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    Summary
    EudraCT Number:2015-003262-86
    Sponsor's Protocol Code Number:B9991001
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2016-05-17
    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 number2015-003262-86
    A.3Full title of the trial
    A PHASE 3, MULTICENTER, MULTINATIONAL, RANDOMIZED, OPEN-LABEL,
    PARALLEL-ARM STUDY OF AVELUMAB (MSB0010718C) PLUS BEST
    SUPPORTIVE CARE VERSUS BEST SUPPORTIVE CARE ALONE AS A
    MAINTENANCE TREATMENT IN PATIENTS WITH LOCALLY ADVANCED OR
    METASTATIC UROTHELIAL CANCER WHOSE DISEASE DID NOT PROGRESS
    AFTER COMPLETION OF FIRST-LINE PLATINUM-CONTAINING
    CHEMOTHERAPY
    ESTUDIO DE FASE III, MULTICÉNTRICO, MULTINACIONAL, ALEATORIZADO, ABIERTO, CON GRUPOS PARALELOS SOBRE AVELUMAB* (MSB0010718C) MÁS LOS MEJORES CUIDADOS PALIATIVOS FRENTE A LOS MEJORES CUIDADOS PALIATIVOS SOLOS COMO TRATAMIENTO DE MANTENIMIENTO EN PACIENTES CON CÁNCER UROTELIAL LOCALMENTE AVANZADO O MESTASTÁSICO SIN PROGRESIÓN DE LA ENFERMEDAD TRAS COMPLETAR LA QUIMIOTERAPIA DE PRIMERA LÍNEA BASADA EN PLATINO.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study of Avelumab in Patients with Bladder Cancer that did Not Worsen Following Completion of First-Line Chemotherapy
    Estudio con Avelumab en pacientes con cáncer uroterial que no empeoran tras completaar la quimiterapia de primera línea.
    A.3.2Name or abbreviated title of the trial where available
    JAVELIN Bladder 100
    A.4.1Sponsor's protocol code numberB9991001
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT02603432
    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.
    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 number+1800718 1021
    B.5.5Fax number+1800739 1119
    B.5.6E-mailClinicalTrials.govCallCentre@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.3.9.3Other descriptive nameAnti-PD-L1
    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 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 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.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
    Locally advanced or metastatic urothelial cancer
    Cáncer uroterial localemente advanzado o metastático
    E.1.1.1Medical condition in easily understood language
    Locally advanced or metastatic bladder cancer
    Cáncer uroterial localemente advanzado o metastático
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 19.0
    E.1.2Level LLT
    E.1.2Classification code 10046714
    E.1.2Term Urothelial carcinoma bladder
    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 demonstrate the benefit of maintenance treatment with avelumab plus Best Standard Care (BSC) vs. BSC alone in prolonging overall survival (OS) in patients with unresectable locally advanced or metastatic urothelial cancer (UC) whose disease did not progress on or following completion of first-line platinum-containing chemotherapy in each co-primary UC patient population: 1) patients determined to have PD-L1-positive tumors (including infiltrating immune cells) by a verified GMP PD-L1 IHC test, and 2) all randomized patients.
    Estudio en fase 3 para demostrar la ventaja del tratamiento de mantenimiento con avelumab más los MCP con respecto a los Mejores Cuidados Paliativos (MCP) solo en la prolongación de la supervivencia global (SG) en pacientes con CU no resecable, localmente avanzado o metastásico cuya enfermedad no haya progresado o que hayan completado la quimioterapia con platino de primera línea en las dos poblaciones principales de pacientes con CU: 1) pacientes con tumores PD L1 positivos (incluida la infiltración por células inmunitarias) según una prueba de IHQ de PD-L1 con verificación de PCF, y 2) todos los pacientes aleatorizados.
