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    Summary
    EudraCT Number:2016-003315-35
    Sponsor's Protocol Code Number:B7461006
    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:2017-06-08
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2016-003315-35
    A.3Full title of the trial
    A Phase 3, randomized, open-label study of lorlatinib (PF-06463922) monotherapy versus crizotinib monotherapy in the first-line treatment of patients with advanced ALK-positive non-small cell lung cancer
    ESTUDIO DE FASE III, ALEATORIZADO Y ABIERTO DE LORLATINIB
    (PF˗06463922) EN MONOTERAPIA EN COMPARACIÓN CON CRIZOTINIB EN
    MONOTERAPIA EN EL TRATAMIENTO DE PRIMERA LÍNEA DE PACIENTES
    CON CARCINOMA PULMONAR NO MICROCÍTICO AVANZADO ALKPOSITIVO
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study with investigational drug PF-06463922 and comparator crizotinib in patients with a specific type of advanced lung cancer
    ESTUDIO DE PF˗06463922 EN COMPARACIÓN CON CRIZOTINIB EN
    PACIENTES CON UN TIPO ESPECÍFICO DE CANCER DE PULMÓN AVANZADO
    A.4.1Sponsor's protocol code numberB7461006
    A.5.4Other Identifiers
    Name:US INDNumber:118296
    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 SponsorPfizer Inc., 235 East 42nd Street, New York, NY 10017
    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 supportPfizer Inc., 235 East 42nd Street, New York, NY 10017
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPfizer Inc
    B.5.2Functional name of contact pointClinical Trials.gov Call Centre
    B.5.3 Address:
    B.5.3.1Street Address235 E 42nd Street
    B.5.3.2Town/ cityNew York, NY
    B.5.3.3Post code10017
    B.5.3.4CountryUnited States
    B.5.4Telephone number+3491490 99 00
    B.5.6E-mailClinicalTrials.gov_Inquiries@pfizer.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 namePF-06463922
    D.3.2Product code PF-06463922
    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 INNPF-06463922
    D.3.9.3Other descriptive namePF-06463922
    D.3.9.4EV Substance CodeSUB126819
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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 RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Xalkori
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Limited Ramsgate Road Sandwich Kent CT13 9NJ United Kingdom
    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 nameXalkori (crizotinib)
    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.3.8INN - Proposed INNXalkori
    D.3.9.1CAS number 877399-52-5
    D.3.9.3Other descriptive nameCRIZOTINIB
    D.3.9.4EV Substance CodeSUB32267
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number250
    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
    Advanced ALK positive non small cell lung cancer
    CARCINOMA PULMONAR NO MICROCÍTICO AVANZADO ALKPOSITIVO
    E.1.1.1Medical condition in easily understood language
    A specific type of advanced lung cancer
    Un tipo específico de cancer de pulmón avanzado.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level 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 20.0
    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 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.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    - To demonstrate that lorlatinib as a single agent (Arm A) is superior to crizotinib alone (Arm B) in prolonging progression-free survival (PFS) in advanced ALK-positive NSCLC patients who are treatment naïve.
    Demostrar que el lorlatinib en monoterapia (grupo A) es superior a crizotinib solo
    (grupo B) en la prolongación de la supervivencia sin progresión (SSP) en pacientes
    con CPNM avanzado ALK-positivo que no han recibido tratamiento previo.
    E.2.2Secondary objectives of the trial
    - To compare Arm A with Arm B in treatment-naïve advanced ALK-positive NSCLC patients with respect to overall survival (OS);
    - To evaluate the antitumor activity in each treatment arm;
    - To evaluate the safety and tolerability in each treatment arm;
    - To evaluate patient-reported outcomes (PROs) of health-related quality of life, disease/treatment-related symptoms of lung cancer, and general health status for each treatment arm;
    - To evaluate candidate biomarkers of sensitivity or resistance to single-agent crizotinib or lorlatinib in pre-treatment tumor tissue;
    - To evaluate candidate biomarkers of sensitivity or resistance to single-agent crizotinib or lorlatinib in peripheral blood.
    - Comparar el grupo A y el grupo B en pacientes con CPNM avanzado ALK-positivo
    que no han recibido tratamiento previo, en lo que se refiere a supervivencia general
    (SG).
    - Evaluar la actividad antineoplásica en cada grupo de tratamiento.
    - Evaluar la seguridad y la tolerabilidad en cada grupo de tratamiento.
