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    Summary
    EudraCT Number:2015-003594-14
    Sponsor's Protocol Code Number:KCP-330-020
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2018-04-20
    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 number2015-003594-14
    A.3Full title of the trial
    A Phase 2-3 Multicenter, Randomized, Double-blind Study of Selinexor (KPT-330) versus Placebo in Patients with Advanced Unresectable Dedifferentiated Liposarcoma (DDLS)
    Estudio de fase II-III, multicéntrico, aleatorizado, con doble enmascaramiento de selinexor (KPT-330) comparado con placebo en pacientes con liposarcoma desdiferenciado irresecable avanzado (LSDD)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2-3 Multicenter, Randomized, Double-blind Study of Selinexor (KPT-330) versus Placebo in Patients with Advanced Unresectable Dedifferentiated Liposarcoma (DDLS)
    Estudio de fase II-III, multicéntrico, aleatorizado, con doble enmascaramiento de selinexor (KPT-330) comparado con placebo en pacientes con liposarcoma desdiferenciado irresecable avanzado (LSDD)
    A.3.2Name or abbreviated title of the trial where available
    SEAL: Selinexor in Advanced Liposarcoma
    A.4.1Sponsor's protocol code numberKCP-330-020
    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 SponsorKaryopharm Therapeutics, 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 supportKaryopharm Therapeutics, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationKaryopharm Therapeutics, Inc.
    B.5.2Functional name of contact pointClinical Trial Information Desk
    B.5.3 Address:
    B.5.3.1Street Address85 Wells Ave
    B.5.3.2Town/ cityNewton
    B.5.3.3Post codeMA 02459
    B.5.3.4CountryUnited States
    B.5.6E-mailclinicaltrials@karyopharm.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 nameSelinexor 20mg coated tablets
    D.3.2Product code KPT-330
    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 INNSelinexor
    D.3.9.1CAS number 1393477-72-9
    D.3.9.2Current sponsor codeKPT-330
    D.3.9.3Other descriptive nameSELINEXOR
    D.3.9.4EV Substance CodeSUB177942
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Dedifferentiated Liposarcoma (DDLS)
    Liposarcoma desdiferenciado (LSDD)
    E.1.1.1Medical condition in easily understood language
    Dedifferentiated Liposarcoma (DDLS)
    Liposarcoma desdiferenciado (LSDD)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10073135
    E.1.2Term Dedifferentiated liposarcoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase 2 (now complete):
    Assess and compare PFS of patients with advanced unresectable DDLS treated with selinexor (60 mg) or placebo twice weekly. Progression will be defined by disease progression according to RECIST v. 1.1 (Eisenhauer 2009), or by death due to any cause

    Phase 3:
    Assess and compare PFS of patients with advanced unresectable DDLS treated with selinexor (60 mg) or placebo twice weekly. PFS is defined as time from date of randomization until the first date of progression per RECIST v. 1.1, or death due to any cause. Evaluation of the radiographic data for the PFS primary endpoint will be based on data from a scan review by the independent central reader.
    Fase II (ahora completa)
    Evaluar y comparar la SSP de pacientes con LSDD irresecable avanzado tratados con selinexor (60 miligramos [mg]) o placebo dos veces a la semana. La SSP se definirá en función de la progresión de la enfermedad de acuerdo con los criterios RECIST v. 1.1 (Eisenhauer 2009) o de la muerte por cualquier causa.

    Fase III
    Evaluar y comparar la SSP de pacientes con LSDD irresecable avanzado tratados con selinexor (60 mg) o placebo dos veces a la semana. La SSP se define como el tiempo transcurrido desde la fecha de la aleatorización hasta la fecha de la primera progresión según los criterios RECIST v. 1.1 o hasta la muerte por cualquier causa. La evaluación de los datos radiográficos para el criterio principal de valoración de la SSP se basará en los datos de una revisión de los resultados de las pruebas de imagen por parte del evaluador central independiente.
    E.2.2Secondary objectives of the trial
    Phase 2 (now complete, refer to protocol for Phase 2 secondary objectives).

    Phase 3:
    • Assess Overall Survival (OS), measured from date of randomization until death due to any cause.
    • Compare TTP on study treatment, per RECIST v. 1.1, with TTP on the patient’s last prior systemic therapy.
