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    Summary
    EudraCT Number:2016-001407-23
    Sponsor's Protocol Code Number:GEICAM/2015-06
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2016-12-13
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2016-001407-23
    A.3Full title of the trial
    A Phase II Clinical Trial to analyse Olaparib Response in patients with BRCA1 and/or 2 Promoter Methylation Diagnosed of Advanced Breast Cancer (COMETA-Breast study).
    Ensayo Clínico Fase II para analizar la Respuesta a Olaparib de pacientes con Metilación del Promotor de BRCA1 y/o 2 diagnosticadas de Cáncer de Mama Avanzado (estudio COMETA-Breast).
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase II Clinical Trial to analyse the efficacy and safety of the treatment with Olaparib in patients diagnosed of metastatic or locally advanced breast cancer who show methylation in the promoter of the genes BRCA1 and/or 2 (COMETA-Breast study).
    Ensayo clinico fase II para evaluar la eficacia y la seguridad del tratamiento con Olaparib en pacientes diagnosticadas de cáncer de mama metastásico o localmente avanzado y que presentan metilación del promotor de los genes BRCA1 y/o 2 (Estudio COMETA-Breast).
    A.3.2Name or abbreviated title of the trial where available
    COMETA-Breast
    COMETA-Breast
    A.4.1Sponsor's protocol code numberGEICAM/2015-06
    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 SponsorGEICAM (Fundación Grupo Español de Investigación en Cáncer de Mama)
    B.1.3.4CountrySpain
    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 supportASTRAZENECA FARMACÉUTICA SPAIN S.A.
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGEICAM (Fundación Grupo Español de Investigación en Cáncer de Mama)
    B.5.2Functional name of contact pointClinical Operations Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenida de los Pirineos nº 7, 1ª Planta, oficina 1-14
    B.5.3.2Town/ citySan Sebastián de los Reyes (Madrid)
    B.5.3.3Post code28703
    B.5.3.4CountrySpain
    B.5.4Telephone number+34916592870
    B.5.5Fax number+34916510406
    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 Yes
    D.2.5.1Orphan drug designation numberEU/1/14/959
    D.3 Description of the IMP
    D.3.1Product nameOlaparib
    D.3.2Product code AZD2281
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNOLAPARIB
    D.3.9.1CAS number 763113-22-0
    D.3.9.2Current sponsor codeD0810000000//AZD2281, KU-0059436
    D.3.9.3Other descriptive nameOlaparib
    D.3.9.4EV Substance CodeSUB32234
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP 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 Yes
    D.2.5.1Orphan drug designation numberEU/1/14/959
    D.3 Description of the IMP
    D.3.1Product nameOlaparib
    D.3.2Product code AZD2281
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNOLAPARIB
    D.3.9.1CAS number 763113-22-0
    D.3.9.2Current sponsor codeD0810000000//AZD2281, KU-0059436
    D.3.9.3Other descriptive nameOlaparib
    D.3.9.4EV Substance CodeSUB32234
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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
    Patients with advanced triple negative breast cancer (TNBC) with BRCA1 and/or BRCA2 promoter methylation assessed in DNA from metastatic lesions and absence of BRCA1 and 2 germline mutations.
    Pacientes con cáncer de mama triple negativo (CMTN) avanzado con metilación del promotor de BRCA1 y/o BRCA2 determinada en ADN de lesiones metastásicas y ausencia de mutaciones germinales de BRCA1 y 2.
    E.1.1.1Medical condition in easily understood language
    Patients with advanced triple negative breast cancer who lack of hereditary mutations in BRCA1 and 2 genes, but show methylation of promoter regions of BRCA1 y/o 2 in the tumor.
    Pacientes con cáncer de mama avanzado triple negativo que carecen de mutaciones hereditarias en los genes BRCA1 y 2, pero que muestran metilación en el promotor de los genes BRCA1 y/o 2 en el tumor.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 19.0
    E.1.2Level PT
    E.1.2Classification code 10075566
    E.1.2Term Triple negative breast cancer
    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 analyse the olaparib efficacy in the treatment of patients diagnosed of advanced triple negative breast cancer (TNBC) with BRCA1 and/or BRCA2 promoter methylation assessed in somatic DNA.
