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    Summary
    EudraCT Number:2013-003452-21
    Sponsor's Protocol Code Number:BRF117277
    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:2013-12-05
    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 number2013-003452-21
    A.3Full title of the trial
    BRF117277: A Phase II, Open-Label, Multicentre Study of Dabrafenib plus Trametinib in Subjects with BRAF Mutation-Positive Melanoma that has Metastasized to the Brain.
    BRF117277: Estudio de fase II, abierto, multicéntrico, de dabrafenib en combinación con trametinib en pacientes con melanoma BRAF positivo y metástasis cerebrales.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Open-Labeled Study of Dabrafenib plus Trametinib in Subjects with BRAF Mutation-Positive Melanoma that has Metastasized to the Brain.
    Estudio abierto de dabrafenib en combinación con trametinib en pacientes con melanoma BRAF positivo y metástasis cerebrales.
    A.4.1Sponsor's protocol code numberBRF117277
    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 SponsorGlaxoSmithKline, 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 supportGSK USA
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGlaxoSmithKline Reseacrh & Development Ltd
    B.5.2Functional name of contact pointClinical Trials HelpDesk
    B.5.3 Address:
    B.5.3.1Street AddressIron Bridge road
    B.5.3.2Town/ cityUxbridge
    B.5.3.3Post codeUB11 IBU
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+44208990 4466
    B.5.5Fax number+44208990 1234
    B.5.6E-mailGSKClinicalSupportHD@gsk.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 Yes
    D.2.1.1.1Trade name Tafinlar
    D.2.1.1.2Name of the Marketing Authorisation holderGlaxoSmithKline trading Services 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.3.1Product nameTafinlar
    D.3.2Product code GSK1218436
    D.3.4Pharmaceutical form Capsule, hard
    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 INNDABRAFENIB
    D.3.9.1CAS number 1195765-45-7
    D.3.9.2Current sponsor codeGSK2118436
    D.3.9.3Other descriptive nameDabrafenib mesilate
    D.3.9.4EV Substance CodeSUB45696
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Tafinlar
    D.2.1.1.2Name of the Marketing Authorisation holderGlaxoSmithKline trading Services 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.3.1Product nameTafinlar
    D.3.2Product code GSK1218436
    D.3.4Pharmaceutical form Capsule, hard
    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 INNDABRAFENIB
    D.3.9.1CAS number 1195765-45-7
    D.3.9.2Current sponsor codeGSK2118436
    D.3.9.3Other descriptive nameDabrafenib mesilate
    D.3.9.4EV Substance CodeSUB45696
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameTrametinib
    D.3.2Product code GSK1120212
    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 INNTRAMETINIB
    D.3.9.2Current sponsor codeGSK1220212
    D.3.9.3Other descriptive nameN-[3-[3-cyclopropyl-5-[(2-fluoro-4-iodophenyl)amino]- 6,8-dimethyl-2,4,7-trioxo-
    D.3.9.4EV Substance CodeSUB119776
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP 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 nameTrametinib
    D.3.2Product code GSK1120212
    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 INNTRAMETINIB
    D.3.9.2Current sponsor codeGSK1220212
    D.3.9.3Other descriptive nameN-[3-[3-cyclopropyl-5-[(2-fluoro-4-iodophenyl)amino]- 6,8-dimethyl-2,4,7-trioxo-
    D.3.9.4EV Substance CodeSUB119776
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2
    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
    Subjects with BRAF Mutation-Positive Melanoma that has Metastasized to the Brain
    Pacientes con melanoma BRAF positivo y metástasis cerebrales.
    E.1.1.1Medical condition in easily understood language
    Metastic Melanoma.
    Melanoma metastásico.
    E.1.1.2Therapeutic area Diseases [C] - Skin and Connective Tissue Diseases [C17]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.1
    E.1.2Level LLT
    E.1.2Classification code 10027481
    E.1.2Term Metastatic melanoma
    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 assess the intracranial response (IR) of subjects with centrally confirmed BRAF V600E-mutation positive melanoma that has metastasized to the brain without symptoms and have not undergone prior local therapy for brain metastases (Cohort A).
