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    Summary
    EudraCT Number:2015-004454-17
    Sponsor's Protocol Code Number:ACE-CL-309
    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:2016-09-09
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2015-004454-17
    A.3Full title of the trial
    A Randomized, Multicenter, Open-Label, Phase 3 Study of Acalabrutinib (ACP-196) Versus Investigator’s Choice of Either Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Subjects with Relapsed or Refractory Chronic Lymphocytic Leukemia
    Estudio de fase 3, multicéntrico, aleatorizado, abierto, de acalabrutinib (ACP-196) frente a idelalisib más rituximab o bendamustine más rituximab a elección del investigador en pacientes con leucemia linfocítica crónica recidivante o resistente al tratamiento
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Clinical trial to compare Acalabrutinib (ACP-196) versus investigator's choice standard treatment with Bendamustine/Rituximab or Idelalisib/Rituximab alone in patients with Relapsed or Refractory Chronic Lymphocytic Leukemia
    Ensayo clínico para comparar acalabrutinib (ACP-196) frente al tratamiento habitual a elección del investigador con bendamustine/rituximab o idelalisib/rituximab solo en pacientes con leucemia linfocítica crónica recidivante o resistente al tratamiento
    A.4.1Sponsor's protocol code numberACE-CL-309
    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 SponsorAcerta Pharma BV
    B.1.3.4CountryNetherlands
    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 supportAcerta Pharma
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAcerta Pharma
    B.5.2Functional name of contact pointMedical Director
    B.5.3 Address:
    B.5.3.1Street Address2200 Bridge Parkway, Suite 202
    B.5.3.2Town/ cityRedwood City, CA
    B.5.3.3Post code94065
    B.5.3.4CountryUnited States
    B.5.4Telephone number+34900 811 335
    B.5.5Fax number+1650 591 2816
    B.5.6E-mailp.patel@acerta-pharma.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 nameAcalabrutinib
    D.3.2Product code ACP-196
    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 INNACALABRUTINIB
    D.3.9.1CAS number 1420477-60-6
    D.3.9.2Current sponsor codeACP-196
    D.3.9.4EV Substance CodeSUB182073
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    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 Zydelig® (idelalisib) 100 mg
    D.2.1.1.2Name of the Marketing Authorisation holderGilead Sciences International Ltd
    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 nameIdelalisib
    D.3.4Pharmaceutical form Film-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 INNIDELALISIB
    D.3.9.1CAS number 870281-82-6
    D.3.9.4EV Substance CodeSUB126168
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP 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 Zydelig® (idelalisib) 150 mg
    D.2.1.1.2Name of the Marketing Authorisation holderGilead Sciences International Ltd
    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 nameIdelalisib
    D.3.4Pharmaceutical form Film-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 INNIDELALISIB
    D.3.9.1CAS number 870281-82-6
    D.3.9.4EV Substance CodeSUB126168
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    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 MabThera® (rituximab) 500 mg
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration 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 nameRituximab
    D.3.4Pharmaceutical form Concentrate for 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 INNRITUXIMAB
    D.3.9.1CAS number 174722-31-7
    D.3.9.4EV Substance CodeSUB12570MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    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 Levact® (bendamustine hydrochloride), powder for concentrate for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderAstellas Pharma GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameBendamustine
    D.3.4Pharmaceutical form Powder for concentrate for 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 INNBENDAMUSTINE HYDROCHLORIDE
    D.3.9.1CAS number 3543-75-7
    D.3.9.4EV Substance CodeSUB00696MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 6
    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 Bendamustine hydrochloride Accord 2.5 mg/ml Powder for concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare 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 nameBendamustine
    D.3.4Pharmaceutical form Powder for concentrate for 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 INNBENDAMUSTINE HYDROCHLORIDE
    D.3.9.1CAS number 3543-75-7
    D.3.9.4EV Substance CodeSUB00696MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Relapsed or Refractory Chronic Lymphocytic Leukemia
    Leucemia linfocítica crónica recidivante o resistente al tratamiento
    E.1.1.1Medical condition in easily understood language
    Chronic Leukemia
    Leucemia crónica
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 19.0
    E.1.2Level LLT
    E.1.2Classification code 10008978
    E.1.2Term Chronic lymphocytic leukemia refractory
    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
    To evaluate the efficacy of acalabrutinib monotherapy (Arm A) compared with idelalisib/rituximab or bendamustine/rituximab (Arm B) based on Independent Review Committee (IRC) assessment of progression-free survival (PFS) per International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 criteria (Hallek 2008) with incorporation of the clarification for treatment-related lymphocytosis (Cheson 2012)—hereafter referred to as IWCLL 2008 criteria in subjects with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL).
