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    Summary
    EudraCT Number:2016-002438-58
    Sponsor's Protocol Code Number:BAY88-8223/18987
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2016-09-09
    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 number2016-002438-58
    A.3Full title of the trial
    A phase 1b/2 trial to evaluate the safety and efficacy of radium-223 dichloride (BAY 88-8223) in combination with bortezomib and dexamethasone in early relapsed multiple myeloma
    Ensayo de fase Ib/II para evaluar la seguridad y eficacia del dicloruro de radio-223 (BAY 88-8223) en combinación con bortezomib y dexametasona en el tratamiento del mieloma múltiple en recidiva precoz
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the safety and efficacy of study drug radium-223 dichloride when given in combination with bortezomib and dexamethasone in patients with multiple myeloma that has recurred
    Ensayo para evaluar la seguridad y eficacia del dicloruro de radio-223 (BAY 88-8223) cuando es dado en combinación con bortezomib y dexametasona en el tratamiento del mieloma múltiple en recidiva precoz
    A.3.2Name or abbreviated title of the trial where available
    Phase 1b/2 study testing radium-223 dichloride in relapsed multiple myeloma
    Fase Ib/II para probar el dicloruro de radio-223 en el tratamiento del mieloma múltiple en recidiva
    A.4.1Sponsor's protocol code numberBAY88-8223/18987
    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 SponsorBayer AG
    B.1.3.4CountryGermany
    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 supportBayer AG
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationBayer AG
    B.5.2Functional name of contact pointBayer Clinical Trials Contact
    B.5.3 Address:
    B.5.3.1Street Address-
    B.5.3.2Town/ cityBerlin
    B.5.3.3Post code13342
    B.5.3.4CountryGermany
    B.5.4Telephone number0034900102372
    B.5.6E-mailclinical-trials-contact@bayer.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Xofigo
    D.2.1.1.2Name of the Marketing Authorisation holderBayer Pharma AG
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameRadium RA 223 dichloride
    D.3.2Product code BAY88-8223
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRadium-223 dichloride
    D.3.9.1CAS number 444811-40-9
    D.3.9.2Current sponsor codeBAY 88-8223
    D.3.9.3Other descriptive nameRADIUM RA 223 DICHLORIDE
    D.3.9.4EV Substance CodeSUB129907
    D.3.10 Strength
    D.3.10.1Concentration unit kBq/ml kilobecquerel(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1100
    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 Yes
    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 Yes
    D.2.1.1.1Trade name Velcade
    D.2.1.1.2Name of the Marketing Authorisation holderJanssen-Cilag International NV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameBortezomib
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNBORTEZOMIB
    D.3.9.1CAS number 179324-69-7
    D.3.9.4EV Substance CodeSUB20020
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3.5
    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: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Dexamethasone
    D.2.1.1.2Name of the Marketing Authorisation holderratiopharm GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameDexamethasone
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDEXAMETHASONE
    D.3.9.1CAS number 50-02-2
    D.3.9.4EV Substance CodeSUB07017MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    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: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Dexamethasone
    D.2.1.1.2Name of the Marketing Authorisation holderratiopharm GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameDexamethasone
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDEXAMETHASONE
    D.3.9.1CAS number 50-02-2
    D.3.9.4EV Substance CodeSUB07017MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number8
    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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for injection
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Relapsed multiple myeloma
    Mieloma múltiple en recidiva
    E.1.1.1Medical condition in easily understood language
    Multiple myeloma
    Mieloma múltiple
    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 LLT
    E.1.2Classification code 10028228
    E.1.2Term Multiple myeloma
    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
    Phase 1b part (open-label)

    1. To evaluate the safety of the combination of radium-223 dichloride plus bortezomib and dexamethasone

    2. To determine the dose of radium-223 dichloride that will be used in the phase 2 part of the study (recommended phase 2 dose [RP2D])

    Phase 2 part (double-blind, randomized):

    1. To compare radium-223 dichloride with placebo in addition to background treatment with bortezomib plus dexamethasone in terms of progression-free survival (PFS) in relapsed multiple myeloma subjects.
    Parte de fase Ib (sin enmascaramiento)
    1. Evaluar la seguridad de la combinación de dicloruro de radio-223 con bortezomib y dexametasona.
    2. Determinar la dosis de dicloruro de radio-223 que se utilizará en la parte de fase II del estudio (dosis recomendada para la fase II [DRF2]).