    - Evaluar los resultados notificados por los pacientes (RNP) de la calidad de vida
    relacionada con la salud, los síntomas de cáncer de pulmón relacionados con la
    enfermedad/el tratamiento y el estado de salud general en cada grupo de tratamiento.
    - Evaluar posibles biomarcadores de sensibilidad o resistencia al crizotinib o al
    lorlatinib en monoterapia en tejido tumoral antes del tratamiento.
    - Evaluar posibles biomarcadores de sensibilidad o resistencia al crizotinib o al
    lorlatinib en monoterapia en sangre periférica.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    - To evaluate the pharmacokinetics (PK) of lorlatinib and potential pharmacokinetic/pharmacodynamic (PK/PD) relationship for lorlatinib if appropriate
    E.3Principal inclusion criteria
    1.Diagnosis:
    a.Study Population: Patients with histologically or cytologically confirmed diagnosis of locally advanced or metastatic ALK-positive NSCLC where ALK status is determined by the FDA-approved (for use in US) and CE (Conformité Européene)marked (for use ex-US) Ventana ALK (D5F3) CDx Assay;
    b.Tumor Requirements: At least 1 extracranial measurable target lesion per RECIST v. 1.1 that has not been previously irradiated. CNS metastases are allowed if:
    i.Asymptomatic: either not currently requiring corticosteroid treatment, or on a stable or decreasing dose of ≤ 10 mg QD prednisone or equivalent; or
    ii.Previously diagnosed and treatment has been completed with full recovery from the acute effects of radiation therapy or surgery prior to randomization, and if corticosteroid treatment for these metastases has been withdrawn for at least 4 weeks with neurological stability; or
    iii.Leptomeningeal disease (LMD) or carcinomatous meningitis (CM) if visualized on MRI (magnetic resonance imaging), or if baseline CSF positive cytology is available.
    c.Tissue Requirements: All patients must have an archival formalin fixed, paraffin embedded (FFPE) tissue specimen available and collected prior to randomization. If archived tissue is unavailable, then a mandatory de novo biopsy must be performed.
    2.No prior systemic NSCLC treatment, including molecularly targeted agents, angiogenesis inhibitors, immunotherapy, or chemotherapy. Adjuvant/neoadjuvant NSCLC treatment only allowed if completed more than 12 months prior to randomization.
    3.Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, 1, or 2.
    4.Age ≥18 years (or ≥20 years as required by local regulation).
    5.Adequate Bone Marrow Function, including:
    a.Absolute Neutrophil Count (ANC) ≥ 1,500/mm3 or ≥ 1.5 x 109/L;
    b.Platelets ≥100,000/mm3 or ≥100 x 109/L;
    c.Hemoglobin ≥ 9 g/dL.
    6.Adequate Pancreatic Function, including:
    a.Serum total amylase ≤ 1.5 x upper limit of normal (ULN)*;
    b.Serum lipase ≤ 1.5 x ULN.
    *if total amylase > 1.5 x ULN, but pancreatic amylase is within the ULN, then patient may be enrolled
    7.Adequate Renal Function, including:
    a.Serum creatinine ≤ 1.5 x ULN or estimated creatinine clearance ≥ 60 mL/min as calculated using the method standard for the institution.
    8.Adequate Liver Function, including:
    a.Total serum bilirubin ≤ 1.5 x ULN;
    b.Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 x ULN (≤ 5.0 x ULN in case of liver metastases);
    9.Acute effects of prior radiotherapy resolved to baseline severity or to CTCAE Grade ≤1 except for AEs that in the investigator’s judgment do not constitute a safety risk for the patient.
    10.Serum pregnancy test (for females of childbearing potential) negative at screening. Female patients of non-childbearing potential must meet at least 1 of the following criteria:
    •Achieved postmenopausal status, defined as follows: cessation of regular menses for at least 12 consecutive months with no alternative pathological or physiological cause; status may be confirmed with a serum follicle-stimulating hormone (FSH) level confirming the postmenopausal state;
    •Have undergone a documented hysterectomy and/or bilateral oophorectomy;
    •Have medically confirmed ovarian failure.
    11.Evidence of a personally signed and dated informed consent document indicating that the patient (or a legally acceptable representative) has been informed of all pertinent aspects of the study.
    12.Willing and able to comply with scheduled visits, treatment plans, laboratory tests and other procedures.
