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    Summary
    EudraCT Number:2015-001879-43
    Sponsor's Protocol Code Number:B9991005
    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:2016-01-13
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2015-001879-43
    A.3Full title of the trial
    A Phase 1b/2, Open-Label, Dose-Finding Study to Evaluate Safety, Efficacy, Pharmacokinetics and Pharmacodynamics of Avelumab (MSB0010718C) in Combination with Either Crizotinib or PF-06463922 in Patients with Advanced or Metastatic Non-Small Cell Lung Cancer
    ESTUDIO ABIERTO DE FASE IB/II, DE BÚSQUEDA DE DOSIS, PARA EVALUAR LA SEGURIDAD, LA EFICACIA, LA FARMACOCINÉTICA Y LA FARMACODINÁMICA DE AVELUMAB (MSB0010718C) EN COMBINACIÓN CON CRIZOTINIB O CON PF-06463922 EN PACIENTES CON CARCINOMA DE PULMÓN NO MICROCÍTICO METASTÁSICO O AVANZADO
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 1b/2, Open-Label, Dose-Finding Study to Evaluate Safety, Efficacy, Pharmacokinetics and Pharmacodynamics of Avelumab (MSB0010718C) in Combination with Either Crizotinib or PF-06463922 in Patients with Advanced or Metastatic
    Non-Small Cell Lung Cancer
    ESTUDIO ABIERTO DE FASE IB/II, DE BÚSQUEDA DE DOSIS, PARA EVALUAR LA SEGURIDAD, LA EFICACIA, LA FARMACOCINÉTICA Y LA FARMACODINÁMICA DE AVELUMAB (MSB0010718C) EN COMBINACIÓN CON CRIZOTINIB O CON PF-06463922 EN PACIENTES CON CARCINOMA DE PULMÓN NO MICROCÍTICO METASTÁSICO O AVANZADO
    A.4.1Sponsor's protocol code numberB9991005
    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 SponsorPfizer Inc, 235 East 42nd Street, New York, NY 10017
    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 supportPfizer Inc., 235 East 42nd Street, New York, NY 10017
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPfizer Inc.
    B.5.2Functional name of contact pointClinical Trials.gov Call Center
    B.5.3 Address:
    B.5.3.1Street Address235 East 42nd Street
    B.5.3.2Town/ cityNew York
    B.5.3.3Post codeNY 10017
    B.5.3.4CountryUnited States
    B.5.4Telephone number+3491490 99 00
    B.5.5Fax number+1303739 1119
    B.5.6E-mailclinicaltrials.govcallcenter@pfizer.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 nameAvelumab
    D.3.2Product code MSB0010718C
    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 INNN/A
    D.3.9.2Current sponsor codeMSB0010718C
    D.3.9.3Other descriptive nameAvelumab
    D.3.9.4EV Substance CodeSUB176547
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Xalkori ?
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Ltd
    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 nameCrizotinib
    D.3.2Product code PF-02341066
    D.3.4Pharmaceutical form Capsule
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNN/A
    D.3.9.1CAS number 877399-52-5
    D.3.9.2Current sponsor codePF-02341066
    D.3.9.3Other descriptive nameCRIZOTINIB
    D.3.9.4EV Substance CodeSUB32267
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number250
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP 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 namePF-06463922
    D.3.2Product code PF-06463922
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNN/A
    D.3.9.2Current sponsor codePF-06463922 Form 3 (acetic acid solvate)
    D.3.9.4EV Substance CodeSUB126819
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNN/A
    D.3.9.2Current sponsor codePF-06463922 (anhydrous Form 7)
    D.3.9.4EV Substance CodeSUB126819
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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
    Anaplastic Lymphoma Kinase (ALK) (negative and positive) Non-Small Cell Lung Cancer (NSCLC)
    Cinasa de linfoma anaplásico (Anaplastic Lymphoma Kinase, ALK)-negativo localmente avanzado o metastásico
    E.1.1.1Medical condition in easily understood language
    Lung Cancer
    Cáncer de pulmón
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.1
    E.1.2Level LLT
    E.1.2Classification code 10025051
    E.1.2Term Lung cancer non-small cell stage II
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.1
    E.1.2Level LLT
    E.1.2Classification code 10025052
    E.1.2Term Lung cancer non-small cell stage III
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.1
    E.1.2Level LLT
    E.1.2Classification code 10025055
    E.1.2Term Lung cancer non-small cell stage IV
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase 1b Primary Objective:
    - Group A (ALK-negative): To determine MTD and the recommended Phase 2 dose (RP2D) of the combination of avelumab with crizotinib.
