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    Summary
    EudraCT Number:2016-001271-68
    Sponsor's Protocol Code Number:AP32788-15-101
    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:2021-01-26
    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 number2016-001271-68
    A.3Full title of the trial
    A Phase 1/2 Study of the Safety, Pharmacokinetics, and Anti-Tumor Activity of the Oral EGFR/HER2 Inhibitor TAK-788 (AP32788) in Non-Small Cell Lung Cancer
    Studio di fase 1/2 volto a valutare la sicurezza, la farmacocinetica e l’attività antitumorale di TAK-788 (AP32788), un inibitore orale di EGFR/HER2 nel carcinoma polmonare non a piccole cellule
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    TAK-788 (AP32788) in Patients With Non-Small Cell Lung Cancer
    TAK-788 (AP32788) in Pazienti con carcinoma polmonare non a piccole cellule
    A.3.2Name or abbreviated title of the trial where available
    na
    na
    A.4.1Sponsor's protocol code numberAP32788-15-101
    A.5.3WHO Universal Trial Reference Number (UTRN)U1111-1217-7205
    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 SponsorMILLENNIUM PHARMACEUTICALS, INC.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMillennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMillennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
    B.5.2Functional name of contact pointStudy Registration Call Center
    B.5.3 Address:
    B.5.3.1Street Address40 Landsdowne Street
    B.5.3.2Town/ cityCambridge
    B.5.3.3Post codeMA 02139
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018668352233
    B.5.6E-mailGlobalOncologyMedinfo@takeda.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 nameTAK-788
    D.3.2Product code [TAK-788 (formerly AP32788)]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.9.1CAS number 1847461-43-1
    D.3.9.2Current sponsor codeTAK-788
    D.3.9.3Other descriptive nameAP32788
    D.3.9.4EV Substance CodeSUB195427
    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.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
    Non-Small Cell Lung Cancer (NSCLSC)
    Carcinoma polmonare non a piccole cellule
    E.1.1.1Medical condition in easily understood language
    Non-Small Cell Lung Cancer (NSCLSC)
    Carcinoma polmonare non a piccole cellule
    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 PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10029521
    E.1.2Term Non-small cell lung cancer stage IIIB
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10029522
    E.1.2Term Non-small cell lung cancer stage IV
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10059515
    E.1.2Term Non-small cell lung cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10025054
    E.1.2Term Lung cancer non-small cell stage IIIB
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    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 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To determine the efficacy of TAK-788, as evidenced by confirmed ORR, as assessed by the IRC, in patients with locally advanced or metastatic NSCLC harboring EGFR in-frame exon 20 insertion mutations and who have received at least 1 prior line of therapy for locally advanced or metastatic NSCLC.
    Determinare l’efficacia di TAK-788, come evidenziato dall’ORR confermato, secondo la valutazione dell’IRC, in pazienti affetti da NSCLC localmente avanzato o metastatico con mutazioni in frame di inserzione nell’esone 20 di EGFR e che hanno ricevuto almeno 1 terapia di prima linea per NSCLC localmente avanzato o metastatico.
