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    Summary
    EudraCT Number:2016-000706-12
    Sponsor's Protocol Code Number:SUNNIFORECAST
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-09-10
    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 number2016-000706-12
    A.3Full title of the trial
    A Phase 2, Randomized, Open-Label Study of Nivolumab Combined with Ipilimumab Versus Sunitinib Monotherapy in Subjects with Previously Untreated and Advanced (unresectable or metastatic) non-clear Cell Renal Cell Carcinoma
    Studio randomizzato aperto di Fase II che monitora la somministrazione di Nivolumab in combinazione con Ipilimumab rispetto alla monoterapia Sunitinib in soggetti con avanzato carcinoma renale a cellule non-chiare non precedentemente trattato (non resecabile o metastatico).
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2, Randomized, Open-Label Study of Nivolumab Combined with Ipilimumab Versus Sunitinib Monotherapy in Subjects with Previously Untreated and Advanced (unresectable or metastatic) non-clear Cell Renal Cell Carcinoma
    Studio randomizzato aperto di Fase II che monitora la somministrazione di Nivolumab in combinazione con Ipilimumab rispetto alla monoterapia Sunitinib in soggetti con avanzato carcinoma renale a cellule non-chiare non precedentemente trattato (non resecabile o metastatico).
    A.3.2Name or abbreviated title of the trial where available
    SUNNIFORECAST
    SUNNIFORECAST
    A.4.1Sponsor's protocol code numberSUNNIFORECAST
    A.5.4Other Identifiers
    Name:SUNNIFORECASTNumber:SUNNIFORECAST
    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 SponsorGOETHE UNIVERSITY FRANKFURT
    B.1.3.4CountryGermany
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportGoethe University Frankfurt
    B.4.2CountryGermany
    B.4.1Name of organisation providing supportBristol-Myers-Squibb
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGoethe University Frankfurt
    B.5.2Functional name of contact pointDr. Nicola Goekbuget
    B.5.3 Address:
    B.5.3.1Street AddressTHEODOR-W.-ADORNO-PLATZ
    B.5.3.2Town/ cityFrankfurt
    B.5.3.3Post code60323
    B.5.3.4CountryGermany
    B.5.4Telephone number0049 69 6301 6366
    B.5.5Fax number0049 69 6301 7463
    B.5.6E-mailgoekbuget@em.uni-frankfurt.de
    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 OPDIVO - 10 MG/ML- CONCENTRATO PER SOLUZIONE PER INFUSIONE- USO ENDOVENOSO- FLACONCINO (VETRO)- 10 ML- 1 FLACONCINO
    D.2.1.1.2Name of the Marketing Authorisation holderBRISTOL-MYERS SQUIBB PHARMA EEIG
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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.3.11 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) Yes
    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 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 YERVOY - 5 MG/ML - CONCENTRATO PER SOLUZIONE PER INFUSIONE - USO ENDOVENOSO - FLACONCINO (VETRO) - 40 ML 1 FLACONCINO
    D.2.1.1.2Name of the Marketing Authorisation holderBRISTOL-MYERS SQUIBB PHARMA EEIG
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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.3.11 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) Yes
    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 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 SUTENT - 50 MG CAPSULE 30 CAPSULE
    D.2.1.1.2Name of the Marketing Authorisation holderPFIZER LIMITED
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    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 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
    The primary objective of the study is to compare the of OS rate at 12 months of Nivolumab combined with Ipilimumab to Sunitinib monotherapy in patients with previously untreated and advanced non-clear cell
    RCC.
    L’obiettivo primario di questo studio è di confrontare la quota di sopravvivenza globale a 12 mesi con Nivolumab in combinazione con Ipilimumab rispetto alla monoterapia Sunitinib in soggetti con avanzato carcinoma renale a cellule non-chiare non precedentemente trattato (non resecabile o metastatico).
    E.1.1.1Medical condition in easily understood language
    Survival of patients with kidney cancer.