    - Group B (ALK-positive): To determine the MTD and the RP2D of the combination of avelumab with PF-06463922.
    Phase 2 Primary Objective:
    - To assess ORR per RECIST v.1.1 in previously treated locally advanced or metastatic ALK-negative NSCLC patients treated with the combination of avelumab and crizotinib at the RP2D (Group A).
    Objetivo principal de la fase Ib:
    - Grupo A (ALK-negativo): determinar la dosis máxima tolerada (DMT) y la dosis recomendada para la fase II (DRF2) de la combinación de avelumab y crizotinib.
    - Grupo B (ALK-positivo): determinar la DMT y la DRF2 de la combinación de avelumab y PF-06463922.
    Objetivo principal de la fase II:
    - Analizar la tasa de respuesta objetiva (TRO) según los criterios de evaluación de la respuesta al tratamiento en tumores sólidos (RECIST) v. 1.1 en pacientes con CPNM ALK-negativo localmente avanzado o metastásico tratados anteriormente con la combinación de avelumab y crizotinib a la DRF2 (grupo A).
    E.2.2Secondary objectives of the trial
    - To evaluate the safety and tolerability of avelumab in combination with crizotinib (Group A) or with PF-06463922 (Group B).
    - To assess antitumor activity of avelumab in combination with crizotinib (Group A) or with PF-06463922 (Group B).
    - To characterize the PK of avelumab in combination with crizotinib (Group A) or with PF-06463922 (Group B).
    - To assess the immunogenicity of avelumab.
    - To evaluate candidate predictive biomarkers of sensitivity or resistance to combination therapy in pretreatment tumor tissue.
    - Evaluar la seguridad y tolerabilidad del avelumab combinado con el crizotinib (grupo A) o con PF-06463922 (grupo B).
    - Analizar la actividad antineoplásica del avelumab combinado con el crizotinib (grupo A) o con PF-06463922 (grupo B).
    - Caracterizar la FC del avelumab combinado con el crizotinib (grupo A) o con PF-06463922 (grupo B).
    - Analizar la inmunogenicidad del avelumab.
    - Evaluar biomarcadores candidatos predictivos de la sensibilidad o la resistencia a la politerapia en tejidos tumorales antes del tratamiento.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Diagnosis.
    Histologically or cytologically proven diagnosis of NSCLC that is locally advanced
    or metastatic:
    - Group A: ALK-negative NSCLC based on locally approved testing. No known
    ROS1 or c-MET alterations predicted to confer sensitivity to crizotinib (testing is not required if not locally available). EGFR mutations must also have been evaluated based on locally approved testing. Patients with EGFR mutation positive NSCLC will be permitted onto this study group if standard treatment options for EGFR mutation positive NSCLC have been exhausted.
    - Group B: ALK-positive NSCLC based on locally approved testing.
    2. Mandatory archival FFPE tumor tissue. If tissue is unavailable, a mandatory tumor biopsy must be performed.
    3. At least one measurable lesion as defined by RECIST v.1.1 that has not previously been irradiated.
    4. Age = or >18 years (>20 years for Japan).
    5. Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1.
    6. Estimated life expectancy of at least 3 months.
    7. Adequate Bone Marrow Function, including:
    a. Absolute Neutrophil Count (ANC) = or > 1,500/mm3 or = or >1.5 x 109/L;
    b. Platelets = or >100,000/mm3 or = or >100 x 109/L;
    c. Hemoglobin = or > 9 g/dL (may have been transfused).
    8. Adequate Renal Function as evidenced by:
    a. Estimated creatinine clearance = or > 50 mL/min as calculated using the
    Cockcroft-Gault equation.
    9. Adequate Liver Function, including:
    a. Total serum bilirubin = or >1.5 x ULN;
    b. Aspartate and alanine aminotransferase (AST and ALT) = or >2.5 x ULN; in all patients.
    10. Adequate Pancreatic Function, including:
    a. Serum amylase < 1.5 x ULN;
    b. Serum lipase < 1.5 x ULN.
    11. INR or prothrombin time (PT) <1.5 x ULN.
    12. Serum pregnancy test (for females of childbearing potential) negative at screening.
    13. Male patients able to father children and female patients of childbearing potential and at risk for pregnancy must agree to use 2 highly effective methods of contraception throughout the study and for at least 90 days after the last dose of assigned treatment.
