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    EudraCT Number:2014-002113-39
    Sponsor's Protocol Code Number:BAY88-8223/16298
    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:2014-10-03
    Trial results View results
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    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2014-002113-39
    A.3Full title of the trial
    A phase II randomized, double-blind, placebo-controlled trial of radium-223 dichloride versus placebo when administered to metastatic HER2 negative hormone receptor positive breast cancer subjects with bone metastases treated with hormonal treatment background therapy.
    Ensayo de fase II aleatorizado, doble ciego, controlado con placebo, de dicloruro de radio-223 en comparación con un placebo cuando se administra a sujetos con cáncer de mama metastásico negativo para HER2, positivo para los receptores hormonales y con metástasis óseas tratadas con hormonoterapia de base
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of radium-223 dichloride versus placebo and hormonal treatment as background therapy in subjects with bone predominant HER2 negative hormone receptor positive metastatic breast cancer.
    Estudio de dicloruro de radio-223 frente a placebo y hormonoterapia como tratamiento de base en sujetos con cáncer de mama metastásico predominantemente en hueso, negativo para HER2 y positivo los para receptores hormonales.
    A.4.1Sponsor's protocol code numberBAY88-8223/16298
    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 SponsorBayer HealthCare AG
    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 supportBayer HealthCare AG
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationBayer HealthCare AG
    B.5.2Functional name of contact pointBayer Clinical Trials Contact
    B.5.3 Address:
    B.5.3.1Street AddressCTP Team/Ref:"EU CTR"/ Bayer Pharma AG
    B.5.3.2Town/ cityBerlin
    B.5.3.3Post code13342
    B.5.4Telephone number0034900102372
    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. name Xofigo
    D. of the Marketing Authorisation holderBayer Pharma AG
    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 nameRadium-223 dichloride
    D.3.2Product code BAY88-8223
    D.3.4Pharmaceutical form Solution for injection
    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 INNRadium-223 dichloride
    D.3.9.1CAS number 444811-40-9
    D.3.9.2Current sponsor codeBAY88-8223
    D.3.9.3Other descriptive nameRADIUM RA 223 DICHLORIDE
    D.3.9.4EV Substance CodeSUB129907
    D.3.10 Strength
    D.3.10.1Concentration unit kBq/ml kilobecquerel(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1000
    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. cell therapy medicinal product No
    D. therapy medical product No
    D. Engineered Product No
    D. ATIMP (i.e. one involving a medical device) No
    D. 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 Yes
    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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for injection
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    HER2 negative hormone receptor positive metastatic breast cancer with bone metastases treated with standard of care hormonal treatment.
    Cáncer de mama negativo para HER2 y positivo los para receptores hormonales y con metástasis óseas, que están recibiendo hormonoterapia de base
    E.1.1.1Medical condition in easily understood language
    Breast cancer that has spread to the bone treated with the standard of care hormonal treatment.
    Cancer de mama que ha diseminado a huesos, tratado con tratamiento hormonal estándar.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 17.0
    E.1.2Level PT
    E.1.2Classification code 10055113
    E.1.2Term Breast cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    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 efficacy and safety of radium-223 dichloride in subjects with HER2 negative, hormone receptor positive breast cancer with bone metastases treated with hormonal treatment background therapy.
    Evaluar la eficacia y la seguridad del dicloruro de radio-223 en sujetos con cáncer de mama negativo para el receptor del factor de crecimiento 2 (negativo para HER2), positivo para los receptores hormonales y con metástasis óseas, que están recibiendo hormonoterapia de base.
    E.2.2Secondary objectives of the trial
    Not applicable.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    - Have provided written informed consent. Subjects must be able to understand and be willing to sign the written informed consent. A signed informed consent form must be appropriately obtained prior to the conduct of any study-specific procedure.
    - Documentation of histological or cytological confirmation of estrogen receptor positive (ER+) and HER2 negative adenocarcinoma of the breast must be available. HER2 status should be determined by an accredited/Ministry of Health approved laboratory by immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), or chromogenic in situ hybridization (CISH).
    - Tumors (from either primary or metastatic sites) must be ER+ defined as >= 10% positive tumor nuclei in the analyzed sample. ER+/progesterone receptor positive (PR+) and ER+/ progesterone receptor negative (PR-) subjects are eligible whereas estrogen receptor negative (ER- )/PR+ and ER-/PR- disease will not be eligible.
    - Women (>=18 years of age) with metastatic breast cancer not amenable to curative treatment by surgery or radiotherapy. Women of reproductive potential and their male partners must agree to use adequate contraception during treatment and for 6 months following the completion of treatment with radium-223 dichloride/placebo.
    - Documentation of menopausal status: post-menopausal or pre-menopausal subjects are eligible.
    - Pre-menopausal subjects as well as subjects with ovarian radiation or concomitant treatment with an LH-RH agonist/antagonist must have a negative pregnancy test and agree to use an adequate method of contraception as recommended by their treating physicians
    - Post-menopausal status is defined either by:
    - age >=55 years and one year or more of amenorrhea, o age <55 years and one year or more of amenorrhea with an estradiol assay <20 pg/mL o bilateral oophorectomy
    - Subjects with bone dominant disease (with or without metastases in soft tissue including lymph nodes) with at least 2 skeletal metastases identified at baseline by bone scintigraphy and confirmed by computed tomography (CT)/magnetic resonance imaging (MRI).
    - Measurable or non-measurable disease (but radiologically evaluable) according to Response Evaluation Criteria in Solid Tumors v1.1 criteria. All disease burden must be assessed at baseline by CT or MRI of chest, pelvis and abdomen and any additional fields as needed. A bone scan should also be done at baseline for all subjects.
    CT/MRI done as part of the standard of practice within 6 weeks of randomization and standard of care bone scans done within 6 weeks of randomization are acceptable.
    18F-sodium fluoride positron emission tomography/CT scan is acceptable as an alternative to technetium-99m bone scintigraphy if it is the standard of care at the institution, provided the same bone imaging modality is used throughout the study.
    - Subjects must have received at least one line of hormonal therapy in the metastatic setting.
    - Subjects who are eligible for further standard of care endocrine treatment with any of the following administered as in second line or greater of hormone therapy in metastatic setting:
    - Selective estrogen receptors modulators such as tamoxifen and toremifene
    - Non-steroidal aromatase inhibitors such as anastrozole and letrozole
    - Steroidal aromatase inhibitors such as exemestane
    - Estrogen receptor down-regulators such as fulvestrant
    Subjects enrolled in the current study (signature of the informed consent) will start treatment with the single hormone agent after randomization either before or simultaneously to the first injection of radium-223 dichloride/placebo. Subjects already receiving the single agent hormone treatment prior to study entry are not eligible. Combination hormonal treatment is not allowed.
    - Subjects must have experienced no more than 2 skeletal-related events (SREs) prior to study entry defined as: external beam radiotherapy (EBRT) for bone pain, pathological bone fracture (excluding major trauma), spinal cord compression, and/or orthopedic surgical procedure. Subjects with no prior SREs are not permitted.
    - Subjects must be on therapy with bisphosphonate or denosumab and are required to have been on such therapy for at least 3 months before the start of study treatment.
    - Asymptomatic or mildly symptomatic breast cancer. A worst pain score (WPS) of 0 to 1 on the Brief Pain Inventory-Short Form Question #3 (worst pain in the last 24 hours) will be considered asymptomatic and a WPS of 2 to 3 will be considered mildly symptomatic. This is to be assessed once during the screening period.
    - Eastern Cooperative Oncology Group (ECOG) Performance Status 0 or 1
    - Life expectancy >= 6 months
    - Laboratory requirements:
    - Absolute neutrophil count >= 1.5 x 109/L
    - Platelet count >= 100 x 109/L without platelet transfusion within 3 weeks prior to randomization