    • Assess Quality of Life (QoL) and patient-reported outcomes as measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of-Life Questionnaire (QLQ-C30) and the EuroQoL Group Health Questionnaire (EQ-5D-5L).
    • Determine the ORR, supported by DOR. Responses will be defined by RECIST v. 1.1.
    • Assess PFS according to the Investigator based on clinical and/or radiologic criteria.
    • Assess safety of each treatment arm
    Fase 2 (ahora completa, consultar el protocolo para los objetivos secundarios de la Fase 2).

    Fase III
    • Evaluar la supervivencia global (SG), medida desde la fecha de aleatorización hasta la muerte por cualquier causa.
    • Comparar el THP con el tratamiento del estudio según los criterios RECIST v. 1.1 con el THP con la última terapia sistémica anterior del paciente.
    • Evaluar la calidad de vida (CdV) y los resultados referidos por el paciente medidos con el cuestionario de calidad de vida (QLQ-C30) de la European Organization for Research and Treatment of Cancer (EORTC) y el cuestionario de salud de EuroQoL Group (EQ-5D-5L).
    • Determinar la TRG, respaldada por la DdR. Las respuestas se definirán según los criterios RECIST v. 1.1.
    • Evaluar la SSP según el investigador con arreglo a los criterios clínicos y/o radiológicos.
    • Evaluar la seguridad de cada grupo de tratamiento.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Patients eligible for inclusion in this study must meet all of the following criteria:
    1. Written informed consent in accordance with national, local, and institutional guidelines obtained prior to any screening procedures
    2. Must be willing and able to comply with the protocol
    3. Patients ≥ 12 years of age
    4. Patients with a BSA ≥ 1.2 m2 as calculated per Dubois 1916 or Mosteller 1987
    5. Histologic evidence of DDLS at any time prior to randomization AND current evidence of DDLS requiring treatment:
    • This information will be provided based on prior diagnostic testing and is required for randomization.
    • Tissue (fresh or archival) will be provided for confirmatory histology at a central laboratory but confirmatory results are not required prior to randomization.
    • If archival tissue > 12 months old, the quality of the sample for confirmatory histology must be confirmed by the site histopathologist prior to randomization.
    6. Must have measurable disease according to:
    • The bidimensional WHO Response Criteria (Miller 1981) (Phase 2 patients only)
    • RECIST v. 1.1 (Eisenhauer 2009)(Phase 3 patients only)
    7. Radiologic evidence of progressive disease (PD) within 6 months prior to randomization. If the patient received other intervening therapy after PD is documented, further PD must be documented after the completion of the intervening therapy.
    8. Must have received at least 2 but no more than 5 prior systemic therapies for the treatment of liposarcoma.
    9. Patients should have recovered from all major surgery, radiation or other interventions ≥ 21 days prior to randomization. Patients must have recovered from any clinically significant therapy-related toxicity to ≤ Grade 1 per CTCAE v. 4.03. Minor procedures, such as biopsies, dental work, or placement of a port or intravenous line for infusion, are permitted.
    10. If patients received any previous systemic therapy, the last dose must have been ≥ 21 days prior to randomization (or ≥ 5 half-lives of that drug [whichever is shorter]), with all clinically significant therapy-related toxicities having resolved to ≤ Grade 1 CTCAE v. 4.03.
    11. ECOG performance status ≤ 1 (Oken 1982)
    12. Adequate laboratory functional values:
    • Adequate hematopoietic function:
    o Absolute neutrophil count (ANC) ≥ 1500/mm3
    o Platelets ≥ 100,000/mm3
    o Hemoglobin (Hb) ≥ 9 g/dL at baseline
    o Transfusions, hematopoietic growth factors, and hematinics are NOT permitted during screening
    • Adequate hepatic function:
    o Bilirubin ≤ 1.5 x upper limit of normal (ULN) (except patients with Gilbert’s syndrome [hereditary indirect hyperbilirubinemia] who must have a total bilirubin of ≤ 3 x ULN)
    o Alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) < 3.0 x ULN (except patients with liver involvement of their liposarcoma who must have an AST and ALT ≤ 5 x ULN).
    • Adequate renal function: estimated creatinine clearance of ≥ 50 mL/min, calculated using the Cockcroft and Gault formula (140 – Age) • Mass (kg)/ (72 • creatinine mg/dL); multiply by 0.85 if female (Cockcroft 1976).