    El objetivo principal del estudio es evaluar la respuesta intracreaneal (TRI) de los pacientes con melanoma cutáneo portador de BRAF V600E confirmado en un laboratorio central que presentan metástasis cerebrales confirmadas mediante RM, asintomáticos, que no han recibido tratamiento local previo y con una puntuación de 0-1 en la escala ECOG (cohorte A).
    E.2.2Secondary objectives of the trial
    - To assess cohort B for IR of subjects with locally confirmed BRAF V600E cutaneous melanoma with metastases to the brain confirmed by MRI, asymptomatic with prior local therapy for brain metastases;
    - To assess cohort C for IR of subjects with locally confirmed BRAF V600 D/K/R cutaneous melanoma with metastases to the brain confirmed by MRI, asymptomatic, with or without prior local therapy; ECOG score of 0-1.
    - To assess cohort D for IR of subjects with locally confirmed BRAF V600 D/E/K/R cutaneous melanoma with metastases to the brain confirmed by MRI, symptomatic; with or without prior local therapy; ECOG score of 0-2.
    - To assess Cohorts A, B, C and D for Disease Control for intracranial, extracranial and overall response (IDC, EDC and ODC respectively)
    - To assess Cohorts A, B, C and D for extracranial response rate (ER)
    - To assess Cohorts A, B, C and D for overall response rate (OR)
    For further information please view section 2 of the protocol.
    - Evaluar la TRI de los pacientes con melanoma cutáneo con mutación BRAF V600E confirmada por un laboratorio local, con metástasis cerebrales confirmadas mediante RM, asintomáticos y con tratamiento local (cerebral) previo (cohorte B);
    - Evaluar la TRI de los pacientes con melanoma cutáneo con mutación BRAF V600D/K/R confirmada por un laboratorio local, con metástasis cerebrales confirmadas mediante RM, asintomáticos; con o sin tratamiento local (cerebral) previo (cohorte C); puntuación de 0 1 en la escala ECOG.
    - Evaluar la TRI de los pacientes con melanoma cutáneo con mutación BRAF V600D/E/K/R confirmada por un laboratorio local, con metástasis cerebrales confirmadas mediante RM, sintomáticos; con o sin tratamiento local (cerebral) previo (cohorte D); puntuación de 0 2 en la escala ECOG.
    Para más información ver el Apartado 2 del Protocolo.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Estudio Farmacogenético. La fecha y la versión coinciden con la del protocolo: 2013N168437_00 del 4 de octubre de 2013. Los objetivos del estudio farmacogenético vienen especificados en el apartado 12.8 (Apendice 8).
    E.3Principal inclusion criteria
    1. Is >= 18 years of age
    2. Has signed written informed consent.
    3. ECOG score of 0-1 for Cohorts A, B and C and ECOG score of 0-2 for Cohort D.
    4. Histologically confirmed via CLIA-certified assay for cutaneous metastatic melanoma (Stage IV; See Appendix 1 for staging), and determined to be V600 E, K, D or R. BRAF V600E mutation status for the subjects in Cohort A will be determined prospectively by the THxIDTM BRAF assay conducted in a central reference laboratory. Subjects in cohorts B, C and D are eligible to enroll based on local test results. Certified local test results will be subjected to retrospective central confirmation by a GSK designated assay.
    5. May be systemic naïve or received up to two previous systemic treatment regimens for metastatic melanoma including chemo-, cytokine-, immune-, biological- and vaccine therapy. Prior TMX for brain metastases and adjuvant IFN are acceptable and does not count toward the two previous systemic treatment regimens.