    Please refer to the protocol for full list of the inclusion criteria.
    Haber otorgado CI por escrito. Las ptes deben ser capaces de entender y estar dispuestas a firmar el CI por escrito. Antes de llevar a cabo ningún procedimientos específicos del estudio, debe obtenerse correctamente un CI firmado
    - Disponer de documentación de confirmación histológica o citológica del diagnóstico de adenocarcinoma de mama positivo para receptores de estrógenos (ER+) y negativo para HER2. Un laboratorio acreditado o aprobado por el MoH debe determinar presencia o ausencia de HER2 mediante (IHQ), h (FISH) o (CISH)
    - Los tumores (ya sea primarios o metastásicos) deben ser ER+, definidos como presencia de >= 10 % de núcleos tumorales ositivos en la muestra analizada. Son idóneas ptes ER+/positivas para el receptor de progesterona (PR+) y R+/negativas para receptor de progesterona (PR-), no lo son las ptes con enfermedad negativa para receptores de estrógenos (ER-)/PR+ y ER-/PR-
    - Ser mujer (>= 18 años de edad) con cáncer de mama metastásico no susceptible de tto curativo por cirugía o radioterapia. Las que puedan tener hijos y sus parejas masculinas deben aceptar usar métodos anticonceptivos adecuados durante el tto y hasta 6 meses tras tratamiento con dicloruro de radio-223/placebo
    -Documentación de menopausia: son idóneas mujeres pos- o premenopáusicas
    - Las mujeres premenopáusicas, así como las sometidas a irradiación ovárica o tto simultáneo con un agonista/antagonista de la LH-RH deben obtener un resultado negativo en prueba de embarazo y aceptar usar un método anticonceptivo adecuado según lo recomienden los médicos que las tratan
    - El estado posmenopáusico se define por:
    - >= 55 años de edad y un año o más de amenorrea
    - < 55 años de edad y un año o más de amenorrea, con un análisis de estradiol < 20 pg/ml u
    - ovariectomía bilateral
    - Ser Ptes con enfermedad preponderantemente ósea (con o sin metástasis en los tejidos blandos, incluy ganglios linfáticos) con al menos 2 metástasis óseas identificadas en la visita inicial mediante centelleografía ósea y confirmadas por (TC)/ (RM)
    - Enfermedad mensurable o no mensurable (pero evaluable radiológicamente) según RECIST v1.1. Debe evaluarse toda la carga de enfermedad en la visita inicial por TC o RM de tórax, pelvis y abdomen, y de campos adicionales según sea necesario. En visita inicial también debe efectuarse una gammagrafía ósea a todas las ptes. Son aceptables las TC/RM efectuadas como parte de la práctica habitual en 6 semanas antes a aleatorización y las gammagrafías óseas obtenidas como pauta de atención en 6 semanas antes a aleatorización.
    Las exploraciones por tomografía de emisión de positrones con 18F-fluoruro de sodio/TC son aceptables como alternativa a las centelleografías óseas con tecnecio- 99m, si esa es la pauta de atención del centro, si se usa la misma modalidad de obtención de imágenes óseas durante todo el estudio
    -Las ptes deben haber recibido al menos una línea de hormonoterapia para su enfermedad metastásica
    -Ptes que sean idóneas para continuar con el tto endocrino habitual con alguno de los siguientes agentes, administrados como segunda línea o posterior de hormonoterapia para enfermedad metastásica:
    - Moduladores selectivos de los receptores estrogénicos, como tamoxifeno y toremifeno
    - Inhibidores no esteroideos de la aromatasa, como el anastrozol y el letrozol
    - Inhibidores esteroideos de la aromatasa, como el exemestano
    - Reguladores a la baja de los receptores estrogénicos, como el fulvestrant. Las ptes inscritas en el presente estudio (que hayan firmado el CI) comenzarán el tto con el agente único hormonal tras aleatorización, antes o a la vez que la primera inyección de dicloruro de radio-223/placebo. No son idóneas ptes que ya estén recibiendo hormonoterapia con agente único antes de incorporación en el estudio. No se permite el tto hormonal combinado
    - Las ptes no deben haber experimentado más de 2 (SRE) antes de incorporarse en el estudio, definidos como: (EBRT) para el dolor óseo, fractura ósea patológica (excepto por traumatismos importantes), compresión de la médula espinal y/o procedimiento quirúrgico ortopédico. No se permite la incorporación de ptes sin SRE anteriores
