E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Anaplastic lymphoma kinase-positive (ALK-positive) non-small cell lung cancer (NSCLC) |
CÁNCER DE PULMÓN NO MICROCÍTICO (CPNM) QUINASA DEL LINFOMA ANAPLÁSICO POSITIVO (ALK POSITIVO) |
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E.1.1.1 | Medical condition in easily understood language |
ALK+ NSCLC is a type of cancer that forms in tissues of the lung, and has an alteration in the ALK gene |
CPNM ALK+ es un tipo de cancer que se forma en los tejidos del pulmón, y que tiene una alteración en el gen ALK |
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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 | 18.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10029522 |
E.1.2 | Term | Non-small cell lung cancer stage IV |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10029521 |
E.1.2 | Term | Non-small cell lung cancer stage IIIB |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate and compare between treatment groups the efficacy of alectinib versus chemotherapy in patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) who were previously treated with chemotherapy and crizotinib, as measured by investigator-assessed progression-free survival (PFS) |
Evaluar y comparar la eficacia de alectinib frente a quimioterapia entre los grupos de tratamiento, en pacientes con cáncer de pulmón no microcítico (CPNM) avanzado quinasa del linfoma anaplásico (ALK) positivo, tratados previamente con quimioterapia y crizotinib, que se determinará basándose en la supervivencia libre de progresión (SLP) evaluada por el investigador |
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E.2.2 | Secondary objectives of the trial |
?To evaluate and compare between treatment groups the central nervous system (CNS) objective response rate (C-ORR) in patients with measurable CNS metastases at Baseline ?To evaluate and compare between treatment arms the PFS (by IRC);objective response rate (ORR); disease control rate (DCR) and duration of response (DOR) in all patients;time to CNS progression in all patients, CNS duration of response (C-DOR), CNS disease control rate (C-DCR) and C-ORR for all patients with baseline CNS metastasis, and overall survival (OS) ?To evaluate the safety and tolerability of alectinib compared with chemotherapy in all patients and patients with CNS metastases at Baseline ?To characterize the pharmacokinetics of alectinib and its major metabolite(s) ?To evaluate and compare time to deterioration (TTD) in patient-reported lung cancer symptoms ?To evaluate and compare patient-reported outcomes (PROs) of health-related quality of life (HRQoL) patient functioning and side effects of treatment |
?Evaluar y comparar el índice de respuesta objetiva en el sistema nervioso central en pacientes que presentan metástasis medibles en el período basal ?Evaluar y comparar entre los grupos de tratamiento la SLP, Indice de respuesta objetiva, índice de control de la enfermedad y duración de la respuesta; Tiempo a la progresion en el SNC, duración de la respuesta en el SNC, índice de control de la enfermedad en el SNC e IRO-SNC en todos los pacientes con metástasis en el SNC en el período basal, y supervivencia global (SG) ?Evaluar la seguridad y la tolerancia de alectinib comparado con quimioterapia, en todos los pacientes y en los pacientes con metástasis en el SNC en el período basal ?Definir la farmacocinética de alectinib y de su metabolito(s) principal(es) ?Evaluar y comparar el tiempo hasta el deterioro en pacientes con sintomas de cancer de pulmon ?Evaluar y comparar los resultados percibidos por los pacientes relativos a la calidad de vida relacionada con la salud |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Histologically or cytologically confirmed diagnosis of advanced or recurrent (Stage IIIB not amenable for multimodality treatment) or metastatic (Stage IV) NSCLC that is ALK-positive - Patient had received two prior systemic lines of therapy, which must have included one line of platinum-based chemotherapy and one line of crizotinib - Prior CNS or leptomeningeal metastases allowed if asymptomatic. - Patients with symptomatic CNS metastases for whom radiotherapy is not an option will be allowed to participate in this study - Measurable disease (by Response Evaluation Criteria in Solid Tumors v1.1) prior to the administration of study treatment - Age >=18 years old - Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0?2 - Adequate hematologic and renal function - Life expectancy of at least 12 weeks - For all females of childbearing potential, a negative pregnancy test must be obtained within 3 days before starting study treatment - For women who are not postmenopausal (>=12 months of non-therapy-induced amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to remain abstinent or use single or combined contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 3 months after the last dose of study drug - For men: agreement to remain abstinent or use a condom plus an additional contraceptive method that together result in a failure rate of <1% per year during the treatment period and for at least 3 months after the last dose of study drug |
-Presentar diagnóstico de CPNM avanzado o recurrente (en estadio IIIB, que no pueda ser tratado con múltiples modalidades de tratamiento) o metastásico (en estadio IV) confirmado histológica o citológicamente, que sea ALK-positivo -Haber recibido previamente dos regímenes de tratamiento sistémico, que deben haber incluido quimioterapia basada en platino y crizotinib -Está permitida la inclusión de pacientes con metástasis en el SNC o leptomeníngeas previas, si son asintomáticas -Los pacientes con metástasis sintomáticas en el SNC para los cuales la radioterapia no sea una opción adecuada, podrán participar en este estudio -Presentar enfermedad medible (de acuerdo con los criterios RECIST v1.1) antes de la administración del tratamiento del estudio -Tener ?18 años de edad -Estado funcional (EF) del Eastern Cooperative Oncology Group (ECOG) 0?2 -Función hematológica y renal adecuada -Esperanza de vida de al menos 12 semanas -Todas las mujeres potencialmente fértiles deben presentar un resultado negativo en la prueba de embarazo que se realizará en los 3 días previos al inicio del tratamiento del estudio -Las mujeres que no estén en fase postmenopáusica (es decir, sin amenorrea no inducida terapéuticamente desde hace >=12 meses) o que no estén esterilizadas quirúrgicamente (es decir, a las que no se les han extirpado los ovarios y/o el útero) deben comprometerse a practicar la abstinencia sexual o a utilizar uno o varios métodos anticonceptivos combinados que tengan una tasa de fallos anual < 1%, durante el período de tratamiento y, como mínimo, hasta 3 meses después de que reciban la última dosis del fármaco del estudio -Los varones deben comprometerse a practicar la abstinencia sexual o a utilizar preservativos más un método anticonceptivo adicional que proporcionen conjuntamente una tasa de fallos <1% al año, durante el período de tratamiento y como mínimo hasta 3 meses después de administrar la última dosis del fármaco del estudio. |