    1. Diagnóstico:
    a. Población de estudio: Pacientes con diagnóstico de CPNM confirmado histológica o citológicamente localmente avanzado o metastásico ALK-positivo en el que el estado de ALK viene determinado por el ensayo Ventana ALK (D5F3) CDx aprobado por la FDA (para su uso en EE. UU.) y el marcado CE (Conformité Européenne, para su usofuera de EE. UU.);
    b. Requisitos del tumor: Al menos 1 lesión diana extracraneal mesurable definida por los RECIST v 1.1 que no haya sido irradiada previamente. Se permiten las metástasis en el SNC si:
    i. Son asintomáticas: no requieren actualmente tratamiento con corticoesteroides o reciben una dosis estable o decreciente de ≤ 10 mg 1 v/d de prednisona o
    equivalente; o
    ii. Se diagnosticaron previamente y el tratamiento ha finalizado con recuperación completa de los efectos agudos de la radioterapia o la cirugía antes de la
    aleatorización, y, si el tratamiento con corticoesteroides para esas metástasis se ha retirado durante al menos 4 semanas con estabilidad neurológica; o
    iii. Enfermedad leptomeníngea (ELM) o meningitis carcinomatosa (MC) si se visualiza en una RM (resonancia magnética) o se dispone de una citología
    inicial positiva de LCR.
    c. Requisitos tisulares: Todos los pacientes deben tener disponible una muestra de tejido fijada en formol e incluida en parafina (FFIP) de archivo y recogida antes de la aleatorización. Si no se dispone de tejido de archivo, es obligatorio realizar una biopsia tumoral nueva.
    2. Ausencia de tratamiento sistémico previo para el CPNM, incluidos los fármacos selectivos moleculares, inhibidores de la angiogénesis, inmunoterapia o quimioterapia. El tratamiento adyuvante/neoadyuvante para el CPNM solo está permitido si finalizó más de 12 meses antes de la aleatorización.
    3. Estado general 0, 1 o 2 conforme a la escala del Grupo Oncológico Cooperativo del Este (Eastern Cooperative Oncology Group, ECOG).
    4. Edad ≥ 18 años (o ≥ 20 años según lo exija la legislación local).
    5. Función adecuada de la médula ósea, lo que incluye:
    a. Recuento absoluto de neutrófilos (RAN) ≥ 1500/mm3 o ≥ 1,5 × 109/l;
    b. Trombocitos ≥ 100 000/mm3 o ≥ 100 x 109/l;
    c. Hemoglobina ≥ 9 g/dl.
    6. Función pancreática adecuada, lo que incluye:
    d. Amilasa total en suero ≤ 1,5 x límite superior de la normalidad (LSN)*;
    e. Lipasa en suero ≤ 1,5 x LSN.
    *si la amilasa total > 1,5 x LSN, pero la amilasa pancreática está dentro del LSN, se puede inscribir al
    paciente
    7. Función renal adecuada, lo que incluye:
    f. Creatinina sérica ≤ 1,5 x LSN o aclaramiento de creatinina estimado ≥ 60 ml/min, calculado utilizando el método habitual de la institución.
    8. Función hepática adecuada, lo que incluye:
    g. Bilirrubina sérica total ≤ 1,5 x LSN;
    h. Aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) ≤ 2,5 x LSN (≤ 5,0 x LSN en caso de metástasis en el hígado);
    9. Efectos agudos de cualquier tratamiento previo resueltos hasta la intensidad inicial o hasta el grado ≤ 1 según los CTCAE, excepto en el caso de AA que no constituyan un riesgo para la seguridad a criterio del investigador.
    10. Prueba de embarazo en suero (en mujeres con capacidad de concebir) negativa en la selección. Las pacientes que no tengan capacidad de concebir deben cumplir al menos 1 de los criterios siguientes:
    - haber alcanzado el estado posmenopáusico, definido como: cese de la menstruación periódica durante al menos 12 meses seguidos sin una causa patológica o fisiológica alternativa; el estado se puede confirmar con un nivel de hormona foliculoestimulante (FSH) sérica que confirme el estado posmenopáusico;
    - haberse sometido a histerectomía u ovariectomía bilateral documentada;
    - presentar insuficiencia ovárica médicamente confirmada.
    Todas las pacientes restantes (incluidas las mujeres con ligadura de trompas) se considerarán con capacidad de concebir.
    11. Constancia de un documento de consentimiento informado firmado y fechado personalmente que indique que se ha informado al paciente (o a un representante legal) de todos los aspectos pertinentes del estudio.
    12. Pacientes que quieran y puedan cumplir con las visitas programadas, los planes de tratamiento, las pruebas analíticas y otros procedimientos.
