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    Summary
    EudraCT Number:2014-003574-16
    Sponsor's Protocol Code Number:MK3475-059
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-02-02
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2014-003574-16
    A.3Full title of the trial
    A Phase II Clinical Trial of Pembrolizumab as Monotherapy and in Combination with Cisplatin+5-Fluorouracil in Subjects with Recurrent or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma (KEYNOTE-059)
    Studio Clinico di Fase II con Pembrolizumab in monoterapia ed in combinazione con Cisplatino+5-Fluorouracile in pazienti con ricorrente o metastatico Adenocarcinoma Gastrico o della Giunzione Gastroesofagea (KEYNOTE-059)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase II Study of Pembrolizumab in Subjects with Gastric Cancer
    Studio di Fase II con Pembrolizumab in pazienti con tumore gastrico
    A.3.2Name or abbreviated title of the trial where available
    A Phase II Study of Pembrolizumab in Subjects with Gastric Cancer
    Studio di Fase II con Pembrolizumab in pazienti con tumore gastrico
    A.4.1Sponsor's protocol code numberMK3475-059
    A.5.4Other Identifiers
    Name:KeynoteNumber:059
    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 SponsorMERCK SHARP & DOHME CORP. UNA SUSSIDIARIA DI MERCK & CO. INC.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp&Dohme Corp.,a subsid of Merck&Co.,Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMSD Italia S.r.l.
    B.5.2Functional name of contact pointDivisione Ricerca Clinica
    B.5.3 Address:
    B.5.3.1Street AddressVia Vitorchiano, 151
    B.5.3.2Town/ cityRoma
    B.5.3.3Post code00189
    B.5.3.4CountryItaly
    B.5.4Telephone number00390636191371
    B.5.5Fax number00390636380371
    B.5.6E-mailgcto.italy@merck.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePembrolizumab
    D.3.2Product code MK-3475, SCH900175
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.3Other descriptive nameAnti-PD-1 monoclonal antibody
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Fluorouracil - GRY ¿ 50 mg/mL soluzione iniettabile
    D.2.1.1.2Name of the Marketing Authorisation holderTEVA GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameFluorouracil - GRY ¿
    D.3.2Product code [-]
    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 INNFLUOROURACILE
    D.3.9.1CAS number 51-21-8
    D.3.9.2Current sponsor code.
    D.3.9.3Other descriptive name5-FU
    D.3.9.4EV Substance CodeSUB07721MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 Cisplatin Teva ¿ 1 mg/ml
    D.2.1.1.2Name of the Marketing Authorisation holderGRY-Pharma GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameCisplatin Teva ¿
    D.3.2Product code .
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCISPLATINO
    D.3.9.1CAS number 15663-27-1
    D.3.9.2Current sponsor code.
    D.3.9.3Other descriptive namePlatinol
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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
    Gastric cancer
    Tumore gastrico
    E.1.1.1Medical condition in easily understood language
    Gastric or Gastroesophageal Junction Adenocarcinoma
    Adenocarcinoma Gastrico o della Giunzione Gastroesofagea
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10001150
    E.1.2Term Adenocarcinoma gastric
    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 determine the safety and tolerability of pembrolizumab administered at 200 mg Q3W dosing as monotherapy and in combination with cisplatin and 5-fluorouracil or cisplatin and capecitabine.
    - To estimate the Objective Response Rate (ORR) per RECIST 1.1 assessed by central imaging vendor in all subjects and in PD-L1 positive subjects.
    - To estimate the ORR per RECIST 1.1 assessed by central imaging vendor review.
    - Determinare la sicurezza e la tollerabilit¿ di pembrolizumab somministrato alla dose di 200 mg Q3W in monoterapia e in combinazione con cisplatino e 5-fluorouracile o cisplatino e capecitabina.
    - Valutare l¿Objective Response Rate (ORR) secondo RECIST 1.1, mediante revisione del vendor di imaging centralizzato in tutti i soggetti e nei soggetti PD-L1 positivi.
    - Valutare l¿ORR secondo RECIST 1.1 mediante revisione del vendor di imaging centralizzato.
    E.2.2Secondary objectives of the trial
    * To estimate by central imaging vendor:
    - DOR per RECIST 1.1. Supportive analyses for this objective and primary objective include ORR and DOR per irRECIST as well as DCR, PFS and OS
    per RECIST 1.1 and irRECIST in all subjects and in PD-L1 positive subjects.