    E.2.2Secondary objectives of the trial
    1. To further characterize the efficacy of TAK-788 as shown by confirmed ORR, as assessed by the investigator, duration of response, progression free survival (PFS), disease control rate (DCR), time to response, and overall survival (OS)
    2. To assess the safety and tolerability of TAK-788
    3. To collect sparse plasma concentration-time data of TAK 788 and its active metabolites, AP32960 and AP32914, to contribute to population PK and exposure response analyses
    4. To assess change from baseline in overall global quality of life (the Global Health Status/QoL Scale) with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and change from baseline in the Dyspnea Scale, based on the EORTC lung cancer module QLQ LC13
    1. Caratterizzare ulteriormente l’efficacia di TAK-788, come dimostrato dall’ORR confermato, secondo la valutazione dello sperimentatore, la durata della risposta, la sopravvivenza libera da progressione (progression-free survival, PFS), il tasso di controllo della malattia (disease control rate, DCR), il tempo alla risposta e la sopravvivenza complessiva (overall survival, OS)
    2. Valutare la sicurezza e la tollerabilità di TAK-788
    3. Raccogliere dati sul rapporto concentrazione-tempo per campioni residui di plasma e dei suoi metaboliti attivi, AP32960 e AP32914, per contribuire alle analisi di farmacocinetica (PK) della popolazione e di esposizione-risposta
    4. Valutare la variazione dal basale della qualità della vita globale (Global Health Status/QoL Scale) con il Questionario sulla qualità della vita (QLQ)-C30 della European Organisation for Research and Treatment of Cancer (EORTC) e la variazione rispetto al basale sulla Dyspnea Scale, in base
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Have histologically or cytologically confirmed locally advanced (and not a candidate for definitive therapy) or metastatic disease (Stage IIIB or IV). For all cohorts except Expansion Cohort 7, the locally advanced or metastatic disease is NSCLC. 2.Must have sufficient tumor tissue available for analysis (see Study Reference Manual for specific requirements). For patients in the expansion cohorts and in the extension cohort, tumor tissue obtained after progression on the most recent prior therapy is preferred. 3.Must have measurable disease by RECIST v1.1 (Appendix B).4.Male or female patients =18 years old. For patients in Japan, aged =20 years.5.Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (Appendix A). 6.Minimum life expectancy of 3 months or more.7.Adequate renal and hepatic function as defined by the following criteria:
    a.Total serum bilirubin =1.5 × upper limit of normal (ULN) (=3.0 × ULN for patients with Gilbert syndrome or if liver function abnormalities are due to underlying malignancy);b.Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =2.5 × ULN (or =5 × ULN if liver function abnormalities are due to underlying malignancy);c.Estimated creatinine clearance =30 mL/min (calculated by using the Cockcroft-Gault equation);d.Serum albumin =2 g/dL; and e.Serum lipase/amylase =1.5 × ULN. 8.Adequate bone marrow function as defined by the following criteria: a.Absolute neutrophil count (ANC) =1.5 × 109/L; b.Platelet count =75 × 109/L; and c.Hemoglobin =9.0 g/dL. 9.Normal QT interval on screening electrocardiogram (ECG), defined as QTcF of =450 ms in males or =470 ms in females. 10.All toxicities from prior therapy have resolved to = grade 1 according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v5.0 [18]), or have resolved to baseline, at the time of first dose of TAK 788. Note: treatment-related grade >1 alopecia or treatment-related grade 2 peripheral neuropathy are allowed if deemed irreversible. 11.Female patients who: •Are postmenopausal for at least 1 year before the screening visit, OR •Are surgically sterile, OR •If they are of childbearing potential, agree to practice 1 highly effective, nonhormonal method of contraception and 1 additional effective (barrier) method at the same time, from the time of signing the informed consent through 30 days after the last dose of study drug, OR •Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
    Male patients, even if surgically sterilized (ie, status postvasectomy), who: •Agree to practice effective barrier contraception during the entire study treatment period and through 30 days after the last dose of study drug, OR •Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
    Extension Phase specific
    1.Have a documented EGFR in-frame exon 20 insertion (including A763_Y764insFQEA, V769_D770insASV, D770_N771insNPG, D770_N771insSVD, H773_V774insNPH, or any other in-frame exon 20 insertion mutation) by a local test and sufficient tumor tissue available for central analysis (see Study Reference Manual). The EGFR exon 20 insertion mutation can be either alone or in combination with other EGFR or HER2 mutations. Note: central confirmation is not required for enrollment.
