E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
A-Anal Squamous Cell Carcinoma (CA)
B-Biliary Adenocarcinoma (Gallbladder&Biliary Tree but excluding Ampulla of Vater Cancers)
C-Neuroendocrine Tumors (well&moderately-differentiated,including Carcinoid)
D-Endometrial CA
E-Cervical Squamous Cell CA
F-Vulvar Squamous Cell CA
G-Small Cell Lung CA
H-Malignant Pleural Mesothelioma
I-Thyroid CA (Papillary or Follicular Subtype)
J-Salivary Gland CA OR
K-Other advanced solid tumor (except CRC) which is MSI-H from a newly obtained tumor biopsy |
A-Carcinoma anal
B-Carcinoma biliar
C-Tumores neuroendocrinos (bien y moderadamente diferenciados, como el carcinoide),
D-Carcinoma endometrial
E-Carcinoma cervicouterino
F-Carcinoma vulvar
G-Carcinoma pulmonar microcítico,
H-Mesotelioma,
I-Carcinoma tiroideo
J-Carcinoma de las glándulas salivales
K-Cualquier otro tumor sólido avanzado, con excepción del CCR, con MSI-elevada basándose en el examen de una biopsia tumoral |
|
E.1.1.1 | Medical condition in easily understood language |
Advanced Solid Tumors |
tumores sólidos avanzados |
|
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 | PT |
E.1.2 | Classification code | 10061045 |
E.1.2 | Term | Colon neoplasm |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Objective 1: To evaluate the ORR to pembrolizumab, based on RECIST 1.1 as assessed by independent central radiologic review, in biomarker-unselected subjects with any one of multiple types of advanced (metastatic and/or unresectable) solid tumors (Groups A-J) for which prior standard of care (SOC) treatments have failed
Objective 2: To evaluate the ORR to pembrolizumab, based on RECIST 1.1 as assessed by independent central radiologic review, in biomarker-selected subjects with any one of multiple types of advanced (metastatic and/or unresectable) solid tumors (Groups A-K) for which prior SOC treatments have failed. The primary biomarkers to be evaluated are (1) tumor expression of PD-L1 by IHC (Groups A-J), (2) tumor GEP by RNA analysis (Groups A-J), and (3) tumor MSI by DNA analysis (Groups A-J) or routine local testing (Group K). |
Objetivo 1: Determinar la TRO a pembrolizumab, basándose en los criterios RECIST 1.1 según la revisión radiológica central independiente, en pacientes no seleccionados por los biomarcadores con cualquiera de los múltiples tipos de tumores sólidos avanzados (metastásicos o irresecables) (grupos A-J)
Objetivo 2: Determinar la TRO a pembrolizumab, basándose en los criterios RECIST 1.1 según la revisión radiológica central independiente, en pacientes seleccionados por los biomarcadores con cualquiera de los múltiples tipos de tumores sólidos avanzados (metastásicos o irresecables) (grupos A-K). Los biomarcadores primarios que se evaluarán son (1) expresión de PD-L1 en el tumor mediante IHQ (grupos A-J), (2) PEG en el tumor mediante análisis del ARN (grupos A-J) y (3) MSI-H en el tumor (grupos A-K). |
|
E.2.2 | Secondary objectives of the trial |
The following secondary objectives will be evaluated across the ten specified tumor types (Groups A-J):
-To evaluate DOR (based on RECIST 1.1 as assessed by independent central radiologic review) in subjects receiving pembrolizumab and the relationship between DOR and tumor PD-L1 expression and GEP score
-To evaluate PFS (based on RECIST 1.1 as assessed by independent central radiologic review ) in subjects receiving pembrolizumab and the relationship between PFS and tumor PD-L1 expression and GEP score
- To evaluate OS in subjects receiving pembrolizumab and the relationship between OS and tumor PD-L1 expression and GEP score
The following secondary objectives will be evaluated across all tumor types (Groups A-K):
-To determine the safety and tolerability of pembrolizumab
Refer to protocol for complete list |
Se evaluarán los objetivos secundarios siguientes en los 10 tipos de tumores especificados (grupos A-J):
-Determinar la DR (basándose en los criterios RECIST 1.1 según la revisión radiológica central independiente) en los pacientes que reciban pembrolizumab y la relación entre la DR y la expresión de PD-L1 y la puntuación del PEG en el tumor
-Determinar la SSP (basándose en los criterios RECIST 1.1 según la revisión radiológica central independiente) en los pacientes que reciban pembrolizumab la relación entre la SSP y la expresión de PD-L1 y la puntuación del PEG en el tumor
-Determinar la SG en los pacientes que reciban pembrolizumab y la relación entre la SG y la expresión de PD-L1 y la puntuación del PEG en el tumor
Se evaluarán los objetivos secundarios siguientes en todos los tipos de tumor (grupos A-K):
-Determinar la seguridad y la tolerabilidad de pembrolizumab
Leer en el protocolo la lista completa |
|
E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related 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. |
Merck llevará a cabo investigaciones biomédicas futuras con las
muestras obtenidas específicamente con estos fines durante este ensayo
clínico. Estas investigaciones tendrán por objeto el análisis de
biomarcadores para abordar aspectos nuevos que no se describen en
otras partes del protocolo (como parte del ensayo principal) y solo se
llevarán a cabo en muestras de los sujetos que hayan otorgado el
consentimiento correspondiente. El objetivo de la obtención de muestras
para investigaciones biomédicas futuras consiste en estudiar e
identificar biomarcadores que proporcionen información a los científicos
sobre las enfermedades y sus tratamientos. El objetivo último es utilizar
tal información para desarrollar fármacos más seguros y eficaces y/o
para garantizar que los pacientes reciban la dosis correcta del fármaco
adecuado en el momento preciso. |
|
E.3 | Principal inclusion criteria |
1.Have a histologically or cytologically-documented, advanced (metastatic and/or unresectable) solid tumor that is incurable and for which prior standard first-line or later-line SOC treatments have failed. There is no limit to the number of prior treatment regimens.