    - Anti-tumor activity of pembrolizumab in combination with cisplatin and 5-fluorouracil or cisplatin and capecitabine, by ORR per RECIST 1.1. Supportive analyses for this objective include ORR per irRECIST as well as DOR, DCR, PFS and OS per RECIST1.1 and irRECIST in all subjects and
    in PD-L1 positive subjects.
    - DOR per RECIST 1.1 in PD-L1 positive subjects. Supportive analyses for this objective and primary objective include ORR and DOR per irRECIST as well as DCR, PFS and OS per RECIST 1.1 and irRECIST in PDL1 positive subjects.
    * To evaluate the relationship between PD-L1 status and efficacy endpoints in subjects receiving pembrolizumab (as monotherapy or in combination with chemotherapy) with gastric cancer.
    * Valutare mediante rev. del vendor di imaging centralizzato:
    - DOR secondo il RECIST 1.1.Le analisi a supporto per questo obiettivo e l¿obiettivo 1ario includono ORR e DOR secondo il irRECIST nonch¿ DCR,PFS e OS secondo il RECIST 1.1 e irRECIST in tutti i sog e nei sog PD-L1 positivi.
    - Attivit¿ anti-tumorale di pembrolizumab in combinaz con cisplatino e 5-fluorouracile o cisplatino e capecitabina,mediante ORR secondo il RECIST 1.1.Le analisi a supporto per questo obiettivo includono ORR secondo il irRECIST nonch¿ DOR,DCR,PFS e OS secondo il RECIST1.1 e irRECIST in tutti i sog e nei sog PD- L1 positivi.
    - DOR secondo il RECIST 1.1 nei sog PD-L1 positivi.Le analisi a supporto per questo obiettivo e l¿obiettivo 1ario includono ORR e DOR secondo il irRECIST nonch¿ DCR,PFS e OS secondo il RECIST 1.1 e irRECIST in sog PD-L1 positivi.
    *Valutare la relaz. tra lo stato PD-L1 e l'endpoint di efficacia in sog con tumore gastrico,in trattam con pembrolizumab(in monoterap o in associaz a chemio)
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: Merck will conduct Future Biomedical Research on DNA (blood) specimens collected during this clinical trial. Such research is for biomarker testing to address emergent questions not described elsewhere in the protocol (as part of the main trial) and will only be conducted on specimens from appropriately consented subjects. The objective of collecting specimens for Future Biomedical Research is to explore and identify biomarkers that inform the scientific understanding of diseases and/or their therapeutic treatments. The overarching goal is to use such information to develop safer, more effective drugs, and/or to ensure that subjects receive the correct dose of the correct drug at the correct time.

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: Merck condurr¿ una Ricerca Biomedica Futura su campioni di DNA (estratti dal sangue) raccolti nel corso di questo studio clinico. Tale ricerca ha lo scopo di esaminare vari biomarcatori per rispondere a domande che stanno emergendo e che non sono descritte in altre parti del protocollo (nell¿ambito dello studio principale), e verr¿ condotta solo su campioni di soggetti che abbiano rilasciato apposito consenso. L'obiettivo della raccolta dei campioni per la Ricerca Biomedica Futura ¿ quello di esplorare e identificare biomarcatori che contribuiscano scientificamente alla comprensione delle malattie e/o della relative terapie. L'obiettivo ultimo ¿ quello di utilizzare tali informazioni per sviluppare farmaci pi¿ sicuri e pi¿ efficaci, e/o per garantire che i soggetti ricevano la dose giusta del giusto farmaco al momento giusto.
    E.3Principal inclusion criteria
    For potential subjects in Cohort 1 (3L+ cohort):
    1. Have received, and progressed on, at least two prior chemotherapy regimens. For the purposes of this study, perioperative, neoadjuvant, adjuvant chemotherapy regimens will not count as a prior regimen, unless the patient progressed while receiving adjuvant therapy or within 6 months of receiving adjuvant treatment. The date of progression and how progression was determined must be known with documentation available confirming progression on or after treatment. Previous treatment regimens must have included a fluoropyridine and platinum doublet (as part of either a line oftherapy or adjuvant treatment.