    6. Must be able to undergo MRI and have at least one measurable intracranial lesion for which all of the following criteria have to be met:
    a. Previously untreated or progressive according to RECIST 1.1 (>/= 20% increase in longest diameter on baseline scan) after previous local therapy
    b. Largest diameter of >/= 0.5cm diameter but </= 4cm as determined by contrast-enhanced MRI.
    c. for target lesions with diameter of > 0.5cm but <= 1 cm documented measurement by a neurologist is required.
    d. For all lesions with a diameter of ? 3cm but <= 4 cm documented measurement by a neuroradiologist is required.
    7. All prior anti-cancer treatment related toxicities (except alopecia) must be <= Grade 1 according to Common Terminology Criteria for Adverse Events version 4 (CTCAE version 4.0; National Cancer Institute (NCI 2009) at the time of entry
    a.http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf
    8. Able to swallow and retain oral medication and must not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels.
    9. Must have adequate organ function as defined in Table 2 please view the protocol.
    10. Women of childbearing potential must have a negative serum pregnancy test within 14 days of first dose of study treatment and agree to use effective contraception throughout the treatment period and for 4 months after the last dose of study treatment.
    NOTE: Oral contraceptives are not reliable due to potential drug-drug interaction with dabrafenib
    11. French subjects: In France, a subject will be eligible for inclusion in this study only if either affiliated to or a beneficiary of a social security category.
    1. Edad >= 18 años.
    2. Firma del consentimiento informado escrito.
    3. Puntuación de 0-1 en la escala funcional del Eastern Cooperative Oncology Group (ECOG) en las cohortes A, B y C y puntuación de 0-2 en la escala ECOG en la cohorte D. Véase el Apéndice 4 [Oken, 1982] (véase el Apéndice 3).
    4. Melanoma cutáneo metastásico histológicamente confirmado mediante certificación CLIA (estadio IV; véase la estadificación en el Apéndice 1), y positivo para la mutación V600 E, K, D o R. El estado de la mutación BRAF V600E en los sujetos de la cohorte A se determinará prospectivamente mediante análisis THxIDTM BRAF realizado en un laboratorio central de referencia. Los sujetos de las cohortes B, C y D serán elegibles en función de los resultados de un laboratorio local. Los resultados certificados por el laboratorio local se someterán a confirmación centralizada retrospectiva según un método designado por GSK.
    5. Los pacientes podrán no haber recibido ningún tratamiento sistémico previo o haber recibido hasta dos regímenes sistémicos previos para tratar el melanoma metastásico, ya sea quimioterapia, tratamiento con citocinas, inmunoterapia-, terapia biológica o vacunoterapia. La administración previa de TMX para tratar las metástasis cerebrales y de IFN adyuvante es aceptable, y no contabilizaría como régimen sistémico previo.
    6. El paciente debe poder someterse a RM y presentar al menos una lesión intracraneal mediblemedible que cumpla los siguientes criterios:
    a. no tratada previamente o progresiva según los criterios RECIST 1.1 (aumento >/= 20 % del diámetro mayor en la exploración basal) después del tratamiento local previo;
    b. el diámetro mayor debe ser >/= 0,5 cm pero </= 4 cm, determinado mediante RM potenciada por un agente de contraste.
    c. En caso de lesiones diana de diámetro > 0,5 cm pero <= 1 cm se exige medición documentada por un neurólogo.
    d. En todas las lesiones de diámetro >= 3cm pero <= 4 cm se exige medición documentada por un radioneurólogo.
    7. Todos los efectos tóxicos relacionados con el tratamiento antineoplásico previo (excepto la alopecia) deben ser ? grado 1 según los Criterios terminológicos comunes para acontecimientos adversos versión 4 (CTCAE versión 4.0; National Cancer Institute [NCI], 2009) en el momento de la incorporación al estudio.
    a. http://evs.NCI.nih.gov/ftp1/CTCAE/CTCAE4.03_2010-06-14_QuickReference_8.5x11.pdf
    8. Capacidad para tragar y retener la medicación administrada por vía oral y ausencia de anomalías digestivas clínicamente importantes que puedan alterar la absorción, como síndrome de malabsorción o resección amplia del estómago o el intestino.