    Analizar la eficacia de olaparib en el tratamiento de pacientes diagnosticadas de cáncer de mama triple negativo (CMTN) avanzado con metilación del promotor de BRCA1 y/o BRCA2, evaluada en ADN somático.
    E.2.2Secondary objectives of the trial
    -To analyse other efficacy measures.
    -To analyse olaparib safety.
    -To explore changes in the methylation status of BRCA1/2 promoter in germline DNA prior and after treatment discontinuation for any reason and correlate germline BRCA1/2 methylation data with efficacy parameters.
    -To correlate BRCA1/2 methylation between germline and somatic DNA and between primary tumor and metastatic lesions.
    -To correlate BRCA1/2 expression with methylation status of BRCA1/2 promoter and efficacy parameters.
    -Analizar otras medidas de eficacia.
    -Analizar la seguridad de olaparib.
    -Explorar los cambios en el estado de metilación del promotor(es) de BRCA1/2 en ADN germinal antes y después de la suspensión del tratamiento por cualquier motivo y correlacionar los datos de la metilación de BRCA1/2 germinal con los parámetros de eficacia.
    -Correlacionar el estado de metilación de BRCA1/2 entre el DNA germinal y el somático y entre el tumor primario y las lesiones metastásicas.
    -Correlacionar los niveles de expresión de BRCA1/2 con el estado de metilación del promotor(es) de BRCA1/2 y con los parámetros de eficacia.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Patients are eligible to be included in the study only if they meet all of the following criteria. Any asterisked* are also applicable as an inclusion criteria prior to perform the BRCA testing via central testing:
    1.The patient has signed and dated the informed consent document and it has been obtained before conducting any procedure specifically for the study.
    2.Female ≥ 18 years of age on day of signing informed consent.
    3.Patient with histological confirmation of breast cancer with evidence of advanced disease not amenable to resection or radiation therapy with curative intent.
    4.Documented triple negative disease by immunohistochemistry (IHC) and/or in situ hybridization based on local testing (preferably assessed on the most recent tumour biopsy available). TN is defined as negative hormone receptor status (< 1% of tumour cells with ER and PgR expression) and HER2-negative status (defined as IHC score 0/1+ or negative by in situ hybridization defined according to local criteria).
    5.Patient must have received at least one previous regimen in the advance disease setting.
    6.Absence of deleterious or suspected deleterious germline mutations in BRCA1 and BRCA2. Germinal BRCA mutational status will be centrally assessed in Myriad laboratories to check eligibility unless the test has been previously performed at Myriad and absence of mutations has been determined.
    7.Availability of a tumour tissue sample from the metastatic lesions (preferably obtained after the previous therapeutic regimen for advance disease) for central testing.
    8.Documented methylation of BRCA1 and/or 2 promoters based on central testing by analysis on the most recent tumour from metastatic lesions available (preferably obtained after the previous therapeutic regimen for advance disease).
    9.At least one lesion measurable not previously irradiated, that can be accurately measured at baseline as ≥ 10 mm in the longest diameter (except lymph nodes which must have short axis ≥ 15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI) or clinical examination and which is suitable for accurate repeated measurements according to RECIST v.1.1.
    10.Patient must have normal organ and bone marrow function measured within 28 days prior to administration of study treatment as defined below:
    -Haemoglobin ≥ 10.0 g/dL with no blood transfusions in the past 28 days.
    -Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
    -Platelet count ≥ 100 x 109/L
    -Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN)
    -Aspartate aminotransferase (AST) (Serum Glutamic Oxaloacetic Transaminase, SGOT) /Alanine aminotransferase (ALT) (Serum Glutamic Pyruvate Transaminase, SGPT) ] ≤ 2.5 x institutional upper limit of normal unless liver metastases are present in which case they must be ≤ 5 x ULN
    -Patients must have creatinine clearance estimated using the Cockcroft-Gault equation of ≥51 mL/min:
    Estimated creatinine clearance =(140-age [years]) x weight (kg) (x F)a / serum creatinine (mg/dL) x 72
    a where F=0.85 for females.
    11.Please refer to protocol.
    12.Please refer to protocol.
