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    Summary
    EudraCT Number:2015-004699-31
    Sponsor's Protocol Code Number:I3O-MC-JSBF
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2021-07-28
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2015-004699-31
    A.3Full title of the trial
    Randomized, Double-Blind, Phase 2 Study of Ramucirumab or Merestinib or Placebo plus Gemcitabine and Cisplatin as First-Line Treatment in Patients with Advanced or Metastatic Biliary Tract Cancer
    Studio di fase II, randomizzato, in doppio cieco di ramucirumab o merestinib o placebo pi¿ cisplatino e gemcitabina come trattamento di prima linea nei pazienti con carcinoma delle vie biliari avanzato o metastatico.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study investigates whether ramucirumab or merestinib in combination with cisplatin and gemcitabine can help patients with biliary tract cancer.
    Lo studio valuta se ramucirumab o merestinib, in associazione a cisplatino e gemcitabina, possono essere utili per i pazienti affetti da carcinoma delle vie biliari (BTC).
    A.3.2Name or abbreviated title of the trial where available
    Study investigates whether ramucirumab or merestinib in combination with cisplatin and gemcitabine c
    Studio volto ad indagare se ramucirumab o merestinib in combinazione con cisplatino e gemcitabina po
    A.4.1Sponsor's protocol code numberI3O-MC-JSBF
    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 SponsorELI LILLY & COMPANY, LILLY CORPORATE CENTER
    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 supportEli Lilly and Company
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEli Lilly
    B.5.2Functional name of contact pointClinical Trial Registry Office
    B.5.3 Address:
    B.5.3.1Street AddressLilly Corporate Center, DC 1526
    B.5.3.2Town/ cityIndianapolis
    B.5.3.3Post code46285
    B.5.3.4CountryUnited States
    B.5.4Telephone number+390554257386
    B.5.5Fax number+390554257348
    B.5.6E-mailEU_Lilly_Clinical_Trials@lilly.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 Yes
    D.2.1.1.1Trade name Cyramza
    D.2.1.1.2Name of the Marketing Authorisation holderEli Lilly Nederland B.V
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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.3.4Pharmaceutical 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 INNRAMUCIRUMAB
    D.3.9.1CAS number 947687-13-0
    D.3.9.2Current sponsor codeLY3009806
    D.3.9.4EV Substance CodeSUB32795
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation 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 nameMerestinib
    D.3.2Product code LY2801653
    D.3.4Pharmaceutical form 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 INNMerestinib
    D.3.9.2Current sponsor codeLY2801653
    D.3.9.4EV Substance CodeSUB180030
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP 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.3.4Pharmaceutical form Powder 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 INNGEMCITABINA CLORIDRATO
    D.3.9.2Current sponsor codeNA
    D.3.9.4EV Substance CodeSUB02324MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNGEMCITABINA CLORIDRATO
    D.3.9.2Current sponsor codeNA
    D.3.9.4EV Substance CodeSUB02324MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1000
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    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.3.4Pharmaceutical 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 INNCISPLATINO
    D.3.9.2Current sponsor codeNA
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboConcentrate for solution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    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
    Advanced or Metastatic Biliary Tract Cancer
    Carcinoma delle vie biliari avanzato o metastatico
    E.1.1.1Medical condition in easily understood language
    Advanced or Metastatic Biliary Tract Cancer
    Tumore delle vie biliari avanzato o metastatico
    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 LLT
    E.1.2Classification code 10004648
    E.1.2Term Bile ducts, cancer of, nonresectable
    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
    Evaluate the efficacy, in terms of PFS, in patients with advanced or metastatic BTC, for
    ¿ ramucirumab (8 mg/kg, IV) versus placebo, in combination with cisplatin (25 mg/m2, IV) and gemcitabine (1000 mg/m2, IV), on Days 1 and 8 of a 21-day cycle.
    ¿ merestinib (80 mg, oral each day) versus placebo, in combination with cisplatin (25 mg/m2, IV) and gemcitabine (1000 mg/m2 IV), on Days 1 and 8 of a 21-day cycle.
    Valutare l¿efficacia, in termini di PFS, nei pazienti con BTC avanzato o metastatico, dei seguenti farmaci:
    ¿ ramucirumab (8 mg/kg, ev) vs. placebo, in associazione a cisplatino (25 mg/m2, ev) e gemcitabina (1000 mg/m2, ev), nei Giorni 1 e 8 nell¿ambito di un ciclo della durata di 21 giorni;
    ¿ merestinib (80 mg/die, orale) vs. placebo, in associazione a cisplatino (25 mg/m2, ev) e gemcitabina (1000 mg/m2, ev), nei Giorni 1 e 8 nell¿ambito di un ciclo della durata di 21 giorni.