    Sopravvivenza di soggetti con cancro ai reni
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10038415
    E.1.2Term Renal cell carcinoma stage unspecified
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to compare the OS rate at 12 month of Nivolumab combined with Ipilimumab to Sunitinib monotherapy in patients with previously untreated and advanced non-clear cell RCC.
    L’obiettivo primario di questo studio è di confrontare la quota di sopravvivenza globale a 12 mesi con Nivolumab in combinazione con Ipilimumab rispetto alla monoterapia Sunitinib in soggetti con avanzato carcinoma renale a cellule non-chiare non precedentemente trattato (non resecabile o metastatico).
    E.2.2Secondary objectives of the trial
    • To compare the OS rate at 12 months of Nivolumab combined with Ipilimumab to Sunitinib monotherapy in patients with previously untreated and advanced non-clear cell RCC (ncRCC) in relation to histological subgroups
    • To compare the OS rate at 6 and 18 months of Nivolumab combined with Ipilimumab to Sunitinib monotherapy in previously untreated and advanced ncRCC.
    • Duration of reponse (DOR) for both arms and subgroups
    • To compare the PFS (Progression Free Survival) of Nivolumab combined with Ipilimumab to Sunitinib monotherapy with previously untreated metastatic ncRCC.
    • To compare the median OS of Nivolumab combined with Ipilimumab to Sunitinib monotherapy in subjects with previously untreated metastatic ncRCC (based on hazard ratio)
    • To estimate the objective response rate (ORR) of Nivolumab combined with Ipilimumab to Sunitinib monotherapy in subjects with previously untreated mRCC
    • Confrontare la quota di sopravvivenza globale del trattamento Nivolumab in combinazione con Ipilimumab (N+I) rispetto alla monoterapia Sunitinib (S) a 12 mesi in soggetti con avanzato carcinoma renale a cellule non-chiare (ncRCC) non precedentemente trattato in relazione ai sottogruppi istologici.
    • Confrontare la quota di sopravvivenza globale del trattamento N+I rispetto alla monoterapia S a 6 e 18 mesi in pazienti con ncRCC non precedentemente trattati.
    • La durata della risposta per i due rami e sottogruppi.
    • Confrontare la sopravvivenza libera da progressione del trattamento N+I rispetto alla monoterapia S con ncRCC metastatiche non precedentemente trattati.
    • Confrontare la sopravvivenza globale mediana di N+I rispetto alla monoterapia S in soggetti con ncRCC metastatiche non precedentemente trattati (basato sull’hazard ratio).
    • Stimare la quota di risposta obiettiva di N+I rispetto alla monoterapia S in soggetti con ncRCC metastatiche non precedentemente trattati.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Signed Written Informed Consent
    a) Subjects must have signed and dated an IRB/IEC approved written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol related procedures that are not part of normal subject care.
    b) Subjects must be willing and able to comply with scheduled visits, treatment schedule, laboratory testing, and other requirements of the study.
    2. Target Population
    a) Histological confirmation of non-clear RCC with at least 50% non-clear cell component according to actual WHO classification36
    b) Advanced (not amenable to curative surgery or radiation therapy) or metastatic (AJCC Stage IV) RCC
    c) Karnofsky > 70% (See Appendix 2, 14.2)
    d) Measurable disease as per RECIST v 1.1 (See Appendix 3, 14.3) documented by an English radiology report
    e) Tumor tissue (FFPE archival or recent acquisition) must be available and sent to the central pathological reviewer (see Table 6) in order to confirm the diagnosis. (Note: Fine Needle Aspiration [FNA] and bone metastases samples are not acceptable for submission).
    f) Patients with all risk categories will be eligible for the study. Patients will be stratified for papillary or non-papillary non-clear cell histology and IMDC risk score Patients will be categorized according to favorable versus intermediate versus poor risk status at registration according to the International Metastatic RCC Database Consortium (IMDC) criteria:
    i. KPS equal to 70%
    ii. Less than 1 year from diagnosis to randomization
    iii. Hemoglobin less than the lower limit of normal (LLN)
    iv. Corrected calcium concentration greater than the upper limit of normal (ULN)
    v. Absolute neutrophil count greater than the ULN
    vi. Platelet count greater than the ULN
    If none of the above factors are present, subjects are only eligible for the favorable-risk cohort, if 1-2 factors are present subjects are catogerized as intermediate risk and > 3 factors as poor risk.