    - Las ptes deben estar en tto con bisfosfonatos o denosumab y que hayan estado bajo ese tto durante al menos 3 meses antes de iniciar tto del estudio
    - Cáncer de mama asintomático o ligeramente sintomático. Se considerará asintomática si (WPS) es de 0 a 1 en la pregunta n.º 3 del formulario abreviado del Brief Pain Inventory, y ligeramente sintomática si la WPS es de 2 a 3. Este dato debe evaluarse una vez durante el período de selección
    - Estado funcional de 0 o 1 del (ECOG)
    - Esperanza de vida >=6 meses
    -Requisitos de laboratorio:
    -Recuento absoluto de neutrófilos >=1,5 × 109/l
    -Recuento de plaquetas >=100 × 109/l sin transfusión de plaquetas en las 3 semanas anteriores a aleatorización
    Ver protocolo para descripción completa de criterios de inclusión
    E.4Principal exclusion criteria
    - HER2-positive breast cancer (IHC=3+, positive FISH, or positive CISH); equivocal or unknown HER2 status
    Note: Subjects with 3+ by IHC cannot be chosen regardless of their FISH/CISH status and those with positive FISH/CISH (>= 2 amplifications) cannot be chosen either, regardless of the IHC findings. Subjects with 2+ by IHC will not be eligible if no negative FISH/CISH is available.
    - Subjects eligible for treatment with everolimus
    -Subjects with any of the following cancers:
    - Inflammatory breast cancer
    - Bilateral breast cancer or a history of 2 distinct breast cancers
    - History and/or presence of visceral metastases
    - Subjects who have either received chemotherapy for metastatic disease or are considered by the treating Investigator to be appropriate candidates for chemotherapy as current treatment for metastatic breast cancer are excluded. Chemotherapy administered for adjuvant/neo-adjuvant disease is acceptable provided it was administered at least 1 year prior to study entry.
    - Subjects with any previous untreated or concurrent cancer that is distinct in primary site or histology from the cancer under study, except treated basal cell carcinoma or superficial bladder tumor (Ta and Tis, American Joint Committee on Cancer, 7th edition). Subjects surviving a cancer that was curatively treated and without evidence of disease for more than 3 years before enrollment are allowed. All cancer treatments must be completed at least 3 years prior to study entry (i.e., signature date of informed consent form).
    - Subjects with known or history of brain metastases or leptomeningeal disease: subjects with neurological symptoms must undergo a contrast CT scan or MRI of the brain within 28 days prior to randomization to exclude active brain metastasis. Imaging of the central nervous system is otherwise not required.
    - Imminent or established untreated spinal cord compression based on clinical findings and/or MRI. Following treatment of spinal cord compression, the subject may be eligible if all other eligibility criteria are fulfilled.
    - Prior treatment with radium-223 dichloride
    - Prior hemibody external radiotherapy. Subjects who received other types of prior external radiotherapy are allowed provided that bone marrow function is assessed and meets the protocol requirements for hemoglobin, absolute neutrophil count, and platelets.
    - Prior systemic radiotherapy with strontium-89, samarium-153, rhenium-186, or rhenium-188
    - ECOG Performance Status >=2
    - Blood transfusions or use of erythropoietin within 6 weeks prior to randomization. Platelet transfusions are not allowed within 3 weeks prior to randomization.
    - Use of biologic response modifiers, such as granulocyte macrophage colony-stimulating factor or granulocyte colony-stimulating factor, within 6 weeks prior to randomization.
    - Treatment with an investigational drug or with any anti cancer treatments not permitted by the protocol, within 4 weeks prior to randomization
    - Chronic conditions associated with non-malignant abnormal bone growth (e.g., confirmed Paget?s disease of bone)
    - Any other serious illness or medical condition such as, but not limited to:
    - Any uncontrolled infection
    - Cardiac failure New York Heart Association Class III or IV
    - Crohn's disease or ulcerative colitis
    - Bone marrow dysplasia