    13.*Postmenopausal or evidence of non-childbearing status for women of childbearing potential: negative urine or serum pregnancy test within 28 days of study treatment and confirmed prior to treatment on day 1.
    Postmenopausal patient is defined as a woman fulfilling any one of the following criteria (based on the NCCN definition of menopause [National Comprehensive Cancer Network 2008]):
    -Prior bilateral oophorectomy.
    -Age > 60 years.
    -Age ≤ 60 years and with amenorrhea for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression and follicle stimulating hormone and estradiol in the postmenopausal range.
    14.Olaparib is regarded as a compound with medium/high foetal risk, patients of childbearing potential and their partners, who are sexually active, must agree to the use of TWO highly effective forms of contraception in combination as listed below throughout period of taking study treatment and for at least 1 month after last dose of study drug or they must totally/truly abstain from any form of sexual intercourse (see below).
    Acceptable non-hormonal birth control methods include:
    Please refer to protocol for read this completed criteria.
    15.*Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits, laboratory tests and examinations and other study procedures including follow up.
    Las pacientes serán elegibles para su inclusión en el estudio tan solo si cumplen todos los criterios indicados a continuación. Los criterios marcados con un asterisco (*) también serán aplicables como criterios de inclusión antes de realizar las pruebas de BRCA en el laboratorio central:
    1.La paciente ha firmado y fechado el documento de consentimiento informado y este se ha obtenido antes de realizar cualquier procedimiento específico del estudio.
    2.Mujer ≥ 18 años de edad el día de la firma del documento de consentimiento informado.
    3.Paciente con confirmación histológica de cáncer de mama que presenta evidencias de enfermedad avanzada que no sea susceptible de resección ni radioterapia con intención curativa.
    4.Enfermedad triple negativa según las pruebas inmunohistoquímicas (IHQ) y/o de hibridación in situ realizadas en el centro participante (efectuadas preferentemente en la biopsia más reciente disponible). El estatus TN se define como estado de receptores hormonales negativo (< 1% de células tumorales con expresión de RE y RPg) y estado de HER2-negativo (definido como una puntuación de 0/1+ mediante IHQ o bien resultado negativo de hibridación in situ, de acuerdo con los criterios locales del centro).
    5.La paciente debe haber recibido al menos una línea previa de tratamiento para la enfermedad avanzada.
    6.Ausencia de mutaciones germinales deletéreas o que se sospeche su naturaleza deletérea en BRCA1 y BRCA2. El estatus germinal del gen BRCA se analizará de forma centralizada en los laboratorios Myriad, a fin de comprobar la elegibilidad, excepto si la prueba ya se hubiese realizado previamente en Myriad y se hubiese determinado la ausencia de mutaciones.
    7.Disponibilidad de al menos una muestra de tejido tumoral procedente de una lesión metastásica (obtenida preferentemente después del régimen terapéutico previo para la enfermedad avanzada), para su evaluación por el laboratorio central.
    8.Estado positivo de metilación del promotor de BRCA1 y/o 2 documentado, según la evaluación del laboratorio central mediante análisis de las muestras de tumor metastásico más recientes disponibles (obtenidas preferentemente después del régimen terapéutico previo para la enfermedad avanzada).
    9.Las pacientes deben presentar al menos una lesión medible, no irradiada previamente, que pueda medirse con precisión en la visita basal y cuyo diámetro mayor sea ≥ 10 mm (a excepción de los ganglios linfáticos, que deberán tener un eje corto ≥ 15 mm) mediante tomografía axial computarizada (TAC), resonancia magnética nuclear (RMN) o exploración clínica, y que sea apta para realizar mediciones repetidas con exactitud según los criterios RECIST v.1.1.