    E.4Principal exclusion criteria
    1.Spinal cord compression unless the patient has good pain control attained through therapy, and there is stabilization or recovery of neurological function for the 4 weeks prior to randomization.
    2.Major surgery within 4 weeks prior to randomization. Minor surgical procedures (eg, port insertion) are not excluded, but sufficient time should have passed for adequate wound healing.
    3.Radiation therapy within 2 weeks prior to randomization, including stereotactic or partial brain irradiation. Patients who complete whole brain irradiation within 4 weeks prior to randomization or palliative radiation therapy outside of the CNS within 48 hours prior to randomization will also not be included in the study.
    4.Gastrointestinal abnormalities, including inability to take oral medication; requirement for intravenous alimentation; prior surgical procedures affecting absorption including total gastric resection or lap band; active inflammatory gastrointestinal disease, chronic diarrhea, symptomatic diverticular disease; treatment for active peptic ulcer disease in the past 6 months; malabsorption syndromes.
    5.Known prior or suspected severe hypersensitivity to study drugs or any component in their formulations.
    6.Active and clinically significant bacterial, fungal, or viral infection including hepatitis B virus (HBV) or hepatitis C virus (HCV) (e.g., in case of known HBsAg or HCV antibody positivity), known human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS)-related illness.
    7.Clinically significant cardiovascular disease, that is, active or within 3 months prior to enrollment: cerebral vascular accident/stroke, myocardial infarction, unstable angina, congestive heart failure (New York Heart Association Classification Class ≥ II), second- degree or third-degree AV block (unless paced) or any AV block with PR >220 msec; or
    Ongoing cardiac dysrhythmias of NCI CTCAE Grade ≥ 2, uncontrolled atrial fibrillation of any grade, bradycardia defined as <50 bpm (unless patient is otherwise healthy such as long-distance runners, etc.), machine-read ECG with QTc >470 msec, or congenital long QT syndrome.
    8.Patients with predisposing characteristics for acute pancreatitis according to investigator judgment (eg, uncontrolled hyperglycemia, current gallstone disease) in the last month prior to randomization.
    9.History of extensive, disseminated, bilateral or presence of Grade 3 or 4 interstitial fibrosis or interstitial lung disease including a history of pneumonitis, hypersensitivity pneumonitis, interstitial pneumonia, interstitial lung disease, obliterative bronchiolitis, and pulmonary fibrosis.
    10.Evidence of active malignancy (other than NSCLC, non melanoma skin cancer, in situ cervical cancer, papillary thyroid cancer, lobular carcinoma in situ/ductal carcinoma in situ (LCIS/DCIS) of the breast, or localized prostate cancer) within the last 3 years prior to randomization.
    11.Concurrent use of any of the following food or drugs (consult the sponsor if in doubt whether a food or a drug falls into any of the above categories) within 12 days prior to the first dose of lorlatinib or crizotinib.
    a.known strong CYP3A inhibitors (eg, atazanavir, boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, lopinavir, mibefradil, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, troleandomycin, voriconazole, grapefruit juice or grapefruit/grapefruit-related citrus fruits [eg, Seville oranges, pomelos]). The topical use of these medications (if applicable), such as 2% ketoconazole cream, is allowed.
    b.known strong CYP3A inducers (eg, avasimibe, carbamazepine, phenobarbital, phenytoin, rifatutin, rifampin, St. John’s Wort).
    c.known P gp substrates with a narrow therapeutic index (eg, digoxin).
    12.Concurrent use of CYP3A substrates with narrow therapeutic indices (e.g., alfentanil, astemizole*, cisapride*, cyclosporine, dihydroergotamine, ergotamine, fentanyl including transdermal patch, pimozide, quinidine, sirolimus, tacrolimus, terfenadine* [*withdrawn from US market]) within 12 days prior to the first dose of lorlatinib or crizotinib

    Patients who are investigational site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the Investigator, or patients who are Pfizer employees, including their family members, directly involved in the conduct of the study.
    15.Participation in other studies involving investigational drug(s) within 2 weeks prior to study entry and/or during study participation.
    16.Pregnant female patients; breastfeeding female patients; fertile male patients and female patients of childbearing potential who are unwilling or unable to use 2 highly effective methods of contraception as outlined in this protocol for the duration of the study and for at least 90 days after the last dose of investigational product.
    Compresión de la médula espinal, a menos que el paciente tenga un buen control del dolor conseguido mediante tratamiento y haya estabilización o recuperación de la función neurológica durante las 4 semanas previas a la aleatorización.