    - Previous assignment to treatment in this study

    All local label specific criteria for the standard of care hormonal treatment as well as denosumab and bisphosphonates apply. Subjects must be treated according to the local standard of care requirements.
    Las pacientes idóneas para participar no deben presentar ninguno de los criterios de exclusión que se mencionan a continuación:

    - Cáncer de mama positivo para HER2 (IHQ=3+, FISH o CISH positivos); presencia de HER2 dudosa o desconocida. Nota: No puede incluirse a las pacientes con resultados 3+ por IHQ, independientemente de sus resultados por FISH/CISH, ni a las que obtengan resultados positivos por FISH/CISH (>= 2 amplificaciones), independientemente de los resultados de IHQ. No son idóneas las pacientes con resultados 2+ por IHQ si no se dispone de un resultado negativo por FISH/CISH

    - Pacientes aptas para el tratamiento con everolimús

    - Pacientes con alguno de los siguientes tumores malignos:

    - Cáncer de mama inflamatorio

    - Cáncer de mama bilateral o antecedentes de 2 tumores de mama diferentes

    - Antecedentes y/o presencia de metástasis viscerales

    - Se excluirá a las pacientes que hayan recibido quimioterapia para la enfermedad metastásica o aquellas a las que el investigador que las trata considere candidatas adecuadas para la quimioterapia como tratamiento actual para el cáncer de mama metastásico. Es aceptable la quimioterapia administrada en el contexto adyuvante/neoadyuvante, siempre y cuando se haya administrado al menos 1 año antes de la incorporación al estudio.