    14. Evidence of a personally signed and dated informed consent document indicating that the patient (or a legally acceptable representative) has been informed of all pertinent aspects of the study.
    1. Diagnóstico.
    Diagnóstico comprobado histológica o citológicamente de CPNM localmente avanzado o metastásico:
    - Grupo A: CPNM ALK-negativo según las pruebas aprobadas localmente. Ausencia de alteraciones conocidas de ROS1 o c-MET con previsión de conferir sensibilidad a crizotinib (las pruebas no son obligatorias si no están disponibles localmente). Las mutaciones de EGFR también deben evaluarse a partir de las pruebas aprobadas localmente. Se permite la entrada en este grupo del estudio a pacientes con CPNM con mutaciones en EGFR si han agotado todas las opciones de tratamiento estándar del CPNM con mutación de EGFR.
    - Grupo B: CPNM ALK-positivo según las pruebas aprobadas localmente.
    2. Tejido tumoral FFIP de archivo obligatorio (todos los pacientes; consulte el apartado 6.1.1). Si no se dispone de tejido, es obligatorio realizar una biopsia tumoral.
    3. Al menos una lesión medible definida por los RECIST v. 1.1 que no haya sido irradiada previamente.
    4. Edad igual o mayor 18 años (>20 años en Japón).
    5. Estado general (EG) según el Grupo Oncológico Cooperativo del Este (ECOG) de 0 o 1 (consulte el Apéndice 3).
    6. Esperanza de vida estimada de al menos 3 meses.
    7. Función adecuada de la médula ósea, lo que incluye:
    a. Recuento absoluto de neutrófilos (RAN) igual o mayor 1500/mm3 o igual o mayor 1,5 x 109/l.
    b. Plaquetas igual o mayor 100 000/mm3 o ?100 x 109/l.
    c. Hemoglobina igual o mayor 9 g/dl (se podrán efectuar transfusiones).
    8. Función renal adecuada a partir de los datos de:
    a. Aclaramiento de creatinina estimado igual o mayor 50 ml/min según lo calculado con la ecuación de Cockcroft-Gault.
    9. Función hepática adecuada, lo que incluye:
    a. Bilirrubina sérica total igual o menor 1,5 x LSN.
    b. Aspartato y alanina aminotransferasa (AST y ALT) igual o menor 2,5 x LSN; en todos los pacientes.
    10. Función pancreática adecuada, lo que incluye:
    a. Amilasa en suero <1,5 x LSN.
    b. Lipasa en suero <1,5 x LSN.
    11. INR o tiempo de protrombina (TP) <1,5 x LSN.
    12. Prueba de embarazo en suero (en mujeres con capacidad para concebir) negativa en la selección.
    13. Los pacientes varones capaces de engendrar hijos y las mujeres con capacidad para concebir en riesgo de embarazo deben aceptar el uso de 2 métodos anticonceptivos de alta eficacia durante todo el estudio y al menos durante 90 días después de la última dosis del tratamiento asignado.
    14. Constancia de un documento de consentimiento informado firmado y fechado personalmente que indique que se ha informado al paciente (o a un representante legal) de todos los aspectos pertinentes del estudio.
    E.4Principal exclusion criteria
    1. Patients with any of the following characteristics/conditions will not be included in the study: Major surgery ?4 weeks or radiation therapy = or >2 weeks prior to study entry. Prior palliative radiotherapy (= or > 10 fractions) to metastatic lesion(s) is permitted, provided it has been completed 48 hours prior to patient registration.
    2. Prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) antibody (including any other antibody or drug specifically targeting T cell co-stimulation or immune checkpoint pathways).
    3. Systemic anti-cancer therapy = or >2 weeks prior to study entry.
    4. Brain metastases, except:
    - Patients with previously diagnosed brain metastases are eligible if they have completed their treatment and have recovered from the acute effects of radiation therapy or surgery prior to study entry, have discontinued corticosteroid treatment for these metastases for at least 4 weeks and are neurologically stable (Group A).
    - Patients with asymptomatic brain metastases currently requiring no steroids (Group B).
    5. Persisting NCI CTCAE v4.0 Grade >1 toxicity related to prior therapy; however, alopecia Grade 2 is acceptable.
    6. Diagnosis of any other malignancy within 5 years prior to study entry, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ of the breast or of the cervix, or low-grade (Gleason 6 or below) prostate cancer on surveillance without any plans for treatment intervention (eg, surgery, radiation, or castration).