    Evaluar la eficacia de acalabrutinib en monoterapia (Grupo A) en comparación con Idelalisib/Rituximab o Bendamustina/Rituximab (Grupo B) sobre la base de la evaluación por un Comité independiente de supervisión (CIS) de la supervivencia sin progresión (SSP) según los criterios del Grupo de trabajo internacional sobre leucemia linfocítica crónica (International Workshop on Chronic Lymphocytic Leukemia, IWCLL) 2008 (Hallek 2008), con la incorporación de la aclaración para la linfocitosis relacionada con el tratamiento (Cheson 2012), denominados en adelante criterios IWCLL 2008, en pacientes con leucemia linfocítica crónica (LLC) recidivante o resistente (R/R) al tratamiento.
    E.2.2Secondary objectives of the trial
    To evaluate Arm A (acalabrutinib) compared with Arm B (idelalisib/rituximab or bendamustine/rituximab) in terms of:
    - Investigator (INV)-assessed PFS per IWCLL 2008 criteria.
    - INV- and IRC-assessed objective response rate (ORR) per IWCLL 2008 criteria.
    - Overall survival (OS).
    - Patient-reported outcomes (PROs) by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT Fatigue).
    - INV- and IRC-assessed duration of response (DOR).
    - INV- and IRC-assessed time to next treatment (TTNT).
    Evaluar el Grupo A (acalabrutinib)en comparación con el Grupo B (idelalisib/rituximab o bendamustine/rituximab)en los términos siguientes:
    - SSP evaluada por el investigador (INV) según los criterios IWCLL 2008.
    - Tasa de respuesta objetiva (TRO) evaluada por INV y CIS según los criterios IWCLL 2008.
    - Supervivencia total (ST).
    - Resultados según los pacientes (RSP) mediante la Evaluación funcional del tratamiento de la enfermedad crónica (Fatiga FACIT).
    - Duración de la respuesta (DdR) según la evaluación de INV y CIS.
    - Tiempo hasta el siguiente tratamiento (TTNT) según la evaluación de INV y CIS.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Men and women >/= 18 years of age.
    2. ECOG performance status of 0 to 2.
    3. Diagnosis of CLL that meets published diagnostic criteria (Hallek 2008):
    a. Monoclonal B-cells (either kappa or lambda light chain restricted) that are clonally co-expressing >/= 1 B-cell marker (CD19, CD20, or CD23) and CD5.
    b. Prolymphocytes may comprise </= 55% of blood lymphocytes.
    c. Presence of >/= 5 x 109 B lymphocytes/L (5000 µL) in the peripheral blood (at any point since diagnosis).
    4.Must have documented CD20-positive CLL.
    5.Active disease meeting >/= 1 of the following IWCLL 2008 criteria for requiring treatment:
    a. Evidence of progressive marrow failure as manifested by the development of, or worsening of, anemia (hemoglobin < 10 g/dL) and/or thrombocytopenia (platelets < 100,000/μL).
    b. Massive (ie, >/= 6 cm below the left costal margin), progressive, or symptomatic splenomegaly.
    c. Massive nodes (ie, >/= 10 cm in the longest diameter), progressive, or symptomatic lymphadenopathy.
    d. Progressive lymphocytosis with an increase of > 50% over a 2-month period or a LDT of < 6 months. LDT may be obtained by linear regression extrapolation of ALC obtained at intervals of 2 weeks over an observation period of 2 to 3 months. In subjects with initial blood lymphocyte counts of < 30 x 109/L (30,000/μL), LDT should not be used as a single parameter to define indication for treatment. In addition, factors contributing to lymphocytosis or lymphadenopathy other than CLL (eg, infections) should be excluded.
    e. Autoimmune anemia and/or thrombocytopenia that is poorly responsive to standard therapy.
    f. Constitutional symptoms documented in the subject’s chart with supportive objective measures, as appropriate, defined as >/= 1 of the following disease- related symptoms or signs:
    i. Unintentional weight loss >/= 10% within the previous 6 months before screening.
    ii. Significant fatigue (ECOG performance score 2 or worse; inability to work or perform usual activities).
    iii. Fevers higher than 38.0°C for >/= 2 weeks before screening without evidence of infection.
    iv. Night sweats for > 1 month before screening without evidence of infection.
