E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Previously untreated metastatic triple negative breast cancer |
Cáncer de mama triple negativo metastásico no tratado previamente |
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E.1.1.1 | Medical condition in easily understood language |
Metastatic breast cancer |
Cáncer de mama metastásico |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10027475 |
E.1.2 | Term | Metastatic breast cancer |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
? to evaluate the efficacy of MPDL3280A + nab-paclitaxel compared with placebo + nab-paclitaxel as measured by progression-free survival (PFS; per investigator assessment using Response Evaluation Criteria in Solid Tumors [RECIST] v1.1) ? To evaluate the efficacy of atezolizumab + nab-paclitaxel compared with placebo + nab-paclitaxel as measured by overall survival (OS) |
? Evaluar la eficacia de atezolizumab (MPDL3280A) + nab-paclitaxel en comparación con placebo + nab-paclitaxel, medida mediante la supervivencia sin progresión (SSP; conforme a la evaluación del investigador aplicando los Criterios de evaluación de la respuesta en tumores sólidos [RECIST] v1.1) ? Evaluar la eficacia de atezolizumab + nab-paclitaxel en comparación con placebo + nab-paclitaxel, medida mediante la supervivencia global (SG) |
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E.2.2 | Secondary objectives of the trial |
? To evaluate the efficacy of atezolizumab + nab-paclitaxel compared with placebo + nab-paclitaxel as measured by objective response rate (ORR; per investigator assessment using RECIST v1.1) ? To evaluate the efficacy of atezolizumab + nab-paclitaxel compared with placebo + nab-paclitaxel as measured by duration of objective response (DOR; per investigator using RECIST v1.1) among patients with an objective response ? To evaluate patient-reported outcomes (PROs) of health status/health-related quality of life (HRQoL) associated with atezolizumab + nab-paclitaxel compared with placebo + nab-paclitaxel, as measured by the time to deterioration (TTD) in Items 29 and 30 of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) |
? Evaluar la eficacia de atezolizumab + nab-paclitaxel en comparación con placebo + nab-paclitaxel, medida mediante la tasa de respuestas objetivas (TRO; conforme a la evaluación del investigador aplicando los criterios RECIST v1.1) ? Evaluar la eficacia de atezolizumab + nab-paclitaxel en comparación con placebo + nab-paclitaxel, medida mediante la duración de la respuesta objetiva (DRO; conforme al investigador aplicando los criterios RECIST v1.1) en las pacientes con una respuesta objetiva ? Evaluar los resultados comunicados por las pacientes (RCP) del estado de salud/calidad de vida relacionada con la salud (CVRS) asociados a atezolizumab + nab-paclitaxel en comparación con placebo + nab-paclitaxel, medidos mediante el tiempo transcurrido hasta el deterioro (TTD) en los ítems 29 y 30 del Cuestionario de calidad de vida esencial 30 (QLQ-C30) de la European Organisation for Research and Treatment of Cancer |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
? Women aged ? 18 years ? Metastatic or locally advanced, histologically documented TNBC (absence of HER2, ER, and PR expression) ? No prior chemotherapy or targeted systemic therapy for inoperable locally advanced or metastatic TNBC ? Representative FFPE tumor specimens in paraffin blocks (preferred) or at least 15 unstained slides, with an associated pathology report documenting ER, PR, and HER2 negativity ?A tumor specimen obtained from metastatic or locally advanced disease (if applicable) must be submitted if clinically feasible ? ECOG performance status of 0 or 1 ? Life expectancy ? 12 weeks ? Measurable disease, as defined by RECIST v1.1 ?Adequate hematologic and end-organ function defined by laboratory results obtained within 2 weeks prior to first study treatment. ?Women of child bearing potential must agree to use adequate contraception (double barrier methods of birth control or abstinence) prior to study entry, for the duration of study treatment, and for 90 days after the last dose of study treatment. ? Patients who are not postmenopausal (? 12 months of non?therapy-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 14 days prior to initiation of study drug |