2.Have one of the following advanced (unresectable and/or metastatic) tumor types:
(A)Anal Squamous Cell Carcinoma,
(B)Biliary Adenocarcinoma (Gallbladder and Biliary Tree but excluding Ampulla of Vater Cancers),
(C)Neuroendocrine Tumors (well- and moderately-differentiated, including Carcinoid),
(D)Endometrial Carcinoma (a)
(E)Cervical Squamous Cell Carcinoma,
(F)Vulvar Squamous Cell Carcinoma,
(G)Small Cell Lung Carcinoma,
(H)Mesothelioma (Malignant Pleural Mesothelioma),
(I)Thyroid Carcinoma (Papillary or Follicular Subtype),
(J)Salivary Gland Carcinoma (a)
OR
(K)Any other advanced solid tumor (except CRC), which is MSI-H from a newly obtained tumor biopsy.
(a)Note: All carcinoma subtypes are allowed; however, sarcomas or mesenchymal tumors are excluded.
3.Have submitted an evaluable tissue sample for biomarker analysis from a newly obtained core, incisional, or excisional biopsy of a tumor lesion not previously irradiated (exceptions may be considered after Sponsor consultation). Note: A newly obtained tumor specimen (i.e., collected since the completion of the most recent cancer therapy) for biomarker characterization will be required for enrollment of all subjects. Tissue from tumor progressing at a site of prior radiation may be allowed for biomarker characterization, based on the Sponsor?s approval.
4.If enrollment in Groups A-J has moved to biomarker enrichment, have a tumor that is positive for one or more of the pre-specified primary biomarker(s), as assessed by the central laboratory. These enrichment biomarkers may be PD-L1 expression by IHC (at a percentage to be prespecified), a positive tumor RNA GEP score (at a prespecified cut-off), and/or tumor MSI-H.
5.Have radiologically measurable disease based on RECIST 1.1. Independent central radiologic review must confirm the presence of radiologically measureable disease based on RECIST 1.1 for the subject to be eligible to participate in the trial (see Site Procedure Manual for detailed instructions). Tumor lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions.
Refer to protocol for complete list |
1.Presentar tumor sólido avanzado (metastásico y/o irresecable) documentado mediante histología o citología que sea incurable y no haya respondido a los tratamientos habituales de primera línea o líneas posteriores. No hay límite en el número de pautas de tratamiento previas.
2.Presentar uno de los siguientes tipos de tumores avanzados (irresecables y/o metastásicos):
A)Carcinoma epidermoide anal,
(B)Adenocarcinoma de las vías biliares (vesícula biliar y árbol biliar, salvo los cánceres de la ampolla de Vater),
(C)Tumores neuroendocrinos (bien y moderadamente diferenciados, como el carcinoide),
(D)Carcinoma endometrial, a
(E)Carcinoma epidermoide cervicouterino,
(F)Carcinoma epidermoide vulvar,
(G)Carcinoma pulmonar microcítico,
(H)Mesotelioma (mesotelioma pleural maligno),
(I)Carcinoma tiroideo (subtipos papilar o folicular),
(J)Carcinoma de las glándulas salivales, a
O
(K)Cualquier otro tumor sólido avanzado (excepto el CCR), que tenga MSI-H, basándose en el examen de una biopsia tumoral recién obtenida.
aNota: Se admitirán todos los subtipos de carcinoma; sin embargo, están excluidos los sarcomas o los tumores mesenquimatosos.
3.Haber enviado una muestra de tejido evaluable para análisis de biomarcadores de una biopsia con aguja gruesa, de incisión o de escisión recién obtenida de una lesión tumoral no irradiada previamente (se podrán considerar excepciones después de consultar al promotor). Nota: Se exigirá una muestra tumoral "recién obtenida" (es decir, recogida desde la finalización del tratamiento antineoplásico más reciente) para caracterización de biomarcadores con vistas a la inscripción de todos los pacientes. Si lo aprueba el promotor, se permitirá la obtención de tumor que progrese en una zona radiada previamente para caracterización de biomarcadores.