    2. Be HER-2/neu -, or, if HER2/neu +, must have previously received treatment with trastuzumab
    For potential subjects in Cohorts 2 or 3 (1L cohorts):
    3. Is HER2/neu –
    4. Have not received prior systemic anti-cancer therapy for their metastatic or advanced gastric or gastroesophageal junction adenocarcinoma. For the purposes of this study, perioperative, neoadjuvant, adjuvant chemotherapy regimens will not count as a prior regimen, unless disease progression has occurred during or within 6 months of adjuvant chemotherapy.
    For all potential subjects:
    5. Be willing and able to provide written informed consent for the trial. The subject may also provide consent for FBR. However, the subject may participate in the main trial without participating in FBR.
    6. Be ¿¿18 years of age on day of signing informed consent.
    7. Have histologically or cytologically-confirmed recurrent or metastatic gastric or gastroesophageal junction adenocarcinoma that is considered incurable by local therapies.
    8. Be willing to provide newly-obtained or archived tissue for PD-L1 biomarker analysis and, based on the adequacy of the tissue sample quality for assessment of PD-L1 status, have received notice of eligibility. Newly-obtained tissue will be from the stomach and/or gastroesophageal junction (endoscopic tumor biopsy) or a metastatic location IF obtained as part of normal clinical practice. Repeat samples may be required if adequate tissue is not provided.
    9. Be PD-L1 positive, if the subject is being allocated to a cohort which, at the time of enrollment, is only enrolling PD-L1 positive subjects
    10. Have measurable disease based on RECIST 1.1 as determined by central imaging vendor.
    11. Have a performance status of 0 or 1 on the ECOG Performance Scale
    within 3 days prior to the first dose of study therapy.
    12. Life expectancy of at least 3 months.
    13. Females of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 or 180 days after the last dose of study medication. Males should agree to use an adequate method of contraception starting with the first dose of study therapy through 120 or 180 days after the last dose of study therapy. Duration will be determined when
    the subject is assigned to treatment. Abstinence is acceptable if this is the usual lifestyle and preferred
    contraception for the subject.
    14. Demonstrate adequate organ function
    15. Female subjects of childbearing potential should have a negative urine or serum
    pregnancy test within 72 h prior to receiving the first dose of study medication.
    Per i potenziali soggetti nella Coorte 1 (coorte 3L+):
    1. Avere ricevuto e avere mostrato progressione in almeno due precedenti regimi di chemioterapia. Ai fini del presente studio, i regimi di chemioterapia perioperatori, neoadiuvanti, adiuvanti non valgono come regime precedente, a meno che il paziente non abbia mostrato progressione durante la terapia adiuvante o entro 6 mesi dalla ricezione del trattamento adiuvante. La data della progressione e la modalità di determinazione della progressione devono essere rese note attraverso la documentazione disponibile che confermi la progressione in corrispondenza o dopo il trattamento. I precedenti regimi di trattamento devono aver incluso una doppietta a base di fluoropirimidina e platino (come parte di una linea di terapia o trattamento adiuvante).
    2. Essere HER-2/neu - o, se HER2/neu +, essere stati precedentemente sottoposti a trattamento con trastuzumab.
    Per i potenziali soggetti nella Coorte 2 o 3 (coorti 1L):
    3. Essere HER2/neu -
    4. Non avere ricevuto precedente terapia antitumorale sistemica per il trattamento dell’adenocarcinoma gastrico o della giunzione gastroesofagea metastatico o in stato avanzato. Ai fini del presente studio, i regimi chemioterapici perioperatori, neoadiuvanti, adiuvanti non valgono come regime precedente, a meno che non si sia verificata progressione della malattia durante o entro 6 mesi dalla chemioterapia adiuvante.
    Per tutti i potenziali soggetti:
    5. Essere disposto e in grado di fornire un consenso informato scritto alla sperimentazione. Il soggetto può inoltre decidere di fornire il consenso per FBR. Tuttavia, il soggetto può partecipare alla sperimentazione principale senza prendere parte all’FBR.
    6. Avere compiuto = 18¿ anni alla data della firma del consenso informato.
    7. Avere un adenocarcinoma gastrico o della giunzione gastroesofagea recidivante o metastatico confermato da esami istologici o citologici, che sia considerato incurabile con le terapie locali.
