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    Summary
    EudraCT Number:2014-000793-19
    Sponsor's Protocol Code Number:SOLTI-1203
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2014-08-06
    Trial 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 number2014-000793-19
    A.3Full title of the trial
    A Phase II, Randomized Study of T DM1 versus T DM1 plus short induction with docetaxel in first line treatment for locally advanced or metastatic HER2+ breast cancer.
    Estudio fase II, aleatorizado, de T-DM1 frente a T-DM1 e inducción corta con docetaxel en primera línea de tratamiento del cáncer de mama HER2 positivo localmente avanzado no operable o metastásico.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Early phase Clinical trial, Randomized Study of T DM1 versus T DM1 plus docetaxel in first line treatment for locally advanced or metastatic HER2+ breast cancer.
    Ensayo clínico de fase temprana, aleatorizado, de T-DM1 frente a T-DM1 e inducción corta con docetaxel en primera línea de tratamiento del cáncer de mama localmente avanzado o metastásico HER2+.
    A.4.1Sponsor's protocol code numberSOLTI-1203
    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 SponsorSOLTI
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportSOLTI
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationSOLTI
    B.5.2Functional name of contact pointOficina Operaciones
    B.5.3 Address:
    B.5.3.1Street AddressC/ DIPUTACION 256 4º1ª
    B.5.3.2Town/ cityBARCELONA
    B.5.3.3Post code08007
    B.5.3.4CountrySpain
    B.5.4Telephone number0034933436302
    B.5.5Fax number0034932702383
    B.5.6E-mailmorales.pepi@gruposolti.org
    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 Kadcyla
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Limited
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder for solution for injection/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 INNTRASTUZUMAB EMTANSINE
    D.3.9.1CAS number 1018448-65-1
    D.3.9.3Other descriptive nameTRASTUZUMAB EMTANSINE
    D.3.9.4EV Substance CodeSUB35467
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number160
    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) Yes
    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.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Concentrate for solution for injection/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 INNDOCETAXEL
    D.3.9.3Other descriptive nameDOCETAXEL
    D.3.9.4EV Substance CodeSUB12492MIG
    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.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Kadcyla
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Limited
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Powder for solution for injection/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 INNTRASTUZUMAB EMTANSINE
    D.3.9.1CAS number 1018448-65-1
    D.3.9.3Other descriptive nameTRASTUZUMAB EMTANSINE
    D.3.9.4EV Substance CodeSUB35467
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number160
    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) Yes
    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
    Progressive or recurrent, locally advanced unresectable or metastatic HER2+ breast carcinoma in patients who have not received previous chemotherapy for the advanced disease.
    Carcinoma de mama HER2+, localmente avanzado no operable o metastásico, en pacientes que no han recibido quimioterapia previa para la enfermedad avanzada.
    E.1.1.1Medical condition in easily understood language
    Progressive or recurrent, locally advanced unresectable or metastatic HER2+ breast carcinoma in patients who have not received previous chemotherapy for the advanced disease.
    Carcinoma de mama HER2+, localmente avanzado no operable o metastásico, en pacientes que no han recibido quimioterapia previa para la enfermedad avanzada.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare the early efficacy (measured as the rate of PFS at 4 months) of T DM1 together with SI docetaxel versus monotherapy treatment with T DM1
    1. Comparar la eficacia temprana, medida como la tasa de supervivencia libre de progresión (SLP) a los 4 meses de T-DM1 más IC-docetaxel frente al tratamiento en monoterapia con T-DM1.
    E.2.2Secondary objectives of the trial
    2.To compare the combination of T DM1 together with SI docetaxel versus monotherapy treatment with T DM1 in terms of:
    a.Overall Response Rate (ORR), measured as the percentage of patients who achieve Complete Response (CR) and/or Partial Response (PR), in accordance with the RECIST 1.1 criteria throughout the study treatment.
    b.Clinical Benefit Rate (CBR), measured as the percentage of patients with CR, PR or Stable Disease (SD) with a duration of at least 6 months.
    c.Duration of Response (DR)
    d.Overall Survival (OS)
    e. Progression Free Survival (PFS)
    f.Breast cancer specific survival, measured as the time from randomization to death due to breast cancer.