    9. Función orgánica adecuada, como se define en la Tabla 2 del apartado 4.1.2 del Protocolo.
    10. Las mujeres en edad fértil deberán presentar un resultado negativo en la prueba de embarazo en suero en los 14 días previos a la administración de la primera dosis del tratamiento del estudio, y se comprometerán a utilizar un método anticonceptivo eficaz durante todo el tratamiento y hasta 4 meses después de la última dosis del fármaco del estudio.
    NOTA: Los anticonceptivos orales no son fiables debido a posibles interacciones con dabrafenib.
    11. En Francia sólo se podrá incluir en este estudio a los sujetos afiliados o beneficiarios de alguna categoría de la seguridad social.
    E.4Principal exclusion criteria
    1. Neurological symptoms related to brain metastasis except for Cohort D where subjects can be symptomatic.
    2. Prior treatment with any BRAF inhibitor (including but not limited to dabrafenib, vemurafenib, LGX818, or any BRAF mutant selective agent) or any MEK inhibitor (including but not limited to trametinib, AZD6244, and RDEA119).
    3. Anti-cancer therapy (chemotherapy with delayed toxicity, extensive radiation therapy, immunotherapy, biologic therapy, or major surgery) or investigational anti-cancer therapy within 3 weeks, or chemotherapy without delayed toxicity within the 2 weeks of starting study treatment. (Note: Ipilimumab treatment must end at least 8 weeks prior to dosing.
    4. Treatment with stereotactic radiosurgery within 14 days prior to start of study treatment, or treatment with whole-brain radiation within 28 days prior to study treatment.
    5. Any presence of leptomeningeal disease or any parenchymal brain metastasis >4.0 cm in diameter.
    6. Taken an investigational drug within 28 days or 5 half-lives (minimum 14 days), whichever is longer, prior to dosing.
    7. Current or expected use of a prohibited medication
    8. History of another malignancy.
    Exception: Subjects who have been disease-free for 3 years (i.e. subjects with second malignancies that are indolent or definitively treated at least 3 years) or subjects with a history of completely resected non-melanoma skin cancer.
    9. Any serious or unstable pre-existing medical conditions (aside from malignancy exceptions specified above), psychiatric disorders, or other conditions that, in the opinion of the investigator, could interfere with the subject?s safety, obtaining informed consent, or compliance with study procedures.
    10. Known Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV) infection (subjects with laboratory evidence of cleared HBV and/or HCV will be permitted).
    11. Acute infection requiring intravenous antibiotics.
    12. A history or evidence of cardiovascular risk including any of the following:
    a. Current LVEF <LLN
    b. A QT interval corrected for heart rate using the Bazett?s formula (QTcB; ?480 msec; See Appendix 4
    c. A history or evidence of current clinically significant uncontrolled arrhythmias;
    Exception: Subjects with atrial fibrillation controlled for >30 days prior to dosing are eligible.
    d. A history (within 6 months prior dosing) of acute coronary syndromes (including myocardial infarction or unstable angina), coronary angioplasty,
    e. A history or evidence of current ?Class II congestive heart failure as defined by the New York Heart Association (NYHA) guidelines.
    f. Treatment refractory hypertension defined as a blood pressure of systolic >140mmHg and/ or diastolic > 90 mmHg which cannot be controlled by anti-hypertensive therapy;
    g. Patients with intra-cardiac defibrillators.
    h. Abnormal cardiac valve morphology (?grade 2) documented by echocardiogram (subjects with grade 1 abnormalities [i.e., mild regurgitation/stenosis] can be entered on study). Subjects with moderate valvular thickening should not be entered on study.