    13. Female patients of childbearing potential must agree to use two methods of contraception (including one highly effective and one effective method of contraception [as defined in Section 12.2.5.3]) and have a negative serum pregnancy test at Screening. Male patients must use an effective barrier method of contraception if sexually active with a female of childbearing potential. For both male and female patients, effective methods of contraception must be used throughout the study and for 3 months following the last dose of study treatment.
    Los pacientes elegibles para la inclusión en este estudio deben cumplir con todos los siguientes criterios:
    1. Consentimiento informado por escrito de acuerdo con las pautas nacionales, locales e institucionales obtenidas antes de cualquier procedimiento de detección
    2. Debe estar dispuesto y ser capaz de cumplir con el protocolo
    3. Pacientes ≥ 12 años de edad
    4. Pacientes con un BSA ≥ 1.2 m2 según lo calculado por Dubois 1916 o Mosteller 1987
    5. Evidencia histológica de DDLS en cualquier momento antes de la aleatorización Y evidencia actual de DDLS que requiere tratamiento:
    • Esta información se proporcionará en base a pruebas diagnósticas previas y se requiere para la randomización.
    • Se proporcionarán tejidos (frescos o de archivo) para la histología confirmatoria en un laboratorio central, pero no se requieren resultados confirmatorios antes de la randomización.
    • Si el tejido de archivo> 12 meses, la calidad de la muestra para la histología confirmatoria debe ser confirmada por el histopatólogo del sitio antes de la randomización.
    6. Debe tener una enfermedad mensurable de acuerdo con:
    • Los criterios de respuesta bidimensionales de la OMS (Miller 1981) (pacientes de fase 2 solamente)
    • RECIST v. 1.1 (Eisenhauer 2009) (pacientes de fase 3 solamente)
    7. Evidencia radiológica de enfermedad progresiva (EP) dentro de los 6 meses previos a la randomización. Si el paciente recibió otra terapia intermedia después de que se documenta la EP, se debe documentar más PD después de la finalización de la terapia intermedia.
    8. Debe haber recibido al menos 2 pero no más de 5 terapias sistémicas previas para el tratamiento del liposarcoma.
    9. Los pacientes deberían haberse recuperado de toda cirugía mayor, radiación u otras intervenciones ≥ 21 días antes de la randomización. Los pacientes deben haberse recuperado de cualquier toxicidad clínicamente significativa relacionada con la terapia ≤ Grado 1 por CTCAE v. 4.03. Se permiten procedimientos menores, como biopsias, trabajos dentales o la colocación de un puerto o línea intravenosa para perfusión.
    10. Si los pacientes recibieron alguna terapia sistémica previa, la última dosis debe haber sido ≥ 21 días antes de la randomización (o ≥ 5 semividas de ese medicamento [la que sea más corta]), con todas las toxicidades clínicamente significativas relacionadas con la terapia que hayan resuelto ≤ Grado 1 CTCAE v. 4.03.
    11. Estado de funcionamiento del ECOG ≤ 1 (Oken 1982)
    12. Valores funcionales adecuados de laboratorio:
    • Función hematopoyética adecuada:
    o recuento absoluto de neutrófilos (ANC) ≥ 1500 / mm3
    o Plaquetas ≥ 100,000 / mm3
    o Hemoglobina (Hb) ≥ 9 g / dL al inicio del estudio
    o Transfusiones, factores de crecimiento hematopoyéticos y hematínicos NO están permitidos durante la detección
    • Función hepática adecuada:
    o Bilirrubina ≤ 1,5 x límite superior de la normalidad (LSN) (excepto los pacientes con síndrome de Gilbert [hiperbilirrubinemia indirecta hereditaria] que deben tener una bilirrubina total de ≤ 3 x LSN)
    o Fosfatasa alcalina (ALP), aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) <3.0 x LSN (excepto pacientes con compromiso hepático de su liposarcoma que debe tener un AST y ALT ≤ 5 x LSN).
    • Función renal adecuada: depuración de creatinina estimada de ≥ 50 ml / min, calculada con la fórmula de Cockcroft y Gault (140 - Edad) • Masa (kg) / (72 • creatinina mg / dL); multiplicar por 0,85 si es mujer (Cockcroft 1976).