    Parte de fase II (doble ciego, aleatorizada)
    1. Comparar el dicloruro de radio-223 con el placebo añadido al tratamiento de base con bortezomib y dexametasona en cuanto a supervivencia sin progresión (SSP) en pacientes con mieloma múltiple en recidiva.
    E.2.2Secondary objectives of the trial
    Phase 1b:
    1. To evaluate the objective response rate (ORR) at 6 months and 9 months, as determined by International Myeloma Working Group (IMWG) uniform response criteria

    2. To evaluate the duration of response (DOR)

    Phase 2:
    1. To evaluate safety, acute and long-term
    2.To evaluate the ORR, as determined by IMWG uniform response criteria
    3. To evaluate overall survival (OS)
    4. To evaluate time to first on-study SSE
    5. To evaluate SSE-FS
    6. To evaluate time to pain progression
    7. To evaluate the DOR
    Parte de fase Ib
    1. Evaluar la tasa de respuesta objetiva (TRO) a los 6 meses y a los 9 meses, según los criterios de respuesta uniforme del Grupo de Trabajo Internacional del Mieloma (IMWG).
    2. Evaluar la duración de la respuesta (DR).

    Parte de fase II
    1. Evaluar la seguridad, a corto y a largo plazo.
    2. Evaluar la TRO, según los criterios de respuesta uniforme del IMWG.
    3. Evaluar la supervivencia general (SG).
    4. Evaluar el tiempo hasta el primer SSE durante el estudio.
    5. Evaluar la SSE-FS.
    6. Evaluar el tiempo hasta la progresión del dolor.
    7. Evaluar la DR.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Subjects must meet the following criteria for inclusion in the study (applicable to both parts of the study):

    1. Males or females ≥18 years of age

    2. Have provided written informed consent. Subjects must be able to understand and be willing to sign the written informed consent, expressing their willingness and ability tocomply with protocol-required treatment and assessment schedule, including follow-up visits. A signed ICF must be appropriately obtained prior to the conduct of any trial-specific procedure.

    3. Subject must have documented monoclonal plasma cells as defined by their institutional standard in the bone marrow >=10% at some point in their disease history or presence of a biopsy proven plasmacytoma

    4. Subjects must have received at least 1 and not more than 3 previous lines of treatment and have had a response to treatment (i.e., achieved a minimal response [MR] or better) according to the IMWG uniform response criteria; see Definition of terms section for description of lines of therapy

    5. Subject must be non-refractory to bortezomib or another PI, like ixazomib and carfilzomib (Refractory is defined: progression of disease while receiving bortezomib therapy or within 60 days of ending bortezomib therapy or another PI therapy, like ixazomib and carfilzomib)

    6. Subjects must have had progressive disease according to the IMWG uniform response criteria following the last multiple myeloma treatment

    7. Subjects must have measurable disease defined as at least 1 of the following (according to central laboratory results):
    - Serum M-protein defined by the following:
    * IgG multiple myeloma: Serum monoclonal paraprotein (M-protein) level ≥1.0 g/dL
    * IgA, IgD, IgE, IgM multiple myeloma: serum M-protein level ≥0.5 g/dL
    - Urine M-protein ≥200 mg/24 hours (any immunoglobulin heavy chain type)
    - Serum free light chain (FLC) ≥10 mg/dL with abnormal ratio

    8. ≥1 bone lesion identifiable by radiograph, computed tomography, PET-CT, or MRI