? Mujeres o varones de ? 18 años de edad ? CMTN metastásico o localmente avanzado, documentado mediante examen histológico (ausencia de expresión de HER2, RE y RP) ? Ausencia de quimioterapia o tratamiento sistémico dirigido previos para CMTN localmente avanzado o metastásico inoperable ? Muestras tumorales FFIP representativas (una muestra de archivo o tejido reciente de la recidiva tumoral antes del tratamiento) en bloques de parafina (preferido) o al menos 15 cortes no teñidos, con un informe de anatomía patológica adjunto que documente negatividad de RE, RP y HER2 ? También se debe enviar (si procede) una muestra tumoral obtenida de enfermedad metastásica o localmente avanzada recidivante, si es clínicamente factible. ? Estado funcional de 0 o 1 del ECOG ? Esperanza de vida ? 12 semanas ? Enfermedad mensurable, definida según los criterios RECIST v1.1 ? Función hematológica y orgánica adecuada, definida por los resultados analíticos siguientes obtenidos en las dos semanas previas a la administración de la primera dosis del tratamiento del estudio ? Mujeres en edad fértil deben comprometerse a usar métodos anticonceptivos adecuados (métodos de control de natalidad de doble barrera o abstinencia) antes de la primera dosis del estudio, durante el periodo de tratamiento y durante al menos 90 días después de la última dosis. ? Las mujeres que no sean posmenopáusicas (? 12 meses de amenorrea no inducida por tratamiento) ni quirúrgicamente estériles deben tener un resultado negativo en una prueba de embarazo en suero en los 14 días previos al inicio del fármaco del estudio. |
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E.4 | Principal exclusion criteria |
? Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for > 2 weeks prior to randomization ? Known CNS disease, except for treated asymptomatic CNS metastases ? Leptomeningeal disease ? Uncontrolled pleural effusion, pericardial effusion, or ascites (indwelling drainage catheters are permitted) ? Uncontrolled tumor-related pain ? Uncontrolled hypercalcemia ?Pregnancy or lactation ? Evidence of significant uncontrolled concomitant disease that could affect compliance with the protocol or interpretation of results, including significant liver disease (such as cirrhosis, uncontrolled major seizure disorder, or superior vena cava syndrome) ? Significant cardiovascular disease ? Severe infection within 4 weeks prior to randomization, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia ? History of autoimmune disease (Autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone and Type 1 diabetes mellitus on an stable insulin regimen may be eligible for this study) ? Prior allogeneic stem cell or solid organ transplantation ? History of idiopathic pulmonary fibrosis (including pneumonitis), drug-induced pneumonitis, organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing pneumonia), or evidence of active pneumonitis on screening chest CT scan. History of radiation pneumonitis in the radiation field (fibrosis) is permitted. ? Positive test for HIV ? Active hepatitis B or hepatitis C ?Active tuberculosis ?Treatment with systemic corticosteroids or other systemic immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [TNF] agents) within 2 weeks prior to randomization, or anticipated requirement for systemic immunosuppressive medications during the trial. Low dose steroids for nausea, adrenocortical insufficiency or orthostatic hypotension, IV contrast allergic reactions and inhaled corticosteroids are permitted. |
? Compresión de médula espinal no tratada definitivamente con cirugía o radioterapia o diagnosticada y tratada previamente sin signos de estabilización clínica de la enfermedad durante > 2 semanas previas a la aleatorización. ? Enfermedad confirmada en el SNC, salvo las metástasis asintomáticas en el SNC tratadas ? Afectación leptomeníngea ? Derrame pleural, derrame pericárdico o ascitis no controlados (Las pacientes con catéteres permanentes podrán participar) ? Dolor no controlado relacionado con el tumor. ? Hipercalcemia no controlada ? Embarazo o lactancia ? Signos de enfermedades concomitantes importantes no controladas que podrían afectar al cumplimiento del protocolo o a la interpretación de los resultados, como hepatopatías importantes (por ejemplo, cirrosis, trastorno convulsivo importante no controlado o síndrome de la vena cava superior). ? Enfermedades cardiovasculares importantes ? Infecciones graves en las 4 semanas previas a la aleatorización, entre ellas, infecciones complicadas que requieran hospitalización, bacteriemia o neumonía grave ? Antecedentes de enfermedades autoinmunitarias (podrán participar pacientes con antecedentes de hipotiroidismo autoinmunitario que estén