    3. To compare the safety and tolerability of both treatment regimens.
    4. To compare the cardiac safety of both treatment regimens.
    5. To compare the hepatic safety of both treatment regimens.
    2. Comparar la eficacia de la combinación de T-DM1 más IC-docetaxel frente al tratamiento en monoterapia con T-DM1 en términos de:
    a.Tasa de respuesta global (TRG), medida como la proporción de pacientes que logran una respuesta completa (RC) y/o respuesta parcial (RP), de acuerdo con los criterios RECIST 1.1 a lo largo del tratamiento en estudio.
    b.Tasa de beneficio clínico (TBC), medida como la proporción de pacientes con RC, RP o enfermedad estable (EE) de al menos 6 meses de duración.
    c.Duración de la respuesta (DR).
    d.Supervivencia global (SG)
    e.Supervivencia libre de progresión (SLP)
    f.La supervivencia específica de cáncer de mama, medida como el tiempo desde la aleatorización hasta la muerte por cáncer de mama.
    3.Comparar la seguridad y tolerabilidad de ambas pautas de tratamiento.
    4.Comparar la seguridad cardíaca de ambas pautas de tratamiento.
    5.Comparar la seguridad hepática de ambas pautas de tratamiento.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Written Informed Consent for all study procedures in accordance with the local regulatory requirements prior to starting any Protocol specific procedures.
    2.To provide tumor tissue or to have the possibility to collect newly tumor sample from the patient to be able to perform PAM50 analysis. The minimum conditions to achieve this are 1) presence of at least 1 tumor core with a minimum tissue area of 10mm2, 2) with at least 35% of tumoral cells and 3) enough tissue to perform at least 3 sections of 10 ?m each.
    3.Women.
    4.Age ? 18 years.
    5.ECOG performance status of 0 or 1.
    6.Invasive HER2+ breast cancer assessed centrally, defined by the clinical guidelines of the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) (Wolff JCO 2013):
    a)IHC 3+ overexpression (circumferential membrane staining that is complete, intense, observed in >10% of the invasive tumor cells)
    b)In situ Hybridization positive (ISH: FISH/CISH/SISH >10% of the invasive tumor cells and by count of at least 20 cells in the area) based on:
    ?Single probe average HER2 gene copy number f ? 6 signals/cell
    ?Dual probe HER2/CEP17 ratio ? 2.0 with an average HER2 gene copy number ? 4.0 signals/cell
    ?Dual probe HER2/CEP17 ratio ? 2.0 with an average HER2 gene copy number < 4.0 signals/cell
    ?Dual probe HER2/CEP17 ratio < 2.0 with an average HER2 gene copy number ? 6.0 signals/cell
    7.Histologically confirmed adenocarcinoma of the breast, MBC or locally advanced breast cancer, eligible for chemotherapy.
    a)The patients with locally advanced disease must present recurrent disease or disease progression, which cannot be treated through resection with curative intent. Patients with standard curative options available will not be eligible.
    b)In patients with bilateral, HER2+ breast cancer, this must be demonstrated in both sites or in a metastatic biopsy.
    8.Measurable or non measurable (but evaluable) disease according to RECIST 1.1 criteria.
    9.Adequate organ function, as determined by the following laboratory tests, in the 14 days prior to randomization:
    a)Absolute neutrophil count (ANC) ? 1.5 x 109/L.
    b)Hemoglobin (Hb: ? 9 g/dL (Transfusion of red blood cells and/or erythropoietin permitted).
    c)Platelets > 100,000/mm3
    d)Serum creatinine ? 1.5x Upper limit of normal (ULN).
    e)Total bilirubin < 1.5 time the upper-normal limits (UNL) of the Institutional normal values and ASAT and/or ALAT < 2.5 UNL, alkaline phosphatase < 5 UNL (unless bone metastases are present in the absence of any liver disorders).
    f)International Normalized Ratio (INR) and activated partial thromboplastin time (aPTT) <1.5 x ULN (except in cases of ongoing anticoagulant treatment).