    3. Age and Reproductive Status
    a) Males and Females, ¿ 18 years of age
    b) WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the start of study drug.
    c) Women must not be breastfeeding
    d) WOCBP must agree to follow instructions for a period of 30 days (duration of ovulatory cycle) plus the time required for the investigational drug to undergo five half-lives. The terminal half-lives of Nivolumab and Ipilimumab are up to 25 days and 18 days, respectively. The terminal half-life of the active metabolite of Sunitinib is up to 110 hours.
    i. WOCBP randomized to receive Nivolumab + Ipilimumab should use an adequate method to avoid pregnancy for 23 weeks (30 days plus the time required for Nivolumab to undergo five half-lives) after the last dose of investigational drug.
    ii. WOCBP randomized to receive Sunitinib should use an adequate method to avoid pregnancy for 8 weeks (30 days plus the time required for the active metabolite of Sunitinib to undergo five half-lives)
    e) Males who are sexually active with WOCBP must agree to follow instructions for method(s) of contraception for a period of 90 days (duration of sperm turnover) plus the time required for the investigational drug to undergo five half-lives. The terminal half lives of Nivolumab and Ipilimumab are up to 25 days and 18 days, respectively. The terminal half-life of the active metabolite of Sunitinib is up to 110 hours.
    i. Males randomized to receive Nivolumab combined with Ipilimumab who are sexually active with WOCBP must continue contraception for 31 weeks (90 days plus the time required for Nivolumab to undergo five half-lives) after the last dose of investigational drug.
    ii. Males randomized to receive Sunitinib who are sexually active with WOCBP must continue contraception for 16 weeks (90 days plus the time required for the active metabolite of Sunitinib to undergo five half-lives) after the last dose of investigational drug.
    f) Azoospermic males and WOCBP who are continuously not heterosexually active are exempt from contraceptive requirements. However they must still undergo pregnancy testing as described in this section.
    1. Consenso informato scritto firmato
    a. Soggetti devono aver’ datato e firmato il consenso informato scritto approvato da IRB/IEC in conformità delle linee-guida istituzionali e regolamentari. Questo deve essere ottenuto prima di qualsiasi procedura correlato al protocollo diverso dell’assistenza regolare del soggetto.
    b. Soggetti devono essere idoneo e disposto di rispettare il programma di visite, trattamenti, test di laboratori e altre necessità dello studio.
    2. Popolazione Target
    a. Conferma istologica del RCC non-chiaro con la parte non-chiaro di almeno 50% secondo la classificazione attuale del WHO.
    b. RCC avanzato (non adatti all’intervento chirurgico o radio-terapia) o metastatico (AJCC stadio IV).
    c. Karnofsky > 70% (vedi appendice 2, 14.2)
    d. Malattia misurabile come previsto da RECIST v1.1 (vedi appendice 3, 14.3) documentato da una relazione radiologica in Inglese.
    e. Il Tessuto tumorale (FFPE d’archivio o acquisizione recente) deve essere disponibile e mandato al reviewer di patologia centrale (vedi tabella 6) per confermare la diagnosi. (Nota: Ago-aspirazione e campioni di metastasi ossee non sarebbero accettabili per la sottomissione).
    f. Pazienti in tutte le categorie di rischio saranno idonei per lo studio. Pazienti saranno stratificati per l’istologia di cellule non-chiare papillare e non-papillare e pazienti del punteggio di rischio IMDC saranno categorizzati secondo il livello di rischio favorevole versus intermedio versus povero al momento della registrazione secondo i criteri dell’International Metastatic RCC Database Consortium (IMDC):
    i. KPS uguale 70%
    ii. Meno di 1 anno dalla diagnosi alla randomizzazione
    iii. Emoglobina meno del limite basso del normale (LBN)
    iv. Concentrazione corretta del calcio più alta del limite massima del normale (LMN)
    v. Conteggio Neutrofili assoluti più alto del LMN.
    vi. Conteggio Piastrini più alto del LMN
    Se nessuno dei fattori di sopra è presente, soggetti sono ammissibili per la coorte a rischio favorevole, se 1-2 dei fattori sono presente, soggetti sono ammissibili per la coorte a rischio intermedio e = 3 fattori a rischio povero.