    1. Conferma istologica o citologica di malattia localmente avanzata (e non candidato a terapia definitiva) o metastatica (stadio IIIB o IV). Per tutte le coorti, fatta eccezione per la coorte di espansione 7, la malattia localmente avanzata o metastatica è NSCLC. 2. Presenza di tessuto tumorale disponibile sufficiente per l’analisi (vedere Manuale di riferimento dello studio per i requisiti specifici). Per i pazienti nelle coorti di espansione e nella coorte di estensione, è preferibile il tessuto tumorale ottenuto dopo la progressione durante la terapia precedente più recente. 3. Presenza di malattia misurabile in base ai criteri RECIST v1.1 (Appendice B).4. Pazienti di entrambi i sessi di età =18 anni. Per i pazienti in Giappone, età =20 anni.5. Stato di performance secondo l’Eastern Cooperative Oncology Group (ECOG) da 0 a 1 (Appendice A).6. Aspettativa minima di vita di 3 mesi o maggiore.7. Adeguata funzionalità epatica e renale, come definita dai seguenti criteri:a. bilirubina sierica totale =1,5 × limite superiore della norma (ULN) (=3,0 x ULN per i pazienti con sindrome di Gilbert o se le anomalie della funzionalità epatica derivano dalla malignità sottostante);
    b. alanina aminotransferasi (ALT) e aspartato aminotransferasi (AST) =2,5 × ULN (o =5 × ULN se le anomalie della funzionalità epatica derivano dalla malignità sottostante);c. clearance della creatinina stimata =30 mL/min (calcolata secondo l’equazione di Cockcroft-Gault);d. albumina sierica =2 g/dL; e e. amilasi/lipasi sierica =1,5 × ULN. 8. Adeguata funzionalità del midollo osseo, come definita dai seguenti criteri: a. conta assoluta dei neutrofili (ANC) =1,5 × 109/l;b. conta piastrinica =75 × 109/L; e c. emoglobina =9,0 g/dL. 9. Intervallo QT normale all’elettrocardiogramma (ECG) di screening, definito come QTcF di =450 ms negli uomini o =470 ms nelle donne. 10. Tutte le tossicità da una precedente terapia risolte a un grado = 1 secondo il National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v 5.0 [18]) o risolte al basale, al momento della prima dose di TAK-788. Nota: se ritenute irreversibili, sono ammesse l’alopecia correlata al trattamento di grado >1 o la neuropatia periferica correlata al trattamento di grado 2. 11. Pazienti di sesso femminile che: • sono in post-menopausa da almeno 1 anno prima della visita di screening; OPPURE • sono chirurgicamente sterili; OPPURE • se in età fertile, accettano di utilizzare 1 metodo contraccettivo non ormonale altamente efficace insieme a 1 metodo efficace (barriera) aggiuntivo dal momento della firma del consenso informato fino a 30 giorni dopo l’ultima dose di farmaco dello studio; OPPURE
    • accettano di praticare l’astinenza totale, ove in linea con lo stile di vita preferito e abituale del soggetto (l’astinenza periodica [per es., metodi del calendario, dell’ovulazione, sintotermico, post-ovulatorio], il coito interrotto, l’uso di soli spermicidi e l’amenorrea lattazionale non sono metodi contraccettivi accettabili. Preservativi maschili e femminili non devono essere utilizzati insieme).
    Specifici per fase di estensione
    1. Presentano un’inserzione in frame nell’esone 20 di EGFR (ivi comprese A763_Y764insFQEA, V769_D770insASV, D770_N771insNPG, D770_N771insSVD, H773_V774insNPH o qualsiasi altra mutazione in frame di inserzione nell’esone 20) documentata da un test locale e sufficiente tessuto tumorale disponibile per l’analisi centrale (vedere il Manuale di riferimento dello studio). La mutazione di inserzione nell’esone 20 di EGFR può presentarsi da sola o in combinazione con altre mutazioni di EGFR o HER2. Nota: la conferma centrale non è richiesta per l’arruolamento. 2. Le metastasi cerebrali sono ammesse purché siano state trattate con chirurgia e/o radioterapia e siano rimaste stabili, senza bisogno di corticosteroidi per controllare i sintomi, entro i 7 giorni precedenti la prima dose di TAK-788.
    E.4Principal exclusion criteria
    1.Previously received TAK-788.