    8. Essere disposti a fornire un nuovo campione/un campione d’archivio di tessuto per l’analisi del biomarcatore PD-L1 e, in base all’adeguatezza della qualità del campione di tessuto per la valutazione dello stato PD-L1, avere ricevuto notifica di eleggibilità. I nuovi campioni di tessuto saranno prelevati dallo stomaco e/o dalla giunzione gastroesofagea (biopsia endoscopica) o da una localizzazione metastatica se ottenuta come normale pratica clinica. Se non viene fornito tessuto adeguato potranno essere prelevati altri campioni.
    9. Essere PD-L1 positivo, se il soggetto deve essere assegnato ad una coorte che, al momento dell’arruolamento, sta arruolando solo soggetti PD-L1 positivi.
    10. Presentare una malattia misurabile in base ai criteri RECIST 1.1, come determinato vendor di imaging centralizzato.
    11. Presentare uno stato di validità pari a 0 o 1 nella scala dello stato prestazionale ECOG, entro i 3 giorni precedenti la prima dose di terapia in studio .
    12. Aspettativa di vita di almeno 3 mesi.
    13. Le donne potenzialmente fertili devono essere disposte a utilizzare 2 metodi contraccettivi o essere chirurgicamente sterili o astenersi dall’attività eterosessuale per tutta la durata dello studio fino a 120 o 180 giorni dopo l’ultima dose del medicinale in studio.
    Gli uomini devono accettare di utilizzare un metodo contraccettivo adeguato a partire dalla prima dose della terapia dello studio fino a 120 o 180 giorni dopo l'ultima dose della terapia dello studio. La durata sarà definita quando il sog sarà assegnato al trattam. L'astinenza è accettabile se questa è la pratica comune e il metodo contraccettivo preferito dal sog.
    14. Dimostrare una funzionalità organica adeguata
    15. Le donne potenzialmente fertili devono presentare un test di gravidanza sulle urine o sul siero negativo entro 72 ore dall’assunzione della prima dose del farmaco in studio.
    E.4Principal exclusion criteria
    The subject must be excluded from participating in the trial if the subject:
    1. Experienced weight loss > 10 % over 2 months prior to first dose of study therapy.
    2. Has clinical evidence of ascites by physical exam.
    3. Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigation al device within 4 weeks of the first dose of treatment.
    4. Has active autoimmune disease that has required systemic treatment in past 2 years. Replacement therapy is not considered a form of systemic treatment.
    5. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment. The use of physiologic doses of corticosteroids (prednisone 10 mg or equivalent) may be approved after consultation with the Sponsor.
    6. Has had a prior anti-cancer mAb within 4 weeks prior to study Day 1 or who has not recovered (i.e., = Grade 1 or at baseline) from AE due to agents administered more than 4 weeks earlier.
    7. Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to Day 1 or who has not recovered (i.e., = Grade 1 or at baseline) from AE due to a previously administered agent.
    8. Has a known additional malignancy that is progressing or requires active treatment
    9. Has known active CNS metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are stable, have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.
    10. Has known history of, or any evidence of active, non-infectious pneumonitis.
    11. Has an active infection requiring systemic therapy.
    12. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject’s participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
    13. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
    14. Is pregnant or breastfeeding, or expecting to conceive children within the trial, starting with the screening visit through 120 or 180 which the subject would be assigned.
    15. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent.
    16. Has a known history of HIV.
    17. Has known chronic or acute Hepatitis B or C infection.
    18. Has received a live vaccine within 30 days of planned start of study therapy.
    19. Is or has an immediate family member who is investigational site or sponsor staff directly involved with this trial, unless prospective IRB approval (by chair or designee) is given allowing exception to this criterion for a specific subject.
    Il soggetto deve essere escluso dalla partecipazione alla sperimentazione se:
    1. Ha una comprovata perdita di peso > 10% nei 2 mesi precedenti la prima dose di terapia in studio.
    2. Ha evidenza clinica di ascite da esame medico.
    3. Sta attualmente partecipando e ricevendo una terapia dello studio oppure ha partecipato a uno studio relativo a un agente sperimentale e ha ricevuto la terapia dello studio o utilizzato un dispositivo sperimentale entro 4 settimane dalla prima dose di trattamento.
    4. Presenta una malattia autoimmune in fase attiva che ha richiesto un trattamento per via sistemica negli ultimi 2 anni. La terapia sostitutiva non è considerata una forma di trattamento sistemico.
    5. Presenta una diagnosi di immunodeficienza o sta assumendo una terapia con steroidi sistemici o altra forma di terapia immunosoppressiva nei 7 giorni precedenti la prima dose del trattamento sperimentale. L’uso di dosi fisiologiche di corticosteroidi (prednisone 10 mg o equivalente) può essere approvato previa consulenza con lo sponsor.