    6. Meet the following laboratory parameters:
    a. Absolute neutrophil count (ANC) >/= 750 cells/μL (0.75 x 109/L), or >/= 500 cells/μL (0.50 x 109/L) in subjects with documented bone marrow involvement, and independent of growth factor support 7 days before assessment.
    b. Platelet count >/= 50,000 cells/μL (50 x 109/L), or >/= 30,000 cells/μL
    (30 x 109/L) in subjects with documented bone marrow involvement, and without transfusion support 7 days before assessment. Subjects with transfusion-dependent thrombocytopenia are excluded. If an investigator has chosen bendamustine/rituximab as the Arm B treatment, platelets must be >/= 75,000 cells/μL (75 x 109/L).
    c. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) </= 2.0 x upper limit of normal (ULN).
    d. Total bilirubin </= 1.5 x ULN.
    e. Estimated creatinine clearance of >/= 30 mL/min, calculated using the formula of Cockcroft and Gault.
    7.Must have received >/= 1 prior systemic therapies for CLL. Note: Single-agent steroids or localized radiation are not considered a prior line of therapy. If a single- agent anti-CD20 antibody was previously administered, subjects must have received >/= 2 doses.
    8.Able to receive all outpatient treatment, all laboratory monitoring, and all radiologic evaluations at the institution that administers study drug for the entire study.
    9.Men and women who are sexually active and can beget/bear children must agree to use highly effective forms of contraception while on the study and for 90 days after the last dose of acalabrutinib or idelalisib, 120 days after the last dose of bendamustine, or 12 months after the last dose of rituximab, whichever is longer. Highly effective forms of contraception are defined in Section 9.2.2.
    10.Men must agree to refrain from sperm donation during the study and for 90 days after the last dose of of acalabrutinib or idelalisib, 120 days after the last dose of bendamustine, or 12 months after the last dose of rituximab, whichever is longer.
    11.Willing and able to participate in all required evaluations and procedures in this study protocol, including swallowing capsules without difficulty.
    12.Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (in accordance with national and local patient privacy regulations).
    1.Hombres y mujeres >/= 18 años.
    2.Escala de valoración del ECOG de 0 a 2.
    3.Diagnóstico de LLC que cumpla los criterios de diagnóstico publicados (Hallek 2008):
    a.Células B monoclonales (con restricciones en la cadena ligera kappa o lambda) que coexpresen clónicamente >/= 1 marcadores de células B (CD19, CD20 o CD23) y CD5.
    b.Los prolinfocitos pueden incluir </= 55 % de linfocitos en sangre.
    c.Presencia de >/= 5 x 109 linfocitos B/L (5000 μL) en sangre periférica (en cualquier momento desde el diagnóstico).
    4.Deben tener LLC con CD20 positivo documentado.
    5.Enfermedad activa que cumpla >/= 1 de los siguientes criterios IWCLL 2008 para requerir tratamiento:
    a.Insuficiencia progresiva de médula ósea manifestada por el desarrollo o el empeoramiento de anemia (hemoglobina < 10 g/dL) y/o trombocitopenia (plaquetas < 100.000/μL).
    b.Esplenomegalia masiva (>/= 6 cm por debajo del margen costal izquierdo), progresiva o sintomática.
    c.Linfadenopatía con nodos masivos (>/= 10 cm en el diámetro más largo), progresiva o sintomática.