    3. Età e status riproduttivo
    a. Maschio e Femmina, = 18 anni di età.
    b. Donne in età fertile (DIEF) devono essere negative in un test di siero o urina di gravidanza (sensitività minima 25 IU/L o unita equivalente di HCG) entro 24 ore prima dello start del farmaco.
    c. Donne non devono essere in un periodo di allattamento.
    d. DIEF devono accettare di seguire le istruzioni dei metodi contraccettivi per un periodo di 30 giorni (durata del ciclo ovulatorio) più il tempo necessario per il farmaco sperimentale di effettuare cinque emivite. L’emivita terminale di Nivolumab e Ipilimumab è fino a 25 giorni e 18 giorni, rispettivamente. L’emivita terminale del metabolita attiva di Sunitinib è fino a 110 ore.
    i. DIEF randomizzate per ricevere Nivolumab + Ipilimumab dovrebbero usare un metodo adeguato per evitare la gravidanza per 23 settimane (30 giorni più il tempo necessario per Nivolumab di effettuare cinque emivite) dopo l’ultima dose del farmaco sperimentale.
    ii. DIEF randomizzate per ricevere Sunitinib dovrebbero usare un metodo adeguato per evitare la gravidanza per 8 settimane (30 giorni più il tempo necessario per Sunitinib di effettuare cinque emivite).
    e. Maschi che sono sessualmente attivi con DIEF devono accettare di seguire le istruzioni dei metodi contraccettivi per un periodo di 90 giorni (la durata del turnover dello sperma) più il tempo necessario del farmaco sperimentale di effettuare cinque emivite. L’emivita terminale di Nivolumab e Ipilimumab è fino a 25 giorni e 18 giorni, rispettivamente. L’emivita terminale del metabolita attiva di Sunitinib è fino a 110 ore.
    i. Maschi randomizzati per ricevere Nivolumab in combinazione con Ipilimumab che sono sessualmente attivi con DIEF devono continuare la contraccezione per 31 settimane (90 giorni più il tempo necessario per Nivolumab di effettuare cinque emivite) dopo l’ultima dose del farmaco sperimentale.
    ii. Maschi randomizzati per ricevere Sunitinib che sono sessualmente attivi con DIEF devono continuare la contraccezione per 16 settimane (90 giorni più il tempo necessario per il metabolita attiva di Sunitinib di effettuare cinque emivite) dopo l’ultima dose del farmaco sperimentale.
    f. Maschi azoospermi e DIEF che non sono continuamente etero sessualmente attive sono liberati dall’uso di metodi contraccettivi. Però le DIEF devono lo stesso sottoporsi al test di gravidanza descritto in questa sezione.
    E.4Principal exclusion criteria
    • Any active brain metastases requiring systemic corticosteroids. Baseline imaging of the brain by MRI is required in patients with clinical signs of potential CNS involvement within 28 days prior to randomization.
    • Tumors with a clear-cell component of > 50%.
    • Prior systemic treatment with VEGF or VEGF receptor targeted therapy (including, but not limited to, Sunitinib, pazopanib, axitinib, tivozanib, and bevacizumab) or prior treatment with an mTOR inhibitor or cytokines.
    • Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti CTLA 4 antibody, or antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways.
    • Any active or recent history of a known or suspected autoimmune disease or recent history of a syndrome that required systemic corticosteroids (> 10 mg daily prednisone equivalent) or immunosuppressive medications except for syndromes which would not be expected to recur in the absence of an external trigger. Subjects with vitiligo or type I diabetes mellitus or residual hypothyroidism due to autoimmune thyroiditis only requiring hormone replacement are permitted to enroll.