    - Las pacientes con algún tipo de cáncer no tratado anterior o simultáneo que sea diferente del cáncer en estudio, ya sea por su localización primaria o por su histología, excepto el carcinoma basocelular tratado o los tumores superficiales de vejiga (Ta y Tis, American Joint Committee on Cancer, 7.ª edición). Se permiten pacientes que hayan sobrevivido a un cáncer tratado curativamente y sin evidencias de enfermedad durante más de 3 años. Todos los tratamientos antineoplásicos deben haber finalizado al menos 3 años antes de la incorporación al estudio (es decir, de la fecha de la firma del formulario de consentimiento informado).

    - Pacientes con metástasis cerebrales conocidas o antecedentes de ellas, o con enfermedad leptomeníngea: las pacientes con síntomas neurológicos deben someterse a una exploración por TC con contraste o una RM de cerebro en los 28 días anteriores a la aleatorización, para excluir las metástasis cerebrales activas. No es necesario obtener imágenes del sistema nervioso central por ningún otro motivo.

    -Compresión de la médula espinal inminente o confirmada sin tratar según los hallazgos clínicos y/o la RM. Después del tratamiento de la compresión de la médula espinal, es posible que la paciente resulte idónea si se cumplen todos los demás criterios de idoneidad.

    - Tratamiento anterior con dicloruro de radio-223.

    - Radioterapia externa hemicorporal anterior. Se admiten pacientes que hayan recibido otros tipos de radioterapia externa previa, siempre que se evalúe la función de la médula ósea y reúna los requisitos del protocolo en cuanto a la hemoglobina y el recuento absoluto de neutrófilos y plaquetas.

    - Radioterapia sistémica anterior con estroncio-89, samario-153, renio-186 o renio-188. - ECOG status >=2.

    - Transfusiones de sangre o uso de eritropoyetina en las 6 semanas anteriores a la aleatorización. No se permiten las transfusiones de plaquetas en las los 3 semanas anteriores a la aleatorización.

    - Uso de modificadores de la respuesta biológica, como el factor estimulante de las colonias de granulocitosmacrófagos el factor estimulante de las colonias de granulocitos en las 6 semanas anteriores a la aleatorización.

    - El protocolo no permite el tratamiento con un medicamento en fase de investigación ni ningún tratamiento antineoplásico en las 4 semanas anteriores a la aleatorización.

    - Afecciones crónicas asociadas al crecimiento óseo anómalo no neoplásico (por ejemplo, enfermedad ósea de Paget confirmada).

    - Alguna otra enfermedad o afección médica grave como, por ejemplo, entre otras:

    - Alguna infección no controlada

    - Insuficiencia cardíaca NYHA de clase III o IV

    - Enfermedad de Crohn o colitis ulcerosa

    - Displasia de médula ósea

    - Asignación anterior a tratamiento en este estudio. Se aplican todos los criterios específicos de las fichas técnicas locales para la pauta de atención con hormonoterapia, así como con denosumab y bisfosfonatos. Las pacientes deben recibir tratamiento de acuerdo con los requisitos locales de la pauta de atención
    E.5 End points
    E.5.1Primary end point(s)
    - Symptomatic skeletal event free survival(SSE-FS)
    - Supervivencia sin acontecimientos óseos sintomáticos (SSE-FS)
    E.5.1.1Timepoint(s) of evaluation of this end point
    The time from randomization to the occurrence of one of the following:
    (1) An on-study SSE, which is defined as:
    a. the use of EBRT to relieve skeletal symptoms
    b. the occurrence of new symptomatic pathological bone fractures (vertebral or non-vertebral)
    c. the occurrence of spinal cord compression
    d. a tumor related orthopedic surgical intervention.
    (2) Death from any cause
    (1) Un SSE durante el estudio, que se define como:

    a. el uso de EBRT para aliviar los síntomas en los huesos

    b. la aparición de nuevas fracturas óseas patológicas sintomáticas (vertebrales o no)