    E.2.2Secondary objectives of the trial
    To compare the progression-free survival (PFS) of avelumab plus BSC vs. BSC alone in each of the co-primary UC patient populations treated with avelumab;
    To evaluate the anti-tumor activity of avelumab plus BSC and BSC alone according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 in each of the co-primary UC patient populations treated with avelumab;
    To evaluate the overall safety profile of avelumab plus BSC and BSC alone;
    To evaluate the PK of avelumab in each of the co-primary UC patient populations treated with avelumab;
    To assess the immunogenicity of avelumab in each of the co-primary UC patient populations treated with avelumab;
    To evaluate candidate predictive biomarkers of sensitivity or resistance to avelumab in pre-treatment tumor tissue in each of the co-primary UC patient populations treated with avelumab;
    To evaluate the effect of avelumab plus BSC and BSC alone on patient-reported outcomes (PROs) in each of the co-primary UC patient populations.
    Comparar la SSP del avelumab más MCP o con los MCP a solas en cada una de las poblaciones principales tratadas con avelumab.
    Evaluar la actividad antitumoral de avelumab más MCP y de los MCP solo según la v 1.1 de los criterios de evaluación de la respuesta en tumores sólidos (RECIST), en cada una de las poblaciones principales tratadas con avelumab.
    Evaluar el perfil de seguridad general de avelumab más MCP y de los MCP solo.
    Evaluar la farmacocinética del avelumab en cada una de las poblaciones principales tratadas con avelumab.
    Evaluar la inmunogenia del avelumab en cada una de las poblaciones principales tratadas con avelumab.
    Evaluar posibles biomarcadores predictivos de la sensibilidad o la resistencia al avelumab en tejido tumoral obtenido antes del tratamiento en cada una de las poblaciones principales tratadas con avelumab.
    Evaluar el efecto del avelumab más MCP y de MCP solo en los resultados notificados por el paciente en cada una de de las poblaciones principales.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Histological diagnosis of confirmed, unresectable locally advanced or metastatic transitional cell carcinoma of the urothelium. patients with documented Stage IV disease at the start of first-line chemotherapy and measurable disease prior to the start of first-line chemotherapy by RECIST v1.1.
    2. Prior first-line chemotherapy must have consisted of at least 4 cycles and no more than 6 cycles of gemcitabine + cisplatin and/or gemcitabine + carboplatin. No other chemotherapy regimens are allowed in this study;
    3. Patients without progressive disease as per RECIST v1.1 guidelines (ie, with an ongoing CR, PR, or SD) following completion of 4 to 6 cycles of first-line chemotherapy. Eligibility based on this criterion will be determined by an independent expedited central review of pre-chemotherapy and post-chemotherapy radiological assessments (CT/MRI scans);
    4. Provision of a recent formalin-fixed, paraffin-embedded (FFPE) tumor tissue block (slides not acceptable) from the most recent primary or metastatic tumor biopsy or resection obtained prior to treatment with first line chemotherapy but within one year of randomization, with no intervening systemic anti-cancer therapy. If a suitable tissue sample is not otherwise available, then an FFPE tissue block from a de novo biopsy (core needle or excisional) must have been obtained for research purposes prior to randomization in this study;
    5. Provision of an archival FFPE tumor tissue block from primary tumor resection specimen (if not provided per above). If an FFPE tissue block cannot be provided, 15 unstained slides (10 minimum) will be acceptable;
    6. Evidence of a 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,
    7. Patients who are willing and able to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures;
    8. Age above 18 years;
    9. Estimated life expectancy of at least 3 months;
    10. Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1;
    11. Adequate bone marrow, renal and liver function;
    12. Negative serum pregnancy test at screening (for females of childbearing potential);
    13. Male and female patients able to have children must agree to use 2 highly effective methods of contraception throughout the study and for at least 60 days after the last dose of assigned treatment.
    1 Carcinoma de células de transición del urotelio, no resecable, localmente avanzado o metastásico, confirmado por histología. pacinete con enfermadad en estadio IV documentada, al inicio de la quimioterapia de primera línea, mediante RECIST v1.1.
    2 La quimioterapia de primera línea deberá haber consistido en un mínimo de 4 y un máximo de 6 ciclos de gemcitabina + cisplatino o gemcitabina + carboplatino. En este estudio no se permitirán otras pautas de quimioterapia.