    • Any condition requiring systemic treatment with corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days prior to first dose of study drug. Inhaled steroids and adrenal replacement steroid doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
    • Uncontrolled adrenal insufficiency.
    • Ongoing symptomatic cardiac dysrhythmias, uncontrolled atrial fibrillation, or prolongation of the Fridericia corrected QT (QTcF) interval defined as > 450 msec for males and > 470 msec for females, where QTcF = QT / 3vRR.
    • Poorly controlled hypertension (defined as systolic blood pressure of ¿ 150 mmHg or diastolic blood pressure of ¿ 90 mmHg), despite antihypertensive therapy.
    • History of any of the following cardiovascular conditions within 12 months of enrollment: cardiac angioplasty or stenting, myocardial infarction, unstable angina, coronary artery by-pass graft surgery, symptomatic peripheral vascular disease, class III or IV congestive heart failure (New York Heart Association).
    • History of cerebrovascular accident including transient ischemic attack within the past 12 months.
    • History of deep vein thrombosis unless adequately treated with low molecular weight heparin.
    • History of pulmonary embolism within the past 6 months unless stable, asymptomatic, and treated with low molecular weight heparin for at least 6 weeks.
    • History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months.
    • Serious, non-healing wound or ulcer.
    • Evidence of active bleeding or bleeding susceptibility; or medically significant hemorrhage within prior 30 days.
    • Any requirement for anti-coagulation, except for low molecular weight heparin.
    • Prior malignancy active within the previous 3 years except for locally curable cancers that have been apparently cured, such as basal or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the prostate, cervix, or breast.
    • Known history of testing positive for human immunodeficiency virus or known acquired immunodeficiency syndrome.
    • Any positive test for hepatitis B or hepatitis C virus indicating acute or chronic infection.
    • Known medical condition (condition associated with diarrhea or acute diverticulitis) that, in the investigator’s opinion, would increase the risk associated with study participation or study drug administration or interfere with the interpretation of safety results.
    • Major surgery (eg, nephrectomy) less than 28 days prior to the first dose of study drug.
    • Anti-cancer therapy less than 28 days prior to the first dose of study drug or palliative, focal radiation therapy less than 14 days prior to the first dose of study drug.
    • Receiving concomitant CYP3A4 inducers or strong CYP3A4 inhibitors.
    • Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of Sunitinib (malabsorptive disorder, ulcerative disease, uncontrolled nausea, vomiting, diarrhea, or small bowel resection).
    • Hypersensitivity to sunitinib or any of the excipients.
    • Left ventricular ejection fraction less than the LLN as assessed by echocardiography or multigated acquisition (MUGA) scan.
    • Any of the following laboratory test findings:
    WBC < 2,000/mm3.
    Neutrophils < 1,500/mm3.
    Platelets < 100,000/mm3.
    AST or ALT > 3 x ULN (> 5 x ULN if liver metastases are present).
    Total Bilirubin > 1.5 x ULN (except subjects with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL).
    Serum creatinine > 1.5 x ULN or creatinine clearance < 40 mL/min (measured or calculated by Cockroft-Gault formula).
    • History of severe hypersensitivity reaction to any monoclonal antibody.
    • Subjects who are incompetent to understand and sign the informed consent.
    • Qualsiasi metastasi attivi al cervello, che richiedono corticosteroide sistemico. Immagini baseline del cervello generati dal MRI sono richieste entro 28 giorni prima della randomizzazione in pazienti con segni clinici di un coinvolgimento potenziale del sistema nervoso centrale (SNC).
    • Tumori con una parte di cellule non-chiare = 50%.
    • Trattamento sistemico precedente con terapia che mira VEGF o VEGF recettore (incluso ma non limitato a Sunitinib, pazopanib, axitinib, tivozanib e bevacizumab) o trattamento precedente con inibitore mTOR o citochine.
    • Trattamento precedente con anticorpi anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti CTLA 4 o qualsiasi anticorpo o farmaco the mira specificamente T-cell costimulazione o pathways di controllo.