    10.La paciente deberá presentar una función orgánica y de la médula ósea normales, evaluadas dentro de los 28 días previos a la administración del tratamiento del estudio, cómo se define a continuación:
    -Hemoglobina ≥ 10,0 g/dl sin haberse administrado transfusiones de sangre en los 28 días anteriores
    -Recuento absoluto de neutrófilos (RAN) ≥ 1,5 x 109/l
    -Recuento de plaquetas ≥ 100 x 109/l
    -Bilirrubina total ≤ 1,5 x límite superior de normalidad (LSN) del centro
    -[Aspartato aminotransferasa (AST) (transaminasa glutámico oxalacética sérica, SGOT) / Alanina aminotransferasa (ALT) (transaminasa glutámico pirúvica sérica, SGPT)] ≤ 2,5 x LSN del centro, excepto en presencia de metástasis hepáticas, en cuyo caso el valor deberá ser ≤ 5 x LSN
    -La paciente deberá presentar un aclaramiento de creatinina estimado mediante la fórmula de Cockcroft-Gault ≥ 51 ml/min:
    Aclaramiento de creatinina estimado = (140 - edad [años]) x peso (kg) (x F)a / creatinina sérica (mg/dl) x 72
    a donde F = 0,85 para las mujeres.
    11.Consulte el protocolo.
    12.Consulte el protocolo.
    13.*Posmenopausia o datos que prueben la ausencia de gestación en las mujeres en edad fértil: prueba de embarazo en orina o en suero con resultado negativo dentro de los 28 días previos a la administración del tratamiento del estudio, confirmándose adicionalmente el día 1 antes del inicio del tratamiento.
    Como paciente posmenopáusica se define a aquella mujer que cumple con cualquiera de los siguientes criterios (basados en la definición de menopausia de la NCCN [National Comprehensive Cancer Network 2008]):
    -Ooforectomía bilateral previa.
    -Edad > 60 años.
    -Edad ≤ 60 años y amenorrea durante 12 meses o más en ausencia de quimioterapia, tratamiento con tamoxifeno, toremifeno o supresión ovárica, y hormona folículoestimulante y estradiol en rangos posmenopáusicos.
    14.Consulte el protocolo.
    15.*La paciente debe estar de acuerdo y puede cumplir con los requerimientos del protocolo durante toda la duración del estudio, lo que incluye someterse al tratamiento y realizar las visitas programadas, los análisis de laboratorio, pruebas de evaluación y el resto de procedimientos, incluido el seguimiento.
    E.4Principal exclusion criteria
    Patients will be excluded from the study if they meet any of the following criteria. Any asterisked* are also applicable as an exclusion criteria prior to perform the BRCA testing via central testing:
    1.Please refer to protocol.
    2.Please refer to protocol.
    3.Participation in another clinical study with an investigational product during the last 4 weeks.
    4.*Any previous treatment with a PARP inhibitor, including olaparib.
    5.*Patients with second primary cancer, except: adequately treated non-melanoma skin cancer (basal cell or squamous cell carcinoma), curatively treated in-situ cancer of the cervix, ductal carcinoma in situ (DCIS), stage 1, grade 1 endometrial carcinoma, or other solid tumours including lymphomas (without bone marrow involvement) curatively treated with no evidence of disease for ≥ 5 years prior to study inclusion. Patients with a history of localised breast cancer with a tumor histology different of TN, with no evidence of disease for ≥ 5 years since they completed their adjuvant chemotherapy.
    6.Patients receiving any systemic chemotherapy or radiotherapy (except for palliative reasons), within 3 weeks prior to study treatment (or a longer period depending on the defined characteristics of the agents used).
    7.Resting ECG with QTc > 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome.
    8.*Concomitant use of known strong CYP3A inhibitors (e.g. itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (e.g. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil). The required washout period prior to starting olaparib is 2 weeks. Please refer to section 5.5.2.1 about strong and moderate CYP3A inhibitors.
    9.*Concomitant use of known strong CYP3A inducers (e.g. phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John’s Wort) or moderate CYP3A inducers (eg. bosentan, efavirenz, modafinil). The required washout period prior to starting olaparib is 5 weeks for enzalutamide or phenobarbital and 3 weeks for other agents. Please refer to section 5.5.2.2 about strong and moderate CYP3A inducers.
    10.*Persistent toxicities (> NCI-CTCAE grade 2) caused by previous cancer therapy (except alopecia or other toxicities not considered a safety risk for the patient at investigator´s discretion).
    11.*Patients with myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML) or with features suggestive of MDS/AML.