    7. Current or prior use of immunosuppressive medication within 7 days prior to randomization, except the following: Intranasal, inhaled, topical steroids, or local steroid injections (eg, intra-articular injection); Systemic corticosteroids at physiologic doses = or > 10 mg/day of prednisone or equivalent; Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication).
    8. Active autoimmune disease that might deteriorate when receiving an immunostimulatory agents. Patients with diabetes type I, vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible.
    9. Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) related illness.
    10. Rapidly progressive disease (eg, tumor lysis syndrome).
    11. Gastrointestinal abnormalities including:
    - Inability to take oral medication;
    - Requirement for intravenous alimentation;
    - Prior surgical procedures affecting absorption including total gastric resection;
    - Treatment for active peptic ulcer disease in the past 6 months;
    - Active gastrointestinal bleeding, unrelated to cancer, as evidenced by clinically significant hematemesis, hematochezia or melena in the past 3 months without evidence of resolution documented by endoscopy or colonoscopy;
    - Malabsorption syndromes;
    - History of pancreatitis.
    12. Known prior or suspected hypersensitivity to study drugs or any component in their formulations.
    13. Active infection requiring systemic therapy.
    14. Any test for hepatitis B virus (HBV) or hepatitis C virus (HCV) indicating acute or chronic infection.
    15. Vaccination within 4 weeks of the first dose of avelumab and while on trial is prohibited except for administration of inactivated vaccines (for example, inactivated influenza vaccines).
    16. Any of the following in the previous 6 months: myocardial infarction, congenital long QT syndrome, Torsades de pointes, arrhythmias (including sustained ventricular tachyarrhythmia and ventricular fibrillation), right bundle branch block and left anterior hemiblock (bifascicular block), unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure (CHF New York Heart Association Class III or IV), cerebrovascular accident, transient ischemic attack, or symptomatic pulmonary embolism. Ongoing cardiac dysrhythmias of NCI CTCAE Grade = or > 2, atrial fibrillation of any grade, or QTc interval >470 msec at screening.

    Please refer to the protocol for the remaining of the exclusion criteria
    1. No se incluirá en el estudio a ningún paciente con alguna de las características o los trastornos que se indican a continuación: Cirugía mayor ?4 semanas o radioterapia = or >2 semanas antes de entrar en el estudio. Se permite la radioterapia paliativa anterior (= or > 10 fracciones) en la lesión o lesiones metastásicas, siempre que se haya finalizado 48 horas antes del registro del paciente.
    2. Tratamiento anterior con anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137 o anticuerpos contra el antígeno 4 asociado a los linfocitos T citotóxicos (CTLA-4) (incluyendo todos los anticuerpos o fármacos que actúen de manera específica sobre la coestimulación de linfocitos T o las vías de los puntos de control inmunitario).
    3. Tratamiento antineoplásico sistémico = or >2 semanas antes de entrar en el estudio.
    4. Metástasis cerebrales, excepto:
    - Los pacientes con metástasis cerebrales previamente diagnosticadas serán elegibles si han concluido su tratamiento y se han recuperado de los efectos agudos de la radioterapia o cirugía con anterioridad a la entrada en el estudio, han cesado el tratamiento con corticoesteroides para dichas metástasis durante al menos 4 semanas y son estables neurológicamente (grupo A).
    - Pacientes con metástasis cerebrales asintomáticas que actualmente no necesiten corticoesteroides (grupo B).
    5. Toxicidad persistente de grado >1 según los CTCAE del NCI v. 4.0 relacionada con el tratamiento anterior. Sin embargo, se acepta la alopecia de grado 2.
    6. Diagnóstico de otra neoplasia maligna en los 5 años anteriores a la entrada en el estudio, salvo carcinoma basocelular o espinocelular tratado adecuadamente, o carcinoma in situ de mama o de cuello uterino, o cáncer de próstata de grado bajo (Gleason 6 o inferior) en vigilancia sin previsión de intervención (p. ej., cirugía, radiación o castración).
    7. Uso anterior o actual de inmunodepresores en los 7 días anteriores a la aleatorización, excepto en los casos siguientes: Corticoesteroides intranasales, inhalados o tópicos, o inyecciones locales de corticoesteroides (p. ej., infiltración intrarticular); corticoesteroides sistémicos a dosis fisiológicas ?10 mg/día de prednisona o equivalente; premedicación con corticoesteroides para tratar las reacciones de hipersensibilidad (p. ej., premedicación para TAC).