    13. A history or current evidence/risk of retinal vein occlusion (RVO) or central serous retinopathy (RPED) including:
    a. Presence of predisposing factors to RVO or RPED (e.g., uncontrolled glaucoma or ocular hypertension, uncontrolled hypertension, uncontrolled diabetes mellitus, or a history of hyperviscosity or hypercoagulability syndromes); or
    b. Visible retinal pathology as assessed by ophthalmic examination that is considered a risk factor for RVO or RPED such as:
    i. Evidence of new optic disc cupping;
    ii. Evidence of new visual field defects on automated perimetry;
    iii. Intraocular pressure >21 mm Hg as measured by tonography.
    14. Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the study treatments, their excipients, and/ or dimethyl sulfoxide (DMSO).
    15. Pregnant or nursing females.
    16. Interstitial lung disease or pneumonitis.
    1. Síntomas neurológicos relacionados con las metástasis cerebrales, a excepción de la cohorte D, donde los pacientes pueden ser sintomáticos.
    2. Tratamiento previo con un inhibidor de BRAF (como, por ejemplo, dabrafenib, vemurafenib, LGX818 o cualquier fármaco selectivo contra la mutación BRAF) o de MEK (como, por ejemplo, trametinib, AZD6244 o RDEA119).
    3. Otros tratamientos antineoplásicos aprobados (quimioterapia con toxicidad retardada, radioterapia extensiva, inmunoterapia, biofármacos o cirugía mayor) o experimentales en las 3 semanas precedentes, o quimioterapia sin toxicidad retardada en las 2 semanas que preceden al inicio del tratamiento del estudio. (Nota: el tratamiento con ipilimumab debe concluir al menos 8 semanas antes de la medicación del estudio.)
    4. Radiocirugía estereotáctica en los 14 días precedentes, o radioterapia holocraneal en los 28 días que preceden al inicio del tratamiento del estudio.
    5. Cualquier indicio de enfermedad leptomeníngea o de metástasis en el parénquima cerebral >4,0 cm de diámetro.
    6. Uso de un fármaco en investigación en los 28 días previos o 5 semividas antes de la aleatorización (mínimo de 14 días), lo que sea más breve..
    7. Uso actual o previsto de un medicamento prohibido.
    8. Antecedentes de otras neoplasias malignas.
    Excepción: Pacientes que hayan permanecido sin enfermedad durante 3 años (es decir, sujetos con segundas neoplasias malignas inactivas o tratadas definitivamente hace al menos 3 años) o sujetos con antecedentes de cáncer de piel distinto del melanoma totalmente resecado.
    9. Cualquier efecto adverso o enfermedad médica preexistente grave o inestable (aparte de las excepciones de neoplasias malignas especificadas anteriormente), trastornos psiquiátricos u otros procesos que, en opinión del investigador, puedan afectar a la seguridad del paciente, la obtención del consentimiento informado o el cumplimiento de los procedimientos del estudio.
    10. Infección conocida por el virus de la inmunodeficiencia humana (VIH), el virus de la hepatitis B (VHB) o el virus de la hepatitis C (VHC) (se permitirá la participación de sujetos con infección por el VHB y/o el VHC eliminada, demostrada analíticamente).
    11. Infección aguda que requiera antibioterapia intravenosa.
    12. Antecedentes o indicios de riesgo cardiovascular, como cualquiera de los siguientes
    a. FEVI actual < LIN
    b. Intervalo QT corregido en el electrocardiograma con la fórmula de Bazett (QTcB; Apéndice 5) >=480 ms; Véase el Apéndice 4 del Protocolo.
    c. Antecedentes o signos actuales de arritmias no controladas clínicamente significativas.