    12.*Patients with symptomatic uncontrolled brain metastases. A scan to confirm the absence of brain metastases is not required. Patients with brain metastases may be eligible for the study only if more than 4 weeks from treatment completion for these metastases (including radiation and/or surgery), are clinically stable at the time of study entry.
    Please refer to protocol for read this completed criteria.
    13.Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery.
    14.*Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication.
    15.*Breast feeding women.
    16.*Immunocompromised patients, e.g. patients who are known to be serologically positive for human immunodeficiency virus (HIV).
    17.*Patients with known active hepatitis (i.e., Hepatitis B or C) due to risk of transmitting the infection through blood or other body fluids.
    18.*Patients with a known hypersensitivity to olaparib or any of the excipients of the product.
    19.*Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study. Examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 3 months) myocardial infarction, uncontrolled major seizure disorder, unstable spinal cord compression, superior vena cava syndrome, moderate or severe hepatic impairment (according to Child-Pugh classification), an extensive interstitial bilateral lung disease on High Resolution Computed Tomography (HRCT) or any psychiatric disorder that prohibits obtaining informed consent.
    20.*Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT).
    21.*Whole blood transfusions in the last 120 days prior to entry to the study (packed red blood cells and platelet transfusions are acceptable, for timing refer to inclusion criteria no 10).
    Las pacientes quedarán excluidas del estudio si cumplen cualquiera de los siguientes criterios. Los criterios marcados con un asterisco (*) también serán aplicables como criterios de exclusión antes de realizar las pruebas de BRCA en el laboratorio central:
    1.Consulte el protocolo.
    2.Consulte el protocolo.
    3.Participación en otro estudio clínico con un producto en investigación en las últimas 4 semanas.
    4.*Cualquier tratamiento previo con un inhibidor de PARP, incluido olaparib.
    5.*Pacientes con un segundo tumor primario, a excepción de: cáncer cutáneo no-melanoma (carcinoma de células basales o de células escamosas) tratado adecuadamente, cáncer de cérvix in situ tratado con intención curativa, carcinoma ductal in situ (CDIS), carcinoma endometrial en estadío 1 y grado 1 u otros tumores sólidos, incluidos los linfomas (sin afectación de la médula ósea) tratados con intención curativa que hayan permanecido sin signos de la enfermedad durante ≥ 5 años antes de la inclusión en el estudio y pacientes con antecedentes de cáncer de mama localizado con histología tumoral distinta a TN que hayan permanecido sin signos de la enfermedad durante ≥ 5 años desde que completaron la quimioterapia adyuvante.
    6.Pacientes que hayan recibido cualquier quimioterapia sistémica o radioterapia (excepto por razones paliativas) dentro de las 3 semanas previas al inicio del tratamiento del estudio (o durante un período más largo, dependiendo de las características de los fármacos utilizados).
    7.ECG en reposo con un QTc > 470 ms en dos o más ocasiones dentro de un período de 24 horas o antecedentes familiares de síndrome de QT largo.
    8.*Uso concomitante de inhibidores potentes del CYP3A (por ejemplo, itraconazol, telitromicina, claritromicina, inhibidores de las proteasas reforzados con ritonavir o cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir, etc.) o inhibidores moderados de CYP3A (por ejemplo, ciprofloxacino, eritromicina, diltiazem, fluconazol, verapamilo, etc.) conocidos. El período de lavado farmacológico requerido antes de iniciar la terapia con olaparib es de 2 semanas. Consúltese la sección 5.5.2.1 sobre los inhibidores potentes y moderados del CYP3A.
    9.*Uso concomitante de inductores potentes del CYP3A (por ejemplo, fenobarbital, enzalutamida, fenitoína, rifampicina, rifabutina, rifapentina, carbamazepina, nevirapina e hierba de San Juan) o moderados (por ejemplo, bosentán, efavirenz, modafinilo) conocidos. El período de lavado farmacológico requerido antes de iniciar la terapia con olaparib es de 5 semanas para enzalutamida y fenobarbital y de 3 semanas para el resto de fármacos. Consúltese la sección 5.5.2.2 sobre los inductores potentes y moderados del CYP3A.