    3 Se aleatorizará a pacientes sin progresión de la enfermedad según las directrices de la v1.1 de los RECIST (es decir, que presente RC, RP o EE en ese momento) tras 4 a 6 ciclos de quimioterapia de primera línea. a. La idoneidad basada en este criterio se determinará mediante una revisión central independiente agilizada basada en las evaluaciones radiológicas de confirmación (TC y RM) efectuadas antes y después de la quimioterapia.
    4a Provisión de un bloque de tejido tumoral FFPE reciente (no se aceptan frotis) de la última biopsia o resección del tumor primario o metastásico obtenida antes del tratamiento con quimioterapia de primera línea, pero en el año previo a la aleatorización, sin que se haya administrado tratamiento sistémico contra el cáncer entre el momento de la obtención y el inicio de la quimioterapia de primera línea. Si no se dispone de una muestra de tejido adecuada, deberá haberse obtenido un bloque de tejido FFPE de una biopsia de novo (aguja gruesa) para los fines de la investigación antes de la aleatorización en este estudio.
    b.Provisión de un bloque de tejido tumoral FFPE de archivo procedente de una muestra de resección del tumor primario (si no se ha facilitado lo anterior). Si no es posible disponer de un bloque de tejido FFPE, se aceptarán 15 frotis sin teñir (mínimo 10).
    5 Demostración de la existencia de un documento de consentimiento informado firmado y fechado que indique que el paciente (o un representante legal, como permitan las directrices o la práctica locales) ha sido informado de todos los aspectos pertinentes del estudio.
    6 Pacientes que quieran y puedan acudir a las visitas programadas y cumplir los planes de tratamiento, los análisis de laboratorio y otros procedimientos del estudio.
    7 Edad mayores de 18 años
    8 Esperanza de vida prevista de 3 meses como mínimo.
    9 Estado funcional (EF) del Eastern Cooperative Oncology Group (ECOG) de 0 o 1
    10 Adecuada función medualr, renal y del hígado.
    11 Prueba de embarazo en suero (para mujeres en edad fértil) negativa en el cribado.
    12 Los varones y las mujeres en edad fértil y con posibilidad de embarazo deberán comprometerse a utilizar 2 métodos anticonceptivos de alta eficacia durante todo el estudio y hasta al menos 60 días después de la última administración del tratamiento asignado.
    E.4Principal exclusion criteria
    1. Patients whose disease progressed by RECIST v1.1 on or after first-line chemotherapy for urothelial cancer;
    2. Prior adjuvant or neoadjuvant therapy within 12 months of randomization;
    3. Prior immunotherapy with IL-2, IFN-?, or an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or CTLA-4 antibody (including ipilimumab), or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways;
    4. Major surgery within 4 weeks or major radiation therapy within 2 weeks prior to randomization. Prior palliative radiotherapy (<= 10 fractions) to metastatic lesion(s) is permitted, provided it has been completed at least 48 hours prior to patient randomization;
    5. Patients with known symptomatic central nervous system (CNS) metastases requiring steroids. Patients with previously diagnosed CNS 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;
    6. Persisting toxicity related to prior therapy NCI CTCAE v4.0 Grade >1; however, sensory neuropathy Grade <= 2 is acceptable;
    7. 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 without any plans for treatment intervention (eg, surgery, radiation, or castration);
    8. Participation in other studies involving investigational drug(s) within 4 weeks prior to randomization. Observational studies are permitted;
    9. Active autoimmune disease that might deteriorate when receiving an
    immunostimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible;
    10. Any of the following in the previous 6 months: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident, transient ischemic attack, deep vein thrombosis, or symptomatic pulmonary embolism;
    11. Active infection requiring systemic therapy;
    12. Known severe hypersensitivity reactions to monoclonal antibodies (Grade >= 3), any history of anaphylaxis, or uncontrolled asthma;
    13. Known prior or suspected hypersensitivity to study drugs or any component in their formulations;
    14. Current or prior use of immunosuppressive medication within 7 days prior to randomization;
    15. Diagnosis of prior immunodeficiency or organ transplant requiring
    immunosuppressive therapy, or known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness;
    16. Positive test for human immunodeficiency virus (HIV) infection or known acquired immunodeficiency syndrome (AIDS)
    17. Positive hepatitis B virus (HBV) or hepatitis C virus (HCV) inidcating acute or chronic infection
    18. Vaccination within 4 weeks of the first dose of study treatment and while on trial is prohibited except for administration of inactivate vaccines (for example, inactivated influenza vaccines);
    19. Patients who are investigational site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the investigator, or patients who are Pfizer employees directly involved in the conduct of the study;
    20. Pregnant female patients; breastfeeding female patients; male patients able to father children, and female patients of childbearing potential who are unwilling or unable to use 2 highly effective methods of contraception as outlined in the protocol for the duration of the study and for at least 60 days after the last dose of investigational product;
    21. Other severe acute or chronic medical conditions including colitis, inflammatory bowel disease, and pneumonitis; and pulmonary fibrosis, psychiatric condition including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormality that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
    1 Pacientes con progresión de la enfermedad según la v.1.1 de los RECIST durante el tratamiento con quimioterapia de primera línea para el cáncer urotelial o después.