    2. Cirugía mayor dentro de las 4 semanas previas a la aleatorización. Las intervenciones quirúrgicas menores (p. ej., inserción de una vía) no están excluidas, pero debe haber transcurrido suficiente tiempo para una adecuada cicatrización de la herida.
    3. Radioterapia dentro de las 2 semanas previas a la aleatorización, incluida la irradiación parcial o estereotáctica del cerebro. Los pacientes que se sometan a irradiación completa de todo el cerebro dentro de las 4 semanas previas a la aleatorización o a radioterapia paliativa fuera del SNC dentro de las 48 horas previas a la aleatorización tampoco serán incluidos en el estudio.
    4. Anomalías gastrointestinales, incluida la incapacidad para tomar medicación oral; requisito de alimentación intravenosa; intervenciones quirúrgicas previas que afecten a la absorción, incluida resección gástrica completa o banda gástrica; enfermedad gastrointestinal inflamatoria activa, diarrea crónica, enfermedad diverticular sintomática; tratamiento para úlcera gastroduodenal activa en los últimos 6 meses; síndromes de malabsorción.
    5. Hipersensibilidad grave presunta o conocida a los fármacos del estudio o a cualquier componente de sus formulaciones.
    6. Infección bacteriana, fúngica o vírica, activa y clínicamente significativa, incluidos el virus de la hepatitis B (VHB), el virus de la hepatitis C (VHC) (p. ej., en caso de positivo para el antígeno de superficie de la hepatitis B [hepatitis B surface antigen, HBsAg] o para anticuerpos del VHC), infección conocida por el virus de inmunodeficiencia humana (VIH) o enfermedad relacionada con el síndrome de inmunodeficiencia adquirida (SIDA).
    7. Enfermedad cardiovascular clínicamente significativa, es decir, activa o dentro de los 3 meses previos a la inscripción: accidente cerebrovascular/ictus, infarto de miocardio, angina inestable, insuficiencia cardíaca congestiva (Clasificación de la Asociación del Corazón de Nueva York [New York Heart Association Classification] clase ≥ II), bloqueo AV de grado dos o tres (a menos que lleve marcapasos) o cualquier bloqueo de AV con PR > 220 ms; o Arritmias cardiacas en curso de grado ≥ 2 según CTCAE del NCI, fibrilación auricular no controlada de cualquier grado, bradicardia definida como < 50 lpm (a menos que, por lo demás, el paciente esté sano, como en los corredores de largas distancias, etc.), ECG leído por máquina con QTc > 470 ms, o síndrome de TQ largo congénito.
    8. Los pacientes con características predisponentes a pancreatitis aguda a criterio del investigador (p. ej., hiperglucemia no controlada, cálculos biliares actuales) en el último mes previo a la aleatorización.
    9. Antecedentes o presencia conocida de fibrosis intersticial o enfermedad pulmonar intersticial diseminada/bilateral extensa o de grado 3 o 4, incluidos los antecedentes de neumonitis, neumonitis por hipersensibilidad, neumonía intersticial, enfermedad pulmonar intersticial, bronquiolitis obliterante y fibrosis pulmonar.
    10. Signos de neoplasia maligna activa (distinta de CPNM, cáncer de piel no melanómico, cáncer del cuello del útero localizado, cáncer papilar de tiroides, carcinoma lobulillar localizado/carcinoma ductal localizado (CLL/CDL) de la mama o cáncer de próstata localizado) dentro de los últimos 3 años previos a la aleatorización.
    11. Uso concurrente de alguno de los siguientes alimentos o fármacos (consulte al promotor si duda de si un alimento o fármaco queda comprendido en alguna de las categorías anteriores) dentro de los 12 días previos a la primera dosis de lorlatinib o crizotinib.
    a. Inhibidores potentes conocidos del CYP3A (p. ej., atazanavir, boceprevir, claritromicina, conivaptán, indinavir, itraconazol, ketoconazol, lopinavir, mibefradil, nefazodona, nelfinavir, posaconazol, ritonavir, saquinavir, telaprevir, telitromicina, troleandomicina, voriconazol, zumo de pomelo o pomelo/frutas cítricas relacionadas con el pomelo [p. ej., naranjas amargas o pomelos]). Se permite el uso tópico de estos medicamentos (si procede), como crema de ketoconazol al 2 %.
    b. Inductores potentes conocidos del CYP3A (p. ej., avasimiba, carbamazepina, fenobarbital, fenitoína, rifatutina, rifampina, hierba de San Juan).
    c. Sustratos conocidos de la glucoproteína P (gp-P) con un índice terapéutico estrecho (p. ej., digoxina).