    10.*Toxicidades persistentes (> grado 2 según NCI-CTCAE) debidas a tratamientos antineoplásicos previos (a excepción de la alopecia y de otras toxicidades que, a juicio del investigador, no se consideren un riesgo de seguridad para la paciente).
    11.*Pacientes con síndrome mielodisplásico (SMD)/ leucemia mieloide aguda (LMA) o con características sugestivas de SMD/LMA.
    12.Consulte el protocolo.
    13.Cirugía mayor dentro de las 2 semanas previas al inicio del tratamiento del estudio y las pacientes deberán haberse recuperado de cualquier efecto debido a cualquier intervención quirúrgica mayor.
    14.*Pacientes que no puedan ingerir medicación por vía oral y pacientes con trastornos gastrointestinales que probablemente interfieran con la absorción de la medicación del estudio.
    15.*Mujeres en período de lactancia.
    16.Consulte el protocolo.
    17.Consulte el protocolo.
    18.*Pacientes con hipersensibilidad conocida a olaparib o a alguno de los excipientes del producto.
    19.*Pacientes que se consideren de riesgo debido a trastornos médicos graves no controlados, enfermedades sistémicas no malignas, infecciones activas no controladas o resultados de laboratorio fuera de los rangos normales que puedan incrementar los riesgos asociados a la participación en el estudio o puedan interferir con la interpretación de los resultados del mismo y, a criterio del investigador, esto determine que la paciente resulte inadecuada para su inclusión en el ensayo. Como ejemplos pueden citarse, entre otros, las arritmias ventriculares no controladas, el infarto de miocardio reciente (dentro de los 3 meses previos), las patologías no controladas asociadas a convulsiones importantes, la compresión medular inestable, el síndrome de la vena cava superior, el daño hepático severo o moderado (de acuerdo a la clasificación de Child-Pugh), neumopatía intersticial extensa bilateral evidenciada por tomografía axial computarizada de alta resolución (TACAR) o cualquier trastorno psiquiátrico que impida la obtención del consentimiento informado.
    20.Consulte el protocolo.
    21.Consulte el protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    Objective Response Rate (ORR) defined as Complete Response (CR) plus Partial Response (PR) according to Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1.
    Tasa de respuestas objetivas (TRO), definidas como las respuestas completas (RC) más las respuestas parciales (RP) de acuerdo con la versión 1.1 de los Criterios de Evaluación de la Respuesta en Tumores Sólidos (Response Evaluation Criteria in Solid Tumours (RECIST)).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Twelve evaluable patients will be analyzed in a first stage, and if at least 4 patients of them have tumour response, additional patients will be recruited to get a total of 31 evaluable patients. This study will be considered complete following the data cut-off date and data-lock for the final analysis; the data cut-off date will be the date of last patient´s death or the date when there is sufficient data to achieve the final analysis, whichever comes first. It is estimated that the final analysis could be performed approximately 30 months after the enrolment of the first patient.
    En una primera fase se analizarán 12 pacientes evaluables y si al menos 4 de ellas presentan respuesta tumoral se incluirán pacientes adicionales hasta alcanzar un total de 31 pacientes evaluables. El estudio se considerará completado después de la fecha de corte de datos y del cierre de la base de datos para el análisis final; la fecha de corte de los datos será la fecha del éxitus de la última paciente o la fecha en que se disponga de datos suficientes para realizar el análisis final, lo que suceda en primer lugar. Se ha estimado que el análisis final podría realizarse aproximadamente 30 meses después de la inclusión de la primera paciente.
    E.5.2Secondary end point(s)
    -Clinical Benefit Rate (CBR), Response Duration (RD), Progression Free Survival (PFS) and Overall Survival (OS).
    -Adverse events defined by the NCI-CTCAE (National Cancer Institute Common Terminology Criteria for Adverse Events) version 4.0.
    -The methylation status of BRCA 1 and 2 promoters will be measured in germline DNA from blood cells at the beginning of the study and after disease progression, or at the end of study treatment by other reason, and in paired primary and metastatic lesions. It will be analysed: 1) changes of germline methylation pre and post-treatment; 2) correlation between germline methylation status and efficacy outcome data; 3) correlation between germline and somatic methylation status and 4) correlation between primary and metastatic lesions.