    2.Received small-molecule anticancer therapy (including cytotoxic chemotherapy and investigational agents) =14 days prior to first dose of TAK 788 (except for reversible EGFR TKIs [ie, erlotinib or gefitinib], which are allowed up to 7 days prior to the first dose of TAK 788).
    3.Received antineoplastic monoclonal antibodies including immunotherapy within 28 days of the first dose of TAK-788.
    4.Have been diagnosed with another primary malignancy other than NSCLC except for adequately treated non-melanoma skin cancer or cervical cancer in situ; definitively treated non-metastatic prostate cancer; or patients with another primary malignancy who are definitively relapse-free with at least 3 years elapsed since the diagnosis of the other primary malignancy. Note: This exclusion criterion does not apply to Expansion Cohort 7.
    5.Received radiotherapy =14 days prior to the first dose of TAK 788. SRS, stereotactic body radiotherapy, and palliative radiation outside the chest and brain are allowed up to 7 days prior to the first dose.
    6.Received a strong CYP3A inhibitor or strong CYP3A inducer within 2 weeks prior to first dose of TAK 788 (see Appendix C).
    7.Have undergone major surgery within 28 days prior to first dose of TAK 788. Minor surgical procedures, such as catheter placement or minimally invasive biopsy, are allowed.
    8.Have symptomatic CNS metastases (parenchymal or leptomeningeal) at screening or asymptomatic disease requiring corticosteroids to control symptoms within 7 days prior to the first dose of TAK 788.
    Note: If a patient has worsening neurological symptoms or signs due to CNS metastases, the patient needs to complete local therapy and be neurologically stable (with no requirement for corticosteroids or use of anticonvulsants) for 7 days prior to the first dose of TAK-788. Patients with no prior history of signs or symptoms of CNS metastases but who receive prophylactic steroids or anticonvulsants are allowed.
    9.Have current spinal cord compression (symptomatic or asymptomatic and detected by radiographic imaging) or leptomeningeal disease (symptomatic or asymptomatic).
    10.Have significant, uncontrolled, or active cardiovascular disease, including, but not restricted to:
    a.Myocardial infarction (MI) within 6 months prior to the first dose of study drug;
    b.Unstable angina within 6 months prior to first dose;
    c.Congestive heart failure (CHF) within 6 months prior to first dose;
    d.History of clinically significant (as determined by the treating physician) atrial arrhythmia;
    e.Any history of ventricular arrhythmia; or
    f.Cerebrovascular accident or transient ischemic attack within 6 months prior to first dose.
    11.Have a known history of uncontrolled hypertension. Patients with hypertension should be under treatment on study entry to control blood pressure.
    12.Have prolonged QTcF interval, or being treated with medications known to be associated with the development of Torsades de Pointes (Appendix D).
    13.(Parts 1 and 2 [dose escalation and expansion cohorts] only) Have an ongoing or active infection including, but not limited to, the requirement for intravenous (IV) antibiotics, or a known history of human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Testing is not required in the absence of history.
    (Part 3 [extension cohort] only) Have an ongoing or active infection including, but not limited to, the requirement for IV antibiotics, or a known history of HIV. Testing is not required in the absence of history.
    (Part 3 [extension cohort] only) Hepatitis B surface antigen (HBsAg) positive patients are allowed to enroll if HBV DNA is below 1000 copies/mL in the plasma. Patients who are positive for anti-HCV antibody (HCVAb) can be enrolled but must not have detectable HCV RNA in the plasma.
    14.Currently have or have a history of interstitial lung disease, radiation pneumonitis that required steroid treatment, or drug-related pneumonitis.