    6. Ha già assunto mAb nelle 4 sett. precedenti il Giorno 1 o non si è ripreso (vale a dire grado =1 o al basale) da EA dovuti agli agenti somministrati più di 4 sett. prima.
    7. Si è già sottoposto a chemioterapia, terapia mirata con piccole molecole oppure a radioterapia nelle 2 settimane precedenti il Giorno 1 o non si è ripreso (vale a dire grado =1 o al basale) da EA dovuti a un agente somministrato in precedenza.
    8. Presenta un altro tumore maligno noto in progressione o che richiede un trattamento attivo.
    9. Presenta metastasi attive al SNC note e/o meningite carcinomatosa. I soggetti con metastasi cerebrali già trattate in precedenza possono partecipare purché siano stabili, non abbiano evidenze di metastasi cerebrali nuove o ingrossate e non assumano steroidi da almeno 7 giorni prima del trattamento sperimentale. Questa eccezione non comprende la meningite carcinomatosa che è esclusa a prescindere dalla stabilità clinica.
    10. Presenta un’anamnesi o evidenza di polmonite non infettiva attiva.
    11. Presenta un’infezione attiva che richiede una terapia per via sistemica.
    12. Presenta un’anamnesi o prova ricorrente di qualsiasi condizione, terapia o anomalia nelle analisi di laboratorio che potrebbe inficiare i risultati della sperimentazione, interferire con la partecipazione del soggetto per tutta la durata della sperimentazione oppure non è nell’interesse del soggetto parteciparvi, a giudizio dello sperimentatore.
    13. Presenta disturbi psichiatrici o di abuso di sostanze noti che interferirebbero con la collaborazione agli obblighi posti dalla sperimentazione.
    14. È in gravidanza o allatta o prevede di concepire nell’arco della sperimentazione, a partire dallo screening fino a 120 o 180 giorni dopo l’ultima dose del trattamento sperimentale. La durata è determinata dalla coorte a cui il soggetto verrebbe assegnato.
    15. Ha ricevuto una precedente terapia con un agente anti-PD-1, anti-PD-L1 o anti-PD-L2.
    16. Presenta un’anamnesi nota di infezione da HIV.
    17. Ha un'anamnesi di infezione cronica o acuta da Epatite B o C.
    18. Ha ricevuto un vaccino vivo nei 30 giorni che precedono l’inizio programmato della terapia dello studio.
    19. È o ha un familiare stretto fra i membri del personale del centro sperimentale o dello sponsor direttamente coinvolto nella sperimentazione, salvo approvazione prospettica del Comitato etico (presidente o designato) che consenta l’eccezione a tale criterio per uno specifico soggetto.
    E.5 End points
    E.5.1Primary end point(s)

    The primary efficacy objective of this study is to evaluate the anti-tumor activity of pembrolizumab in subjects with advanced gastric cancer. Objective Response rates per RECIST 1.1as assessed by the central imaging vendor will be used as the primary response rate efficacy endpoint. Objective response rate will also be used as the primary endpoint due to the single-arm design of this study. RECIST 1.1 will also be used by the local site for treatment decisions. However RECIST 1.1 will be adapted to account for the unique tumor response profile seen with immunotherapies such as pembrolizumab. The primary safety objective of this trial is to characterize the safety and tolerability of pembrolizumab in subjects with gastric cancer. The primary safety analysis will be based on subjects who experienced toxicities as defined by CTCAE criteria. Safety will be assessed by quantifying the toxicities and grades experienced by subjects who have received pembrolizumab, including serious adverse events (SAEs) and events of clinical interest (ECIs).