    13. Las pacientes femeninas en edad fértil deben aceptar el uso de dos métodos anticonceptivos (incluido un método anticonceptivo altamente eficaz y uno efectivo [como se define en la Sección 12.2.5.3]) y tener una prueba negativa de embarazo en el suero durante el screening. Los pacientes varones deben usar un método anticonceptivo de barrera eficaz si son sexualmente activos con una mujer en edad fértil. Tanto para pacientes masculinos como femeninos, se deben usar métodos anticonceptivos efectivos durante todo el estudio y durante 3 meses después de la última dosis del tratamiento del estudio.
    E.4Principal exclusion criteria
    Patients meeting any of the following exclusion criteria are not eligible to enroll in this study:
    1. Patients with liposarcoma of pure WDLS, myxoid/round cell or pleomorphic tumor histologic subtypes.
    2. Significant cardiovascular impairment, defined as:
    a. Cardiac failure, New York Heart Association (NYHA) Class ≥ 3 according to the NYHA Functional Classification
    b. Unstable angina or myocardial infarction within 3 months of enrollment
    c. Serious and potentially life-threatening arrhythmia.
    3. Patients with known central nervous system metastases.
    4. Female patients who are pregnant or nursing.
    5. Prior malignancy that required treatment, or has shown evidence of recurrence (except for non melanoma skin cancer or adequately treated cervical carcinoma in situ) during the 5 years prior to randomization. Cancer treated with curative intent > 5 years prior to randomization and without evidence of recurrence is allowed.
    6. Known active Hepatitis B (HepB), Hepatitis C (HepC) or human immunodeficiency virus (HIV) infection. Note: (HepB, HepC, or HIV testing is not required as part of this study).
    7. Any medical condition, such as an uncontrolled infection or uncontrolled diabetes mellitus (Type 2), which in the opinion of the Investigator would make study involvement unreasonably hazardous
    8. Psychiatric illness that would prevent the patient from giving informed consent or being compliant with the study procedures
    9. Patients unable to swallow tablets, patients with malabsorption syndrome, or any other GI disease or GI dysfunction that could interfere with absorption of study treatment
    10. Inability or unwillingness to take supportive medications such as anti-nausea and anti-anorexia agents as recommended by the NCCN CPGO for antiemesis and anorexia/cachexia (palliative care).
    11. Patients who had involuntary weight loss of ≥ 10% in the 3 months prior to randomization.
    12. Participation in an investigational anticancer study ≤ 21 days prior to randomization.
    Los pacientes que cumplen cualquiera de los siguientes criterios de exclusión no son elegibles para participar en este estudio:
    1. Pacientes con liposarcoma de subtipos histológicos de WDLS puro, mixoide / célula redonda o tumor pleomórfico.
    2. Insuficiencia cardiovascular significativa, definida como:
    a. Insuficiencia cardíaca, clase de la Asociación del Corazón de Nueva York (NYHA) ≥ 3 de acuerdo con la clasificación funcional de la NYHA
    b. Angina inestable o infarto de miocardio dentro de los 3 meses de la inscripción
    c. Arritmia grave y potencialmente mortal.
    3. Pacientes con metástasis conocidas del sistema nervioso central.
    4. Pacientes mujeres que están embarazadas o amamantando.
    5. Malignidad previa que requirió tratamiento o que ha mostrado evidencia de recurrencia (excepto cáncer de piel distinto del melanoma o carcinoma cervical adecuadamente tratado in situ) durante los 5 años previos a la randomización. Se permite el cáncer tratado con intención curativa> 5 años antes de la randomización y sin evidencia de recurrencia.
    6. Hepatitis B activa conocida (HepB), Hepatitis C (HepC) o infección por el virus de la inmunodeficiencia humana (VIH). Nota: (HepB, HepC o prueba de VIH no se requiere como parte de este estudio).
    7. Cualquier afección médica, como una infección no controlada o diabetes mellitus no controlada (tipo 2), que en opinión del investigador haría que la participación en el estudio fuera irrazonablemente peligrosa
    8. Enfermedad psiquiátrica que impediría al paciente dar su consentimiento informado o cumplir los procedimientos del estudio
    9. Pacientes incapaces de tragar comprimidos, pacientes con síndrome de malabsorción o cualquier otra enfermedad gastrointestinal o disfunción gastrointestinal que pueda interferir con la absorción del tratamiento del estudio
    10. Incapacidad o falta de voluntad para tomar medicamentos de apoyo, como agentes antináuseas y antianoréticos recomendados por NCCN CPGO para antieméticos y anorexia / caquexia (cuidados paliativos).