    10.Baseline left ventricular ejection fraction (LVEF) ? 50% measured by echocardiography (ECHO) or isotopic ventriculography (MUGA).
    11.? HCG pregnancy test negative (serum) for premenopausal women of childbearing potential (biologically capable of having children) and for women who have been menopausal for fewer than 12 months. All patients biologically capable of bearing children must agree and commit to the use of a reliable contraceptive method from 2 weeks prior to the administration of the first dose of the investigational medicinal product until 28 7 months after the last dose of the study treatment.
    12.Absence of psychological, family, sociological or geographical conditions that could potentially hinder compliance with the study Protocol and monitoring calendar. These conditions must be discussed with the patient prior to her inclusion in the study.
    1.Consentimiento informado por escrito para todos los procedimientos del estudio de acuerdo a los requerimientos regulatorios locales antes de comenzar los procedimientos de protocolos específicos.
    2.Disponer de muestra suficiente o posibilidad de re-biopsiar a la paciente para el análisis por PAM50. Las condiciones mínimas para realizar dicho análisis son la presencia, en 1 bloque tumoral, de 1) al menos 1 cilindro tumoral con un mínimo de 10mm2 de área de tejido, 2) que contenga al menos un 35% de células tumorales y 3) que haya tejido suficiente para realizar al menos 3 cortes de 10 ?m cada uno.
    3.Mujeres.
    4.Edad ?18 años.
    5.Estado funcional ECOG de 0 o 1.
    6.Cáncer de mama invasivo HER2+ determinado localmente, definido por las guías clínicas de la American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) (Wolff JCO 2013):
    a)Sobreexpresión 3+ por IHQ (tinción de la membrana circunferencial completa, intensa observada en >10% de las células tumorales invasivas)
    b)Hibridación in situ positiva (ISH: FISH/CISH/SISH >10% de las células tumorales invasivas y por recuento de al menos 20 células en el área) basado en:
    ?Sonda única del gen HER2 con un número promedio de copias de ?6 señales/célula
    ?Doble sonda HER2/CEP17 ratio ?2,0 con un promedio de copias del gen HER2 ?4,0 señales/célula
    ?Doble sonda HER2/CEP17 ratio ?2,0 con un promedio de copias del gen HER2 <4,0 señales/célula
    ?Doble sonda HER2/CEP17 ratio <2,0 con un promedio de copias del gen HER2 ?6,0 señales/célula
    7.Adenocarcinoma de mama confirmado histológicamente, CMM o localmente avanzado, elegible para quimioterapia.
    a)Las pacientes con enfermedad localmente avanzada deben presentar enfermedad recurrente o progresión de la enfermedad, que no debe ser tratable mediante resección con intención curativa. Las pacientes con opciones de curación estándar disponibles no serán elegibles.
    b)En las pacientes con cáncer de mama bilateral HER2+, éste debe demostrarse en ambas localizaciones o en una biopsia metastásica.
    8.Enfermedad medible o no medible (pero evaluable) según criterios RECIST 1.1.
    9.Función adecuada de los órganos, según lo determinado por las siguientes pruebas de laboratorio, en los 14 días previos a la aleatorización:
    a)Recuento absoluto de neutrófilos (RAN) ?1.5 x 109/L.
    b)Hemoglobina (Hb) ?9 g/dL (transfusión de glóbulos rojos y/o eritropoyetina permitida).
    c)Plaquetas >100,000/mm3
    d)Creatinina sérica ?1,5x límite superior de la normalidad (LSN).
    e)Bilirubina total < 1.5 LSN of the Institutional normal values and ASAT y/o ALAT < 2.5 LSN, Fosfatasa alcalina < 5 LSN al menos que haya metastasis óseas en ausencia de desorden hepático).
    f)Cociente normalizado internacional (INR) y tiempo de tromboplastina parcial activado (TTPA) <1,5 x LSN (salvo en casos con tratamiento anti-coagulante en curso).