    2 Tratamiento adyuvante o neoadyuvante en los 12 meses previos a la aleatorización.
    3 Inmunoterapia previa con IL-2, IFN-? o un anticuerpo anti PD 1, anti PD L1, anti PD L2, anti CD137 o CTLA 4 (como ipilimumab), o con cualquier otro anticuerpo o fármaco que actúe directamente sobre la coestimulación de los linfocitos T o sobre las vías que actúan como punto de control inmunitario.
    4 Cirugía mayor 4 semanas o radioterapia importante 2 semanas antes de la aleatorización. Se permite la radioterapia paliativa previa (10 fracciones) de las lesiones metastásicas, siempre que haya terminado al menos 48 horas antes de la aleatorización del paciente.
    5 Pacientes con metástasis sintomáticas en el sistema nervioso central (SNC) que hayan precisado esteroides. Podrán participar los pacientes con metástasis del SNC diagnosticadas previamente si han completado su tratamiento y se han recuperado de los efectos agudos de la radioterapia o de la cirugía antes de la aleatorización, han dejado recibir el tratamiento con corticosteroides para estas metástasis hace más de 4 semanas, y se encuentran estables desde el punto de vista neurológico.
    6 Toxicidad persistente del tratamiento anterior, de grado >1 según la v4.0 de los CTCAE del NCI; no obstante, se acepta la neuropatía sensitiva de grado <= 2.
    7 Diagnóstico de otro trastorno maligno en los 5 años previos a la aleatorización, excepto el carcinoma cutáneo basocelular o espinocelular, el carcinoma in situ de mama o de cuello del útero o el cáncer de próstata de bajo grado (Gleason ?6) en seguimiento, sin planes de intervención terapéutica (p. ej. cirugía, radiación o castración).
    8 Participación en otros estudios con fármacos en fase de investigación en las 4 semanas previas a la aleatorización. Se permite la participación en estudios observacionales.
    9 Enfermedades autoinmunitarias activas que puedan empeorar al recibir un inmunoestimulador. Podrán participar los pacientes con diabetes de tipo 1, vitiligo, psoriasis, hipotiroidismo o hipertiroidismo que no requieran tratamiento inmunosupresor.
    10.Cualquiera de los siguientes trastornos en los 6 meses previos; infarto de miocardio, angina intensa/inestable, injerto de derivación de arteria coronaria o periférica, insuficiencia cardiaca congestiva, accidente cerebrovascular, ataque isquémico transitorio, trombosis venosa profunda o embolia pulmonar sintomática.
    11 Infección activa que precise tratamiento sistémico.
    12 Reacciones de hipersensibilidad intensa a los anticuerpos monoclonales (grado 3), antecedentes de anafilaxia o asma no controlada
    13 Certeza o sospecha de hipersensibilidad a los fármacos del estudio.
    14 Uso de inmunosupresores en los 7 días previos a la aleatorización
    15 Diagnóstico de inmunodeficiencia, o trasplante que precisa inmunodepresión, o enfermedad relacionada con VIH o con el sida.
