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    Summary
    EudraCT Number:2015-002429-20
    Sponsor's Protocol Code Number:B9991003
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-01-21
    Trial 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 number2015-002429-20
    A.3Full title of the trial
    A PHASE 3, MULTINATIONAL, RANDOMIZED, OPEN-LABEL, PARALLEL-ARM
    STUDY OF AVELUMAB (MSB0010718C) IN COMBINATION WITH AXITINIB
    (INLYTA¿) VERSUS SUNITINIB (SUTENT¿) ) MONOTHERAPY IN THE
    FIRST-LINE TREATMENT OF PATIENTS WITH ADVANCED RENAL CELL CARCINOMA
    STUDIO DI FASE 3, MULTINAZIONALE, RANDOMIZZATO, IN APERTO, A BRACCI PARALLELI DI AVELUMAB (MSB0010718C) IN COMBINAZIONE CON AXITINIB (INLYTA¿) A CONFRONTO CON SUNITINIB (SUTENT¿) IN MONOTERAPIA NEL TRATTAMENTO DI PRIMA LINEA DI PAZIENTI AFFETTI DA CARCINOMA RENALE IN STADIO AVANZATO
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study of Avelumab In Combination with Axitinib Versus Sunitinib In Patients With Advanced Kidney Cancer
    Studio di Avelumab in combinazione con Axitinib a confronto con Sunitinib in pazienti affetti da carcinoma renale in stadio avanzato.
    A.3.2Name or abbreviated title of the trial where available
    JAVELIN Renal 101
    JAVELIN Renal 101
    A.4.1Sponsor's protocol code numberB9991003
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN00000000
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT02684006
    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
    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.
    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 Centre
    B.5.3 Address:
    B.5.3.1Street Address235 E 42nd Street
    B.5.3.2Town/ cityNew York, NY
    B.5.3.3Post code100017
    B.5.3.4CountryUnited States
    B.5.4Telephone number018007181021
    B.5.5Fax number018007391119
    B.5.6E-mailClinicalTrials.gov_Inquiries@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 INNAvelumab
    D.3.9.2Current sponsor codeMSB0010718C
    D.3.9.4EV Substance CodeSUB180078
    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 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 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 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 INLYTA
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 nameAxitinib
    D.3.2Product code [AG-013736]
    D.3.4Pharmaceutical form Coated 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 INNAXITINIB
    D.3.9.1CAS number 319460-85-0
    D.3.9.2Current sponsor codeAG-013736
    D.3.9.4EV Substance CodeSUB25427
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number1 to 5
    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 SUTENT
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 nameSUNITINIB MALEATO
    D.3.2Product code [SU011248]
    D.3.4Pharmaceutical form Capsule, hard
    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 INNSUNITINIB MALEATO
    D.3.9.1CAS number 557795-19-4
    D.3.9.2Current sponsor codeSU011248
    D.3.9.4EV Substance CodeSUB22321
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number12 to 25
    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
    Advanced renal cell carcinoma (aRCC)
    Carcinoma renale in stadio avanzato (aRCC)
    E.1.1.1Medical condition in easily understood language
    Advanced kidney cancer
    Cancro renale avanzato
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10023405
    E.1.2Term Kidney cancer stage IV
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10023404
    E.1.2Term Kidney cancer stage III
    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
    The study is a Phase 3 to evaluate the efficacy and safety of avelumab,
    an anti-PD-L1 monoclonal antibody (mAb), in combination with axitinib
    (Inlyta¿) with the primary objective to demonstrate that the
    combination of avelumab with axitinib (Inlyta¿) is superior to sunitinib
    (Sutent¿) monotherapy in prolonging progression-free survival (PFS)
    based on Blinded Independent Central Review (BICR) assessment per
    RECIST v.1.1 in the first-line treatment of patients with advanced renal
    cell cancer (aRCC).
