimiento en la evaluación del tumor en este estudio, es decir, lesiones no diana) en las 4 semanas anteriores, o productos hormonales, biológicos o en investigación en las 2 semanas anteriores a la primera dosis del medicamento del estudio (o en el plazo de 5 veces la semivida del
    compuesto o 6 semanas en el caso de la mitomicina C o de las nitrosoureas).
    19. Necesidad actual o anticipada de alimentos o medicamentos que se sabe que son inhibidores fuertes o moderados de CYP3A4. Ya que la inhibición de las isoenzimas CYP3A4 puede aumentar la exposición al medicamento del estudio, dando lugar a un posible aumento de las toxicidades, no se permite el uso de inhibidores potentes conocidos (ejemplos de inhibidores potentes de CYP3A4: zumo de pomelo o
    pomelo/cítricos relacionados con el pomelo [p. ej.: naranja amarga, toronja], ketoconazol, miconazol, itraconazol, voriconazol, posaconazol, eritromicina, claritromicina, telitromicina, varapamilo, indinavir, saquinavir, ritonavir, nelfinavir, nefazodona, lopinavir, atazanavir, amprenavir, fosamprenavir y delavirdina, troleandomicina, mibefradil, conivaptán) desde 14 días antes de la primera dosis del
    medicamento del estudio hasta 14 días después de suspender el tratamiento del estudio.
    Para más criterios de inclusión, por favor consulte el protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    Progression-free suvival (PFS), as assessed by Investigators.
    Supervivencia libre de progresión (SLP), evaluada por los investigadores.
    E.5.1.1Timepoint(s) of evaluation of this end point
    The primary analysis for PFS will take place after 110 PFS events in patients who have centrally confirmed KRAS and NRAS wild type status, with a futility analysis after 55% of the events have occurred.
    El análisis principal de la supervivencia libre de progresión (SLP) se llevará a cabo después de 110 acontecimientos de SLP en pacientes que presenten estado de KRAS y NRAS de tipo natural confirmado en el laboratorio central, con un análisis de futilidad una vez que haya ocurrido el 55 % de los acontecimientos.
    E.5.2Secondary end point(s)
    -First cycle unacceptable toxicity (lead-in cohort in Japanese patients only)
    -Objective response (OR), as assessed using the Response Evaluation Criteria in Solid Tumor (RECIST) version 1.1
    -Duration of response (DR)
    -Overall survival (OS)
    -Safety, including assessment of adverse events and laboratory abnormalities
    -QTc interval
    -Pharmacokinetic parameters of PF-05212384 and irinotecan/SN-38
    -Levels of signaling proteins such as p Akt, Akt, PTEN, p S6, p Met, mTOR, p-EGFR and EGFR in paired tumor biopsies
    -Gene sequences and/or gene copy numbers in biopsied tumor tissue relating to EGFR, PI3K and other oncogenic pathways; examples include but are not limited to PIK3CA, PIK3R1, KRAS, NRAS and BRAF sequences and PIK3CA gene amplification
    -PRO as assessed by health-related quality of life (HRQoL) instruments
    - Toxicidad inaceptable en el primer ciclo (CPI de japoneses solo).
    - Respuesta objetiva (RO), evaluada conforme a los criterios de evaluación de respuesta en tumores sólidos (RECIST) versión 1.1.
    - Duración de la respuesta (DR).
    - Supervivencia global (SG).
    - Seguridad, incluidos los acontecimientos adversos (AA) y las anomalías de laboratorio.
    Intervalo QTc.
    - Parámetros farmacocinéticos de PF-05212384 e irinotecán/SN-38.
    - Niveles de proteínas de señalización tales como p-Akt, Akt, PTEN, p-S6, p-Met, p-mTOR, p-EGFR y EGFR en biopsias tumorales pareadas.
    - Secuencias génicas y/o números de copias génicas en tejidos tumorales biopsiados en relación con las vías EGFR, PI3K y otras vías oncogénicas; entre los ejemplos se incluyen aunque sin carácter restrictivo secuencias de PIK3CA, PIK3R1, KRAS, NRAS y BRAF y amplificación génica PIK3CA.
    - Resultados notificados por los pacientes evaluados por los instrumentos de calidad de vida relacionada con la salud.
    E.5.2.1Timepoint(s) of evaluation of this end point
    -LIC (in Japanese patients only) first cycle unaccept.toxicity: Cycle 1
    -Tumor assessments: Within 28 days prior to Cycle 1 and then every 8 weeks after Cycle 1 Day 1.
    -AEs and lab abnormalities: Cycle 1 (for LIC first cycle unaccep.toxicity) and cycles beyond according to scheme. All cycles for Phase 2.
    -PK parameters: See scheme.
    -QTc interval: At Screening, Cycle 2 (Arm A only) and as clinically indicated.
    -Gene sequences and/or gene copy numbers and signaling proteins in biopsied tumor: At Screening
    -Duration of response: At time of final PFS analysis.
    -OS: Patients are followed until death or 18 months after last patient is randomized.
    -PRO as assessed by HRQoL: Prior to dosing and prior to study procedures on Day 1 of each cycle, end of treatment. and follow-up visits.
    - CPI (japoneses solo) 1r ciclo toxic. inaceptable: Ciclo 1
    - Evaluaciones tumorales: en los 28 días anteriores al ciclo 1 y cada 8 semanas tras ciclo1-Día1
    - AA y anormalidades lab.: Ciclo1 (CPI 1r ciclo tox. inaceptable) y ciclos posteriores según esquema. Todos los ciclos para la Fase 2
    - Parámetros PK: ver esquema
    - Intervalo QTc.: en la selección, ciclo 2 (grupo A sólo) y según esté clínicamente indicado
    - Secuencias génicas y/o números de copias génicas en tejidos tumorales biopsiados: en la selección
    - DR: En el análisis final SLP
    - SG: hasta su muerte o 18 meses después del última paciente aleatorizado
    - Resultados notificados por pacientes: pre-dosis y antes de procedimientos del estudio en el día 1 de cada ciclo, final del tratamiento y visitas de seguimiento
    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 Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Patient Reported Outcomes
    Resultados notificados por los pacientes
    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 Yes
    E.8.1.7.1Other trial design description
    2 grupos independientes: PF-05212384 + irinotecan (grupo A), cetuximab + irinotecan (grupo B)
    2 independent arms: PF-05212384 + irinotecan (arm A), cetuximab + irinotecan (arm B)
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA40
    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
    Belgium
    France
    Italy
    Japan
    Germany
    Korea, Republic of
    Spain
    Poland
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    Última visita del último 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 months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months2
    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: 120
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 30
    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 state11
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 68
    F.4.2.2In the whole clinical trial 150
    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)
    In the study, all patients will be treated until disease progression or unacceptable toxicity occurs. The subsequent anticancer treatment will be given upon discretion of treating physician according to clinical practice.
    En el estudio, todos los pacientes serán tratados hasta la progresión de la enfermedad o toxicidad inaceptable. Se le dará el tratamiento contra el cáncer posterior a discreción del médico de acuerdo a la práctica clínica.
    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 Decision2014-04-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2014-04-03
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2016-04-06
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