    8. Enfermedad autoinmunitaria activa que pueda empeorar al recibir inmunoestimuladores. Son aptos para participar los pacientes con diabetes tipo 1, vitiligo, psoriasis o enfermedad hipo o hipertiroidea que no requiera tratamiento con inmunodepresores.
    9. Infección conocida por el virus de la inmunodeficiencia humana (VIH) o enfermedad relacionada con el síndrome de inmunodeficiencia adquirida (SIDA).
    10. Enfermedad con progresión rápida (p. ej., síndrome de lisis tumoral).
    11. Trastornos gastrointestinales tales como:
    - imposibilidad de tomar medicamentos por vía oral;
    - necesidad de nutrición intravenosa;
    - intervenciones quirúrgicas anteriores que afecten a la absorción, incluyendo la resección gástrica total;
    - tratamiento de úlcera gastroduodenal activa en los últimos 6 meses;
    - hemorragia gastrointestinal activa, no relacionada con el tumor, a partir de la observación de hematemesis, rectorragia o melena de importancia clínica en los últimos 3 meses sin indicios de resolución documentados mediante endoscopia o colonoscopia;
    - síndromes de malabsorción;
    - antecedentes de pancreatitis.
    12. Presunta o ya conocida hipersensibilidad a los fármacos del estudio o a cualquier componente de sus formulaciones.
    13. Infección activa que requiere tratamiento sistémico.
    14. Todas las pruebas del virus de la hepatitis B (VHB) o del virus de la hepatitis C (VHC) que indiquen infección aguda o crónica.
    15. Se prohíben las vacunas en el plazo de 4 semanas de la primera dosis de avelumab y mientras se participe en el ensayo, excepto las vacunas inactivadas (por ejemplo, vacunas antigripales inactivadas).
    16. Cualquiera de los trastornos siguientes en los 6 meses anteriores: infarto de miocardio, síndrome de QT largo congénito, torsade de pointes, arritmias (incluyendo taquiarritmia ventricular sostenida y fibrilación ventricular), bloqueo de la rama derecha del haz de His y hemibloqueo anterior izquierdo (bloqueo bifascicular), angina inestable, injerto de revascularización coronaria/periférica, insuficiencia cardíaca congestiva sintomática (clase III o IV de ICC según la Asociación de Cardiología de Nueva York), accidente cerebrovascular, accidente isquémico transitorio o embolia pulmonar sintomática. Arritmias cardíacas en curso de grado = or >2 según los CTCAE del NCI, fibrilación auricular de cualquier grado, o intervalo QTc >470 ms en la selección.


    Remítanse al protocolo para completar lista.
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1b:
    -First 2 cycles DLTs for Group A and Group B.
    Phase 2:
    - Confirmed OR per RECIST v.1.1 for Group A.
    Fase Ib:
    - TLD de los 2 primeros ciclos del grupo A y el grupo B.
    Fase II:
    - Respuesta objetiva (RO) confirmada según los RECIST v. 1.1 en el grupo A.
    E.5.1.1Timepoint(s) of evaluation of this end point
    As per protocol
    Según protocolo
    E.5.2Secondary end point(s)
    Secondary Endpoints
    - Adverse events (AEs) and laboratory abnormalities as graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4 (Appendix 5); vital signs (blood pressure, pulse rate).
    - Confirmed OR (Group B), Disease Control (DC), Duration of Response (DR), Time to Tumor Response (TTR), Progression-Free Survival (PFS) per RECIST v.1.1, and Overall Survival (OS).
    - Pharmacokinetic parameters of crizotinib, its metabolite PF-06260182, and avelumab will be determined as data permit:
    - Maximum plasma concentration (Cmax), time to maximum plasma concentration (Tmax), area under the plasma concentration-time curve during the dosing interval time course (AUCtau), area under the plasma concentration-time curve from time of dosing to the last collection time point (AUClast), apparent plasma clearance (CL/F), and apparent volume of distribution (V/F) for crizotinib following multiple dosing in the presence of avelumab;
    - Cmax, Tmax, AUCtau, metabolite to parent ratio for AUCtau (MRAUCtau), and metabolite to parent ratio for Cmax (MRCmax) for PF-06260182 following multiple doses in the presence of avelumab;
    - Maximum plasma concentration (Cmax), time to maximum plasma concentration (Tmax), area under the plasma concentration-time curve during the dosing interval time course (AUCtau), area under the plasma concentration-time curve from time of dosing to the last collection time point (AUClast), apparent plasma clearance (CL/F), and apparent volume of distribution (V/F) for PF-06463922 following multiple dosing in the presence of avelumab;
    - Single and multiple dose PK (Cmax, Ctrough of avelumab in the presence of crizotinib).