    E.2.2Secondary objectives of the trial
    - Evaluate the efficacy, in combination with cisplatin and gemcitabine, in terms of OS, for ramucirumab versus placebo and merestinib versus placebo.
    - Evaluate the efficacy, in combination with cisplatin and gemcitabine, in terms of ORR and DCR for ramucirumab versus placebo and merestinib versus placebo.
    - Safety profile of merestinib
    - Safety profile of ramucirumab
    - PK of ramucirumab
    - PK of merestinib
    - Immunogenicity of ramucirumab
    - Evaluate PRO measures of disease-specific symptoms, in combination with cisplatin and gemcitabine, for ramucirumab versus placebo and merestinib versus placebo.
    -Valutare l¿efficacia di ramucirumab vs. placebo e merestinib vs. placebo, in associazione a cisplatino e gemcitabina, in termini di OS
    -Valutare l¿efficacia di ramucirumab vs. placebo e merestinib vs. placebo, in associazione a cisplatino e gemcitabina, in termini di ORR e DCR.
    -Profilo di sicurezza di merestinib
    -Profilo di sicurezza di ramucirumab
    -PK di ramucirumab
    -PK di merestinib
    -Immunogenicit¿ di ramucirumab
    -Valutare le misure di PRO per sintomi specifici della malattia di ramucirumab vs. placebo e merestinib vs. placebo, in associazione a cisplatino e gemcitabina.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    [1] Are of an acceptable age to provide informed consent according to the local regulations and are at least 18 years of age.
    [2] Have an estimated life expectancy =3 months.
    [3] Have an Eastern Cooperative Oncology Group performance status of 0 or 1 at the time of randomization (refer to Appendix 7).
    [4] Have a histologically or cytologically confirmed diagnosis of non-resectable, recurrent, or metastatic biliary tract adenocarcinoma (intrahepatic or extrahepatic cholangiocarcinoma, gallbladder cancer, or Ampulla of Vater).
    [5] Have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 on computed tomography (CT) or magnetic resonance imaging (MRI) assessments performed = 28 days prior to Cycle 1 Day 1.
    [6] Have resolution of all clinically significant toxic effects of prior therapy to Grade =1 by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 4.0.
    [7] Have adequate biliary drainage (per investigator’s discretion), with no evidence of ongoing infection.
    [8] Have adequate organ function as determined by:
    a. Hepatic: Total bilirubin, aspartate transaminase (AST), and alanine transaminase (ALT) are all = 3 times upper limit of institutional normal value (ULN) on 2 measurements separated by at least 5 days.
    b. Renal:
    i. Glomerular filtration rate (GFR) of =50 ml/min/1.73 m2. GFR should be calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (refer to Appendix 6), or may be measured using 24 hour urine collection or clearance of exogenous filtration markers (such as iothalamate or 51-CrEDTA or Tc99m-DTPA).
    ii. The patient’s urinary protein is =1+ on dipstick or routine urinalysis. If urine dipstick or routine analysis indicates proteinuria =2+, then a 24-hour urine must be collected and must demonstrate <2 g of protein in 24 hours to allow participation in the study.
    c. Hematologic:
    i. Absolute neutrophil count (ANC) =1.5 x 109/L,
    ii. hemoglobin =9 g/dL (5.58 mmol/L; packed red blood cell transfusions are not allowed within 1 week prior to baseline hematology profile), and
    iii. platelets = 100 x 109/L.
    d. Coagulation: The patient must have adequate coagulation function as defined by International Normalized Ratio (INR) =1.5 and a partial thromboplastin time (PTT/aPTT) =5 seconds above the ULN. Patients receiving low-dose anticoagulant therapy at prophylactic doses (such as prophylaxis with low-molecular weight heparin) are eligible, provided that INR =1.5 and PTT/aPTT =5 seconds above the ULN. Treatment with acetylsalicylic acid (aspirin) at a daily dose of =325 mg is permitted.
    [9] Males and females are sterile, postmenopausal, or compliant with a highly effective contraceptive method during study participation and for 3 months following the last dose of study drug.
    [10] Female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to first dose.
    [11] The patient has provided signed informed consent and authorization for release of health information for research prior to any study-specific procedures and is amenable to compliance with protocol schedules and testing.