    12. El uso simultáneo de sustratos de CYP3A con índices terapéuticos estrechos (p. ej., alfentanilo, astemizol*, cisaprida*, ciclosporina, dihidroergotamina, ergotamina, fentanilo incluidos los parches transdérmicos, pimozida, quinidina, sirolimús, tacrolimús, terfenadina* [*retirado del mercado estadounidense]) dentro de los 12 días previos a la primera dosis de lorlatinib o crizotinib.
    [...] Para más información, por favor consulte el protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    •PFS based on blinded independent central review (BICR) assessment (RECIST v.1.1).
    SSP basada en la evaluación de la revisión central independiente con
    enmascaramiento (RCIE) (RECIST v.1.1).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Please, refer to the Schedule of assessments in the Protocol
    Por favor, refiérase al calendario de actividades en el Protocolo.
    E.5.2Secondary end point(s)
    •Efficacy: OS, PFS based on Investigator’s assessment, OR based on BICR and on Investigator’s assessment; intracranial OR (IC-OR), IC-TTP, DR, TTR and CBR by BICR (RECIST v. 1.1) and PFS2;
    •Safety: AEs (as graded by NCI CTCAE v.4.03); laboratory abnormalities (as graded by NCI CTCAE v.4.03); vital signs (blood pressure, pulse rate) and body weight; electrocardiograms (ECGs); echocardiogram or MUGA scan; ophthalmologic data;

    •PROs as assessed by EORTC QLC-C30, EORTC QLQ-LC13, EQ-5D-5L;

    •Tumor tissue biomarkers including, but not limited to, ALK gene rearrangement and/or mutation as measured by next-generation sequencing (NGS) and/or immunohistochemistry (IHC);
    •Peripheral blood cfDNA (circulating free Deoxyribonucleic acid) biomarkers including, but not limited to, ALK gene rearrangement and/or ALK kinase domain mutations.
    - Eficacia: SG y SSP basada en la evaluación del investigador, respuesta objetiva (RO) basada en la RCIE y en la evaluación del investigador, RO intracraneal (RO-IC), tiempo hasta la progresión IC (THP-IC), duración de la respuesta (DR), tiempo hasta la respuesta del tumor (TRT) y tasa de beneficio clínico (TBC) mediante RCIE (RECIST v. 1.1) y SSP2.
    - Seguridad: acontecimientos adversos (AA), clasificados según la escala CTCAE del NCI (criterios terminológicos comunes para acontecimientos adversos del Instituto Nacional del Cáncer) versión 4.03; anomalías analíticas (clasificadas según la escala CTCAE del NCI versión 4.03); constantes vitales (tensión arterial y frecuencia cardíaca) y peso corporal; electrocardiogramas (ECG), ecocardiograma o ventriculografía isotópica (MUGA); datos oftalmológicos.
    - RNP evaluadas por EORTC (Organización Europea para la Investigación y el Tratamiento del cáncer) QLC-C30, EORTC QLQ-LC13, EQ-5D-5L.
    - Biomarcadores en tejido tumoral, incluidos, entre otros, reordenamiento del gen ALK y/o mutaciones medidas por secuenciación de última generación (SUG) o inmunohistoquímica (IHQ);
    - Biomarcadores de ADNlc (ácido desoxirribonucleico libre circulante) en sangre
    periférica, incluidos, entre otros, reordenamiento del gen ALK y/o mutaciones del
    dominio de cinasa ALK.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Please refer to the Schedule of Activities of the Protocol
    Por favor, refiérase al calendario de actividades en el Protocolo.
    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 Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open 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 No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned16
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA62
    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
    Argentina
    Australia
    Belgium
    Canada
    China
    Czech Republic
    Denmark
    France
    Germany
    Hong Kong
    India
    Italy
    Japan
    Korea, Republic of
    Mexico
    Netherlands
    Poland
    Russian Federation
    Singapore
    Spain
    Taiwan
    Turkey
    United Kingdom
    United States
    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
    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 years1
    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 years1
    E.8.9.2In all countries concerned by the trial months7
    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: 280
    F.1.3Elderly (>=65 years) No
    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 state28
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 124
    F.4.2.2In the whole clinical trial 280
    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)
    Please, refer to the schedule of assessments in the protocol
    Por favor, refiérase al Calendario de Actividades en el Protocolo
    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 Decision2017-06-08
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-05-02
    P. End of Trial
    P.End of Trial StatusOngoing
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