    9. Life expectancy of at least 3 months

    10. Eastern Cooperative Oncology Group (ECOG) PS of 0 to 2

    11. Adequate hepatic function, with bilirubin ≤1.5 x ULN, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤3.0 x ULN

    12. Absolute neutrophil count (ANC) ≥1.5 × 10E9/L, hemoglobin (Hb) ≥9.0 g/dL, and platelet count ≥75.0 × 109/L independent of transfusion of red blood cells (RBC) or platelet concentrates and independent of granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF)

    13. International normalized ratio (INR) ≤ 1.5 and partial thromboplastin time (PTT) ≤ 1.5 x ULN. PT can be used instead of INR if ≤ 1.5 x ULN

    14. Calculated or measured creatinine clearance of ≥30 mL/minute, calculated using the formula of Cockcroft and Gault [(140 - age) x mass (kg)/(72 x creatinine mg/dL)]. Multiply result by 0.85 if female

    15. Female subjects of child-bearing potential must have a negative serum pregnancy test within 72 hours before the first dose. Post-menopausal females (age ≥55 years and 1 year or more of amenorrhea; OR age <55 years and 1 year or more of amenorrhea with an estradiol assay <20 pg/mL; OR bilateral oophorectomy) and surgically sterilized females are exempt from a pregnancy test.

    16. a) Female subjects of child-bearing potential who are sexually active must agree to utilize, during treatment with and for 6 months after the last dose of radium-223 dichloride/placebo/ bortezomib/dexamethasone, 2 reliable and acceptable methods of contraception used simultaneously: a barrier method such as (i) condoms (male or female) with spermicidal agent, or (ii) diaphragm or cervical cap with spermicide, combined with a highly effective non-hormonal birth control method such as intrauterine device.