    - Tumor tissue biomarkers, including but not limited to, PD-L1 expression and tumor infiltrating CD8+ T cells by immunohistochemistry (IHC).
    - Avelumab anti-drug antibodies (ADA; neutralizing antibodies).

    Exploratory Endpoints
    - Immune-related objective response rate (irORR) per irRECIST
    - Peripheral blood and additional tumor tissue biomarkers consisting of the levels of cells, DNA, RNA or proteins that may be related to anti-tumor immune response and/or response to or disease progression on avelumab in combination with either crizotinib or PF-06463922, such as TNF-alpha, IFN? and/or tissue FoxP3, PD-1, PD-L2.
    Criterios de valoración secundarios
    - Acontecimientos adversos (AA) y anomalías analíticas según los criterios de terminología común para acontecimientos adversos (CTCAE) del Instituto Nacional del Cáncer (NCI) v. 4 (Apéndice 5); constantes vitales (presión arterial, pulso).
    - RO confirmada (grupo B), control de la enfermedad (CE), duración de la respuesta (DR), tiempo hasta la respuesta tumoral (TRT), supervivencia sin progresión (SSP) según los RECIST v. 1.1 y supervivencia general (SG).
    - Los parámetros farmacocinéticos del crizotinib, su metabolito PF-06260182 y el avelumab se determinarán según lo permitan los datos:
    - concentración plasmática máxima (Cmáx), tiempo hasta la concentración plasmática máxima (Tmáx), área bajo la curva de concentración plasmática y tiempo durante el curso de tiempo del intervalo de dosificación (ABC?), área bajo la curva de concentración plasmática y tiempo desde el momento de la dosificación hasta el momento de la última obtención (ABCúlt), aclaramiento en plasma aparente (Cl/F) y volumen de distribución aparente (V/F) del crizotinib tras la dosificación múltiple en presencia de avelumab;
    - Cmáx, Tmáx, ABC?, proporción entre metabolito y molécula precursora del ABC? (PMABC?) y proporción entre metabolito y molécula precursora de la Cmáx (PMCmáx) de PF-06260182 tras dosis múltiples en presencia de avelumab;
    - concentración plasmática máxima (Cmáx), tiempo hasta la concentración plasmática máxima (Tmáx), área bajo la curva de concentración plasmática y tiempo durante el curso de tiempo del intervalo de dosificación (ABC?), área bajo la curva de concentración plasmática y tiempo desde el momento de la dosificación hasta el momento de la última obtención (ABCúlt), aclaramiento en plasma aparente (Cl/F) y volumen de distribución aparente (V/F) de PF-06463922 tras la dosificación múltiple en presencia de avelumab;
    - FC de dosis única y dosis múltiple (Cmáx, Cmín del avelumab en presencia de crizotinib).
    - Biomarcadores en tejido tumoral, incluyendo, entre otros, la expresión de PD-L1 y los linfocitos T CD8+ infiltrantes mediante inmunohistoquímica (IHC).
    - Anticuerpos antifármaco de avelumab (ADA; anticuerpos neutralizadores).
    Criterios de valoración exploratorios
    - Tasa de respuesta objetiva relacionada con la inmunidad (TROri) según los irRECIST (consulte el Apéndice 6).
    - Biomarcadores en sangre periférica y tejido tumoral adicional consistentes en los niveles de células, ADN, ARN o proteínas que puedan estar en relación con la respuesta inmunitaria antineoplásica o la respuesta o la evolución de la enfermedad durante el tratamiento con avelumab combinado con crizotinib o PF-06463922, tales como TNF-alpha, IFN? o FoxP3, PD-1 o PD-L2 tisular.
    E.5.2.1Timepoint(s) of evaluation of this end point
    As per protocol
    Según protocolo
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety 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 No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Dose-finding study
    Estudio de búsqueda de dosis.
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Determination of the Maximum Tolerated Dose
    Determinar la dosis máxima tolerada
    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 No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA4
    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
    Australia
    France
    Japan
    Korea, Republic of
    Spain
    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
    Last Patient Last Visit
    Último Paciente Última visita
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    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 years2
    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: 68
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 68
    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 state30
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 40
    F.4.2.2In the whole clinical trial 136
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None specified
    No especificado
    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 Decision2016-03-11
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-02-10
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2022-07-13
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