    10.Fracción de eyección ventricular izquierda basal (FEVI) ? 50% medida por ecocardiografía (ECO) o ventriculografía isotópica (MUGA).
    11.Prueba de embarazo ?-HCG negativa (suero) para las mujeres premenopáusicas con capacidad reproductiva (biológicamente capaces de tener hijos) y para las mujeres menopáusicas desde hace menos de 12 meses. Todas las pacientes biológicamente capaces de tener hijos deben estar de acuerdo y comprometerse con el uso de un método anticonceptivo fiable desde 2 semanas antes de la administración de la primera dosis del fármaco en investigación hasta los 7 meses después de la última dosis del fármaco en investigación.
    12.Ausencia de condiciones psicológicas, familiares, sociológicas o geográficas que potencialmente puedan obstaculizar el cumplimiento del protocolo de estudio y el calendario de seguimiento. Esas condiciones se deberán discutir con la paciente antes de su inclusión en el estudio.
    E.4Principal exclusion criteria
    1.History of systemic anti cancer therapy for MBC or locally advanced breast cancer, with the exception of previous hormonal treatments.
    oThe hormonal regimen for MBC may not include HER2 targeted therapy.
    2.Interval <12 months from the last dose of taxanes in the (neo) adjuvant treatment until the time of diagnosis of the metastasis.
    3.Hormone therapy up to < 7 days prior to randomization.
    4.Trastuzumab, lapatinib and/or pertuzumab in the (neo) adjuvant treatment up to < 21 days prior to randomization.
    5.Previous T DM1 treatment.
    6.Treatment with any anticancer investigational medicinal product in the 28 days prior the start of the study treatment.
    7.History of other malignant tumors in the past 5 years, with the exception of adequately treated in situ carcinoma or stage I of uterine cancer, non melanoma carcinoma of the skin, or other malignant tumors with an expected curative outcome.
    8.Brain metastases that have not be treated previously, are progressive, or that require some type of treatment (for example, radiation, surgery or steroids) to control the symptoms in the 60 days prior to the first dose of the study treatment.
    9.Radiation therapy for the metastases of the non brain disease carried out in the 14 days prior to inclusion in the study and/or radiation > 30% of the bone marrow.
    10.Symptomatic hypercalcemia requiring treatment with bisphosphonates in the 21 days prior to the first study treatment. Patients receiving treatment with bisphosphonates specifically for the prevention of skeletal events and who do not have a RECENTLY history of clinically significant hypercalcemia are eligible.
    11.Current peripheral neuropathy, grade ?2 according to NCI CTCAE version 4.03.
    12.Abnormal liver function defined as:
    o AST or ALT > 2.5 x ULN
    o AST or ALT > 1.5 x ULN with simultaneous serum alkaline phosphatase >2.5 x ULN. The serum alkaline phosphatase may be >2.5 x ULN only in the presence of bone metastases and AST (SGOT) and ALT (SGPT) < 1.5 x ULN.
    o Total bilirubin ? 1.5 x ULN unless the patient has documented Gilbert's syndrome. In the case of documented Gilbert's syndrome, the direct bilirubin must be within the normal range.
    13.History of exposure to the following cumulative doses of anthracyclines:
    ?Doxorubicin > 500 mg/m2
    ?Liposomal doxorubicin > 500 mg/m2
    ?Epirubicin > 720 mg/m2
    ?Mitoxantrone > 120 mg/m2
    ?Idarubicin > 90 mg/m2
    ?If another anthracycline or more than one anthracycline has been used, the cumulative dose must not exceed the equivalent of 500 mg/m2 of doxorubicin.