    11. Pacientes que tuvieron una pérdida de peso involuntaria de ≥ 10% en los 3 meses previos a la randomización.
    12. Participación en un estudio en investigación contra el cáncer ≤ 21 días antes de la randomización.
    E.5 End points
    E.5.1Primary end point(s)
    Phase 2:
    The primary endpoint PFS for Phase 2 is defined as time from date of randomization until the first date of PD per RECIST v. 1.1, or death due to any cause.
    A preplanned preliminary analysis of PFS after 40 PFS events was conducted with an 11 August 2017 data cut with 49 eligible patients whose treatment assignments were available. Patients were analyzed in the treatment arm to which they were randomized. The preliminary PFS analysis was conducted by both WHO and RECIST v. 1.1 Criteria and served as a guideline to inform the final design of the Phase 3 portion of the study.
    At the time of the preliminary PFS analysis, there were 48 events by WHO (22 selinexor, 26 placebo) and 28 events by RECIST v.1.1. (10 selinexor, 18 placebo). Both analyses showed trends favoring selinexor over placebo, while RECIST v. 1.1 results show a more significant effect size (hazard ration [HR] of 0.84, 95% CI [0.47, 1.49] by WHO as compared with HR of 0.60, 95% CI [0.28, 1.31] by RECIST v. 1.1). A Landmark analysis based on RECIST v. 1.1 for patients continuing on study after 45 days showed a more significant HR of 0.24 (95% CI [0.05, 1.15]) in favor of selinexor.
    Of the 57 patients in Phase 2, only 56 met the eligibility criteria for the study. The formal primary Phase 2 PFS analysis will be performed on all 56 eligible patients randomized to study treatment in Phase 2 when their treatment assignments are unblinded. Phase 2 patients will be analyzed in the treatment arm to which they are randomized.

    Phase 3:
    The primary PFS analysis will be performed on the intent-to-treat (ITT) population for Phase 3 patients and on the per-protocol (PP) population as a supportive analysis. The stratified log-rank test will be used to test the null hypothesis that the PFS distributions are the same for both treatment groups versus the alternative hypothesis that the duration of PFS for the selinexor arm is longer than the placebo arm using a 1-sided test and alpha=0.025 level of significance, adjusted using the Cui, Hung, and Wang (CHW) method (Cui 1999).
    Fase II
    El criterio principal de valoración de la fase II, la SSP, se define como el tiempo transcurrido desde la fecha de la aleatorización hasta la fecha de la primera PE según los criterios de RECIST v. 1.1 o hasta la muerte por cualquier causa.
    Se efectúo un análisis preliminar planificado de antemano de la SSP tras la observación de 40 acontecimientos de SSP con una fecha de corte de datos de 11 de agosto de 2017, disponiéndose de las asignaciones del tratamiento de 49 pacientes elegibles. Los pacientes se analizaron en el grupo de tratamiento al que fueron aleatorizados. El análisis preliminar de la SSP se realizó con los criterios de la OMS y los criterios RECIST v. 1.1, y sirvió de orientación para el diseño final de la parte de fase III del estudio.
    En el momento del análisis preliminar de la SSP, se habían producido 48 acontecimientos según los criterios de la OMS (22 selinexor, 26 placebo) y 28 según los criterios RECIST v.1.1. (10 selinexor, 18 placebo). Ambos análisis mostraron tendencias favorables a selinexor respecto a placebo, mientras que los resultados obtenidos aplicando los criterios RECIST v. 1.1 muestran una magnitud del efecto más significativa (cociente de riesgos instantáneos [HR] de 0,84, IC del 95 % [0,47, 1,49] según los criterios de la OMS en comparación con un HR de 0,60, IC del 95 % [0,28, 1,31] según los criterios RECIST v. 1.1). Un análisis de hitos basado en los criterios RECIST v. 1.1 en los pacientes que permanecieron en el estudio después de 45 días reveló un HR más significativo de 0,24 (IC del 95 % [0,05, 1,15]) a favor de selinexor.