    [12] Are willing to provide blood/serum/plasma and tumor tissue samples for research purposes. Submission of blood/serum/plasma and tumor tissue samples is mandatory for participation in this study, unless restricted per local regulations. Tumor tissue biopsies may be taken by either core needle or excisional biopsy.
    [13] Are able to swallow tablets. Patients who have a nontemporary gastric or enteral feeding tube may be permitted to participate in the study with prior approval from the Sponsor’s CRP/CRS.
    [1] Avere almeno 18 anni o, in caso contrario, un’età adeguata per fornire il consenso informato ai sensi dei regolamenti locali.
    [2] Avere un’aspettativa di vita stimata =3 mesi.
    [3] Avere un performance status secondo l’Eastern Cooperative Oncology Group pari a 0 o 1 al momento della randomizzazione (si veda Appendice 7).
    [4] Avere una diagnosi confermata, mediante esame istologico o citologico, di adenocarcinoma delle vie biliari non resecabile, recidivante o metastatico (colangiocarcinoma intraepatico o extraepatico, cancro della cistifellea o dell’ampolla di Vater).
    [5] Avere una malattia misurabile in base ai criteri RECIST (Response Evaluation Criteria in Solid Tumors) versione 1.1 alle scansioni di tomografia computerizzata (TC) o risonanza magnetica (RM) eseguite nei 28 giorni precedenti il Giorno 1 del Ciclo 1.
    [6] Presentare una risoluzione di tutti gli effetti tossici clinicamente significativi di eventuali terapie pregresse a un grado 1 o inferiore ai sensi della versione 4.0 dei criteri NCI-CTCAE (National Cancer Institute Common Terminology Criteria for Adverse Events).
    [7] Avere un drenaggio biliare adeguato (a discrezione dello sperimentatore), senza evidenze di infezione in atto.
    [8] Avere una funzionalità d’organo adeguata, in base ai seguenti criteri:
    a. Epatici: bilirubina totale, aspartato transaminasi (AST) e alanino transaminasi (ALT) devono risultare pari o inferiori a 3 volte il limite superiore dell’intervallo di normalità (ULN) in 2 misurazioni effettuate a distanza di almeno 5 giorni.
    b. Renali:
    1. Velocità di filtrazione glomerulare (GFR) pari o superiore a 50 ml/min/1,73 m2. La GFR deve essere calcolata mediante l’equazione di CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (si veda Appendice 6), oppure può essere misurata utilizzando un campione di urine delle 24 ore o sulla base della clearance dei marker di filtrazione esogeni (come lo iotalamato o il 51-CrEDTA o il Tc99m-DTPA).
    2. La proteinuria del paziente è =1+ all’esame con striscia reattiva o all’analisi delle urine di routine. Se l’esame con striscia reattiva o l’analisi delle urine di routine indica una proteinuria =2+, è necessario raccogliere un campione di urine delle 24 ore, dal quale devono risultare meno di 2 g di proteine nell’arco delle 24 ore per consentire la partecipazione del soggetto allo studio.
    c. Ematologici:
    1. Conta assoluta dei neutrofili (ANC) =1,5 x 109/L
    2. Emoglobina =9 g/dL (5,58 mmol/L; non è ammessa l’esecuzione di trasfusioni di emazie concentrate nella settimana precedente il profilo ematologico basale)
    3. Piastrine =100 x 109/L
    d. Coagulazione: il paziente deve avere un’adeguata funzionalità coagulativa, definita da un rapporto internazionale normalizzato (INR) =1,5 e un tempo di tromboplastina parziale (PTT/aPTT) =5 secondi oltre l’ULN. I pazienti che ricevono una terapia con anticoagulanti a basse dosi a dosi profilattiche (come la profilassi con eparina a basso peso molecolare) sono eleggibili, purché l’INR sia pari o inferiore a 1,5 e il PTT/aPTT sia pari o inferiore a 5 secondi oltre il limite ULN. Il trattamento con acido acetilsalicilico a una dose giornaliera =325 mg è permesso.
    [9] Uomini e donne sono sterili, in postmenopausa o acconsentono a utilizzare un metodo contraccettivo altamente efficace durante la partecipazione allo studio e per i 3 mesi successivi all’assunzione dell’ultima dose di farmaco sperimentale.
    [10] I pazienti di sesso femminile potenzialmente fertili devono sottoporsi a un test di gravidanza su siero entro 7 giorni prima dell’assunzione della prima dose e ottenere esito negativo.