    14.Cardiopulmonary dysfunction defined as:
    o Uncontrolled hypertension (systolic > 150 mmHg and/or diastolic > 100 mmHg) despite optimum medical treatment.
    o Serious cardiac arrhythmia or angina controlled inadequately, not controlled with adequate medication.
    o Inadequate LVEF at study start, defined as LVEF < 50% in any ECHO or MUGA.
    o History of symptomatic congestive heart failure (SCHF): Grade ? 2 according to NCI CTCAE version 4.03 criteria or class ? II according to the criteria of the New York Heart Association (NYHA).
    o History of decrease of the LVEF to < 40% or symptomatic CHF after prior treatment with trastuzumab.
    o Myocardial infarction in the 6 months prior to randomization.
    o Current resting dyspnea due to complications of the advanced malignant disease, or other diseases requiring continuous oxygen therapy.
    15. Current uncontrolled serious systemic disease that is active (for example, clinically significant cardiovascular disease, pulmonary or metabolic disease, wound healing disorders, ulcers, bone fractures).
    16.Pregnant or nursing women.
    17.Major surgical procedure or significant traumatic lesion within approximately 28 days prior to randomization or the anticipation of the need for major surgery during the course of the study treatment.
    18.Simultaneous, serious infections, current known infection with HIV or active Hepatitis B and/or Hepatitis C.
    o For patients who are carriers of the Hepatitis B Virus (HBV), active Hepatitis B infection must be ruled out based on negative serological tests and/or the HBV DNA determination according to local guidelines.
    19.Current daily, chronic treatment with corticosteroids (equivalent dose of methylprednisolone >10 mg/day).
    20.History of intolerance, including grade 3 4 reaction to the infusion, hypersensitivity to trastuzumab or to docetaxel/paclitaxel.
    21.Known hypersensitivity to any of the study drugs, including excipients or any drugs formulated in polysorbate 80.
    22.When the assessment by the investigator is not possible since the patient cannot or does not wish to comply with the Protocol requirements.
    23.History of significant comorbidities that, at the discretion of the investigator, may interfere with the study conduct, the assessment of the response, or with the informed consent.
    1.Antecedentes de terapia anticancerígena sistémica para CMM o localmente avanzado, con excepción de tratamientos hormonales previos.
    oLa pauta hormonal para el CMM no puede incluir terapia dirigida a HER2
    2.Intervalo <12 meses desde la última dosis de taxanos en el tratamiento (neo)adyuvante hasta el momento del diagnóstico de metástasis.
    3.Terapia hormonal hasta <7 días previos a la aleatorización.
    4.Trastuzumab, lapatinib y/o pertuzumab en el tratamiento (neo)adyuvante hasta <21 días previos a la aleatorización.
    5.Tratamiento T-DM1 previo.
    6.Tratamiento con cualquier fármaco anticancerígeno en investigación en los 28 días previos al inicio del tratamiento del estudio.
    7.Antecedentes de otros tumores malignos en los últimos 5 años, excepto aquellos carcinomas in situ o en estadio I de cuello de útero o carcinomas de piel no melanoma, tratados adecuadamente, o de otros tumores malignos con un resultado curativo esperado.
    8.Metástasis cerebrales que no han sido tratadas previamente, progresivas, o que requieren algún tipo de tratamiento (por ejemplo, radiación, cirugía o esteroides) para controlar los síntomas dentro de los 60 días previos a la primera dosis de tratamiento del estudio.
    9.Radioterapia de las metástasis de la enfermedad fuera del cerebro llevada a cabo dentro de los 14 días previos a la inclusión en el estudio y/o radiación >30% de la médula ósea.
    10.Hipercalcemia sintomática que requiere tratamiento con bifosfonatos en los 21 días previos al primer tratamiento del estudio. Las pacientes que reciben tratamiento con bifosfonatos.
    11.Neuropatía periférica actual, grado =2 según NCI-CTCAE versión 4.03.
    12.Función hepática anormal definida como:
    oAST o ALT >2,5 x LSN
    oAST o ALT >1,5 x LSN con fosfatasa alcalina sérica simultánea >2,5 x LSN. La fosfatasa alcalina en suero puede ser >2,5 x LSN sólo si existe presencia de metástasis óseas y AST (SGOT) y ALT (SGPT) <1,5 x LSN.
    oBilirrubina total =1,5x LSN salvo si la paciente tiene síndrome de Gilbert documentado.