    Excepción: Podrán participar pacientes con fibrilación auricular controlada durante > 30 días antes de la primera dosis de la medicación del estudio.
    d. Antecedentes (en los 6 meses previos a la aleatorización) de síndromes coronarios agudos (como infarto de miocardio o angina inestable) o angioplastia coronaria.
    e. Antecedentes o indicios actuales de insuficiencia cardiaca congestiva de clase >= II según las directrices de la New York Heart Association (NYHA) (Apéndice 4). Véase el Apéndice 5 del Protocolo.
    f. La hipertensión arterial resistente al tratamiento se define como una presión arterial sistólica > 140 mm Hg o diastólica > 90 mm Hg que no puede controlarse con tratamiento antihipertensivo.
    g. Pacientes con desfibriladores intracardíacos
    h. Morfología anormal de las válvulas cardíacas (grado >=2) documentada mediante ecocardiografía (podrán participar en el estudio los pacientes con anomalías de grado 1 [es decir, insuficiencia/estenosis leve]). Los pacientes con engrosamiento valvular moderado no deben participar en el estudio.
    13. Antecedentes o signos actuales de oclusión de las venas retinianas (OVR) o desprendimiento del epitelio pigmentario retiniano (DEPR), entre ellos:
    a. presencia de factores predisponentes a la OVR o al DEPR (p. ej., glaucoma o hipertensión ocular no controlados, hipertensión no controlada, diabetes mellitus no controlada o antecedentes de síndromes de hiperviscosidad o hipercoagulabilidad), o
    b. afección retiniana visible, según lo evaluado mediante exploración oftalmológica, que se considere un factor de riesgo de OVR o DEPR, como:
    i. signos de nueva excavación de la papila óptica;
    ii. signos de nuevos defectos del campo visual en la perimetría automática;
    iii. presión intraocular > 21 mm Hg medida mediante tonografía.
    14. Reacción de hipersensibilidad inmediata o tardía conocida o reacción idiosincrásica a medicamentos relacionados químicamente con los tratamientos del estudio, sus excipientes y/o el dimetilsulfóxido (DMSO).
    15. Mujeres embarazadas o lactantes.
    16. Enfermedad pulmonar intersticial o neumonitis
    E.5 End points
    E.5.1Primary end point(s)
    IR is defined as the proportion of subjects with a confirmed intracranial complete response (CR) or partial response (PR) as per investigator assessment using modified RECIST 1.1 guidelines [Eisenhauer, 2009].
    La TRI se define como la proporción de sujetos que tienen respuesta completa (RC) o respuesta parcial (RP) intracraneal confirmada por la evaluación del investigador según las normas RECIST 1.1 modificadas [Eisenhauer, 2009].
    E.5.1.1Timepoint(s) of evaluation of this end point
    Intracranial will be assessed at baseline, Week 4, Week 8, and every 8 weeks thereafter. After Week 40, disease assessments may be performed every 12 weeks
    La evaluación intracraneal se realizará en momento basal, semana 4, semana 8 y después cada 8 semanas. Después de la semana 40 la evaluación de la enfermedad se puede realizar cada 12 semanas.
    E.5.2Secondary end point(s)
    - IR is defined as the percentage of subjects with a confirmed intracranial complete response (CR) or partial response (PR) as per investigator assessment using modified RECIST 1.1 guidelines [Eisenhauer, 2009].
    - Intracranial Disease Control (IDC) is defined as CR+PR+SD for intracranial, extracranial, and overall disease control
    - Extracranial response (ER), defined as the percentage of subjects with a best extracranial response of a confirmed CR or PR by investigator assessment using modified RECIST 1.1
    - Overall response (OR), defined as the percentage of subjects with a best overall confirmed response of CR or PR by investigator assessment.
    - Duration of intracranial, extracranial and overall response (DIR, DER and DOR), defined as the time from first documented evidence of CR or PR until time of first documented intracranial, extracranial and overall disease progression.
    - PFS, defined as the interval between first dose and the earliest date of disease progression or death due to any cause
    - Overall survival (OS), defined as the time from first dose until death due to any cause.
    - Assessment of safety of dabrafenib and trametinib measured by the frequency and severity of adverse events, skin assessments, laboratory abnormalities, vital signs, and assessment data (12-lead electrocardiograms (ECG), echocardiograms, and clinical monitoring/observation including neurological examination).