    -mRNA levels of BRCA1 and 2 will be assessed in blood and available tumor samples. Expression data will be correlated with promoter methylation status of BRCA and outcome data.
    -Tasa de Beneficio Clínico (TBC), Duración de la Respuesta (DR), Supervivencia Libre de Progresión (SLP) y Supervivencia Global (SG).
    -Acontecimientos adversos, definidos según la versión 4.0 de los NCI-CTCAE (Criterios Terminológicos Comunes para los Acontecimientos Adversos del Instituto Nacional del Cáncer, National Cancer Institute Common Terminology Criteria for Adverse Events).
    -Al inicio del estudio y después de la progresión de la enfermedad, o bien al finalizar el tratamiento del estudio por cualquier otra razón, se determinará el estado de metilación del promotor de BRCA 1 y 2 en el ADN germinal procedente de células sanguíneas, así como en las lesiones primarias y metastásicas de forma emparejada. Con estos datos se analizarán: 1) los cambios del estatus germinal de metilación pre y post-tratamiento; 2) la correlación entre el estado de metilación germinal y los datos clínicos de eficacia; 3) la correlación entre el estado de metilación germinal y somática y 4) la correlación entre el tumor primario y las lesiones metastásicas.
    -Se evaluarán los niveles de ARNm de BRCA1 y 2 en sangre y en las muestras de tumor disponibles. Los datos de expresión se correlacionarán con el estado de metilación del promotor de BRCA y con los datos de evolución clínica.
    E.5.2.1Timepoint(s) of evaluation of this end point
    This study will be considered complete following the data cut-off date and data-lock for the final analysis; the data cut-off date will be the date of last patient´s death or the date when there is sufficient data to achieve the final analysis, whichever comes first. It is estimated that the final analysis could be performed approximately 30 months after the enrolment of the first patient because, considering a median Overall Survival (OS) of 12 months, it is estimated that more than 50% of death events will have occurred at that time and OS analysis could be performed.
    El estudio se considerará completado después de la fecha de corte de datos y del cierre de la base de datos para el análisis final; la fecha de corte de los datos será la fecha del éxitus de la última paciente o la fecha en que se disponga de datos suficientes para realizar el análisis final, lo que suceda en primer lugar. Se ha estimado que el análisis final podría realizarse aproximadamente 30 meses después de la inclusión de la primera paciente ya que, considerando una mediana de Supervivencia Global (SG) de 12 meses, se estima que en ese momento se habrán producido más de un 50% de los acontecimientos de éxitus, y podrá realizarse el análisis de SG.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Other exploratory biomarkers.
    Otros biomarcadores exploratorios.
    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 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 Yes
    E.8.1.7.1Other trial design description
    una sola rama de tratamiento
    single-arm
    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.8.3 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 concerned16
    E.8.5The trial involves multiple Member States No
    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 No
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    This study will be considered complete following the data cut-off date and data-lock for the final analysis; the data cut-off date will be the date of last patient´s death or the date when there is sufficient data to achieve the final analysis, whichever comes first. It is estimated that the final analysis could be performed approximately 30 months after the enrolment of the first patient. Performing exploratory objectives will be independent of the date of the end of the study.
    El estudio se considerará completado después de la fecha de cierre de la base de datos para el análisis final; la fecha de corte de datos será la fecha del éxitus de la última paciente o la fecha que se disponga de datos suficientes para el análisis final, lo que suceda antes. Se ha estimado que el análisis final podría realizarse aproximadamente 30 meses después de incluir la primera paciente. La ejecución de los objetivos exploratorios será independiente de la fecha del final del estudio.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned 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: 34
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 34
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state34
    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)
    None. The Patients will receive the study treatment until radiographic or symptomatic progression, unacceptable toxicity or withdraw of the informed consent. After, the treatment will be chosen by medical criteria.
    Ninguno. Las pacientes recibirán el tratamiento del estudio hasta la progresión radiológica o sintomática de la enfermedad, la aparición de toxicidad inaceptable o la retirada del consentimiento informado. Después, el tratamiento será elegido por criterio médico.
    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 Decision2017-01-05
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-12-28
    P. End of Trial
    P.End of Trial StatusOngoing
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