    13.Antecedentes de exposición a las siguientes dosis acumulativas de antraciclinas:
    ?Doxorrubicina >500 mg/m2
    ?Doxorrubicina liposomal >500 mg/m2
    ?Epirubucina >720 mg/m2
    ?Mitoxantrona >120 mg/m2
    ?Idarubicina >90 mg/m2
    ?Si se ha utilizado otra antraciclina o más de una antraciclina, la dosis acumulada no debe exceder el equivalente a 500 mg/m2 de doxorrubicina.
    14.Disfunción cardiopulmonar definida por:
    oHipertensión no controlada (sistólica >150 mmHg y/o diastólica >100 mmHg) a pesar de tratamiento médico óptimo.
    oAngina o arritmias cardíacas graves controladas de forma inadecuada, no controladas con la medicación adecuada.
    oFEVI inadecuada al inicio del estudio, definida como FEVI <50% en cualquiera ECO o MUGA.
    oAntecedentes de insuficiencia cardíaca congestiva sintomática (ICCS): Grado =2 según criterios NCI CTCAE versión 4.03 o clase =II según los criterios de la New York Health Association (NYHA).
    oAntecedentes de disminución de la FEVI a <40% o insuficiencia cardiaca congestiva sintomática tras el tratamiento con trastuzumab previo.
    oInfarto de miocardio en los 6 meses previos a la aleatorización.
    oDisnea actual en reposo debida a complicaciones de la enfermedad maligna avanzada, u otras enfermedades que requieren oxigenoterapia continúa.
    15.Enfermedad actual grave sistémica no controlada, activa (por ejemplo, enfermedad cardiovascular clínicamente significativa, enfermedad pulmonar o metabólica, trastornos de la cicatrización de heridas, úlceras, fracturas de huesos).
    16.Mujeres embarazadas o en periodo de lactancia.
    17.Procedimiento de cirugía mayor o lesión traumática significativa dentro de aproximadamente los 28 días previos a la aleatorización o la anticipación de la necesidad de cirugía mayor durante el curso del tratamiento del estudio.
    18.Infecciones simultáneas, graves, infecciones actuales conocidas con VIH o hepatitis B activa y/o hepatitis C.
    oPara las pacientes que son portadoras del virus de la hepatitis B (VHB), la infección activa por hepatitis B debe descartarse en base a las pruebas serológicas negativas y/o determinación del ADN del VHB según las guías locales.
    19.Tratamiento actual diario, crónico con corticoesteroides (dosis equivalente de metilprednisona >10 mg/día).
    20.Antecedentes de intolerancia, incluyendo la reacción de infusión de grado 3-4, hipersensibilidad a trastuzumab o a docetaxel/paclitaxel.
    21.Hipersensibilidad conocida a cualquiera de los fármacos del estudio, incluyendo excipientes o alguna droga formulada en polisorbato 80.
    22.Cuando la evaluación por parte el investigador no sea posible debido a que el paciente no pueda o no quiera cumplir con los requisitos del protocolo.
    23.Antecedentes de comorbilidades importantes que, a juicio del investigador, puedan interferir con la realización del estudio, la evaluación de la respuesta, o con el consentimiento informado.
    E.5 End points
    E.5.1Primary end point(s)
    To compare the early efficacy (measured as the rate of PFS at 4 months) of T DM1 together with SI docetaxel versus monotherapy treatment with T DM1, in patients recently diagnosed with progressive or recurrent, locally advanced or metastatic HER2+ breast cancer who have not received previous chemotherapy for the advanced disease.
    Comparar la eficacia temprana (medida como la tasa de SLP a los 4 meses) de T-DM1 junto a IC-docetaxel frente al tratamiento en monoterapia con T-DM1, en pacientes recientemente diagnosticadas con cáncer de mama HER2+ localmente avanzado o metastásico, progresivo o recurrente, que no han recibido quimioterapia previa para la enfermedad avanzada.
    E.5.1.1Timepoint(s) of evaluation of this end point
    24 months after the First Patient In.
    A los 24 meses después de la inclusión del primer paciente.