    De los 57 pacientes de la fase II, solo 56 cumplían los criterios de elegibilidad del estudio. El análisis principal formal de la fase II se llevará a cabo con los 56 pacientes elegibles aleatorizados al tratamiento del estudio en la fase II cuando se desenmascaren sus asignaciones del tratamiento. Los pacientes de la fase II serán analizados en el grupo de tratamiento al que sean aleatorizados.

    Fase III
    El análisis principal de la SSP se realizará en la población por intención de tratar (IDT) en el caso de los pacientes de la fase III y en la población por protocolo (PP), como análisis complementario. La prueba del orden logarítmico estratificada se realizará para evaluar la hipótesis nula de que las distribuciones de la SSP son iguales para ambos grupos de tratamiento frente a la hipótesis alternativa de que la duración de la SSP en el grupo de selinexor es mayor que en el grupo de placebo, utilizando una prueba unilateral y un nivel de significación alfa de 0,025, ajustado mediante el método de Cui, Hung y Wang (CHW) (Cui 1999).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Phase 2: The primary endpoint analysis has been completed.

    Phase 3: The primary endpoint analysis will be performed approximately 12 months after enrollment of the last patient, once 209 PFS events have occurred, at which time all Phase 3 patients will be evaluable for assessment of the primary endpoint.
    Fase II: el criterio principal del análisis ha sido completado.

    Fase III: El análisis del criterio principal de valoración se efectuará unos 12 meses después de la inclusión del último paciente, una vez que se observen 209 acontecimientos de SSP. La asignación del tratamiento en todos los pacientes se desenmascarará en el momento del análisis principal de la SSP y todos los pacientes de la fase III serán evaluables en cuanto al criterio principal de valoración.
    E.5.2Secondary end point(s)
    • OS for non-inferiority, measured from date of randomization until death due to any cause, for all randomized patients. Patients who are alive at the time of the analysis will be censored for survival at the date of the last contact.
    • OS for superiority, measured from date of randomization until death due to any cause, for all randomized patients. Patients who are alive at the time of the analysis will be censored for survival at the date of the last contact.
    • TTP, defined as duration of time from date of first dose of study treatment to date of PD or death due to disease progression, per RECIST v. 1.1. Patients who remain progression free (whether they withdrew from the study or reached their maximum follow-up) will be censored at the date of their last disease assessment.
    • SG para la no inferioridad, medida desde la fecha de randomización hasta la muerte por cualquier causa, para todos los pacientes randomizados. Los pacientes que están vivos en el momento del análisis serán censurados para la supervivencia en la fecha del último contacto.
    • SG para la superioridad, medido desde la fecha de randomización hasta la muerte por cualquier causa, para todos los pacientes asignados al azar. Los pacientes que están vivos en el momento del análisis serán censurados para la supervivencia en la fecha del último contacto.
    • TTP, definido como la duración del tiempo desde la fecha de la primera dosis del tratamiento del estudio hasta la fecha de la EP o la muerte debido a la progresión de la enfermedad, según RECIST v. 1.1. Los pacientes que permanecen sin progresión (ya sea que se retiraron del estudio o alcanzaron su máximo seguimiento) serán censurados en la fecha de su última evaluación de la enfermedad.
    E.5.2.1Timepoint(s) of evaluation of this end point
    End of study
    Fin del estudio
    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 Yes
    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) Yes
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Refer to protocol regarding different phases (Phase 2 is now complete).
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA24
    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
    Belgium
    Canada
    France
    Germany
    Israel
    Italy
    Poland
    Spain
    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
    LPLV
    LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months8
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 10
    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) Yes
    F.1.1.6.1Number of subjects for this age range: 10
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 135
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 134
    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 state50
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 110
    F.4.2.2In the whole clinical trial 279
    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)
    Patients will remain on treatment until disease progression, another withdrawal criteria is met or until death. After stopping study treatment patients will be followed up for survival and their own doctor will manage any further treatment.
    Los pacientes permanecerán en tratamiento hasta que la enfermedad progrese, se cumplan otros criterios de retirada o hasta la muerte. Después de suspender el tratamiento del estudio, se realizará un seguimiento de los pacientes para supervivencia y su propio médico gestionará cualquier tratamiento posterior.
    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 Decision2018-05-18
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-05-14
    P. End of Trial
    P.End of Trial StatusCompleted
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