    Si tratta di uno studio di fase 3 per valutare l'efficacia e la sicurezza di avelumab, un anticorpo monoclonale (mAB) anti-PD-L1, in combinazione con axitinib (Inlyta¿) con l'obiettivo primario di dimostrare che la combinazione di avelumab con axitinib (Inlyta¿) ¿ superiore a sunitinib (Sutent¿) in monoterapia nel prolungare la sopravvivenza libera da progressione (PFS) in base alla valutazione di un Comitato di revisione centrale indipendente in cieco (BICR) secondo RECIST v.1.1 nel trattamento di prima linea dei pazienti con cancro cellulare renale in stadio avanzato (aRCC).
    E.2.2Secondary objectives of the trial
    ¿Overall Survival (OS).
    ¿Objective Response (OR), Disease Control (DC), Time to Tumor Response (TTR) and Duration of Response (DR) based on BICR assessment and based on Investigator assessment, per RECIST v.1.1.
    ¿Progression Free Survival (PFS) based on Investigator assessment per RECIST v.1.1.
    ¿Progression-Free Survival on next-line therapy (PFS2). Adverse events (AEs) and laboratory abnormalities as graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03 (Appendix 6); vital signs (blood pressure, pulse rate).
    ¿Time to treatment discontinuation/failure due to toxicity.
    ¿Treatment discontinuation due to toxicity.
    ¿PK parameters including trough concentrations (Ctrough) of avelumab and trough concentrations (Ctrough) and maximum concentrations (Cmax) of axitinib
    v. Protocollo per informazione completa
    ¿Confrontare avelumab in combinazione con axitinib a sunitinib in monoterapia nel trattamento di prima linea di pazienti affetti da RCCa, in relazione alla sopravvivenza globale.
    ¿Valutare altre misure di efficacia di avelumab in combinazione con axitinib e sunitinib in monoterapia nel trattamento di prima linea di pazienti affetti da RCCa.
    ¿Valutare la sopravvivenza libera da progressione nella successiva linea di terapia (PFS2), valutare il profilo di sicurezza complessivo di avelumab in combinazione con axitinib e di sunitinib in monoterapia nel trattamento di prima linea di pazienti affetti da RCCa.
    ¿Valutare il tempo all¿interruzione/fallimento del trattamento a causa di tossicit¿.
    ¿Valutare la percentuale di pazienti che ha interrotto il trattamento a causa della tossicit¿.
    ¿Valutare la farmacocinetica di avelumab e axitinib quando somministrati contemporaneamente.
    v. Protocollo per informazione completa
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    • Histologically or cytologically confirmed advanced or metastatic renal cell carcinoma with a clear cell component. Advanced RCC patients are patients affected by unresectable disease either unresectable locally advanced or metastatic disease;
    • A formalin fixed, paraffin embedded (FFPE) tumor tissue block from a de novo tumor biopsy obtained during screening will be required (biopsied tumor lesion should not be a RECIST target lesion). Alternatively, a recently obtained archival FFPE tumor tissue block (not cut slides from a primary or metastatic tumor resection or biopsy can be provided if the following criteria are met: 1) the biopsy or resection was performed within 1 year of randomization AND 2) the patient has not received any intervening systemic anti cancer treatment from the time the tissue was obtained and randomization onto the current study. If an FFPE tissue block cannot be provided as per documented regulations then 15 unstained slides (10 minimum) will be acceptable
    • Availability of an archival FFPE tumor tissue block from primary diagnosis specimen (if available and not provided per above). If an FFPE tissue block cannot be provided as per documented regulations,then 15 unstained slides (10 minimum) will be acceptable;
    • At least one measureable lesion as defined by RECIST version 1.1 that has not been previously irradiated.
    2. Evidence of a personally signed and dated informed consent document indicating that the patient (or a legally acceptable representative, as allowed by local guideline/practice) has been informed of all pertinent aspects of the study.
    3. Patients who are willing and able to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.
    4. Age ¿18 years (¿20 years in Japan).
    5. Estimated life expectancy of at least 3 months.
    6. ECOG PS 0 or 1.
    7. No evidence of uncontrolled hypertension as documented by 2 baseline blood pressure (BP) readings taken at least 1 hour apart. The baseline systolic BP readings must be ¿140 mm Hg, and the baseline diastolic BP readings must be ¿90 mm Hg. Use of antihypertensive medications to control BP is allowed.