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E.4 | Principal exclusion criteria |
-Patients with a previous malignancy within the past 3 years are excluded (other than curatively treated basal cell carcinoma of the skin, early gastrointestinal (GI) cancer by endoscopic resection or in situ carcinoma of the cervix) -Patients who have received any previous ALK inhibitor other than crizotinib -Any GI disorder that may affect absorption of oral medications, such as mal-absorption syndrome or status post-major bowel resection -Patients with liver disease -National Cancer Institute Common Terminology Criteria for Adverse Events v4.0 Grade 3 or higher toxicities due to any prior therapy (excluding alopecia), which have not shown improvement and are strictly considered to interfere with current study medication -History of organ transplant -Patients with baseline QTc >470 milliseconds or symptomatic bradycardia -Pregnant or lactating women -Known HIV positivity or AIDS-related illness -Any clinically significant concomitant disease or condition that could interfere with, or for which the treatment might interfere with, the conduct of the study or the absorption of oral medications or that would, in the opinion of the Principal Investigator, pose an unacceptable risk to the patient in this study |
-Pacientes con antecedentes de neoplasias malignas en los 3 últimos años estan excluidos (exceptuando carcinoma de piel basocelular tratado con intención curativa, cáncer gastrointestinal (GI) precoz tratado con resección endoscópica o carcinoma in situ de cérvix) -Pacientes tratados previamente con cualquier inhibidor de ALK que no sea crizotinib -Cualquier trastorno GI que pueda afectar a la absorción de medicaciones orales, como síndrome de malabsorción o estado tras resección intestinal mayor -Pacientes con enfermedad hepática -Presencia de toxicidades de grado ?3, de acuerdo con los criterios NCI CTCAE v4.0, debidas a cualquier tratamiento previo (exceptuando alopecia), que no hayan mostrado mejoría y que se considere estrictamente que van a interferir en la medicación actual del estudio -Trasplante de órganos previo -Pacientes con QTc basal > 470 mseg o bradicardia sintomática -Mujeres embarazadas o en período de lactancia -Positividad documentada para VIH o patologías relacionadas con SIDA -Cualquier enfermedad o trastorno concomitante clínicamente significativo que pudiera interferir en el tratamiento, o viceversa, así como en el desarrollo del estudio o en la absorción de medicaciones orales o que, de acuerdo con la opinión del investigador principal, supondría un riesgo inaceptable para el paciente en este estudio |
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E.5 End points |
E.5.1 | Primary end point(s) |
PFS as measured by investigator |
SG medida por el investigador |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Up to 24 months |
Hasta un maximo de 24 meses |
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E.5.2 | Secondary end point(s) |
1. PFS by Independent Review Committee (IRC) 2. ORR and C-ORR 3. DCR and C-DCR 4. DOR and C-DOR 5. OS 6. Time to CNS progression 7. Incidence of adverse events and serious adverse events 8. Safety laboratory tests, Vital signs and ECG 9. Pharmacokinetics of alectinib and metabolite(s) 10. EORTC QLQ-C30 and EORTC QLQ-LC13 scores and the EuroQoL 5 Dimension (EQ-5D-5L) questionnaire score |
1-SLP medida por el Comite independiente de revisión (IRC) 2-IRO y SNC-IRO 3-ICE y SNC-ICE 4-DR y SNC-DR 5-SG 6-Tiempo hasta la progresion en el SNC 7-incidencia de acontecimientos adversos y acontecimientos adversos graves 8-Tests de seguridad de laboratorio, signos vitales y ECG 9-Farmacocinetica del Alectinib y su(s) metabolito(s) 10-Puntuación en el EORTC QLQ-C30 y EORTC QLQ-LC13 y puntuacion en el cuestionario EuroQoL 5 Dimension (EQ-5D-5L) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-8. Up to 24 months 9. Pre-dose at Baseline, Week 3 and Week 6 10. Up to 24 months |
1-8. Hasta un máximo de 24 meses 9. Pre-dosis en basal, semanas 3 y 6 10. Hasta un máximo de 24 meses |
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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 | Yes |
E.6.13.1 | Other scope of the trial description |
To assess exploratory biomarkers |
Evaluar biomarcadores exploratorios |
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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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
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) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 32 |
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 |
Belgium |
Bulgaria |
France |
Germany |
Hong Kong |
Hungary |
Italy |
Korea, Republic of |
Norway |
Poland |
Portugal |
Russian Federation |
Slovakia |
Spain |
Turkey |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end the of study will occur when each patient is followed up for OS for at least 24 months or when 50% of randomized patients have died, whichever occurs first. Study MO29750 will be closed and an updated analysis performed once all patients have either withdrawn or enrolled in the extension study. |
El estudio terminará cuando se haya realizado un seguimiento de la SG en cada paciente durante un mínimo de 24 meses o cuando el 50% de los pacientes randomizados hayan fallecido, dependiendo de lo que ocurra primero. Se cerrará el estudio MO29750 y se realizará un análisis actualizado una vez que todos los pacientes hayan sido retirados del estudio o incluidos en el estudio de extensión. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 5 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 5 |