    16 Resultado positivo del virus de inmunodeficiencia humana (VIH) o concocida síndrome de imnodeficiencia adquirida.
    17. Resultado positivo hepatitis B (VHB) o del hepatitis C (VHC) que indique la presencia de infección aguda o crónica.
    18 Queda prohibido recibir vacunación en las 4 semanas previas a la primera administración del tratamiento del estudio y durante este, salvo la administración de vacuna inactivadas
    19 Pacientes que sean miembros del personal del centro de investigación y que intervengan directamente en la ejecución del estudio y sus familiares, miembros del personal del estudio supervisados por el investigador, o pacientes que sean empleados de Pfizer e intervengan directamente en la ejecución del estudio.
    20 Pacientes embarazadas o en periodo de lactancia y varones y mujeres en edad fértil que no estén dispuestos a utilizar 2 métodos anticonceptivos de gran eficacia como se describe en el protocolo, durante el estudio y hasta al menos 60 días después de la última administración del fármaco del estudio, o que no puedan hacerlo.
    21 Otros trastornos médicos intensos, agudos o crónicos, como colitis, enfermedad inflamatoria intestinal y neumonitis, y fibrosis pulmonar trastornos psiquiátricos como ideas o conducta suicidas activas recientes (en el pasado año), o anomalías de laboratorio que puedan aumentar el riesgo asociado a la participación en el estudio o a la administración del tratamiento del estudio, o que puedan interferir en la interpretación de los resultados del estudio y en el juicio del investigador, pueden hacer que no proceda que el paciente entre en este estudio.
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is the overall survival (OS)
    El objectivo principal es la supervivencia global (SG)
    E.5.1.1Timepoint(s) of evaluation of this end point
    Baseline up to approximately 24 months.
    Disease progression will be assessed through radiological tumor assessments conducted at baseline, at 8 weeks after randomization, then every 8 weeks for up to 1 year from randomization, and every 12 weeks thereafter until documented disease progression regardless of initiation of subsequent anti-cancer therapy.
    Desde la basal hasta aproximadamente 24 meses.
    La progresión de la enfermedad será evaluada mediantes las pruebas radiológicas del tumor, realizadas desde la basal y hasta 8 semnanas después de la aleatorización, posteriormente cada 8 semanas hasta un año desde la aleatorización, y cada 12 semanas y a partir de ahí hasta que se documente la progresión de la enfermedad a pesar de la inciación de la terapia anti cancerosa.
    E.5.2Secondary end point(s)
    1. Progression-free survival (PFS) based on BICR assessment per RECIST v1.1;
    2. Investigator-assessed Progression-Free Survival (PFS). Objective Response (OR), Time to Tumor Response (TTR), Duration of Response (DR), and Disease Control (DC), as assessed per RECIST v1.1 by BICR and investigator.
    3. Safety: Adverse events (AEs) and laboratory abnormalities as graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v.4.03; vital signs (blood pressure, pulse rate).
    4. Pharmacokinetics (PK): maximum concentrations (Cmax) and trough concentrations (Ctrough) for avelumab.
    5. Immunogenicity: Incidence of anti-drug antibodies (ADA; neutralizing antibody [Nab]) against avelumab.
    6. Biomarkers: Tumor tissue biomarkers including, but not limited to, PD-L1 expression and tumor-infiltrating CD8+ T lymphocytes.
    7. Patient-Reported Outcomes: patient-reported bladder cancer symptom, functioning, global quality of life (QOL), and Time to Deterioration (TTD) using the NCCN-FACT FB1SI; and health status using the EQ-5D-5L.
    1 Supervivencia sin progresión (SSP) basada en la revisión central independiente con ocultación (BICR) con arreglo a la v.1.1 de los RECIST.
    2 Supervivencia sin progresión (SSP) evaluada por el investigador. Respuesta objetiva (RO), tiempo hasta la respuesta tumoral (TRT), duración de la respuesta (DR) y control de la enfermedad (CE), evaluados por BICR y por el investigador con arreglo a la v.1.1 de los RECIST.