    d.Linfocitosis progresiva con un aumento > 50 % durante un período de dos meses o un tiempo de duplicación de linfocitos (LDT) < 6 meses. El valor de LDT puede obtenerse mediante extrapolación por regresión lineal de recuentos absolutos de linfocitos (RAL) obtenidos a intervalos de 2 semanas a lo largo de un período de observación de 2 a 3 meses. En pacientes con recuentos iniciales de linfocitos en sangre de < 30 x 109/L (30.000/μL), no debe utilizarse LDT como el único parámetro para definir la indicación del tratamiento. Además, deben excluirse los factores que contribuyan a la linfocitosis o la linfadenopatía aparte de la LLC (por ejemplo, infecciones).
    e.Anemia autoinmune y/o trombocitopenia con mala respuesta al tratamiento estándar.
    f.Síntomas inespecíficos documentados en la historia clínica del paciente con mediciones objetivas que los respalden, según corresponda, definidos como >/= 1 de los siguientes síntomas o signos relacionados con la enfermedad:
    i.Pérdida de peso no intencionada >/= 10 % durante los 6 meses anteriores a la selección.
    ii.Fatiga significativa (puntuación de valoración del ECOG de 2 o peor; incapacidad para trabajar o realizar actividades habituales).
    iii.Fiebre superior a 38,0 ºC durante >/= 2 semanas antes de la selección sin evidencia de infección.
    iv.Sudores nocturnos durante > 1 mes antes de la selección sin evidencia de infección.
    6.Satisfacer los siguientes parámetros analíticos:
    a.Recuento absoluto de neutrófilos (RAN) >/= 750 células/μL (0,75 x 109/L) o >/= 500 células/μL (0,50 x 109/L) en pacientes con afectación documentada de la médula ósea e independiente de la administración de factores de crecimiento 7 días antes de la evaluación.
    b.Recuento de plaquetas >/= 50.000 células/μL (50 x 109/L) o ≥ 30.000 células/μL (30 x 109/L) en pacientes con afectación documentada de la médula ósea y sin transfusión 7 días antes de la evaluación. Los pacientes con trombocitopenia dependiente de la transfusión quedan excluidos. Para Bendamustina/Rituximab como tratamiento del Grupo B, las plaquetas deben ser >/= 75.000 células/μL (75 x 109/L).
    c.Aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) en suero ≤ 2,0 veces el límite superior de la normalidad (LSN).
    d.Bilirrubina total </= 1,5 x LSN.
    e.Aclaramiento de creatinina estimado >/= 30 mL/min, calculado con la fórmula de Cockcroft-Gault.
    7.Debe haber recibido >/= 1 tratamiento sistémico anterior para LLC. Nota: los esteroides en monoterapia o la radiación localizada no se consideran una línea de tratamiento anterior. Si se administró previamente un anticuerpo anti CD20 en monoterapia, los pacientes deben haber recibido >/= 2 dosis.
    8.Capacidad para someterse a todo el tratamiento ambulatorio, toda la supervisión analítica y todas las evaluaciones radiológicas en el centro durante todo el estudio.
    9.Los hombres y mujeres sexualmente activos y con posibilidad de concebir deben estar de acuerdo en utilizar métodos anticonceptivos de alta eficacia durante el estudio y durante 90 días tras la última dosis de Acalabrutinib o Idelalisib, 120 días tras la última dosis de Bendamustina o 12 meses tras la última dosis de Rituximab, lo que dure más.
    10.Los hombres deben estar de acuerdo en no donar esperma durante el estudio y durante 90 días tras la última dosis de Acalabrutinib o Idelalisib, 120 días tras la última dosis de Bendamustina o 12 meses tras la última dosis de Rituximab, lo que dure más.
    11.Voluntad y capacidad para participar en todos los procedimientos y evaluaciones, incluida la capacidad para tragar cápsulas sin dificultad.
    12.Capacidad para comprender el propósito y los riesgos del estudio y proporcionar autorización y consentimiento informado firmados y fechados.
    E.4Principal exclusion criteria
    1.Known CNS lymphoma or leukemia.
    2.Known prolymphocytic leukemia or history of, or currently suspected, Richter’s syndrome.
    3.Uncontrolled AIHA or ITP defined as declining hemoglobin or platelet count secondary to autoimmune destruction within the screening period or requirement for high doses of steroids (> 20 mg daily of prednisone daily or equivalent).