    b) Male subjects with partners of child-bearing potential must be willing to use 2 reliable and acceptable methods of birth control (including adequate barrier protection) used simultaneously as determined to be acceptable by the principal investigator and sponsor during the study and for 6 months following completion of treatment with radium-223 dichloride/placebo or 3 months after the last administration of bortezomib, whichever occurs later. The contraception measures must be discussed with the subject. Suitable contraception could be, for example, the use of condoms combined with an oral contraceptive taken by the female partner of a study subject.
    Los pacientes deben cumplir los siguientes criterios para ser incluidos en el estudio:
    1. Hombres o mujeres de ≥ 18 años.
    2. Haber dado su consentimiento informado por escrito. Deben ser capaces de entender el consentimiento informado por escrito y estar dispuestos a firmarlo, expresando así su voluntad y capacidad para cumplir el tratamiento y el calendario de evaluación requeridos por el protocolo, incluidas las visitas de seguimiento. Antes de llevar a cabo cualquier procedimiento específico del ensayo deberá obtenerse de un modo adecuado el formulario de consentimiento informado (FCI) firmado.
    3. El sujeto debe tener presencia documentada (conforme al procedimiento diagnóstico habitual de la institución) >= 10 % de células plasmáticas monoclonales en la médula ósea en algún momento de la evolución de su enfermedad o presencia de plasmocitoma confirmado mediante biopsia.
    4. Deben haber recibido al menos 1 y no más de 3 líneas de tratamiento previo y haber respondido al tratamiento (es decir, haber obtenido una respuesta mínima [RM] o mejor) conforme a los criterios de respuesta uniforme del IMWG.
    5. Resistente a bortezomib u otro inhibidor de proteasoma (IP), como ixazomib y carfilzomib (“resistente” se define como: progresión de la enfermedad durante la administración del tratamiento con bortezomib o en el plazo de 60 días desde la finalización del tratamiento con bortezomib u otro IP, como ixazomib o carfilzomib).
    6. Haber presentado enfermedad progresiva de acuerdo con los criterios de respuesta uniforme del IMWG tras el último tratamiento para el mieloma múltiple.
    7. Deben presentar una enfermedad medible definida como al menos 1 de los siguientes valores analíticos (de acuerdo con los resultados del laboratorio central): *Proteína M en suero definida por las siguientes características:
    - Mieloma múltiple IgG: Nivel de paraproteína monoclonal en suero (proteína M) ≥ 1,0 g/dl.
    - Mieloma múltiple IgA, IgD, IgE, IgM: nivel de proteína M en suero ≥ 0,5 g/dl.
    *Proteína M en orina ≥ 200 mg/24 horas (cualquier inmunoglobulina de cadena pesada).
    * Cadenas ligeras libres (CLL) en suero ≥ 10 mg/dl con una proporción anómala.
    8. ≥ 1 lesión ósea identificable mediante radiografía, tomografía axial computarizada, tomografía por emisión de positrones - tomografía computarizada (TEP-TC) o RM.
    9. Esperanza de vida de 3 meses como mínimo.
    10. EG de 0-2 según la escala del ECOG.
    11. Función hepática adecuada, con nivel de bilirrubina ≤ 1,5 veces el límite superior de la normalidad (LSN) y niveles de aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) ≤ 3,0 veces el LSN.
    12. Recuento absoluto de neutrófilos (RAN) ≥ 1.5 × 109/l, hemoglobina (Hb) ≥ 9,0 g/dl y recuentos de plaquetas ≥ 75,0 × 109/l independiente de la transfusión de glóbulos rojos (RBC) o concentrados de plaquetas e independiente del factor estimulante de colonias de granulocitos (FEC-G) o del factor estimulante de colonias de granulocitos-macrófagos (FEC-GM).
    13. Índice internacional normalizado (INR) ≤ 1,5 y tiempo de tromboplastina parcial (TTP) ≤ 1,5 veces el LSN. El TP se puede usar en lugar del INR si ≤ 1,5 veces el LSN.
    14. Aclaramiento de creatinina calculado o medido ≥ 30 ml/minuto, calculado utilizando la fórmula de Cockcroft y Gault.
    15. Las mujeres en edad fértil deben dar negativo en una prueba de embarazo en suero en el plazo de 72 horas antes de la primera dosis. Están excluidas de realizar la prueba de embarazo las mujeres posmenopáusicas (edad ≥ 55 años y 1 año o más de amenorrea; O edad < 55 años y 1 año o más de amenorrea con valores de estradiol < 20 pg/ml obtenidos mediante análisis; U ovariectomía bilateral) y mujeres esterilizadas quirúrgicamente.
    16. a) Las mujeres en edad fértil que sean sexualmente activas deben aceptar utilizar durante el tratamiento con dicloruro de radio-223/placebo/bortezomib/dexametasona y en los 6 meses siguientes a la última dosis, 2 métodos anticonceptivos fiables y aceptables de manera simultánea: un anticonceptivo de barrera como (i) el preservativo (masculino o femenino) con espermicida, o (ii) el diafragma o capuchón cervical con espermicida, combinado con un método anticonceptivo no hormonal altamente eficaz como el dispositivo intrauterino. b) Los hombres que tengan pareja con capacidad para concebir deben estar dispuestos a utilizar 2 métodos anticonceptivos fiables y aceptables (incluido el anticonceptivo de barrera adecuado) de manera simultánea -de acuerdo con las indicaciones del investigador principal y el promotor- durante el estudio y en los 6 meses posteriores a la finalización del tratamiento con dicloruro de radio-223/placebo o durante los 3 meses siguientes a la última administración de bortezomib, lo que suceda más tarde. Deben comentarse con el paciente las medidas anticonceptivas adecuadas, que podrían ser, por ejemplo, el uso de preservativo combinado con un anticonceptivo oral que se tomaría la pareja de sexo femenino del paciente del estudio.
    E.4Principal exclusion criteria
    Subjects must not meet any of the exclusion criteria listed below (applicable to both parts of the study):

    1. Systemic glucocorticoid therapy (prednisone >10 mg/day orally or equivalent) within the last 4 weeks prior to first dose, unless tapered and on a stable dose (prednisone ≤10 mg/day orally or equivalent) for at least 1 week