    • Qualsiasi storia attiva o recente di una malattia autoimmune nota o sospettata o storia recente di una sindrome che richiede corticosteroide sistemico (equivalente a > 10 mg prednisone al giorno) o medicamenti immunosoppressivi eccetto sindromi che non si aspettano di recidivare in assenza di un trigger esterno. Soggetti con vitiligine o diabete mellito tipo I o ipotiroidismo residuo a causa di tiroiditi autoimmuni che richiedono solamente terapie sostitutive di ormoni sono consentiti all’arruolamento.
    • Qualsiasi condizione che richiede un trattamento sistemico con corticosteroide (> 10 mg prednisone equivalenti al giorno) o altri medicamenti immunosoppressivi entro 14 giorni prima della prima dose del farmaco sperimentale. Steroidi inalati e steroidi di sostituzione surrenali con la dose > 10 mg prednisone equivalenti al giorno sono permessi in assenza di una malattia autoimmune.
    • Insufficienza surrenale non controllata.
    • Costante aritmia cardiaca sintomatica, fibrillazione atriale incontrollata, o prolungamento dell’intervallo Fridericia corretto QT (QTcF) definito come > 450 msec per maschi e > 470 msec per femmine, dove QTcF = QT / 3vRR.
    • Ipertensione malamente controllata (definito come pressione sanguigna sistolica (PSS) di = 150 mmHg o pressione sanguigna diastolica (PSD) di = 90 mmHg), nonostante terapia antiipertensiva.
    • Storia di qualsiasi seguenti condizioni cardiovascolare entro 12 mesi di arruolamento: angioplastica cardiaca o stenting, l’infarto miocardio, angina instabile, l’impianto di bypass arterioso coronarico, malattia vascolare periferica sintomatica, insufficienza cardiaca congestizia classe III o IV, come definito da New York Heart Association.
    • Storia di un accidente cerebrovascolare incluso attacco ischemico transitorio entro gli ultimi 12 mesi.
    • Storia di trombosi venosa profonda salvo che trattato adeguatamente con eparina a basso peso molecolare.
    • Storia di embolia polmonare entro gli ultimi 6 mesi salvo che stabile, asintomatico e trattato con eparino a basso peso molecolare per almeno 6 settimane.
    • Storia di fistola addominale, perforazione gastrointestinale, o accesso intra-addominale entro gli ultimi 6 mesi.
    • Gravi lesioni che non guariscono o l’ulcera.
    • Prove di sanguinamento attivo o suscettibilità di sanguinamento, o emorragie medicalmente significativi entro primi 30 giorni.
    • Qualsiasi necessità per anti-coagulazione, eccetto eparina a basso peso molecolare.
    • Malignità attiva precedente entro i 3 anni precedenti eccetto cancro curabile localmente che sono stati apparentemente curati, come cancro cutaneo a cellule basali o cellule squamose, cancro superficiale della vescica o carcinoma in situ della prostata, cervice uterina o mammella.
    • Storia nota di positività per il virus dell’immunodeficienza umana (HIV) o sindrome d’immunodeficienza acquisita (AIDS).
    • Qualsiasi test positivo per epatite B o epatite C che indica infezione acuta o cronica.
    • Condizioni mediche note (per esempio condizioni associati a diarrea o diverticolite acuta) che, nel parere dell’investigatore, potrebbero aumentare il rischio associato con la partecipazione allo studio clinico o somministrazione del farmaco sperimentale o che potrebbe interferire col’ interpretazione dei risultati nel campo della sicurezza.
    • Interventi chirurgici maggiori (per esempio nefrectomia) meno di 28 giorni prima della prima dose del farmaco sperimentale.
    • Terapia anti-cancro meno di 28 giorni prima della prima dose del farmaco sperimentale o radioterapia palliativa focale meno di 14 giorni prima della prima dose del farmaco sperimentale.
    • Ricevente di CYP3A4 induttori o forti CYP3A4 inibitori in concomitanza (vedi Appendice 4, 14.4).