    4.Prior exposure to a BCL-2 inhibitor (eg, ABT-199) or a BCR inhibitor (eg, Btk inhibitors or PI3K inhibitors).
    5.Received any chemotherapy, external beam radiation therapy, anticancer antibodies, or investigational drug within 30 days before first dose of study drug.
    6.Corticosteroid use > 20 mg within 1 week before first dose of study drug, except as indicated for other medical conditions such as inhaled steroid for asthma, topical steroid use, or as premedication for administration of study drug or contrast. For example, subjects requiring steroids at daily doses > 20 mg prednisone equivalent systemic exposure daily, or those who are administered steroids for leukemia control or white blood cell count lowering are excluded.
    7.Prior radio- or toxin-conjugated antibody therapy.
    8.Prior allogeneic stem cell transplant or prior autologous transplant within 6 months of first dose of study drug(s) or presence of graft-vs-host disease or recieving treatment for
    graft-vs-host disease.
    9.Major surgical procedure within 30 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug.
    10.History of prior malignancy except for the following:
    a. Malignancy treated with curative intent and with no evidence of active disease present for more than 2 years before screening and felt to be at low risk for recurrence by treating physician.
    b. Adequately treated lentigo maligna melanoma without current evidence of disease or adequately controlled nonmelanomatous skin cancer.
    c. Adequately treated carcinoma in situ without current evidence of disease.
    11.Significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification, or QTc > 480 msec at screening.
    12.Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel or gastric bypass, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction.
    13.Received a live virus vaccination within 28 days of first dose of study drug.
    14.Known history of infection with HIV or any uncontrolled active systemic infection (eg, bacterial, viral or fungal).
    15.Serologic status reflecting active hepatitis B or C infection. Subjects with anti-HBc who are surface antigen negative or who are hepatitis C antibody positive will need to have a negative PCR result before randomization. Those who are HbsAg-positive or hepatitis B PCR positive and those who are hepatitis C PCR positive will be excluded.
    16.Ongoing, drug-induced liver injury, alcoholic liver disease, non-alcoholic steatohepatitis, primary biliary cirrhosis, ongoing extrahepatic obstruction caused by cholelithiasis, cirrhosis of the liver, or portal hypertension.
    17.History of or ongoing drug-induced pneumonitis.
    18.History of serious allergic reactions including anaphylaxis and toxic epidermal necrolysis.
    19.History of stroke or intracranial hemorrhage within 6 months before first dose of study drug.
    20.History of bleeding diathesis (eg, hemophilia, von Willebrand disease).
    21.Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists (eg, phenprocoumon) within 7 days of first dose of study drug.
    22.Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before screening.
    23.Requires treatment with a strong CYP3A inhibitor/inducer.
    24.Requires treatment with proton-pump inhibitors (eg, omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole). Subjects receiving proton-pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment to this study.
    25.Breast feeding or pregnant.
    26.Concurrent participation in another therapeutic clinical trial.
    1.Leucemia o linfoma del SNC confirmados.
    2.Leucemia prolinfocítica confirmada, o antecedentes o sospecha actual de síndrome de Richter.
    3.Anemia hemolítica autoinmune no controlada o púrpura trombocitopénica idiopática definida como reducción de plaquetas o hemoglobina secundaria respecto a la destrucción autoinmune dentro del período de selección o necesidad de altas dosis de esteroides (> 20 mg diarios de Prednisona al día o equivalente).
    4.Exposición previa a un inhibidor de BCL-2 (p.ej., ABT-199) o un receptor de células B (p. ej. inhibidores de Btk o inhibidores de PI3K).
    5.Recepción de quimioterapia, radioterapia de haz externo, anticuerpos anticáncer o fármaco experimental en los 30 días previos a la primera dosis de fármaco del estudio.
    6.Uso de corticoesteroides > 20 mg 1 semana antes de la primera dosis, excepto según lo indicado para otras afecciones (esteroide inhalado para el asma, esteroide de uso tópico o como premedicación para la administración de fármaco del estudio o contraste). P. ej., los pacientes que requieran esteroides a dosis diarias > 20 mg de exposición sistémica a Prednisona o equivalente al día, o aquellos a los que se administren esteroides para el control de la leucemia o para la reducción de leucocitos quedan excluidos.