    2. Subjects with known POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) or light-chain (AL) amyloidosis

    3. Plasma cell leukemia (defined by plasma cell >20%, and/or an absolute plasma cell count of >2 x 10E9/L in peripheral blood)

    4. Subject has received anti-myeloma treatment within 2 weeks or 5 pharmacokinetic half-lives of the treatment, whichever is longer, before the date of randomization. A list of anti-myeloma treatments with the corresponding pharmacokinetic half-lives is provided in the Site Investigational Product Procedures Manual (IPPM)

    5. Radiation therapy in the previous 4 weeks prior to first dose except if given for pain management and involves less than 10% of the bone marrow

    6. Administration of an investigational therapeutic study drug within 4 weeks or within 5 drug half-lives (t1/2), whichever time is greater, prior to first dose

    7. Prior treatment with radium-223 dichloride or any experimental radiopharmaceutical

    8. Major surgery within 4 weeks prior to first dose (central line placement is not considered a major surgery)

    9. Congestive heart failure (New York Heart Association [NYHA] class III to IV), symptomatic cardiac ischemia, cardiomyopathy, clinically relevant ventricular arrhythmia, pericardial disease, unstable angina or myocardial infarct in the previous 6 months prior to first dose, left ventricular ejection fraction <40%

    10. Acute diffuse infiltrative pulmonary disease

    11. Acute active infection requiring systemic antibiotics, antivirals or antifungals within 2 weeks prior to first dose

    12. Known HIV infection or subjects who are known to be HIV seropositive

    13. Subject with active hepatitis B or C infection at screening; subjects with known history of occult or hepatitis B virus (HBV) infection (defined as positive hepatitis B core antibody [HBcAb] and negative hepatitis B surface antigen [HBsAg]), but have undetectable HBV DNA at screening may be included. Subjects with history of positive for hepatitis C virus (HCV) antibody must be negative for HCV RNA by polymerase chain reaction (PCR) assessment or similar technology to be included.

    14. Any history of malignancy within the past 3 years except adequately treated a) basal cell or squamous cell skin cancer, b) carcinoma in situ of the cervix, c) prostate carcinoma in situ < Gleason Score 6 with stable PSA, or d) breast carcinoma in situ

    15. Neuropathy ≥ Grade 2 or Grade 1 with pain

    16. Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis

    17. Hypersensitivity to radium-223 dichloride, bortezomib, or dexamethasone or their excipients

    18. Any clinically significant medical disease or condition that, in the Investigator's opinion, may interfere with protocol adherence or a subject's ability to give informed consent

    19. Female subjects who are pregnant or lactating

    20. Serious psychiatric condition that could interfere with compliance of treatment

    21. Close affiliation with the investigational site (e.g., a close relative of the Investigator, dependent person [e.g., employee or student of the investigational site])

    22. Previous assignment to treatment during this study
    Los pacientes no deben cumplir ninguno de los criterios de exclusión enumerados a continuación:

    1. Haber recibido tratamiento con glucocorticoides sistémicos (prednisona > 10 mg/día por vía oral o equivalente) en las 4 semanas previas a la administración de la primera dosis, a menos que se disminuyese gradualmente la dosis y fuese estable (prednisona ≤ 10 mg/día por vía oral o equivalente) durante al menos 1 semana.

    2. Presentar síndrome de POEMS conocido (polineuropatía, organomegalia, endocrinopatía, proteína monoclonal y alteraciones cutáneas) o amiloidosis de cadenas ligeras (AL).

    3. Padecer leucemia de células plasmáticas (definida por un porcentaje de células plasmáticas > 20 %, y/o un recuento absoluto de células plasmáticas > 2 x 109/l en sangre periférica).

    4. Haber recibido tratamiento contra el mieloma en el plazo de 2 semanas o 5 semividas farmacocinéticas del tratamiento, lo que sea más prolongado, antes de la fecha de aleatorización. En el Manual de procedimientos del producto en investigación (MPPI) del centro se proporciona un listado de los tratamientos contra el mieloma con sus semividas farmacocinéticas correspondientes.