    [11] Il paziente ha fornito il proprio consenso informato firmato e l’autorizzazione alla diffusione di informazioni relative alla propria salute a scopo di ricerca prima dell’esecuzione di una qualsiasi procedura prevista dallo studio ed è disponibile a rispettare il programma stabilito dal protocollo e a sottoporsi agli esami previsti dal medesimo.
    [12] Acconsentire a fornire campioni di sangue/siero/plasma e campioni di tessuto tumorale a scopo di ricerca. La fornitura di campioni di sangue/siero/plasma e di tessuto tumorale è una condizione obbligatoria per la partecipazione allo studio, fatta salva l’esistenza di restrizioni imposte dalle norme locali. Le biopsie dei tessuti tumorali possono essere eseguite mediante agobiopsia o biopsia escissionale.
    [13] Essere in grado di deglutire le compresse. I pazienti muniti di sondino gastrico o per l’alimentazione enterale non temporaneo possono partecipare allo studio, previa autorizzazione del CRP/CRS dello sponsor.
    E.4Principal exclusion criteria
    [14] Previous systemic therapy for locally advanced or metastatic disease is not allowed. Transarterial chemoembolization (TACE) or radiotherapy, including use of radioactive beads, is not allowed unless otherwise addressed in the Exclusion Criterion 18. See protocol for previous allowed treatments:
    [15] Have a history of or have current hepatic encephalopathy of any grade, or ascites of Grade >1, or cirrhosis with Child-Pugh Stage B or higher.
    [16] Have ongoing or recent (=6 months) hepatorenal syndrome
    [17] Have had a major surgical procedure or significant traumatic injury including non-healing wound, peptic ulcer, or bone fracture =28 days prior to randomization, or anticipate having a major surgical procedure during the course of the study. Randomization should only occur after complete wound healing. Subcutaneous venous access device placement should not be considered a significant surgery, but should be placed greater than 7 days prior to randomization.
    [18] Have had radiation to any site (for example, bone) within 14 days prior to randomization. Palliative radiation to symptomatic metastatic sites (for example, bone) is permitted, provided it is performed >14 days prior to randomization. If any tumor lesion is administered radiotherapy, then it cannot be considered for response assessment.
    [19] Has documented brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression. Screening of asymptomatic patients without history of central nervous system (CNS) metastases is not required. However, patients with findings consistent with CNS malignancy or metastasis should be evaluated fully before study participation.
    [20] Have had any previous systemic therapy with VEGF inhibitors or VEGF-Receptor inhibitors (including investigational agents).
    [21] Are receiving therapeutic dose anticoagulation with warfarin, low-molecular-weight heparin, or similar agents (see also Inclusion Criterion 8d).
    [22] Are receiving chronic therapy with nonsteroidal anti-inflammatory agents (NSAIDs: for example, indomethacin, ibuprofen, naproxen, or similar agents) or other anti-platelet agents (for example, clopidogrel, ticlopidine, dipyridamole, anagrelide). Aspirin use at doses up to 325 mg/day is permitted
    [23] Symptomatic congestive heart failure (New York Heart Association III-IV are excluded, Class I and II are eligible), unstable angina pectoris, or symptomatic or poorly controlled cardiac arrhythmia.
    [24] Within 6 months prior to randomization, have had any arterial thrombotic event, including myocardial infarction, unstable angina, cerebrovascular accident, or transient ischemic attack.
    [25] Have an uncontrolled arterial hypertension with systolic blood pressure =150 or diastolic blood pressure =90 mm Hg despite standard medical management.
    [26] Have a previous malignancy within 5 years of study entry or a concurrent malignancy. Patients with carcinoma in situ of any origin and patients with prior malignancies who are in remission and whose likelihood of recurrence is very low, as judged by the Lilly CRP/CRS in consultation with the treating investigator, are eligible for this study. The approval by the CRP/CRS of such patients is required before these patients may be enrolled.
    [28] Have a history of gastrointestinal perforation and/or fistulae within 6 months prior to randomization.
    [29] Have a known allergy or hypersensitivity reaction to any of the treatment components.
    [30] Have a history of uncontrolled hereditary or acquired thrombotic disorder.
    [31] Have uncontrolled metabolic disorders or other nonmalignant organ or systemic diseases or secondary effects of cancer that induce a high medical risk and/or make assessment of survival uncertain. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the patient ineligible for entry into this study.
    [32] Have mixed hepatocellular biliary tract cancer histology.
    [33] Females who are pregnant or lactating.