    E.5.2Secondary end point(s)
    2.To compare the combination of T DM1 together with SI docetaxel versus monotherapy treatment with T DM1 in terms of:
    a.Overall Response Rate (ORR), measured as the percentage of patients who achieve Complete Response (CR) and/or Partial Response (PR), in accordance with the RECIST 1.1 criteria throughout the study treatment.
    b.Clinical Benefit Rate (CBR), measured as the percentage of patients with CR, PR or Stable Disease (SD) with a duration of at least 6 months.
    c.Duration of Response (DR), measured as the time between achieving CR or PR until Disease Progression (DP).
    d.Overall Survival (OS), measured as the time from randomization to death from any cause.
    e.Progression Free Survival (PFS), measured as the time from randomization to progression or death from any cause.
    f.Breast cancer specific survival, measured as the time from randomization to death due to breast cancer.
    3.To compare the safety and tolerability of both treatment regimens.
    4.To compare the cardiac safety of both treatment regimens.
    5.To compare the hepatic safety of both treatment regimens
    Exploratory objectives
    6.To assess if the PAM50 intrinsic subtypes (HER2 enriched in comparison with the rest) predict benefit (in terms of ORR and PFS) based on the addition of docetaxel.
    7.To assess if the PAM50 intrinsic subtypes (HER2 enriched in comparison with the rest) predict the clinical outcome, in terms of CR or PFS, regardless of the addition of docetaxel
    8.To assess if Ki67 predict benefit (in terms of ORR and PFS) based on the addition of docetaxel.
    2.Comparar la eficacia de la combinación de T-DM1 más IC-docetaxel frente al tratamiento en monoterapia con T-DM1 en términos de:
    a.Tasa de respuesta global (TRG), medida como la proporción de pacientes que logran una respuesta completa (RC) y/o respuesta parcial (RP), de acuerdo con los criterios RECIST 1.1 a lo largo del tratamiento en estudio.
    b.Tasa de beneficio clínico (TBC), medida como la proporción de pacientes con RC, RP o enfermedad estable (EE) de al menos 6 meses de duración.
    c.Duración de la respuesta (DR), medida como el tiempo entre la consecución de RC o RP hasta la progresión de la enfermedad (PE).
    d.Supervivencia global (SG), medida como el tiempo desde la aleatorización hasta la muerte por cualquier causa.
    e.Supervivencia libre de progresión (SLP), medida como el tiempo desde la aleatorización hasta la progresión o muerte por cualquier causa.
    f.La supervivencia específica de cáncer de mama, medida como el tiempo desde la aleatorización hasta la muerte por cáncer de mama.
    3.Comparar la seguridad y tolerabilidad de ambas pautas de tratamiento.
    4.Comparar la seguridad cardíaca de ambas pautas de tratamiento.
    5.Comparar la seguridad hepática de ambas pautas de tratamiento.
    Objetivos exploratorios
    6.Evaluar si los subtipos intrínsecos PAM50 (HER2-enriquecido en comparación con el resto) predicen beneficio (en términos de TRG y de SLP) en base a la adición de docetaxel.
    7.Evaluar si los subtipos intrínsecos PAM50 (HER2- enriquecido en comparación con el resto) predicen el resultado clínico, en términos de TRG o SLP, independientemente de la adición de docetaxel.
    8.Evaluar si Ki67 predice beneficio (en términos de TRG y de SLP) en base a la adición de docetaxel.
    E.5.2.1Timepoint(s) of evaluation of this end point
    At the end of the treatment
    Al final del del tratamiento.
    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 No
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    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 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 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 Yes
    E.8.2.3.1Comparator description
    TRASTUZUMAB EMTANSINE (TDM-1) plus DOCETAXEL
    TRASTUZUMAB EMTANSINE (TDM-1) plus DOCETAXEL
    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 concerned10
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    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
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    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: 200
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 36
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state236
    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)
    None
    Ninguno
    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 Decision2014-10-20
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2014-10-10
    P. End of Trial
    P.End of Trial StatusOngoing
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