    5. Haber recibido radioterapia en las 4 semanas anteriores a la administración de la primera dosis excepto si se administra para el abordaje del dolor y no afecta a más del 10 % de la médula ósea.

    6. Haber recibido un fármaco experimental de un estudio terapéutico en las 4 semanas o 5 semividas (t1/2) del fármaco —el periodo de tiempo que seamás largo— anteriores a la administración de la primera dosis.

    7. Haber recibido un tratamiento anterior con dicloruro de radio-223 o cualquier radiofármaco experimental.

    8. Haber sido sometido a cirugía mayor en las 4 semanas anteriores a la administración de la primera dosis (la colocación de una línea central no se considera cirugía mayor).

    9. Padecer insuficiencia cardíaca congestiva (clases III y IV de la Asociación de Cardiología de Nueva York [NYHA]), isquemia cardíaca sintomática, miocardiopatía, arritmia ventricular clínicamente relevante, enfermedad pericárdica, angina inestable o infarto de miocardio en los 6 meses anteriores a la administración de la primera dosis; fracción de eyección ventricular izquierda < 40 %.

    10. Padecer enfermedad pulmonar infiltrante difusa aguda.

    11. Haber sufrido una infección activa aguda que precisase del uso de antibióticos sistémicos, antivirales o antifúngicos en las 2 semanas anteriores a la administración de la primera dosis.

    12. Tener infección por VIH o ser seropositivo por VIH con diagnóstico confirmado.

    13. Tener infección activa por hepatitis B o C en la selección; podrá incluirse a los pacientes con antecedentes conocidos de infección oculta por el virus de la hepatitis B (VHB) (definida como un resultado positivo en anticuerpos nucleares de la hepatitis B [HBcAb] y un resultado negativo en antígenos de superficie de la hepatitis B [HBsAg]), si el ADN del VHB es indetectable en la selección. Los pacientes con antecedentes de resultado positivo en anticuerpos del virus de la hepatitis C (VHC) deben obtener un resultado negativo en el ARN del VHC en la evaluación de la reacción en cadena de la polimerasa (RCP) o una tecnología similar para poder ser incluidos.

    14. Cualquier antecedente de neoplasia maligna en los 3 últimos años excepto, a) carcinoma cutáneo basocelular o de células escamosas; b) carcinoma in situ del cuello uterino; c) carcinoma in situ de próstata con una puntuación de Gleason < 6 con antígeno prostático específico (PSA) estable, o d) carcinoma de mama in situ, que se hayan tratado adecuadamente.

    15. Padecer neuropatía de grado ≥ 2 o grado 1 con dolor.

    16. Presentar efusiones pleurales que requieran toracocentesis o ascitis que precise de paracentesis.

    17. Tener hipersensibilidad a dicloruro de radio-223, bortezomib, dexametasona o a sus excipientes.

    18. Sufrir cualquier enfermedad o afección de importancia clínica que, en opinión del investigador, pueda dificultar el cumplimiento del protocolo o interferir en la capacidad del sujeto para otorgar su consentimiento informado.

    19. Mujeres que estén embarazadas o en periodo de lactancia.

    20. Sufrir un trastorno psiquiátrico grave que pueda dificultar el cumplimiento del tratamiento.

    21. Tener una relación estrecha con el centro de investigación (p. ej., un pariente cercano del investigador, persona dependiente [como un empleado o estudiante del centro de investigación]).

    22. Haber sido asignado anteriormente al tratamiento durante este estudio.
    E.5 End points
    E.5.1Primary end point(s)
    For phase 1b part: Safety

    For phase 2 part: Progression-free survival
    Para la parte de fase Ib: seguridad

    Para la parte de fase II: supervivencia sin progresión,
    E.5.1.1Timepoint(s) of evaluation of this end point
    The final analysis of phase 1b data will be conducted when all subjects in the phase 1b part have completed 6 doses of radium 223 with the required safety follow up of study treatment, or have discontinued early.