    [34] Have a QTc interval >470 msec as calculated be the Fredericia equation.
    [35] The patient experienced any bleeding episode considered life-threatening, or any Grade 3 or 4 gastrointestinal/variceal bleeding episode in the 3 months prior to randomization requiring transfusion or endoscopic or operative intervention
    [14] La pregressa terapia sistemica per malattia metastatica o loc. avanzata non è consentita. La chemioembolizzazione transarteriosa (TACE) o la radioterapia,incluso l’utilizzo di fonti radioattive, non sono consentite,salvo divers. specificato nel Criterio di esclusione 18. Si veda il prot- per i trattamenti precedenti consentiti.
    [15] Encefalopatia epatica in corso o pregressa di qualsiasi grado, o asciti di grado >1, o cirrosi in stadio Child-Pugh B o superiore.
    [16] Sindrome epatorenale recente (=6 mesi) o attualmente in corso
    [17] Pregresso intervento di chirurgia maggiore o lesione traumatica significativa, incluse ferite deiscenti,ulcere peptiche o fratture ossee nei 28 giorni precedenti la randomizzazione,o interv. di chirurgia maggiore programmato durante il corso dello studio. La rand. deve avvenire solo dopo la completa guarigione della ferita. L’impianto di un disp. di accesso venoso sottocutaneo non è considerato un intervento chirurgico importante, ma deve avvenire oltre 7 giorni prima della rand.
    [18] Radioterapia in qualsiasi sito (ad esempio le ossa) nei 14 giorni precedenti la randomizzazione. La radioterapia palliativa nei siti metastatici sintomatici (ad esempio le ossa) è consentita, purché avvenga oltre 14 giorni prima della randomizzazione. In caso di trattamento radioterapico su una o più lesioni tumorali, queste ultime non potranno essere considerate per la valutazione della risposta.
    [19] Presenza di metastasi cerebrali documentate, malattia leptomeningea o compressione del midollo spinale non controllata. Lo screening dei pazienti asintomatici senza anamnesi di metastasi al sistema nervoso centrale (SNC) non è necessario. Tuttavia, i pazienti che mostrano reperti compatibili con una neoplasia maligna o metastasi al SNC devono essere sottoposti a una valutazione completa prima della partecipazione allo studio.
    [20] Una qualsiasi terapia sistemica pregressa con inibitori del VEGF o inibitori dei recettori del VEGF (inclusi agenti sperimentali).
    [21] Attuale anticoagulazione terapeutica a base di warfarin, eparina a basso peso molecolare o agenti simili (si veda anche il Criterio di inclusione 8d).
    [22] Attuale terapia cronica con agenti antinfiammatori non steroidei (FANS: ad esempio, indometacina, ibuprofene, naproxene o agenti simili) o altri agenti antipiastrinici (ad esempio, clopidogrel, ticlopidina, dipiridamolo, anagrelide). È consentito l’uso di aspirina con dosaggi fino a 325 mg/die.
    [23] Insufficienza cardiaca congestizia (le classi New York Heart Association III-IV sono escluse, le classi I e II sono eleggibili), angina pectoris instabile o aritmia cardiaca sintomatica o scarsamente controllata.
    [24] Anamnesi positiva per qualsiasi evento trombotico arterioso, inclusi infarto del miocardio, angina instabile, ictus cerebrovascolare o attacco ischemico transitorio, nei 6 mesi precedenti la randomizzazione.
    [25] Ipertensione arteriosa incontrollata con pressione arteriosa sistolica =150 o pressione arteriosa diastolica =90 mmHg nonostante il trattamento medico standard.
    [26] Neoplasia maligna pregressa nei 5 anni precedenti l’arruolamento nello studio o neoplasia maligna concomitante. I pazienti con carcinoma in situ di qualsiasi origine e i pazienti con precedenti neoplasie maligne in fase di remissione e con una probabilità di recidiva estremamente bassa, sulla base del giudizio del CRP/CRS di Lilly in consultazione con lo sperimentatore curante, sono eleggibili all’arruolamento nello studio.
    Prima che questi pazienti possano essere arruolati, è necessaria l’approvazione da parte del CRP/CRS.
    [28] Anamnesi positiva per perforazione e/o fistola gastrointestinale nei 6 mesi precedenti la randomiz.
    [29] Allergia o reazione da ipersensibilità nota a uno qualsiasi dei componenti del trattamento.
    [30] Anamnesi positiva per disturbi trombotici ereditari o acquisiti non controllati.
    [31] Disturbi metabolici non controllati o altre malattie d’organo o sistemiche di natura non maligna o effetti second. del cancro che producono un rischio medico elevato e/o rendono la valutazione della sopravvivenza incerta. Altre condizioni mediche o psichiatriche croniche o acute gravi o anomalie di laboratorio che possono aumentare il rischio associato alla partecipazione allo studio o alla somministrazione del farmaco sperimentale, o che possono interferire con l’interpretazione dei risultati dello studio e che, secondo il giudizio dello sperimentatore, potrebbero rendere il paz. non eleggibile per l’arruolamento nello studio.
    [32] Carcinoma epatocellulare delle vie biliari a istologia mista.
    [33] Donne in gravidanza o allattamento.
    [34] Intervallo QTc >470 ms, calcolato mediante equazione di Fredericia.
    [35] Il paz. ha sperimentato un qualsiasi episodio emorragico considerato pericoloso per la vita, oppure un qualsiasi episodio di emorragia gastrointestinale/varicosa di grado 3 o 4 nei 3 mesi precedenti la randomizzazione,che ha richiesto una trasfus.o un intervento endoscopico o operatorio.
    E.5 End points
    E.5.1Primary end point(s)
    PFS (objective progression or death), as determined by investigator assessment per RECIST 1.1
    PFS (progressione obiettiva o decesso), in base a quanto stabilito dallo sperimentatore secondo RECIST 1.1
    E.5.1.1Timepoint(s) of evaluation of this end point
    From randomization until the first radiographic documentation of progression or death from any cause in the absence of progressive disease
    Dalla randomizzazione alla prima documentazione radiografica di progressione o morte per qualsiasi causa in assenza di progressione della malattia
    E.5.2Secondary end point(s)
    OS
    ORR and DCR
    The safety endpoints evaluated will include but are not limited to the
    following:
    ¿ TEAEs, AESIs, SAEs, and hospitalizations
    ¿ Clinical laboratory tests, vital signs, and physical examinations
    ¿ Minimum ramucirumab concentration in serum
    ¿ Postdose merestinib concentration in plasma
    Blood samples for immunogenicity testing will be collected to determine
    antibody production against ramucirumab.
    Functional Assessment of Cancer Therapy Hepatobiliary Questionnaire (FACT-Hep)
    EuroQol 5-Dimension 5-Level (EQ-5D-5L)
    OS
    ORR e DCR
    Gli endpoint di sicurezza valutati includeranno, tra gli altri:
    ¿ TEAE, AESI, SAE e ricoveri
    ¿ Test clinici di laboratorio, segni vitali ed esami obiettivi
    ¿ Concentrazione sierica minima di ramucirumab
    ¿ Concentrazione plasmatica di merestinib dopo la somministrazione
    Saranno prelevati campioni di sangue per test di immunogenicit¿, allo scopo di verificare
    la produzione di anticorpi diretti contro ramucirumab.
    Questionario Functional Assessment of Cancer Therapy Hepatobiliary (FACT-Hep)
    Questionario EuroQol 5-Dimension 5-Level (EQ-5D-5L)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Time period for OS is from randomization until death from any cause.
    For ORR/DCR from randomization until the first radiographic documentation of progression or death from any cause in the absence of progressive disease
    Il periodo di tempo per la valutazione dell¿OS va dalla randomizzazione alla morte per qualsiasi causa.
    Il periodo di tempo per l¿ORR/DCR va dalla randomizzazione alla prima documentazione radiografica di progressione o morte per qualsiasi causa in assenza di progressione della malattia
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    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 No
    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 trial4
    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 concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA47
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Korea, Republic of
    Mexico
    Russian Federation
    Taiwan
    Turkey
    United States
    Austria
    Belgium
    Denmark
    France
    Germany
    Hungary
    Italy
    Spain
    Sweden
    United Kingdom
    Czechia
    Argentina
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    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 days5
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days5
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 225
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 75
    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 state14
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 147
    F.4.2.2In the whole clinical trial 300
    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 who are still on study treatment at the time of study completion may continue to receive study treatment if they are experiencing clinical benefit and no undue risks. Placebo will no longer be administered, and crossover will not be permitted.
    I pazienti che sono ancora in trattamento al momento del completamento dello studio possono continuare a ricevere il trattamento in studio qualora ci sia beneficio clinico e senza rischi eccessivi. Il placebo non sar¿ pi¿ somministrato, ed il crossover non sar¿ permesso.
    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 Decision2016-05-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-02-25
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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