recibiendo dosis estables de tratamiento hormonal sustitutivo y pacientes con con diabetes mellitus de tipo 1 controlada que estén recibiendo dosis estables de insulina) ? Alotrasplante previo de células progenitoras u órganos sólidos ? Antecedentes de fibrosis pulmonar idiopática (incluida la neumonitis), neumonitis inducida por fármacos, neumonía organizada (p. ej., bronquiolitis obliterante, neumonía organizada criptogénica) o signos de neumonitis activa en la TC de tórax de la selección. Están permitidos los antecedentes de neumonitis inducida por radiación en el campo irradiado (fibrosis). ? Resultado positivo en el análisis del VIH ? Hepatitis B o Hepatitis C ? Tuberculosis activa ? Tratamiento sistémico con corticosteroides u otros inmunodepresores (entre ellos, prednisona, dexametasona, ciclofosfamida, azatioprina, metotrexato, talidomida y antagonistas del factor de necrosis tumoral [TNF]) en las 2 semanas previas a la aleatorización o pacientes que previsiblemente requieran tratamiento sistémico con inmunodepresores durante el estudio. Las pacientes que hayan recibido inmunodepresores sistémicos en dosis bajas y durante períodos breves (por ejemplo, una sola dosis de dexametasona por náuseas), con antecedente de reacción alérgica al contraste IV y al uso de corticosteroides inhalados podrán participar en el estudio. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Progression free survival (PFS) |
Supervivencia sin progresión (SSP) |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Tumor assessments will be performed every 8 weeks for the first 12 months and every 12 weeks thereafter until disease progression or treatment discontinuation, whichever is later |
Las evaluaciones del tumor llevarán a cabo cada 8 semanas durante los 12 primeros meses y luego cada 12 semanas hasta la progresión de la enfermedad o la suspensión del tratamiento, lo que ocurra más tarde. |
|
E.5.2 | Secondary end point(s) |
Overall survival (OS), Objective response rate (ORR) and duration of objective response (DOR), Patient reported outcomes (PRO) of health status and health quality of life (HRQoL) |
Supervivencia global (SG), Tasa de respuestas objetiva (TRO), Duración de la respuesta objetiva (DRO), resultados comunicados por las pacientes (RCP) del estado de salud/calidad de vida relacionada con la salud (CVRS). |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
OS - every 3 months until death, withdrawal of consent, loss to follow-up, or study termination by the Sponsor ORR and DOR ? tumor assessments will be performed every 8 weeks for the first 12 months and every 12 weeks thereafter until disease progression or treatment discontinuation, whichever is later PRO and HRQoL - at baseline (Cycle 1,Day 1); at Day 1 of each subsequent cycle; and at the treatment discontinuation visit. In addition, all patients will complete the PRO questionnaires every 28 days for 1 year after treatment discontinuation, regardless of whether the patient is receiving subsequent anti-cancer therapy. |
SG - cada 3 meses hasta el fallecimiento, retirada del consentimiento, pérdida del seguimiento o finalización del estudio por parte del promotor. TRO y DRO - Las evaluaciones del tumor llevarán a cabo cada 8 semanas durante los 12 primeros meses y luego cada 12 semanas hasta la progresión de la enfermedad o la suspensión del tratamiento, lo que ocurra más tarde. RCP y CVRS - en la visita basal (Ciclo 1, Día 1); al Día 1 de cada ciclo posterior y hasta la visita de discontinuación. Adicionalmente, todos los pacientes completarán el cuestionario RCP cada 28 días durante un año tras la discontinuación del tratamiento, independientemente de si el paciente está recibiendo tratamiento contra el cáncer. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 9 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 90 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Austria |
Belgium |
Canada |
Czech Republic |
Denmark |
Estonia |
Finland |
France |
Germany |
Greece |
Hungary |
Italy |
Korea, Republic of |
Latvia |
Norway |
Poland |
Portugal |
Romania |
Slovenia |
Spain |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of the study is expected to occur about 53 months after FPI when approximately the pre-planned number of deaths will have been observed |
Está previsto que el estudio termine alrededor de 53 meses después de la inclusión de la primera paciente (IPP) cuando se haya observado aproximadamente la cifra prevista de muertes |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 6 |