    8. Adequate bone marrow function, including:
    • Absolute Neutrophil Count (ANC) ¿1,500/mm3 or ¿1.5 x 10/L;
    • Platelets ¿100,000/mm3 or ¿100 x 10/L;
    • Hemoglobin ¿9 g/dL (may have been transfused).
    9. Adequate renal function, including:
    • Estimated creatinine clearance =30 mL/min as calculated using the Cockcroft Gault (CG) equation.
    • Urinary protein <2+ by urine dipstick. If dipstick is ¿2+, then 24 hour urinary protein <2 g per 24 hours.
    10. Adequate liver function, including:
    • Total serum bilirubin ¿1.5 x ULN;
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ¿2.5 x ULN.
    11. Left ventricular ejection fraction (LVEF) = lower limit of normal (LLN) as assessed by either multigated acquisition (MUGA) scan or echocardiogram (ECHO).
    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
    • Carcinoma renale a cellule chiare avanzato o metastatico, istologicamente o citologicamente confermato. I pazienti affetti da RCC avanzato sono quelli affetti da malattia non resecabile sia localmente avanzata non operabile sia metastatica;
    • Verrà richiesto tessuto tumorale fissato in formalina e incluso in un blocco di paraffina (FFPE) ottenuto mediante una biopsia tumorale de novo eseguita durante lo screening (la lesione tumorale sottoposta a biopsia non deve essere una lesione target secondo i criteri RECIST). In alternativa, può essere fornito un blocco di tessuto tumorale FFPE archiviato di recente (vetrini con sezioni tagliate non sono ammessi) ottenuto da una resezione o biopsia di tumore primario o metastatico, se vengono soddisfatti i seguenti criteri: 1) La biopsia o la resezione sono state eseguite entro 1 anno dalla randomizzazione E 2) il paziente non ha ricevuto alcun trattamento antitumorale sistemico nel periodo compreso fra il momento in cui il tessuto è stato ottenuto e la randomizzazione nel presente studio.
    • Qualora non sia possibile fornire un blocco di tessuto tumorale FFPE ai sensi di normative documentate, verranno accettati 15 vetrini di tessuto non colorato (minimo 10);
    • Disponibilità di tessuto tumorale archiviato FFPE ottenuto dal tumore primario (se disponibile e non fornito in accordo al precedente paragrafo). Qualora non sia possibile fornire un blocco di tessuto tumorale FFPE ai sensi di normative documentate, verranno accettati 15 vetrini di tessuto non colorato (minimo 10);
    • Almeno una lesione misurabile definita secondo la versione 1.1 dei criteri RECIST, che non sia stata precedentemente irradiata.
    2. Evidenza di consenso informato personalmente firmato e datato indicante che il paziente (o un rappresentante legale accettabile, come consentito dalle linee guida locali/dalla prassi locali) sia stato informato su tutti gli aspetti rilevanti dello studio.
    3. Pazienti disponibili e capaci di rispettare il programma delle visite, i piani di trattamento, le analisi di laboratorio e le altre procedure dello studio.
    4. Età ¿ 18 anni (¿ 20 anni in Giappone).
    5. Aspettativa di vita stimata di almeno 3 mesi.
    6. PS ECOG pari a 0 o 1.
    7. Nessuna evidenza di ipertensione non controllata come documentato da 2 misurazioni della pressione arteriosa al basale (PA) effettuate almeno a 1 ora di distanza l’una dall’altra. Le misurazioni della pressione arteriosa (PA) sistolica al basale devono essere ¿ 140 mmHg, e le misurazioni della pressione arteriosa (PA) diastolica al basale devono essere ¿ 90 mm Hg. L’uso di farmaci antipertensivi per controllare la PA è consentito.