    L’obiettivo primario di efficacia di questo studio è la valutazione dell’attività antitumorale di pembrolizumab nei soggetti con tumore gastrico in stato avanzato. L’obiettivo di risposta in base a RECIST 1.1 secondo la valutazione del vendor di imaging centralizzato verranno usati come endpoint primario di efficacia del tasso di risposta. L’obiettivo di risposta complessiva verrà usato anche come endpoint primario in seguito al disegno a braccio singolo di questo studio. RECIST 1.1 verrà utilizzato anche dal centro locale per le decisioni in merito al trattamento. Tuttavia, RECIST 1.1 verrà adattato per rappresentare il profilo univoco di risposta tumorale osservato con immunoterapie come pembrolizumab. L’obiettivo di sicurezza primario di questa sperimentazione è la caratterizzazione della sicurezza e della tollerabilità di pembrolizumab in soggetti con tumore gastrico. L’analisi di sicurezza primaria sarà basata su soggetti che hanno manifestato tossicità secondo quanto definito dai criteri CTCAE. La sicurezza sarà valutata mediante la quantificazione di tossicità e gradi avvertiti dai soggetti che hanno assunto pembrolizumab, compresi gli eventi avversi gravi (Serious Adverse Events, SAE) e gli eventi di interesse clinico (Events of Clinical Interest, ECI).
    E.5.1.1Timepoint(s) of evaluation of this end point

    Safety and Response will be assessed throughout the entire study. The protocol defines response assessment is scheduled for Week 9, with additional assessments following at 6 week intervals.
    La sicurezza e la risposta verranno valutati nel corso dell’intero studio. Il protocollo definisce la valutazione della risposta come fissata per la settimana 9, con ulteriori valutazioni ad intervalli di 6 settimane.
    E.5.2Secondary end point(s)
    A secondary objective of this trial is the evaluation of the relationship between PD-L1 biomarker status as assessed by immunohistochemistry and response to pembrolizumab. This objective will be evaluated using data from both the 3L+ and the 1L monotherapy cohorts. The data obtained in this trial with regard to the biomarker will inform the performance of PD-L1 assessment by IHC, and may determine if the definition of PD-L1 positivity should be modified for future trials or specific populations. Fresh biopsies are currently used for PD-L1 assessment, although in this study archival biopsies will also be obtained to compare the performance of the PD-L1 IHC assay in archived versus fresh biopsies so that it may be possible to use archival biopsies in future studies.
    Un obiettivo secondario di questa sperimentazione ¿ la valutazione del rapporto tra lo stato dei biomarcatori PD-L1 in base alla valutazione immunoistochimica e alla risposta a pembrolizumab. Questo obiettivo verr¿ valutato usando i dati provenienti dalle coorti in monoterapia sia 3L+ sia 1L. I dati ottenuti in questa sperimentazione rispetto al biomarcatore forniranno informazioni sulla valutazione PD-L1 da parte dell¿IHC e possono stabilire se la definizione della positivit¿ PD-L1 debba essere modificata per le sperimentazioni future o per popolazioni specifiche. Attualmente, per la valutazione PD-L1 vengono utilizzati campioni bioptici nuovi, anche se in questo studio verranno prelevati anche campioni bioptici conservati per confrontare le prestazioni del dosaggio PD-L1 IHC nei campioni conservati rispetto a quelli nuovi affinch¿ sia possibile usare quelli archiviati negli studi futuri.
    E.5.2.1Timepoint(s) of evaluation of this end point
    A fresh tumor sample is required at screening. Archival tumor sample may be provided at any time. The timing of response assessments is detailed in Section E.5.1.1
    Allo screening ¿ richiesto un campione tumorale di nuova acquisizione. Campioni tumorali d¿archivio possono essere forniti in qualunque momento. I dettagli relativi ai timepoint per la valuzione della risposta sono definiti nella sezione E.5.1.1
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response 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 No
    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 trial3
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.4.1Number of sites anticipated in Member State concerned1
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA15
    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 Information not present in EudraCT
    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
    Chile
    Colombia
    Israel
    Japan
    Korea, Republic of
    Peru
    Russian Federation
    United States
    Estonia
    France
    Italy
    Lithuania
    Portugal
    Romania
    United Kingdom
    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
    The overall trial ends when the last subject completes the last study-related phone-call or trial visit, discontinues from the trial or is lost to follow-up (i.e. the subject is unable to be contacted by the investigator).
    L¿intera sperimentazione termina quando l¿ultimo soggetto completa l¿ultima visita telefonica o di studio, si ritira dalla sperimentazione o ¿ lost to follow-up (es. lo sperimentatore non riesce a contattare il soggetto)
    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: 190
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 63
    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 state4
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 77
    F.4.2.2In the whole clinical trial 253
    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)
    The protocol does not include any plans for treatment or care following completion of the protocol.
    Il protocollo non include alcun piano di trattamento o cura successivi al completamento del protocollo.
    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 Decision2015-06-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2021-07-20
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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