    • Deterioramento della funzione gastrointestinale o malattia gastrointestinale che potrebbe alterare significativamente l’assorbimento di Sunitinib (per esempio disturbi di malassorbimento, malattia ulcerosa, nausea incontrollata, vomito, diarrea, resezione dell'intestino tenue).
    • Ipersensitivita’ a Sunitinib o degli eccipienti.

    Non tutti criteri di esclusione descritti nel protocollo possono essere elencati qui a causa di mancato spazzio (vedi Protocollo V2.0 (03.01.2017), pagine 35-37).
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint of this study is the overall survival rate at 12 months (OS12) (landmark).
    L´endpoint primario di questo studio clinico è la quota di sopravvivenza globale a 12 mesi (OS12) (punto di riferimento).
    E.5.1.1Timepoint(s) of evaluation of this end point
    12 months after start of treatment of patient.
    12 mesi dopo l’inizio del trattamento del paziente.
    E.5.2Secondary end point(s)
    1. OS rate at 6 and 18 months in overall population and histological and prognostic subgroups.
    2. Overall survival (OS)
    3. Progression-free survival (PFS)
    4. Objective response rate (ORR)
    5. Safety/tolerability
    6. Quality of Life (QoL) as assessed by FKSI-DRS questionnaire
    1. La quota di sopravvivenza globale a 6 e a 18 mesi nella popolazione complessiva e nei sottogruppi istologici e prognostici.
    2. Sopravvivenza globale (OS).
    3. Sopravvivenza libera da progressione della malattia (PFS).
    4. Quota di risposta obiettiva (ORR).
    5. Sicurezza e tollerabilità.
    6. Qualità di vita (QoL) valutato con questionario FKSI-DRS (Functional Assessment of Cancer Therapy-Kidney Symptom Index).
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. 6 and 18 month after time of randomization
    2. Overall survival is defined as the time from randomization to the date of death from any cause
    3. Time between the date of randomization and the first date of documented progression, based on IRRC assessment (as per RECIST 1.1 criteria), or death due to any cause, whichever occurs first.
    4. Objective response rate
    5. Safety and tolerability during the whole time
    6. Quality of life will be assessed by the FKSI-DRS questionnaire before start of therapy, after induction phase, after 3 months, after 12 months and after 18 months.
    1. 6 e 18 mesi dopo il tempo di randomizzazione
    2. La sopravvivenza è definita come intervallo dal tempo di randomizzazione alla data di morte per qualsiasi causa.
    3. Sopravvivenza libera da progressione della malattia e definita come intervallo dal tempo di randomizzazione alla prima data di progressione della malattia documentata sulla base della valutazione RECIST o alla morte per qualsiasi causa.
    4. Quota di risposta obiettiva (ORR).
    5. Sicurezza e tollerabilità per tutto il tempo.
    6. La qualità della vita sarà valutata con il questionario FKSI-DRS prima della terapia e dopo la fase d’induzione dopo 3, 12 e 18 mesi.
    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 No
    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 Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    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) Yes
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    Sunitinib
    Sunitinib
    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 EEA51
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    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 study will end 18 month after the last patient is in.
    La sperimentazione sara' finito 18 mesi dopo l'ultimo paziente e' stato aruollato.
    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 months9
    E.8.9.1In the Member State concerned days1
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months9
    E.8.9.2In all countries concerned by the trial days1
    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: 300
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 6
    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 state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 306
    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)
    The study drug (nivolumab and ipilimumab) is supplied by Bristol- Myers-Squibb (BMS). After the end of the study, subjects who continue to demonstrate clinical benefit will be eligible to receive BMS supplied study drug. Study drug will be provided through another mechanism at the discretion of BMS.
    Il farmaco sperimentale (nivolumab and ipilimumab) e’ fornito da Bristol-Myers-Squibb (BMS). Dopo la fine dello studio, i soggetti che continuano a dimostrare un benefit clinico, avranno il diritto di ricevere il farmaco sperimentale fornito da BMS. Il farmaco sperimentale sara’ fornito tramite un meccanismo alternativo a discrezione di BMS.
    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 Decision2017-09-15
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-05-08
    P. End of Trial
    P.End of Trial StatusOngoing
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