    1. Hanno ricevuto in precedenza TAK-788. 2. Hanno ricevuto terapia antitumorale a piccole molecole (compresa la chemioterapia citotossica e agenti sperimentali) =14 giorni prima della prima dose di TAK-788 (fatta eccezione per gli EGFR-TKI reversibili [ovvero, erlotinib o gefitinib], i quali sono ammessi fino a 7 giorni precedenti la prima dose di TAK-788). 3. Hanno ricevuto anticorpi monoclonali antineoplastici, compresa l’immunoterapia, entro 28 giorni dalla prima dose di TAK-788. 4. Sono stati diagnosticati con un’altra malignità primaria diversa dall’NSCLC, fatta eccezione per il tumore cutaneo diverso dal melanoma, adeguatamente trattato, o il carcinoma in situ della cervice; carcinoma prostatico non metastatico trattato in modo definitivo; o pazienti con un’altra malignità definitivamente liberi da recidiva, per cui siano trascorsi almeno 3 anni dalla diagnosi dell’altra malignità primaria. Nota: questo criterio di esclusione non si applica alla coorte di espansione 7. 5. Pazienti che hanno ricevuto radioterapia =14 giorni prima della prima dose di TAK-788. Sono ammesse SRS, radioterapia stereotassica corporea e radioterapia palliativa al di fuori del torace e del cervello fino a 7 giorni precedenti la prima dose. 6. Pazienti che hanno ricevuto un forte inibitore o un forte induttore del CYP3A nelle 2 settimane precedenti la prima dose di TAK-788 (vedere Appendice C). 7. Sono stati sottoposti a intervento chirurgico maggiore nei 28 giorni precedenti la prima dose di TAK-788. Sono ammesse le procedure chirurgiche minori, come il posizionamento di un catetere o una biopsia minimamente invasiva. 8. Presentano metastasi al SNC sintomatiche (parenchimali o leptomeningee) allo screening o malattia asintomatica con necessità di corticosteroidi per controllare i sintomi nei 7 giorni precedenti la prima dose di TAK-788. Nota: se si presenta un peggioramento dei sintomi o segni neurologici a causa di metastasi al SNC, il paziente deve completare una terapia locale ed essere neurologicamente stabile (senza necessità di corticosteroidi o dell’uso di anticonvulsivanti) per 7 giorni precedenti la prima dose di TAK-788. Sono ammessi i pazienti con precedente anamnesi di segni o sintomi di metastasi al SNC, ma che ricevono profilassi con steroidi o anticonvulsivanti. 9. Presentano un’attuale compressione del midollo spinale (sintomatica o asintomatica e rilevata da immagini radiografiche) o malattia leptomeningea (sintomatica o asintomatica). 10. Presentano una malattia cardiovascolare significativa, non controllata o attiva, tra cui, ma non limitata a:
    a. infarto del miocardio (IM) entro 6 mesi precedenti la prima dose del farmaco dello studio; b. angina instabile entro 6 mesi precedenti la prima dose; c. insufficienza cardiaca congestizia (ICC) entro 6 mesi precedenti la prima dose; d. anamnesi di aritmia atriale clinicamente significativa (come stabilito dal medico curante); e. qualsiasi anamnesi di aritmia ventricolare; o f. attacco ischemico transitorio o incidente cerebrovascolare entro 6 mesi precedenti la prima dose. 11. Hanno un’anamnesi nota di ipertensione non controllata. Al momento dell’ingresso nello studio, i pazienti con ipertensione devono essere sotto trattamento per controllare la pressione sanguigna.
    E.5 End points
    E.5.1Primary end point(s)
    Confirmed ORR, as assessed by the IRC, per RECIST v1.1
    ORR valutato da IRC (utilizzando i criteri RECIST v1.1)
    E.5.1.1Timepoint(s) of evaluation of this end point
    The primary analysis of the primary endpoint, confirmed ORR as assessed by the IRC, will be performed in the full analysis set when all ongoing patients have completed their Cycle 6 disease assessment. A futility analysis will be planned for the primary endpoint when approximately 20 patients have completed their Cycle 4 disease assessment.
    L'analisi primaria dell'endpoint primario, ORR confermato valutato da IRC, sarà eseguita nel set completo di analisi quando in pazienti ongoing avranno completato la valutazione della malattia al ciclo 6.