4.Si la inscripción en los grupos A-J ha llevado al enriquecimiento de biomarcadores, presentar un tumor que sea positivo para uno o más de los biomarcadores primarios especificados de antemano, según la evaluación del laboratorio central. Estos biomarcadores de enriquecimiento son la expresión de PD-L1 mediante IHQ (en un porcentaje que se especificará previamente), una puntuación del PEG del ARN positiva en el tumor (con un valor de corte preespecificado) y/o MSI-H del tumor.
5.Tener enfermedad radiológicamente mensurable según los criterios RECIST 1.1. La revisión radiológica central independiente debe confirmar la presencia de enfermedad radiológicamente mensurable basándose en los criterios RECIST 1.1 para que el paciente pueda participar en el estudio (véanse instrucciones detalladas en el manual de imagen del centro). Las lesiones tumorales ubicadas en una zona previamente irradiada se considerarán mensurables siempre que se haya demostrado progresión en dichas lesiones.
Léase en el protocolo la lista completa. |
|
E.4 | Principal exclusion criteria |
-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 may be approved after consultation with the Sponsor.
-Has an active autoimmune disease that has required systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment.
-Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study Day 1 or who has not recovered (i.e., < or = to Grade 1 or at baseline) from AEs due to mAbs administered more than 4 weeks earlier.
-Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 or who has not recovered (i.e., < or = to Grade 1 or at baseline) from adverse events due to a previously administered agent.
Refer to protocol for complete list. |
-Tener un diagnóstico de inmunodeficiencia o haber recibido corticoterapia sistémica o algún tipo de tratamiento inmunosupresor en los 7 días previos a la primera dosis del tratamiento del ensayo. El uso de dosis fisiológicas de corticosteroides podrá autorizarse previa consulta con el promotor.
-Presentar una enfermedad autoinmunitaria activa que haya necesitado tratamiento sistémico en los dos años anteriores (es decir, fármacos modificadores de la enfermedad, corticosteroides o inmunosupresores). El tratamiento de sustitución (p ej., tiroxina, insulina o corticosteroides en dosis fisiológicas para insuficiencia suprarrenal o hipofisaria, etc.) no se considera una forma de tratamiento sistémico.
-Haber recibido un anticuerpo monoclonal (mAb) antineoplásico en las 4 semanas previas al día 1 del estudio o no haberse recuperado (es decir, a un grado < o = a 1 o a la situación basal) de los AA provocados por los mAb administrados más de 4 semanas antes.
-Haber recibido quimioterapia, un tratamiento dirigido con moléculas pequeñas o radioterapia en las 2 semanas previas al día 1 del estudio o no haberse recuperado (es decir, a un grado < o = a 1 o a la situación basal) de los AA provocados por un fármaco administrado anteriormente.
Léase en el protocolo la lista completa |
|
E.5 End points |
E.5.1 | Primary end point(s) |
ORR based on RECIST 1.1 as assessed by independent central radiologic review |
TRO conforme a los criterios RECIST 1.1 según la evaluación radiológica central |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
The trial incorporates an adaptive design in which multiple interim analyses may be performed. Results will be reviewed by the study team. The cutoffs for the three primary biomarker assays will be selected and specified before the first interim analysis. Details regarding the timing and conduct of the initial interim analysis will be further clarified in the sSAP. The planned sample size may be modified based on the interim results. The timing of additional interim analyses, the final analysis as well as the analysis plan will be documented in the sSAP. The sSAP will also be updated as the trial evolves.
The primary endpoint of ORR will be used for all interim analyses with or without a confirmatory assessment; however, a confirmatory assessment is required for the final analysis |
El estudio incorpora un diseño adaptativo, dónde se pueden realizar análisis intermedios. El equipo del estudio revisará los resultados. Se seleccionarán y especificarán valores de corte para los análisis de los 3 biomarcadores primarios antes del 1º análisis intermedio (AI). Se clarificarán en el sSAP detalles relativos al calendario y la realización del AI inicial. Se podrá modificar el tamaño previsto de la muestra en función de los resultados intermedios. Se documentarán en el sSAP el calendario de los AIs adicionales, el final y el plan de análisis. Se actualizará el sSAP a medida que avance el estudio. Se utilizará el criterio de valoración ppal de la TRO para los AIs con o sin evaluación de confirmación pero será necesaria la evaluación de confirmación para el análisis final. |
|
E.5.2 | Secondary end point(s) |
Safety and Tolerability
Duration of response (DOR)
Progression-free survival (PFS)
Overall survival (OS)
(PK) for the 200 mg iv Q3W fixed dosing regimen |
Seguridad y tolerabilidad
Duración de la respuesta
Supervivencia libre de progresión
Supervivencia global
PK para la dosis fijada de 200 mg iv Q3W |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Secondary efficacy endpoints will be summarized at the time that the primary analysis is conducted; however, these secondary endpoints are not likely to be mature at that time. |
Los criterios de valoración de eficacia secundarios se resumirán en el momento en el que se realice el análisis primario; sin embargo estos criterios de valoración secundarios no se cree que estén preparados en ese momento. |
|
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 | No |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
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 | No |
E.8.2.3 | Other | No |
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 | 22 |
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 |
Denmark |
France |
Germany |
Italy |
Netherlands |
Norway |
Spain |
United Kingdom |
|
E.8.7 | Trial 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
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |