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    Summary
    EudraCT Number:2015-005141-32
    Sponsor's Protocol Code Number:MYL-1402O-3001
    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:2021-01-21
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2015-005141-32
    A.3Full title of the trial
    Multicenter, Double-Blind, Randomized, Parallel-Group Study to Assess the Efficacy and Safety of MYL-1402O Compared With Avastin¿, in the First-line Treatment of Patients with Stage IV Non-Squamous Non-Small Cell Lung Cancer
    Studio multicentrico, in doppio cieco, randomizzato, a gruppi paralleli volto a valutare l¿efficacia e la sicurezza di MYL-1402O rispetto ad Avastin¿, nel trattamento di prima linea di pazienti affetti da carcinoma polmonare non a piccole cellule non squamoso di stadio IV
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to assess the efficacy and safety of MYL-1402O Compared With the drug Avastin, in patients with lung cancer.
    Studio volto a valutare l¿efficacia e la sicurezza di MYL-1402O rispetto ad Avastin, in pazienti affetti da carcinoma polmonare
    A.3.2Name or abbreviated title of the trial where available
    Study to assess the efficacy and safety of MYL-1402O Compared With the drug Avastin, in patients wit
    Studio volto a valutare l¿efficacia e la sicurezza di MYL-1402O rispetto ad Avastin, in pazienti aff
    A.4.1Sponsor's protocol code numberMYL-1402O-3001
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN00000000
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT00000000
    A.5.3WHO Universal Trial Reference Number (UTRN)U0000-0000-0000
    A.5.4Other Identifiers
    Name:NANumber:NA
    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 SponsorMYLAN GMBH
    B.1.3.4CountryIndia
    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 supportMYLAN GMBH
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMylan GmbH
    B.5.2Functional name of contact pointClinial Project Lead
    B.5.3 Address:
    B.5.3.1Street Address1000 Mylan Boulevard
    B.5.3.2Town/ cityCanonsburg
    B.5.3.3Post codePA 15317
    B.5.3.4CountryUnited States
    B.5.4Telephone number00017245142369
    B.5.5Fax numberxxx
    B.5.6E-mailEduardo.Pennella@mylan.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 nameMYL-1402O
    D.3.2Product code NA
    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 INNMylan Bevacizumab
    D.3.9.2Current sponsor codeMYL-14020
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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 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 Yes
    D.3.11.13.1Other medicinal product typeAnticorpo monoclonale
    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 Avastin
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Limited
    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 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 INNBEVACIZUMAB
    D.3.9.1CAS number 216974-75-3
    D.3.9.2Current sponsor code-
    D.3.9.3Other descriptive nameAvastin
    D.3.9.4EV Substance CodeSUB16402MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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 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 Yes
    D.3.11.13.1Other medicinal product typeanticorpo monoclonale
    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 Yes
    D.2.1.1.1Trade name CARBOPLATINO
    D.2.1.1.2Name of the Marketing Authorisation holderActavis Group PTC ehf.
    D.2.1.2Country which granted the Marketing AuthorisationIceland
    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 Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    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 Yes
    D.2.1.1.1Trade name PACLITAXEL 10 mg/ml
    D.2.1.1.2Name of the Marketing Authorisation holderActavis Group PTC ehf.
    D.2.1.2Country which granted the Marketing AuthorisationIceland
    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 Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Stage IV unresectable, recurrent or metastatic
    non-squamous non-small cell lung cancer (nsNSCLC)
    carcinoma polmonare ricorrente o metastatico non a piccole cellule non squamoso di stadio IV (nsNSCLC)
    E.1.1.1Medical condition in easily understood language
    A certain common kind of inoperable, recurrent or metastatic Lung cancer.
    Un certo tipo comune di cancro del polmone non operabile, recidivante 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 10025055
    E.1.2Term Lung cancer non-small cell stage IV
    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
    Compare the overall response rate (ORR) of MYL-1402O with that of Avastin, in combination with CP chemotherapy during the first 18 weeks of first-line treatment in patients with Stage IV nsNSCLC
    Confrontare il tasso di risposta globale (overall response rate, ORR) di MYL-1402O con quello di Avastin, in combinazione con chemioterapia a base di CP durante le prime 18 settimane di trattamento di prima linea in pazienti affetti da nsNSCLC di stadio IV
    E.2.2Secondary objectives of the trial
    1. Assess the safety profile of MYL-1402O as compared with that of Avastin when administered in combination with CP as
    first-line treatment for Stage IV nsNSCLC and when administered alone in the maintenance setting
    2. Assess other efficacy parameters: Disease Control Rate (DCR), Duration of Response (DR), Time To Progression (TP), Progression-Free survival (PFS), and Overall Survival (OS) of
    MYL-1402O as compared to Avastin when administered in
    combination with CP as first-line treatment for Stage IV
    nsNSCLC
    3. Assess the potential immunogenicity at Week 18 and 42 of
    treatment of MYL-1402O as compared with that of Avastin
    4. Compare the pharmacokinetic (PK) profile of MYL-1402O and Avastin using a population PK (PopPK) approach
    ¿ Valutare il profilo di sicurezza di MYL-1402O rispetto a quello di Avastin quando somministrato in combinazione con CP come trattamento di prima linea del nsNSCLC di stadio IV e quando somministrato come monoterapia di mantenimento
    ¿ Valutare altri parametri di efficacia: Tasso di controllo della malattia (disease control rate, DCR), durata della risposta (duration of response, DR), tempo alla progressione (time to progression, TP), sopravvivenza libera da progressione (progression-free survival, PFS) e sopravvivenza complessiva (overall survival, OS) di MYL-1402O rispetto ad Avastin quando somministrato in combinazione con CP come trattamento di prima linea dell¿nsNSCLC di stadio IV
    ¿ Valutare il potenziale immunogenico del trattamento di MYL-1402O alle Settimane 18 e 42 rispetto a quello di Avastin
    ¿ Confrontare il profilo di farmacocinetica (pharmacokinetics, PK) di MYL-1402O e Avastin utilizzando un approccio basato sulla popolazione PK (PopPK)
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Has demonstrated the ability to understand verbal and/or written instructions, to provide written informed consent, and is capable and agreeable to comply with protocol requirements.
    2. Male or female at least 18 years of age at the time of signing an informed consent form.
    3. Has a documented imaging diagnosis of Stage IV unresectable, recurrent or metastatic nsNSCLC.
    4. Has documented histologic or cytologic diagnosis of advanced nsNSCLC with negative or unknown sensitizing epidermal growth factor receptor (EGFR) mutation, and negative or unknown echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) rearrangement.
    5. Has measurable disease with at least 1 measurable lesion as defined by Response Evaluation Criteria in Solid Tumors
    (RECIST 1.1; Section 12.1 [Appendix A]). All target (up to
    5 lesions) and nontarget lesions (other measurable not included in target, nonmeasurable, nonevaluable, or evaluable lesions) should be included in the assessment or evaluation of disease response as defined by RECIST 1.1 (Eisenhauer et al 2009).
    6. Has a performance status of 0 or 1 on the Eastern Cooperative Oncology Group scale.
    7. Has at least 6 months of expected survival.
    8. Has not received any prior systemic therapy for first-line treatment of advanced lung cancer, except adjuvant chemotherapy, and remained disease-free for at least 12 months from time
    9. May have had prior radiation therapy provided <25% of bone marrow is involved (Section 12.3 [Appendix C]), except for previous mediastinal irradiation that is not allowed.
    a. Prior radiation therapy must have been completed at least
    2 weeks prior to Day 0 of Cycle 1
    b. Patient must have recovered from acute toxicities associated with radiation therapy. Radiation-related toxicities must have resolved to Grade 1 according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE; version 4.03) grade prior to Day 0 of Cycle 1.
    10. May have brain metastasis provided the metastasis has been treated and is considered stable at the time of signing the informed consent form. Treated, stable brain metastasis is defined as:
    a. Metastasis having no evidence of progressive disease (PD) or hemorrhage after treatment.
    b. No ongoing requirement for dexamethasone, as ascertained by clinical examination and post-treatment brain imaging (computed tomography [CT] scan or magnetic resonance imaging [MRI]) at baseline.
    c. Anticonvulsants are allowed, provided the dose regimen has been unchanged (stable) for at least 2 weeks prior to patient signing informed consent.
    d. Treatment for brain metastasis may include whole brain
    radiotherapy, radiosurgery (Gamma Knife®, linear particle
    accelerator, or equivalent), or a combination thereof, as
    deemed appropriate by the treating physician. All brain
    metastasis treatments must be completed at least 14 days prior to Day 0 of Cycle 1.
    11. Has adequate organ functions based on the following:
    a. Bone marrow reserve:
    i. White blood cell count =3 × 103/µL;
    ii. Absolute neutrophil count (segmented and bands)
    =1.5 × 103/µL;
    iii. Platelet count =100 × 103/µL;
    iv. Hemoglobin =9.0 g/dL with at least 2 weeks without
    transfusions before Day 0 of Cycle 1.
    b. Hepatic:
    i. Total bilirubin =1.5 × upper limit of normal (ULN); except
    if elevation is due to Gilbert’s Syndrome with transitory
    elevations of indirect bilirubin.
    ii. Alkaline phosphatase, alanine transaminase, and/or
    aspartate transaminase =3 × ULN. Significant levels of
    alanine transaminase or aspartate transaminase should be
    further assessed for viral hepatitis. (Note: Isolated alkaline
    phosphatase elevation beyond 3 × ULN due to bone
    metastasis is allowed).
    c. Renal:
    i. Calculated creatinine clearance =45 mL/min based on the
    original, weight-based Cockcroft and Gault formula
    (Cockcroft and Gault 1976; Section 12.4 [Appendix D])
    ii. Urine protein to creatinine ratio =1. A patient with urine
    protein to creatinine ratio > 1 may be enrolled if =2g of
    protein in 24-hour urine collection.
    12. If capable of reproduction, patients and their partners must use contraceptive methods during the full duration of the study and for 6 months after discontinuation of study.
    A patient who is capable of reproduction must be willing to
    practice birth control by using 2 different highly effective double barrier methods of contraception, or abstinence from sexual intercourse for the duration of the study.
    In particular a female patient of childbearing potential must use a method that results in less than 1% failure rate per year when used consistently and correctly such as implants, injectables, combined oral contraceptives, intrauterine devices, sexual abstinence, or vasectomized partner.
    A male patient of reproductive potential (defined as a male that has not had a vasectomy) must use a condom with spermicide and their female partner to use another highly effective form of contraception.
    1 Ha dimostrato la capacità di comprendere le istruzioni verbali e/o scritte, è in grado di fornire il consenso informato scritto ed è capace e disposto ad attenersi ai requisiti del protocollo.
    2.Di sesso maschile o femminile e di età non inferiore a 18 anni al momento della firma di un modulo di consenso informato
    3.Possiede una diagnosi di nsNSCLC di stadio IV non resecabile ricorrente o metastatico documentata mediante tecniche di diagnostica per immagini.
    4.Possiede una diagnosi istologica o citologica documentata di nsNSCLC avanzato con una mutazione sensibilizzante negativa o sconosciuta nel gene che codifica per il recettore del fattore di crescita epidermico (epidermal growth factor receptor, EGFR) e un riarrangiamento negativo o sconosciuto nel gene che codifica per la proteina 4 del microtubulo di echinodermi associata alla chinasi del linfoma anaplastico
    5.È affetto da una malattia misurabile con almeno 1 lesione misurabile secondo i RECIST 1.1 del protocollo[Appendice A]). Tutte le lesioni target (fino a un massimo di 5 lesioni) e non target (altre lesioni misurabili non incluse tra quelle target, non misurabili, non valutabili o valutabili) dovranno essere incluse nelle valutazioni della risposta della malattia secondo quanto stabilito dai RECIST 1.1 (Eisenhauer et al 2009).
    6.Ha un performance status pari a 0 o 1 sulla scala del Gruppo cooperativo orientale di oncologia (Eastern Cooperative Oncology Group, ECOG).
    7.Ha una sopravvivenza attesa di almeno 6 mesi.
    8.Non ha ricevuto alcuna terapia sistemica precedente come trattamento di prima linea del carcinoma polmonare avanzato, ad eccezione della chemioterapia adiuvante, ed è rimasto privo di malattia per almeno 12 mesi dal momento dell’intervento chirurgico e per almeno 6 mesi dall’ultima dose della chemioterapia.
    9.Può essersi sottoposto in precedenza a radioterapia, a condizione che sia coinvolto meno del 25% del midollo osseo ad eccezione di un’irradiazione mediastinica precedente che non è consentita.
    a.Un’eventuale radioterapia precedente deve essere stata completata almeno 2 settimane prima del Giorno 0 del Ciclo 1.
    b.Il paziente deve essere guarito da tossicità acute associate alla radioterapia. Le tossicità associate alla radiazione devono essersi risolte al Grado 1 in base alla classificazione dei Criteri terminologici comuni per gli eventi avversi (Common Terminology Criteria for Adverse Events, CTCAE; versione 4.03) dell’Istituto nazionale dei tumori (National Cancer Institute, NCI) prima del Giorno 0 del Ciclo 1.
    10.Può essere affetto da metastasi cerebrale, a condizione che la metastasi sia stata trattata e sia considerata stabile al momento della firma dell’ICF. Una metastasi cerebrale stabile e trattata è definita come:
    a.Metastasi che non mostra alcun segno di PD o emorragia dopo il trattamento.
    b.Non è richiesto alcun trattamento con desametasone in corso, come accertato attraverso un esame clinico e una tecnica di diagnostica per immagini eseguita sul cervello dopo il trattamento (TAC o RM) al basale.
    c.È consentito l’uso di anticonvulsivi, a condizione che la posologia sia rimasta invariata (stabile) per almeno 2 settimane prima che il paziente abbia firmato il consenso informato.
    d.Il trattamento di metastasi cerebrali può comprendere radioterapia sull’intero cervello, radiochirurgia (Gamma Knife®, acceleratore lineare di particelle o equivalenti) o una loro combinazione, a seconda di quale viene considerata appropriata dal medico curante. Tutti i trattamenti delle metastasi cerebrali devono essersi conclusi almeno 14 giorni prima del Giorno 0 del Ciclo 1.
    11.Possiede funzioni organiche adeguate in base ai seguenti valori:
    a.Riserva di midollo osseo:
    i.Conta dei globuli bianchi =3 × 103/µl;
    ii.Conta assoluta dei neutrofili (segmentati e a banda) =1,5 × 103/µl;
    iii.Conta piastrinica =100 × 103/µl;
    iv.Emoglobina =9,0 g/dl con almeno 2 settimane senza trasfusioni prima del Giorno 0 del Ciclo 1.
    b.A livello epatico:
    i.Bilirubina totale =1,5 × limite superiore del normale (upper limit of normal, ULN), eccetto nel caso in cui l’aumento sia dovuto alla sindrome di Gilbert con incrementi transitori delle bilirubina indiretta.
    ii.Fosfatasi alcalina (alkaline phosphatase, ALP), alanina transaminasi (alanine transaminase, ALT) e/o aspartato transaminasi (aspartate transaminase, AST) =3 × ULN. Livelli significativi di ALT o AST devono essere ulteriormente valutati per la presenza di un’eventuale epatite virale. (Nota: È consentito un aumento isolato dell’ALP superiore a 3 × ULN dovuto a metastasi ossea).
    c.A livello renale:
    i.Clearance della creatinina calcolata =45 ml/minuto secondo la formula originale di Cockcroft e Gault basata sul peso Rapporto proteine/creatinina nella urine =1.
    12.Se fertili, i pazienti e i rispettivi partner dovranno adottare metodi contraccettivi per l’intera durata dello studio e per i 6 mesi successivi all'interruzione dello studio.
    E.4Principal exclusion criteria
    1. Is pregnant or breast-feeding.
    2. Has documented histology/cytology confirming any of the
    following:
    a. Squamous non-small cell lung cancer. (Note: In the event of mixed tumor histology/cytology or predominant cell type other than non-squamous, eligibility will be determined based on the predominant cell type, which must be non-squamous.)
    b. A patient with any small cell type or large cell neuroendocrine histology.
    3. Has a recent (within 6 months prior to Day 0 of Cycle 1) cardiac condition as defined by the New York Heart Association Class II, III, or IV (AHA 1994).
    4. Has a recent (within 6 months prior to Day 0 of Cycle 1) history of a significant vascular event (such as aortic aneurysm requiring surgical repair or a recent peripheral arterial thrombosis) and/or history of significant and unstable vascular disease.
    5. Has a history of stroke or transient ischemic attack within
    6 months prior to Day 0 of Cycle 1, or has a long-term history of more than one of the following vascular thromboembolic events:
    a. Cerebrovascular accidents
    b. Transient ischemic attacks
    c. Myocardial infarctions
    d. Venous thromboembolic reactions, including pulmonary
    embolism
    6. Is receiving anticoagulant therapy that:
    a. Is not considered ‘stable’, defined as dosage not maintained
    for at least 3 months prior to Day 0 of Cycle 1.
    b. Is not within the targeted international normalized ratio at the time of consent signing.
    7. Has a current diagnosis, history, or risk of hemorrhage in the central nervous system (CNS), including the following:
    a. Patient with CNS metastasis treated by neurosurgical resection or brain biopsy performed within 8 weeks prior to Day 0 of Cycle 1.
    b. Patient should be off corticosteroids for at least 1 week
    (7 days) at the time of the post-treatment (for CNS metastasis) brain CT/MRI.
    8. Has any prior history of hypertensive crisis and/or
    hypertensive encephalopathy, or has a current diagnosis or
    recent history of inadequately controlled hypertension (defined as systolic blood pressure >150 mm Hg and/or diastolic >100 mm Hg, while on antihypertensive medications).
    9. Has a recent history of any of the following:
    a. A major surgical procedure, open biopsy, open pleurodesis, or significant traumatic injury within 28 days prior to Day 0 of Cycle 1.
    b. Documented history of conditions that may need surgery
    during the study or within 6 months of signing informed
    consent.
    c. Has had either a core biopsy or other minor surgical procedure within 7 days prior to Day 0 of Cycle 1. (Note: Placement of a vascular access device, or a closed pleurodesis, thoracentesis, or mediastinoscopy are allowed).
    10. Has a history of any of the following:
    a. Hemoptysis (approximately >2.5 mL or a half teaspoon)
    within 3 months prior to Day 0 of Cycle 1.
    b. A thoracic, central, mediastinal tumor location in contact with major vessels
    c. A cavitated lung tumor.
    11. Has a history of gastrointestinal fistula, perforation, or abscess.
    12. Has a current diagnosis or history of a nonhealing wound, active ulcer, or untreated bone fracture.
    13. Has prior history of another active malignancy within the last 5 years, other than adequately treated superficial basal cell, superficial/skin squamous cell carcinoma, or carcinomas in situ.
    14. Has a known hypersensitivity to any component of carboplatin, paclitaxel, bevacizumab, Chinese hamster ovary cell products, or other recombinant human or humanized antibodies.
    15. Has received treatment with any other investigational drug, within the last 30 days or at least 5 half-lives (if available), whichever is longer, should have elapsed prior to Day 0 of Cycle 1.
    16. Has previously received treatment with the following:
    a. Paclitaxel.
    b. Bevacizumab (Note: Prior intravitreal administration of
    bevacizumab does not preclude study participation).
    c. Anthracycline. (Note: May be allowed on a case by case basis after consulting with the medical monitor to rule out an
    increased risk of cardiac failure).
    17. Has documented or known current alcohol/drug abuse that precludes his/her ability to adhere to the protocol.
    18. Has any of the following concomitant treatments or conditions:
    a. Concomitant vaccination that contains an attenuated virus, for instance Yellow Fever vaccine.
    b. Has a known history of active or latent tuberculosis.
    c. Has a concomitant systemic disorder (e.g., active infection
    including known human immunodeficiency virus, viral
    hepatitis B or C) that, in the opinion of the principal
    investigator (PI; or designee), would compromise the patient's safety (for instance potential drug interactions, or ability to adhere to the protocol).
    d. Has any other concomitant condition that precludes the
    participation in the study through increased risk to the patient and/or potential to impact the PI’s (or designee’s) ability to administer this protocol.
    1 Paziente in gravidanza o allattamento.
    2 Presenta una diagnosi istologica/citologica che conferma una delle seguenti patologie:
    a.Carcinoma polmonare squamoso non a cellule piccole.
    b.Paziente con una qualsiasi istologia neuroendocrina a cellule piccole o grandi.
    3.È affetto da una condizione cardiaca recente (nei 6 mesi che precedono il Giorno 0 del Ciclo 1) definita di Classe II, III o IV dalla New York Heart Association
    4.Presenta un’anamnesi recente (nei 6 mesi che precedono il Giorno 0 del Ciclo 1) di un evento vascolare significativo (come ad esempio un aneurisma aortico che richiede una riparazione chirurgica o una trombosi recente a carico di arterie periferiche) e/o un’anamnesi di malattie vascolari significative e instabili.
    5.Presenta un’anamnesi di ictus o attacco ischemico transitorio recente nei 6 mesi che precedono il Giorno 0 del Ciclo 1 o un’anamnesi a lungo termine che comprende più di uno dei seguenti eventi tromboembolici vascolari:
    a.Incidenti cerebrovascolari
    b.Attacchi ischemici transitori
    c.Infarti miocardici
    d.Reazioni tromboemboliche venose, comprese embolie polmonari
    6.Assume una terapia anticoagulante che:
    a.Non è considerata “stabile”, definita come dosaggio non mantenuto per almeno 3 mesi prima del Giorno 0 del Ciclo 1.
    b.Non rientra nel rapporto internazionale normalizzato che si intende raggiungere al momento della firma del consenso.
    7.Presenta diagnosi in corso, anamnesi o rischio di emorragia a carico del sistema nervoso centrale (SNC), compresi i seguenti casi:
    a.Pazienti con metastasi nel SNC trattate con resezione chirurgica o con biopsia cerebrale effettuata nelle 8 settimane che precedono il Giorno 0 del Ciclo 1.
    b.Il paziente non dovrà assumere corticosteroidi per almeno 1 settimana (7 giorni) prima della TAC/RM cerebrale post-trattamento (per metastasi nel SNC).
    8.Presenta una qualsiasi anamnesi precedente di crisi ipertensiva e/o encefalopatia ipertensiva o possiede una diagnosi corrente o anamnesi recente di ipertensione non controllata adeguatamente (definita come pressione arteriosa sistolica >150 mmHg e/o diastolica >100 mmHg, mentre assume farmaci antipertensivi).
    9.Presenta un’anamnesi recente relativa a uno qualsiasi dei seguenti casi:
    a.Importante intervento chirurgico, biopsia a cielo aperto, pleurodesi a cielo aperto o una lesione traumatica significativa nei 28 giorni che precedono il Giorno 0 del Ciclo 1.
    b.Anamnesi documentata di condizioni che potrebbero richiedere un intervento chirurgico durante lo studio o nei 6 mesi che precedono la firma del consenso informato.
    c.Si è sottoposto a una biopsia percutanea o altra procedura chirurgica minore nei 7 giorni che precedono il Giorno 0 del Ciclo 1. (Nota: Sono consentiti il posizionamento di un dispositivo di accesso vascolare, pleurodesi chiusa, toracentesi o mediastinoscopia).
    10.Presenta un’anamnesi di una qualsiasi delle seguenti patologie:
    a.Emottisi (superiore a circa 2,5 ml) nei 3 mesi che precedono il Giorno 0 del Ciclo 1.
    b.Un tumore mediastinico localizzato a livello centrale nel torace a contatto con vasi maggiori
    c.Un tumore polmonare cavitato.
    11.Presenta un’anamnesi di fistole, perforazioni o ascessi gastrointestinali.
    12.Presenta una diagnosi corrente o anamnesi di ferite che non guariscono, ulcere attive o fratture ossee non trattate.
    13.Presenta un’anamnesi precedente di un altro tumore maligno attivo negli ultimi 5 anni diverso da carcinoma superficiale a cellule basali adeguatamente trattato, carcinoma superficiale/cutaneo a cellule squamose o carcinomi in situ.
    14.È affetto da una ipersensibilità nota a un qualsiasi componente di carboplatino, paclitaxel, bevacizumab, prodotti rilasciati da cellule ovariche di criceto cinese o altri anticorpi ricombinanti umani o umanizzati.
    15.Ha ricevuto un trattamento con qualsiasi altro farmaco sperimentale negli ultimi 30 giorni o almeno nelle ultime 5 emivite (se disponibili), a seconda di quale trattamento duri di più, che devono trascorrere prima del Giorno 0 del Ciclo 1.
    16.Ha ricevuto un precedente trattamento con uno dei seguenti farmaci:
    a.Paclitaxel.
    b.Bevacizumab (Nota: Una precedente somministrazione intravitreale di bevacizumab non preclude la partecipazione allo studio). c.Antraciclina.
    17.Presenta un abuso corrente di alcol/droghe documentato o noto che ne preclude la capacità di aderire al protocollo.