    7.Terapia previa de anticuerpos conjugados con toxinas o radioterapia.
    8.Trasplante de células madres alogénico o trasplante autólogo 6 meses antes de la primera dosis o presencia de enfermedad de injerto contra huésped o recepción de tratamiento para dicha enfermedad.
    9.Procedimiento quirúrgico importante en los 30 días previos a la primera dosis. Nota: si un paciente se ha sometido a ello, debe haberse recuperado adecuadamente de cualquier toxicidad o complicación derivada antes de la primera dosis.
    10.Antecedentes de neoplasia previa, excepto:
    a.Neoplasia tratada con intención de profilaxis, sin evidencia de enfermedad activa presente durante más de 2 años antes de la selección y que con riesgo de recurrencia es bajo según el médico responsable.
    b.Melanoma de tipo lentigo maligno adecuadamente tratado sin evidencia actual de enfermedad o cáncer de piel no melanomatoso adecuadamente controlado.
    c.Carcinoma in situ adecuadamente tratado sin signos de la enfermedad actualmente.
    11.Enfermedad cardiovascular significativa, como arritmias no controladas o sintomáticas, fallo cardíaco congestivo o infarto de miocardio durante los 6 meses previos a la selección, o cualquier enfermedad cardíaca de clase 3 o 4 según lo definido por la clasificación funcional de la New York Heart Association, o intervalo QT corregido (QTc) > 480 msec en el momento de la selección.
    12.Síndrome de mala absorción, enfermedad que afecte significativamente a la función gastrointestinal o resección del estómago o del intestino delgado o derivación gástrica, enfermedad intestinal inflamatoria sintomática u obstrucción intestinal parcial o completa.
    13.Vacunación con virus vivos en los 28 días previos a la primera dosis.
    14.Antecedentes confirmados de infección con VIH o cualquier infección sistémica activa no controlada (bacteriana, vírica o fúngica).
    15.Estado serológico que refleje infección activa por hepatitis B o C. Los pacientes con anti-HBc con un resultado negativo para el antígeno de superficie o con resultado positivo para anticuerpos de hepatitis C necesitarán un resultado negativo de la reacción de polimerasa en cadena (PCR) antes de la aleatorización. Quienes tengan un resultado positivo HBsAg o positivo para PCR de hepatitis B y quienes tengan un resultado positivo para PCR de hepatitis C quedarán excluidos.
    16.Lesión hepática en curso inducida por fármacos, hepatopatía por alcoholismo, esteatohepatitis no alcohólica, cirrosis biliar primaria, obstrucción extrahepática en curso provocada por colelitiasis, cirrosis hepática o hipertensión portal.
    17.Antecedentes de neumonitis provocada por medicamentos o enfermedad en curso.
    18.Antecedentes de reacciones alérgicas graves, incluidas anafilaxia y necrolisis epidérmica tóxica.
    19.Antecedentes de ictus o hemorragia intracraneal en los 6 meses previos a la primera dosis.
    20.Antecedentes de diátesis hemorrágica (p. ej. hemofilia, enfermedad de von Willebrand).
    21.Requerir o estar recibiendo tratamiento anticoagulatorio con warfarina o antagonistas de la vitamina K equivalentes en los 7 días previos a la primera dosis.
    22.Úlcera gastrointestinal diagnosticada mediante endoscopia en los 3 meses previos a la selección.
    23.Necesidad de tratamiento con un inhibidor/inductor potente del CYP3A.
    24.Necesidad de tratamiento con inhibidores de la bomba de protones (p. ej. omeprazol, esomeprazol, lansoprazol, dexlansoprazol, rabeprazol o pantoprazol). Los pacientes que lo reciban y cambien a antagonistas de los receptores de H2 o antiácidos son aptos para su inscripción en este estudio.
    25.Lactancia materna o embarazo.
    26.Participación concurrente en otro estudio clínico terapéutico.
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint of the study is PFS (defined as the time from randomization until disease progression or death from any cause) as assessed by the IRC per IWCLL 2008 criteria.