    8. Adeguata funzionalità del midollo osseo:
    • Conta assoluta dei neutrofili (ANC) ¿ 1.500/mm3 o ¿ 1,5 x 10/l;
    • Piastrine ¿ 100.000/mm3 o ¿ 100 x 10/l;
    • Emoglobina ¿ 9 g/dl (può essere dovuta a trasfusione)
    9. Adeguata funzionalità renale:
    • Clearance stimata della creatinina = 30 ml/min calcolata utilizzando l’equazione di Cockcroft Gault (CG).
    • Proteine nelle urine < 2+ mediante dipstick urinario. Se il dipstick urinario risulta ¿ 2+, occorre verificare che le proteine nelle urine delle 24 ore siano < 2 g nell’arco di 24 ore.
    10. Adeguata funzionalità epatica:
    • Bilirubina sierica totale ¿ 1,5 x LSN;
    • Aspartato aminotransferasi (AST) e alanina aminotransferasi (ALT) ¿ 2,5 x LSN.
    11. Frazione di eiezione ventricolare sinistra (LVEF) = al limite inferiore della norma, come indicato da una scansione con acquisizione a gate multipli (MUGA) o da un ecocardiogramma (ECHO).
    12. Test di gravidanza sul sangue (per donne in età fertile) con risultato negativo al momento dello screening.
    13. I pazienti di sesso maschile in grado di concepire e pazienti di sesso femminile in età fertile e a rischio di gravidanza devono acconsentire ad utilizzare 2 metodi contraccettivi di elevata efficacia durante l’intera durata dello studio e per almeno 90 giorni dopo l’ultima dose del trattamento assegnato.
    E.4Principal exclusion criteria
    • Prior systemic therapy directed at advanced or metastatic RCC.
    • Prior adjuvant or neoadjuvant therapy for RCC if disease progression or relapse has occurred during or within 12 months after the last dose of treatment.
    • Prior immunotherapy with IL 2, IFN a, or anti PD 1, anti PD L1, anti PD L2, anti CD137, or anti cytotoxic T lymphocyte associated antigen 4 (CTLA 4) antibody (including ipilimumab), or any other antibody or drug specifically targeting T cell co stimulation or immune checkpoint pathways.
    • Prior therapy with axitinib and/or sunitinib as well as any prior therapies with other VEGF pathway inhibitors.
    2. Participation in other therapeutic studies within 4 weeks prior to randomization.
    3. Patients with known symptomatic brain metastases requiring steroids. 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 randomization, have discontinued corticosteroid treatment for these metastases for at least 4 weeks and are neurologically stable.
    4. Major surgery ¿4 weeks or major radiation therapy ¿2 weeks prior to randomization. Prior palliative radiotherapy to metastatic lesion(s) is permitted, provided it has been completed at least 48 hours prior to patient randomization.
    5. Persisting toxicity related to prior therapy NCI CTCAE v4.0 Grade >1; however, sensory neuropathy Grade =2 is acceptable.
    6. 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 =10 mg/day of prednisone or equivalent;
    • Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication).
    7. Known severe hypersensitivity reactions to monoclonal antibodies (Grade ¿3), any history of anaphylaxis..
    8. Known prior or suspected hypersensitivity to study drugs or any component in their formulations.
    9. Diagnosis of any other malignancy within 5 years prior to randomization, 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 with no plans for treatment intervention (eg, surgery, radiation, or castration).
    10. 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.
    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.
    • Precedente terapia sistemica destinata a curare l’RCC avanzato o metastatico.
    • Precedente terapia adiuvante o neoadiuvante per RCC se si è verificata progressione di malattia o recidiva durante o entro i 12 mesi successivi all’ultima dose del trattamento.
    • Precedente immunoterapia con IL 2, IFN-a o anti PD 1, anti PD L1, anti PD L2, anti CD137 o anticorpo anti-antigene 4 associato ai linfociti T citotossici (CTLA 4) (tra cui ipilimumab) oppure con qualsiasi altro anticorpo o farmaco rivolto specificatamente alla costimolazione dei linfociti T o alle vie del checkpoint immunitario.
    • Precedente terapia con Axitinib e/o Sunitinib, nonché eventuali terapie precedenti con altri inibitori della via VEGF.