    Exploratory endpoints:
    - Tumour DNA, RNA, and protein content, other tumour tissue aberrations, clinical outcome and their association of the mutation profile with tumour response.
    - BRAF and other cancer gene mutations in cfDNA, cfDNA burden and their association with tumour response
    - Germline genetic variants and their association with safety measures (as listed under secondary endpoints), , and with tumour response.
    - La TRI se define como la proporción de sujetos que tienen respuesta completa (RC) o respuesta parcial (RP) intracraneal confirmada por la evaluación del investigador según las normas RECIST 1.1 modificadas [Eisenhauer, 2009].
    - El control de la enfermedad intracraneal, que se define como la suma de RC+RP+EE de la enfermedad intracraneal, extracraneal o global
    - La respuesta extracraneal (TRE), que se define como el porcentaje de sujetos con mejor respuesta extracraneal confirmada como RC o RP por la evaluación del investigador según las normas RECIST 1.1 modificadas.
    - La respuesta global (TRG), que se define como el porcentaje de sujetos con mejor respuesta global confirmada como RC o RP por la evaluación del investigador.
    - La duración de la respuesta intracreaneal, extracraneal y global (DRI, DRE y DRG), que se define como el tiempo que transcurre desde el primer signo documentado de RC o RP hasta el primer signo documentado de progresión de la enfermedad intracraneal, extracraneal y global.
    - La SLP, definida como el intervalo entre la fecha de la primera dosis y la fecha más precoz de progresión de la enfermedad o la muerte por cualquier causa.
    - La supervivencia global (SG), definida como el tiempo transcurrido entre la aleatorización y la muerte por cualquier causa).
    - La seguridad de dabrafenib y trametinib se determina por la frecuencia e intensidad de los acontecimientos adversos, las exploraciones dermatológicas, las anomalías analíticas, las constantes vitales y los resultados de las evaluaciones programadas [electrocardiogramas (ECG) de 12 derivaciones, ecocardiografía y observación/seguimiento clínico con exploración neurológica).
    Exploratorios:
    - ADN, ARN y proteínas del tumor, otras anomalías del tejido tumoral, resultado clínico y relación del perfil de mutación con la respuesta tumoral.
    - Mutaciones BRAF y otras mutaciones cancerígenas del ADNlc, carga de ADNlc y su asociación con la respuesta tumoral
    - Variaciones genéticas de la estirpe germinativa y su relación con las mediciones de la seguridad (véanse los criterios de valoración secundarios) y con la respuesta tumoral.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Intracranial and extracranial disease will be assessed at baseline, Week 4, Week 8, and every 8 weeks thereafter. After Week 40, disease assessments may be performed every 12 weeks.
    La evaluación intracraneal y extracraneal se realizará en momento basal, semana 4, semana 8 y después cada 8 semanas. Después de la semana 40 la evaluación de la enfermedad se puede realizar cada 12 semanas.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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 concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA26
    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
    Australia
    Canada
    France
    Germany
    Italy
    Spain
    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
    until 70% death.
    Hasta 70% de fallecimientos.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months0
    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: 96
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 24
    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 state16
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 120
    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)
    All subjects who permanently discontinue study treatments will have safety assessments at the time of discontinuation and during post-study treatment follow-up including monthly skin assessments. Subjects who are receiving treatment when the study is closed may continue treatment in a rollover study BRF114144 or choose to take commercially available treatment where available.
    A todos los sujetos que suspendan definitivamente la medicación del estudio se les hará valoraciones de seguridad en el momento de la retiradad y durante el seguimiento post-tratamiento, incluyendo valoraciones dermatológcas mensuales. Los sujetos que estén recibiendo tratamiento cuando el estudio se cierre podrán continuar el tratamiento en el estudio de extensión BRF114144 o, en su caso, optar por los tratamientos comercialmente disponibles.
    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 Decision2014-01-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2014-01-07
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2018-02-14
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