    El criterio principal de valoración del estudio es SSP (definida como el tiempo desde la aleatorización hasta la evolución de la enfermedad o hasta el fallecimiento por cualquier causa), evaluado por el CIS según los criterios IWCLL 2008.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Estimated 48 months
    Se estima en 48 meses
    E.5.2Secondary end point(s)
    - INV-assessed PFS per IWCLL 2008 criteria.
    - INV-assessed ORR (defined as the proportion of patients who achieve a best response of complete remission [CR], complete remission with incomplete bone marrow recovery [CRi], nodal partial remission [nPR], or partial remission [PR]) per IWCLL 2008 criteria.
    - IRC-assessed ORR per IWCLL 2008 criteria.
    - OS (defined as the time from randomization to the date of death due to any cause)
    - PROs as measured by change in scores from baseline to each assessment in the FACIT-Fatigue.
    - INV- and IRC-assessed DOR (defined as the time from the first documentation of objective response to the earlier time of disease progression [assessed by the IRC per IWCLL 2008 criteria] or death from any cause)
    - INV- and IRC-assessed TTNT (defined as the time from randomization to institution of nonprotocol-specified treatment for CLL)
    SSP evaluada por INV según los criterios IWCLL 2008.
    - TRO evaluada por INV (definida como la proporción de pacientes que alcanzan una mejor respuesta de remisión completa [RC], remisión completa con recuperación incompleta de la médula ósea [RCi], remisión parcial nodal [RPn] o remisión parcial [RP]) según los criterios IWCLL 2008.
    - SSP evaluada por CIS según los criterios IWCLL 2008.
    - ST (definida como el intervalo de tiempo desde la aleatorización hasta la fecha del fallecimiento por cualquier motivo)
    - RSP medidos según el cambio en las puntuaciones de Fatiga FACIT desde el inicio hasta cada evaluación.
    - DdR evaluada por INV y CIS (definida como el tiempo desde la primera documentación de respuesta objetiva hasta el primer momento de evolución de la enfermedad [evaluada por el CIS según los criterios IWCLL 2008] o el fallecimiento por cualquier causa)
    - TTNT evaluado por INV y CIS (definido como el tiempo desde la aleatorización hasta la institución de tratamiento no especificado en el protocolo para LLC)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Estimated 48 months
    Se estima en 48 meses
    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 No
    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 Yes
    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 concerned10
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA113
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Austria
    Belgium
    Bulgaria
    Canada
    Croatia
    Czech Republic
    Denmark
    France
    Germany
    Hong Kong
    Hungary
    Israel
    Italy
    Korea, Republic of
    New Zealand
    Poland
    Romania
    Russian Federation
    Singapore
    Slovakia
    Spain
    Sweden
    Taiwan
    Turkey
    Ukraine
    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
    The maximum duration of the study is approximately 48 months from the first subject randomized. Therefore the end of trial will occur approximately 48 months after the first subject is randomized.
    La duración máxima del ensayo es de aproximadamente 48 meses desde que se aleatorice al primer sujeto. Por tanto el fin de ensayo ocurrirá aproximadamente 48 meses después de que se aleatorice al primer sujeto.
    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 months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months3
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 92
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 214
    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 Yes
    F.3.3.7.1Details of other specific vulnerable populations
    Elderly
    Personas mayores
    F.4 Planned number of subjects to be included
    F.4.1In the member state11
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 196
    F.4.2.2In the whole clinical trial 306
    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)
    Any subjects who have not progressed at the end of trial, defined as the point when the last subject on the study exits the study for any reason, and are tolerating study drug, may continue to receive their study treatment after discussion with the Medical Monitor. They will continue to have scheduled visits as outlined on the schedule of assessments. Otherwise, they will be treated according to current standard of care.
    Todos los sujetos que no haya progresado al final del ensayo, que se define como el punto en el que el último sujeto en el ensayo sale del mismo por cualquier motivo, y que toleren el fármaco en estudio, pueden continuar recibiendo el tratamiento del estudio tras analizarlo con el monitor médico. Se continuarán programando visitas como se indica en el calendario de evaluaciones. De lo contrario, serán tratados de acuerdo con el tratamiento habitual.
    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 Decision2016-10-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-10-25
    P. End of Trial
    P.End of Trial StatusOngoing
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