    c. la aparición de compresión de la médula espinal

    d. una intervención quirúrgica ortopédica relacionada con el tumor

    (2) Muerte por cualquier causa
    E.5.2Secondary end point(s)
    1. Overall survival (OS)
    2. Time to opiate use for cancer pain
    3. Time to pain progression
    4. Time to cytotoxic chemotherapy
    5. Radiological progression free survival (rPFS)
    6. Safety, acute and long term, including new primary malignancies and hematopoietic reserve for tolerability of subsequent chemotherapy
    1. SG
    2. El tiempo transcurrido hasta el uso de opiáceos para el dolor neoplásico
    3.El tiempo transcurrido hasta la progresión del dolor
    4.El tiempo transcurrido hasta el uso de quimioterapia citotóxica
    5. SSPr
    6.La seguridad, a corto y a largo plazo, incluidos nuevos procesos malignos y la reserva hematopoyética para la tolerabilidad de la quimioterapia posterior
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. The time (days) from the date of randomization to the date of death due to any cause.
    2. The interval from the date of randomization to the date of opiate use.
    3. The interval from randomization to the first date a subject experiences pain progression based on WPS.
    4. The time (days) from the date of randomization to the date of the first cytotoxic chemotherapy.
    5. The time (days) from the date of randomization to the date of confirmed radiological progression in either soft tissue, viscera or bone, or death (if death occurs before progression).
    6. To be reviewed throughout the course of the study.
    1. Tiempo (dias) transcurrido desde aleatorización hasta el muerte por cualquier causa
    2. El tiempo transcurrido desde fecha de aleatorización hasta fecha uso de opiáceos
    3.El tiempo transcurrido desde aleatorización hasta fecha que la paciente experimenta progresión del dolor segun WPS
    4. El tiempo (dias) transcurridos desde fecha de aleatorización hasta fecha de primer quimioterapia citotóxica
    5. El tiempo (dias) transcurridos desde fecha de aleatorización hasta fecha de confirmación de la progresión radiológica en tejidos blandos , vísceras o hueso, o muerte ( si muerte ocurre antes de la progresión )
    6. A revisarse durante todo el desarollo del estudio.
    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 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. 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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    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 Yes
    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 concerned16
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA112
    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
    Czech Republic
    Hong Kong
    Korea, Republic of
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee No
    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
    The end of study (EOS) will occur when the number of required events is met. All subjects on treatment at that time will be allowed to complete treatment. The 30-day safety follow-up visit is required for all subjects.

    For each participating European Union (EU) country, the end of the study according to the EU Clinical Trial Directive will be reached when the last visit of the last subject in any site has occurred.
    El final del estudio (FdE) tendrá lugar cuando se alcance la cantidad de acontecimientos que se requiere. Se permitirá finalizar el tratamiento a todas las pacientes que se encuentren en tratamiento en ese momento. La visita de seguimiento de seguridad a los 30 días es requisito para todas las pacientes.

    Para países participantes de la UE, siguiendo Directiva sobre estudios clínicos de la UE, el final del estudio se alcanzará cuando se haya realizado la LPLV en cualquier centro.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months11
    E.8.9.1In the Member State concerned days1
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months8
    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: 91
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 136
    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 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 Yes
    F. of subjects incapable of giving consent
    Any illness or medical condition preventing subjects to provide written consent and require legal representative or partial witness
    Cualquier enfermedad o condición médica que impida a los pacientes dar su consentimiento por escrito y requiera representante legal o testigo parcial
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state25
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 132
    F.4.2.2In the whole clinical trial 227
    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)
    Following radium-223 dichloride/placebo treatment discontinuation, subjects will be treated and followed as per the institutional standard of care and/or according to the physician?s clinical judgment. If possible, cytotoxic chemotherapy, other systemic radioisotope, hemibody external radiotherapy, or other investigational drug should not be given before a 4-week washout period after last administration of radium-223 dichloride/placebo, provided the subject?s bone marrow is not compromised.
    Tras interrupción del tratamiento con MI, el tto y seguimiento de las pacientes se realizarán según pauta de atención del centro y/o el criterio del médico

    De ser posible, no debe administrarse quimioterapia citotóxica, otro radioisótopo sistémico, radioterapia hemicorporal externa, ni otro fármaco en fase de investigación antes de 4 semanas de reposo farmacológico tras última administración del MI /placebo, siempre y cuando no se produzca afectación de la médula ósea de la paciente.
    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 Decision2014-11-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2014-11-07
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-08-13
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