    18.Presenta uno qualsiasi dei seguenti trattamenti o condizioni concomitanti: a.Vaccinazione concomitante che contiene virus attenuati, come ad esempio il vaccino contro la febbre gialla. b.Presenta un’anamnesi nota di tubercolosi attiva o latente. c.È affetto da un disturbo sistemico concomitante (ad esempio un’infezione attiva, tra cui quella da virus dell’immunodeficienza umana, un’epatite virale B o C) che, secondo l’opinione dello sperimentatore comprometterebbe la sicurezza del paziente d.È affetto da qualsiasi altra condizione concomitante che preclude la partecipazione allo studio a causa di un elevato rischio.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint is the ORR
    L’endpoint primario di efficacia è il tasso di risposta globale (overall response rate, ORR)
    E.5.1.1Timepoint(s) of evaluation of this end point
    During first 18 weeks
    Durante le prime 18 settimane
    E.5.2Secondary end point(s)
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TPEfficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP
    PK Endpoints:
    PopPK measures of exposure of MYL-1402O and the reference product
    Avastin (e.g., AUC, Cmax, Cmin, CL, Vc, and the terminal elimination
    half-life).
    Safety Endpoints:
    ¿ Incidence, nature, and severity of AEs including adverse drug reactions
    graded according to CTCAE.
    ¿ Detection of antibodies to bevacizumab.
    Efficacy Endpoints:
    ¿ DCR (CR, PR, or stable disease)
    ¿ PFS
    ¿ OS
    ¿ DR
    ¿ TP



    PK Endpoints:
    PopPK measures of exposure of MYL-1402O and the reference product Avastin (e.g., AUC, Cmax, Cmin, CL, Vc, and the terminal elimination half-life).

    Safety Endpoints:

    ¿ Incidence, nature, and severity of AEs including adverse drug reactions graded according to CTCAE.
    ¿ Detection of antibodies to bevacizumab.; Endpoint di efficacia:
    ¿ Tasso di controllo della malattia (disease control rate, DCR) (risposta completa [complete response, CR], risposta parziale [partial response, PR] o malattia stabile [stable disease, SD])
    ¿ Sopravvivenza libera da progressione (progression-free survival, PFS)
    ¿ Sopravvivenza complessiva (overall survival, OS)
    ¿ Durata della risposta (duration of response, DR)
    ¿ Tempo alla progressione (time to progression, TP)
    Endpoint della farmacocinetica(pharmacokinetics, PK):
    Misure dell¿esposizione a MYL-1402O e al prodotto di riferimento avastin effettuate sulla popolazione PK (PopPK) (ad esempio area sotto la curva [area under the curve, AUC], concentrazione massima [Cmax], concentrazione minima [Cmin], clearance [CL], volume centrale di distribuzione [Vc] ed eliminazione terminale dell¿emivita).
    Endpoint di sicurezza:

    Incidenza, natura e gravit¿ degli eventi avversi (EA), comprese le reazioni avverse al farmaco classificate secondo i Criteri terminologici comuni per gli eventi avversi (Common Terminology Criteria for Adverse Events, CTCAE).
    Rilevamento degli anticorpi contro bevacizumab.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Endpoints will be assessed during the entire duration of the study in line
    with the protocol schedule of events.
    Endpoints will be assessed during the entire duration of the study in line with the protocol schedule of events.
    ; Gli endpoint saranno valutati durante l¿intera durata dello studio in linea con la programmazione degli eventi previsto dal protocollo.
    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 Yes
    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) 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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA50
    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
    Argentina
    Belarus
    Bosnia and Herzegovina
    Brazil
    Georgia
    India
    Indonesia
    Korea, Republic of
    Malaysia
    Mexico
    Russian Federation
    Thailand
    Turkey
    Ukraine
    Vietnam
    Bulgaria
    Croatia
    Hungary
    Italy
    Poland
    Romania
    Spain
    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 end of study will occur when any of the following conditions are first met: 15 months after randomization of the last patient, 250 death events recorded, all patients have discontinued the study, or administrative closing of study.
    La fine dello studio si verifica quando una delle seguenti condizioni si verifica per prima: 15 mesi dopo la randomizzazione dell'ultimo paziente, 250 eventi di morte registrati, tutti i pazienti hanno interrotto lo studio, o la chiusura amministrativa di studio.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months5
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months5
    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: 336
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 142
    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 state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 98
    F.4.2.2In the whole clinical trial 478
    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)
    Standard of Care and other treatment options deemed appropriate by
    the physician.
    Standard di cura e altre opzioni di trattamento considerate appropriate dal medico.
    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 Decision2016-12-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-12-22
    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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