    2. Partecipazione ad altri studi terapeutici nelle 4 settimane precedenti la randomizzazione.
    3. Pazienti che presentano metastasi cerebrali sintomatiche note che richiedono l’utilizzo di steroidi. I pazienti che presentano metastasi cerebrali precedentemente diagnosticate sono idonei se hanno completato il loro trattamento e si sono ripresi dagli effetti acuti della radioterapia o dell’intervento chirurgico prima della randomizzazione, hanno interrotto il trattamento con i corticosteroidi per queste metastasi da almeno 4 settimane e sono neurologicamente stabili.
    4. Interventi chirurgici maggiori o trattamenti radioterapici maggiori, rispettivamente ¿ 4 settimane e ¿ 2 settimane prima della randomizzazione. La precedente radioterapia palliativa di lesioni metastatiche è consentita, a condizione che sia stata completata almeno 48 ore prima della randomizzazione dei pazienti.
    5. Tossicità persistente legata a precedente terapia, con grado > 1 sulla scala CTCAE dell’NCI v4.0; tuttavia una neuropatia sensoriale di grado =2 è considerata accettabile.
    6. Uso corrente o precedente di farmaci immunosoppressivi nei 7 giorni precedenti alla randomizzazione, ad eccezione dei seguenti:
    • Farmaci steroidei per via intranasale, inalatoria o topica, o per iniezioni locali (ad es. per iniezione intra articolare);
    • Corticosteroidi sistemici a dosi fisiologiche = 10 mg/giorno di prednisone o equivalente;
    • Farmaci steroidei utilizzati per prevenire reazioni di ipersensibilità (ad es. premedicazione in caso di TAC).
    7. Gravi reazioni di ipersensibilità note agli anticorpi monoclonali (Grado ¿ 3), qualsiasi anamnesi di anafilassi.
    8. Precedente nota o sospetta ipersensibilità ai farmaci in studio o a qualsiasi componente presente nelle loro formulazioni.
    9. Diagnosi di qualunque altro tumore maligno nei 5 anni precedenti alla randomizzazione, ad eccezione del carcinoma cutaneo basocellulare o squamocellulare adeguatamente trattato, del carcinoma mammario o cervicale in situ o del tumore prostatico di basso grado (Gleason 6 o inferiore) in osservazione, per il quale non sono previsti interventi (ad es. chirurgia, radioterapia o castrazione).
    10. Malattia autoimmunitaria attiva che potrebbe peggiorare in seguito alla somministrazione di agenti immunostimolanti. Pazienti affetti da diabete di I tipo, vitiligine, psoriasi, ipertiroidismo o ipotiroidismo che non richiedono trattamenti immunosoppressivi sono considerati idonei.
    11. Anomalie gastrointestinali che includono:
    • Impossibilità di assumere farmaci per via orale;
    • Necessità di alimentazione per via endovenosa;
    • Procedure chirurgiche precedenti che abbiano compromesso l’assorbimento, inclusa la gastrectomiatotale;
    • Trattamenti per ulcera peptica attiva nei 6 mesi precedenti;
    • Emorragia gastrointestinale attiva, non correlata al tumore, come evidenziato da ematemesi, ematochezia o melena clinicamente significative nei 3 mesi precedenti senza alcuna evidenza di risoluzione documentata mediante endoscopia o colonscopia;
    • Sindromi da malassorbimento.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint is the Progression-Free Survival (PFS),
    defined as the time from randomization to the first occurrence of
    disease progression, based on Blinded Independent Central Review
    (BICR) assessment per RECIST v.1.1., or death due to any cause,
    whichever occurs first.
    L'endpoint primario di efficacia è la sopravvivenza libera da progressione (PFS), definita come il tempo dalla randomizzazione alla prima occorrenza di progressione della malattia, sulla base della valutazione di un Comitato di revisione centrale indipendente in cieco (BICR) secondo RECIST v.1.1., o alla morte per qualsiasi causa, a seconda di quale evento si verifica per primo.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Disease progression will be assessed through radiological tumor
    assessment conducted at screening, at 6 weeks from randomization, then every 6 weeks up to 18 months after randomization, and every 12
    weeks thereafter until documented confirmed disease progression.