    For the phase 2 part, the final analysis of PFS will be performed when approximately 101 PFS events have occurred in the 2 study arms combined. The expected study duration for 101 PFS events is 25.1 months.
    El análisis final de los datos de la fase Ib se realizará cuando todos los pacientes de la parte de fase Ib hayan completado 6 dosis de dicloruro de radio-223 con el seguimiento de seguridad requerido del tratamiento del estudio, o se haya interrumpido de forma prematura.

    Para la parte de fase II, el análisis final de SSP se realizará cuando se hayan producido aproximadamente 101 acontecimientos de SSP en los 2 grupos del estudio en conjunto. La duración prevista del estudio hasta alcanzar 101 acontecimientos de SSP es de 25,1 meses.
    E.5.2Secondary end point(s)
    Phase 1b:
    1. Objective response rate at 6 months and 9 months, as determined by IMWG uniform response criteria

    2. Duration of response

    Phase 2:
    1. Safety, acute and long-term
    2. Objective response rate
    3. Overall survival
    4. Time to first on-study SSE
    5. Symptomatic skeletal event-free survival
    6. Time to pain progression
    7. Duration of response
    Parte de fase Ib:
    1. Evaluar la tasa de respuesta objetiva (TRO) a los 6 meses y a los 9 meses, según los criterios de respuesta uniforme del Grupo de Trabajo Internacional del Mieloma (IMWG).
    2. Evaluar la duración de la respuesta (DR).

    Parte de fase II
    1. Evaluar la seguridad, a corto y a largo plazo.
    2. Evaluar la TRO, según los criterios de respuesta uniforme del IMWG.
    3. Evaluar la supervivencia general.
    4. Evaluar el tiempo hasta el primer SSE durante el estudio.
    5. Evaluar la SSE-FS.
    6. Evaluar el tiempo hasta la progresión del dolor.
    7. Evaluar la DR.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Phase 1b:
    1. To evaluate the objective response rate (ORR) at 6 months and 9 months, as determined by International Myeloma Working Group (IMWG) uniform response criteria

    2. To be monitored throughout the course of the study

    Phase 2: To be monitored throughout the course of the study
    Parte de fase Ib:

    1. Evaluar la tasa de respuesta objetiva (TRO) a los 6 meses y a los 9 meses, según los criterios de respuesta uniforme del Grupo de Trabajo Internacional del Mieloma (IMWG).
    2. Ser monitorizados durante todo el curso del estudio.

    Parte de fase II: Ser monitorizados durante todo el curso del estudio.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Dose evaluation of radium-223 dichloride in combination with bortezomib and dexamethasone
    Evaluación de la dosis de la combinación de dicloruro de radio-223 con bortezomib y dexametasona.
    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 Yes
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Fase 1b: estudio sin enmascaramiento: Fase II: doble ciego, aleatorizado
    Phase Ib: open label study; Phase 2: Double-blind, randomized
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial5
    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 concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA38
    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 No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Belgium
    Canada
    Czech Republic
    Germany
    Greece
    Israel
    Italy
    Japan
    Korea, Republic of
    New Zealand
    Poland
    Spain
    Taiwan
    United States
    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
    LVLS
    Última visita del último paciente
    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 months
    E.8.9.1In the Member State concerned days13
    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 days29
    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: 76
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 150
    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 state30
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 110
    F.4.2.2In the whole clinical trial 226
    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)
    Following discontinuation of all study treatments (radium-223 dichloride/placebo treatment, bortezomib and dexamethasone), subjects will be treated and followed as per the institutional standard of care and/or according to the physician’s clinical judgment.
    Tras la interrupción de todos los tratamientos del estudio (tratamiento con dicloruro de radio-223/placebo, bortezomib y dexametasona), los pacientes serán tratados y se les realizará un seguimiento según la pauta de atención de la institución y/o conforme al criterio clínico del 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 Decision2016-11-16
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-10-28
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-03-20
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