    Un'analisi di futilità sarà pianificata per l'endpoint primario quando circa 20 pazienti avranno completato la valutazione della malattia del ciclo 4.
    E.5.2Secondary end point(s)
    1.Confirmed ORR, as assessed by the investigator, per RECIST v1.1
    2.Duration of response, as assessed by the IRC and the investigator
    3.Time to response, as assessed by the IRC and the investigator
    4.DCR (the percentage of patients with best response of complete response [CR], partial response [PR], or SD), as assessed by the IRC and the investigator, per RECIST v1.1
    5.PFS, as assessed by the IRC and the investigator
    6.OS
    7.Change from baseline in overall global quality of life (the Global Health Status/QoL Scale) with the EORTC QLQ-C30 and change from baseline in the Dyspnea Scale, based on the QLQ-LC13
    1. ORR confermato, valutato dello sperimentatore, secondo i criteri RECIST v1.1
    2. Durata della risposta, valutata dall’IRC e dallo sperimentatore
    3. Tempo alla risposta, valutato dall’IRC e dallo sperimentatore
    4. DCR (la percentuale di pazienti con la risposta migliore tra risposta completa [complete response, CR], risposta parziale [partial response, PR] o SD), valutata dall’IRC e dallo sperimentatore, secondo i criteri RECIST v1.1
    5. Sopravvivenza libera da progressione (PFS), valutata dall’IRC e dallo sperimentatore
    6. OS
    7. Variazione rispetto al basale della qualità della vita globale (Global Health Status/QoL Scale) con EORTC QLQ-C30 e variazione
    E.5.2.1Timepoint(s) of evaluation of this end point
    Two-sided exact 95% binomial confidence intervals will be computed for all binary secondary endpoints, including confirmed ORR as assessed by the investigator and DCR as assessed by the IRC and the investigator. Kaplan Meier methods, including medians and confidence intervals, will be used to estimate PFS as assessed by the IRC and the investigator, duration of response as assessed by the IRC and the investigator, and OS. Descriptive statistics will be used to summarize time to response in responders and time on treatment. Patient-reported outcome assessments will be assessed at each cycle using descriptive summary statistics.
    Saranno calcolati intervalli di confidenza al 95% binomiali bilaterali esatti per tutti gli endpoint secondari binari, ivi compresi l’ORR confermato valutato dallo sperimentatore e il DCR valutato dall’IRC e dallo sperimentatore. Verranno usati i metodi di Kaplan-Meier, compresi mediane e intervalli di confidenza per stimare la PFS, valutata dall’IRC e dallo sperimentatore, la durata della risposta, valutata dall’IRC e dallo sperimentatore, e l’OS. Verranno usate statistiche descrittive per riepilogare il tempo alla risposta nei responder e il tempo di trattamento. Le valutazioni degli esiti riferiti dal paziente saranno valutate a ogni ciclo utilizzando statistiche riepilogative descrittive
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis Yes
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    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) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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 concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA35
    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
    China
    Japan
    Korea, Republic of
    Taiwan
    United States
    France
    Germany
    Italy
    Spain
    United Kingdom
    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
    End of study (completion) date is approximately 3 years after the last patient has enrolled in Part 3 (the extension cohort) or when all patients have completed all study visits or have otherwise discontinued from the study.
    La data di fine dello studio (completamento) è circa 3 anni dopo l'arruolamento dell'ultimo paziente nella Parte 3 (coorte di estensione) o quando tutti i pazienti avranno completato tutte le visite dello studio o avranno in alternativa lasciato lo 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 months7
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months1
    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: 80
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 11
    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 state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 20
    F.4.2.2In the whole clinical trial 91
    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)
    Subjects will revert to standard clinical management as directed by attending personal physician.
    I soggetti torneranno ad una gestione clinica standard come indicato dal personale medico coinvolto.
    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 Decision2019-05-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-03-20
    P. End of Trial
    P.End of Trial StatusOngoing
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