    La progressione della malattia sarà verificata attraverso valutazione radiologica del tumore effettuata allo screening, a 6 settimane dalla randomizzazione, quindi ogni 6 settimane fino a 18 mesi dopo la randomizzazione, e successivamente ogni 12 settimane fino a progressione della malattia documentata e confermata.
    E.5.2Secondary end point(s)
    ¿ Overall Survival (OS).
    ¿ Objective Response (OR), Disease Control (DC), Time to Tumor Response (TTR) and Duration of Response (DR) based on BICR assessment and based on Investigator assessment, per RECIST v.1.1.
    ¿ Progression Free Survival (PFS) based on Investigator assessment per RECIST v.1.1.
    ¿ Progression-Free Survival on next-line therapy (PFS2).
    ¿ Adverse events (AEs) and laboratory abnormalities as graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03 (Appendix 6); vital signs (blood pressure, pulse rate).
    ¿ Time to treatment discontinuation/failure due to toxicity.
    ¿ Treatment discontinuation due to toxicity.
    ¿ PK parameters including trough concentrations (Ctrough) of avelumab
    ¿ trough concentrations (Ctrough) and maximum concentrations (Cmax) of axitinib
    ¿ Tumor tissue biomarker status (ie, positive or negative; based on, for example, PD L1 expression and/or quantitation of tumor infiltrating CD8+ T lymphocytes as assessed by immunohistochemistry [IHC]).
    ¿ Measures of clinical outcome (PFS, OS, OR, DC, TTR, and DR) in biomarker positive and biomarker negative subgroups.
    ¿ Anti drug antibodies (ADAs; nAbs) of avelumab when in combination with axitinib.
    ¿ Patient Reported Outcomes (PRO): FACT Kidney Symptom Index (FKSI 19), EuroQol 5-Dimension (EQ 5D).
    ¿ Sopravvivenza globale (OS).
    ¿ Risposta obiettiva (OR), Controllo della malattia (DC), Tempo alla risposta tumorale (TTR) e Durata della risposta (DR) sulla base della valutazione BICR e dello sperimentatore, secondo i RECIST v.1.1.
    ¿ Sopravvivenza libera da progressione (PFS) sulla base della valutazione da parte dello sperimentatore secondo i RECIST v.1.1.
    ¿ Sopravvivenza libera da progressione nella successiva linea di terapia (PFS2).
    ¿ Eventi avversi (EA) e valori anormali di laboratorio secondo i Criteri terminologici comuni per gli eventi avversi (CTCAE) del National Cancer Institute (NCI) v. 4.03 (Appendice 6); segni vitali (pressione sanguigna, pulsazioni).
    ¿ Tempo all¿interruzione/fallimento terapeutico a causa di tossicit¿.
    ¿ Interruzione del trattamento a causa di tossicit¿.
    ¿ Parametri PK tra cui le concentrazioni minime (Ctrough) di avelumab
    ¿ concentrazioni minime (Ctrough) e le concentrazioni massime (Cmax) di axitinib
    ¿ Lo stato dei biomarcatori del tessuto tumorale (ad esempio positivo o negativo; in base all¿espressione di PD L1 e/o la quantificazione di linfociti T CD8+ infiltranti il tumore secondo la valutazione immunoistochimica [IHC]).
    ¿ Misure dell¿esito clinico (PFS, OS, OR, DC, TTR e DR) nei sottogruppi con biomarcatori positivi o negativi.
    ¿ Anticorpi anti-farmaco (ADA; nAb) di avelumab combinato ad axitinib.
    ¿ Esiti riportati dai pazienti (PRO): Indice sintomatico renale FACT (FKSI 19), EuroQol 5 Dimension (EQ 5D).
