E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Relapsed or refractory metastatic colorectal cancer |
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E.1.1.1 | Medical condition in easily understood language |
Advanced colorectal cancer |
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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 | 17.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10052358 |
E.1.2 | Term | Colorectal cancer metastatic |
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 | 17.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10010030 |
E.1.2 | Term | Colorectal cancer recurrent |
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 | 17.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10052362 |
E.1.2 | Term | Metastatic 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 | 17.1 |
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.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Part 1 (Safety Run-in)
• To determine the doses of ruxolitinib and regorafenib that are safe and tolerable when administered in combination.
Part 2 (Randomized Phase)
• To evaluate and compare the OS of subjects with metastatic CRC when treated with ruxolitinib in combination with regorafenib versus regorafenib alone. |
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E.2.2 | Secondary objectives of the trial |
• To evaluate and compare the efficacy of the 2 treatment groups with respect to PFS.
• To evaluate and compare the efficacy of the 2 treatment groups with respect to overall tumor response and duration of response.
• To evaluate and compare disease control of ruxolitinib in combination with regorafenib versus regorafenib alone.
• To evaluate and compare the safety and tolerability of ruxolitinib in combination with regorafenib versus regorafenib alone. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Male or female 18 years or older.
• Histologically or cytologically confirmed adenocarcinoma of the colon or rectum that is metastatic.
• Previous treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy; an anti-VEGF therapy (if no contraindication); and if KRAS wild type and no contraindication, an anti-EGFR therapy; and progressed following the last administration of approved therapy.
• Radiographically measurable or evaluable disease (per RECIST 1.1).
• Eastern Cooperative Oncology Group performance status of 0 to 2.
• Three or more weeks have elapsed from the completion of previous treatment regimen and subjects must have recovered or be at a new stable baseline from any related toxicities.
• Radiotherapy to disease sites is allowed provided:
− Four or more weeks have elapsed since the completion of radiation therapy.
− Subjects who received palliative radiation treatment to a limited field or on an accelerated schedule within the last 7 days are eligible
− Disease sites within the field of prior irradiation have subsequently progressed or there are other metastatic disease sites outside the field of prior irradiation.
− All treatment related toxicities have resolved or are at a new stable baseline. |
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E.4 | Principal exclusion criteria |
Subjects who meet any of the following will not be included in the study:
• Received prior treatment with regorafenib.
• Presence of active gastrointestinal disease or other condition that will interfere significantly with the absorption of drugs.
• History of abdominal fistula or gastrointestinal perforation at any point within 6 months prior to day 1 of study drug administration, unless surgically repaired.
• Active peptic ulcer disease, inflammatory bowel disease (e.g. ulcerative colitis, Crohn's disease), diverticulitis, or other gastrointestinal conditions with increased risk of perforation or gastrointestinal bleeding.
• Recent history (≤4 weeks of Day 1 of study drug administration) of a major surgery or significant traumatic injury.
• Recent history (≤ 3 months) or ongoing partial or complete bowel obstruction unless corrected with surgery.
• Blood pressure ≥ 140/90 mmHg
• Chronic or current active infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment.
• Known central nervous system metastases or history of uncontrolled seizures.
• Clinically significant cardiac disease including unstable angina, acute myocardial infarction within 6 months from Day 1 of study drug administration, New York Heart Association Class II, III, or IV congestive heart failure, and arrhythmia requiring therapy.
• Creatinine clearance < 50 mL/min measured or calculated by Cockroft-Gault equation
• Inadequate hepatic, and bone marrow function as evidenced by:
− Absolute neutrophil count < 1.5 × 109/L.
− Platelets < 100 × 109/L.
− Hemoglobin < 9 g/dL (transfusions are permitted to achieve baseline hemoglobin level).
− ALT/AST > 2.5 × the upper limit of normal (ULN); or > 5 × ULN in the presence of liver metastases.
− Total bilirubin > 1.5 × ULN (if total bilirubin is > 1.5 × ULN then the subject may participate if the direct bilirubin is ≤ 1.5 × ULN).
• Concurrent anticancer therapy
• Subjects who participated in any other study in which an investigational study drug was received within 28 days prior to first dose.
• Current or previous other malignancy within 5 years of study entry, except cured basal or squamous cell skin cancer, superficial bladder cancer, prostate intraepithelial neoplasm, carcinoma in situ of the cervix, or other noninvasive malignancy.
• Known HIV infection.
• HBV or HCV viremia or at risk for HBV or HCV reactivation. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint OS is defined as the interval from date of randomization to death due to any cause. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary endpoint OS is defined as the interval from date of randomization to death due to any cause. Subjects without death observed at the time of the analysis will be censored at last date known to be alive. |
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E.5.2 | Secondary end point(s) |
PFS, defined as the interval from date of randomization to the earlier of death or disease progression by RECIST 1.1 as assessed by the investigator.
ORR by treatment groups along with 95% exact CIs. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
The interval from date of randomization to the earlier of death or disease progression by RECIST 1.1 as assessed by the investigator |
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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 | Yes |
E.6.7 | Pharmacodynamic | Yes |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
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 | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 40 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Austria |
France |
Germany |
Israel |
Italy |
Korea, Republic of |
Spain |
United Kingdom |
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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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There is no predefined end of 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 | 1 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 1 |