    3 Seguridad: acontecimientos adversos (AA) y anomalías de laboratorio, clasificados con arreglo a la v.4.03 de los criterios terminológicos comunes para acontecimientos adversos (CTCAE) del National Cancer Institute (NCI); constantes vitales (presión arterial, frecuencia del pulso).
    4 Farmacocinética (FC): concentraciones máxima (Cmáx) y valle (Cvalle) de avelumab.
    5 Inmunogenia: incidencia de anticuerpos antifármaco (ADA; anticuerpo neutralizante [Nab]) contra avelumab.
    6 Biomarcadores: biomarcadores en tejido tumoral de la expresión de PD-L1 y de linfocitos T CD8+ infiltrantes del tumor, entre otras cosas.
    7 Resultados notificados por el paciente: síntomas del cáncer de vejiga notificados por el pacientes, función, calidad de vida (CdV) general y tiempo hasta el deterioro (TD) con el NCCN-FACT FBlSI; y estado de salud con el EQ-5D-5L.
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Baseline up to approximately 24 months.
    2. Baseline up to approximately 24 months
    3. Recorded at each visit and every 30 days for 3 months after the end of treatment
    4. Pre-dose and at the end of infusion on Day 1 and Day 15 of Cycles 1 ? 3, and then pre-dose and at the end of infusion on Day 1 of Cycle 5, 7, 9, 11 and 13
    5. Pre-dose on Day 1 and Day 15 of Cycles 1 ? 3, and then on Day 1 of Cycle 5, 7, 9, 11 and 13
    6. Prior to Cycle 1 Day 1, and on Day 1 of Cycles 2, 3, and 5 (all pre-dose). An additional sample timepoint will include pre-dose on Cycle 1 Day 15 for Arm A patients
    7. On Day 1 of each cycle
    1 Desde la basal hasta aproximadamente 24 meses.
    2 Recopilar en cada visita y cada 30 días dutante 3 meses después de la finalizacion del tratamiento
    3 Pre-dosis y al final de la infusión en los día 1 y 15 de los ciclos 1-3 y entonces desde la -pre-dosis y hasta el final de la infusión en el día 1 de los ciclos 5, 7, 9, 11 y 13.
    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 Yes
    E.6.11Pharmacogenomic No
    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) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    Mejores Cuidados Paliativos (MCP)
    Best Supportive Care (BSC)
    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 concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA120
    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
    Argentina
    Australia
    Belgium
    Brazil
    Chile
    Czech Republic
    Denmark
    France
    Hong Kong
    Hungary
    India
    Israel
    Italy
    Japan
    Korea, Republic of
    Mexico
    Netherlands
    New Zealand
    Norway
    Portugal
    Serbia
    Slovakia
    South Africa
    Spain
    Sweden
    Taiwan
    Turkey
    United Kingdom
    United States
    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 patients have been recruited and completed the study as stated in the regulatory application (ie, clinical trial application [CTA]) and ethics application in the Member State.

    End of Trial in all other participating countries is defined as Last Patient Last Visit.
    El fin de ensayo en los estados miembros de la Unión Europea (UE) se defince como el tiempo en el cual es estimado que un número suficiente de pacientes han sido reclutados y completados el estudio como es indicado en la solicitud legislativa (por ej, solictud del ensayo clínico) y del comité ético en el estado miembro.

    El fin del ensayo en los otros paises participantes se define como la última visita del último paciente
    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 months6
    E.8.9.1In the Member State concerned days25
    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 days25
    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: 187
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 481
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Legally acceptable representative, as allowed by local guideline/practice
    Representante legal es aceptable, ya que es permitido por las regulación local
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state27
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 400
    F.4.2.2In the whole clinical trial 668
    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 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 experiencing clinical benefit, the patient may be eligible for continued treatment with avelumab.
    A la terminación de la participación del paciente, el médico del estudio tiene la responsabilidad de pre-escribir el tratamiento mejor y más apropiado asi como realizar el seguimiento más adecuado del paciente. Al fianl del estudio, los pacientes que todavia experimenta un beneficio clínico, podría ser elegidos para continuar con el tratamiento de avelumab.
    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 Decision2016-05-31
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-05-26
    P. End of Trial
    P.End of Trial StatusOngoing
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