    E.5.2.1Timepoint(s) of evaluation of this end point
    1 -4 and 6 - 7. Baseline up to approximately 24 months;
    5. Recorded at each visit through and including 90 calendar days after
    the last administration of the study drug;
    8. Pre-dose on Days 1, 15 and 29 of Cycle 1, on Day 1 and 29 of Cycles 2,
    3 and 4, and on Day 1 of Cycle 6 and then every 2 cycles thereafter, plus
    1 month after end of avelumab treatment
    9. Two hours post-dose on Day 1 then at pre-dose and 2 hours post-dose
    on Day 15 and 29 of Cycle 1
    10. Pre-dose at screening, Day 1 of Cycles 1, 2 and 3
    11. Baseline up to approximately 24 months
    12. Pre-dose on Days 1, 15 and 29 of Cycle 1, on Day 1 and 29 of Cycles
    2, 3 and 4, on Day 1 of Cycle 6 and then every 2 cycles thereafter, plus 1
    month after end of avelumab treatment
    13. On Day 1 of each Cycle
    1 -4 e 6-7. Dal basale fino a circa 24 mesi
    5. Registrato ad ogni visita attraverso e tra 90 giorni di calendario dopo l'ultima somministrazione del farmaco in studio
    8. Pre-dose nei giorni 1, 15 e 29 del ciclo 1, il giorno 1 e 29 dei cicli 2, 3 e 4, e il giorno 1 del ciclo 6 e quindi ogni 2 cicli da quel momento in poi, pi¿ 1 mese dopo la fine del trattamento
    9. Due ore dopo la dose il giorno 1 e poi prima della dose e 2 ore dopo la dose il giorno 15 e 29 del Ciclo 1
    10. Pre-dose al momento dello screening, giorno 1 dei cicli 1, 2 e 3
    11. Dal basale fino a circa 24 mesi
    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 No
    E.6.11Pharmacogenomic Yes
    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) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    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 concerned6
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA74
    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
    Israel
    Japan
    Korea, Democratic People's Republic of
    Korea, Republic of
    Mexico
    New Zealand
    Russian Federation
    United States
    Austria
    Belgium
    Denmark
    France
    Germany
    Hungary
    Italy
    Netherlands
    Romania
    Spain
    Sweden
    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
    End of trial in a Member State of the European Union (EU) is defined as
    the time at which it is deemed that a sufficient number of participants
    have been recruited and completed the study as stated in the
    regulatory application (i.e., clinical trial application (CTA)) and ethics
    committee application in the Member State.
    End of trial in all participating countries is defined as Last Subject Last
    Visit.
    La fine della sperimentazione in uno Stato membro dell'Unione europea (UE) ¿ definita come il momento in cui si ritiene che sia stato reclutato un numero sufficiente di partecipanti, i quali hanno completato lo studio come indicato nella domanda regolatoria (cio¿, domanda di sperimentazione clinica [CTA]) e nella domanda al comitato etico nello Stato membro.

    La fine della sperimentazione in tutti i Paesi partecipanti ¿ definita come l¿ultima visita dell¿ultimo soggetto.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months7
    E.8.9.1In the Member State concerned days5
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months7
    E.8.9.2In all countries concerned by the trial days5
    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: 408
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 175
    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 state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 259
    F.4.2.2In the whole clinical trial 583
    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)
    At completion of subject's study participation, it is under the
    Investigator's responsibility to prescribe the most appropriate
    treatment and provide adequate follow up for the subject. At the end of
    the study, patients who are still deriving clinical benefit from study
    treatment will be provided with an option for continued study
    treatment (e.g., rollover study).
    Al termine della partecipazione del soggetto allo studio, ¿ responsabilit¿ dello sperimentatore prescrivere il trattamento pi¿ appropriato e fornire un adeguato follow-up per il soggetto. Alla fine dello studio, i pazienti che stanno ancora ricevendo un beneficio clinico dal trattamento in studio riceveranno un'opzione per il trattamento in studio continuato (ad esempio, studio di rollover).
    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 Decision2016-10-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-11-16
    P. End of Trial
    P.End of Trial StatusOngoing
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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
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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