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    Summary
    EudraCT Number:2016-003801-32
    Sponsor's Protocol Code Number:MEDI4736-MM-005
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2018-02-21
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2016-003801-32
    A.3Full title of the trial
    Multicenter, Single-arm, Phase 2 Study to Determine the Efficacy for the
    Combination of Daratumumab (DARA) Plus Durvalumab (DURVA) (D2) in
    Subjects With Relapsed and Refractory Multiple Myeloma (RRMM) who
    have Progressed on DARA While on a DARA-containing Regimen as the
    Most Recent Multiple Myeloma Therapy.
    Studio di fase 2, multicentrico, a braccio singolo, per determinare l’efficacia dell’associazione di Daratumumab (DARA) e Durvalumab (DURVA) (D2) in soggetti con Mieloma Multiplo recidivante e refrattario (RRMM) che hanno mostrato una progressione di malattia al DARA durante il trattamento con il regime contenente DARA somministrato come più recente terapia per il Mieloma Multiplo
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to determine the effectiveness for the combination of durvalumab
    and daratumumab (D2) to treat relapsed and refractory multiple myeloma
    in subjects whose multiple myeloma has worsened while on a
    daratumumab therapy as their last multiple myeloma treatment.
    Studio per determinare l'efficacia per la combinazione di durvalumab e daratumumab (D2) nel trattamento del mieloma multiplo recidivante e refrattario in soggetti il cui mieloma multiplo è peggiorato durante una terapia con daratumumab quale loro ultimo trattamento del mieloma multiplo.
    A.3.2Name or abbreviated title of the trial where available
    FUSION MM-005
    FUSION MM-005
    A.4.1Sponsor's protocol code numberMEDI4736-MM-005
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03000452
    A.5.3WHO Universal Trial Reference Number (UTRN)U1111-1191-1405
    A.5.4Other Identifiers
    Name:INDNumber:127058
    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 SponsorCELGENE INTERNATIONAL II SàRL
    B.1.3.4CountrySwitzerland
    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 supportCelgene International II Sàrl
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCelgene Corporation
    B.5.2Functional name of contact pointClinicalTrialDisclosure
    B.5.3 Address:
    B.5.3.1Street Address9225 Indian Creek Parkway, Suite 900
    B.5.3.2Town/ cityOverland Park
    B.5.3.3Post codeKS 66210
    B.5.3.4CountryUnited States
    B.5.4Telephone number+18882601599
    B.5.5Fax number+19132660394
    B.5.6E-mailClinicalTrialDisclosure@celgene.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 nameDurvalumab
    D.3.2Product code MEDI4736
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDurvalumab
    D.3.9.2Current sponsor codeMEDI4736
    D.3.9.4EV Substance CodeSUB176342
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product typeAnticorpo monoclonale umanizzato
    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 DARZALEX
    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 Yes
    D.2.5.1Orphan drug designation numberEU/3/13/1153
    D.3 Description of the IMP
    D.3.1Product nameDaratumumab
    D.3.2Product code JNJ-54767414
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDARATUMUMAB
    D.3.9.1CAS number 945721-28-8
    D.3.9.2Current sponsor codeJNJ-54767414
    D.3.9.4EV Substance CodeSUB175772
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product type Anticorpo monoclonale umanizzato
    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
    Relapsed and Refractory Multiple Myeloma
    Mieloma multiplo recidivante e refrattario
    E.1.1.1Medical condition in easily understood language
    Cancer of the bone marrow that has recurred or no longer responds to current treatment
    Cancro del midollo osseo che è recidivato o non risponde più al trattamento corrente
    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 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
    The primary objective of the study is to determine the efficacy of
    daratumumab (DARA) plus durvalumab (DURVA) in subjects with
    relapsed and refractory multiple myeloma (RRMM) who have progressed
    on a current treatment regimen containing DARA.
    L’obiettivo primario dello studio è quello di determinare l'efficacia di daratumumab (DARA) più durvalumab (DURVA) in soggetti con mieloma multiplo recidivante e refrattario (‘relapsed and refractory multiple myeloma’, RRMM) che sono progrediti durante l’attuale regime terapeutico contenente DARA.
    E.2.2Secondary objectives of the trial
    Determine the safety of DARA plus DURVA in subjects with RRMM who have progressed while on a current treatment regimen containing DARA.
    Evaluate additional measures of efficacy of DARA plus DURVA in subjects with RRMM who have progressed on a current treatment regimen
    containing DARA.
    Evaluate the pharmacokinetics (PK) of DARA plus DURVA in subjects with RRMM who have progressed on a current treatment regimen containing DARA.
    Determinare la sicurezza di DARA più DURVA in soggetti con RRMM che sono progrediti durante l’attuale regime terapeutico contenente DARA.

    Valutare ulteriori misure di efficacia di DARA più DURVA in soggetti con RRMM che sono progrediti durante l’attuale regime terapeutico contenente DARA.

    Valutare ulteriori misure di farmacocinetica (PK) di DARA più DURVA in soggetti con RRMM che sono progrediti durante l’attuale regime terapeutico contenente DARA.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Subject received at least 3 prior anti-myeloma regimens including a PI
    and an immunomodulatory agent or is double-refractory to a PI and an
    immunomodulatory agent.
    • Induction, bone marrow transplant with or without maintenance
    therapy is considered one regimen.
    • Refractory is defined as disease that is nonresponsive on therapy, or
    progresses within 60 days of last therapy. Nonresponsive disease is
    defined as either failure to achieve minimal response or development of
    progressive disease while on therapy.
    • For subjects who received more than 1 regimen containing a PI their
    disease must be refractory to the most recent PI containing regimen.
    • For subjects who received more than 1 regimen containing a immunomodulatory agent their disease must be refractory to the most
    recent immunomodulatory agent containing regimen.
    2. All subjects must have failed DARA either as a single agent or in
    combination on last MM therapy. Failure is defined as PD on DARA either
    as a single agent or in combination.
    3. Subject has measurable disease defined as:
    a. M-protein (serum protein electrophoresis (sPEP) or urine protein
    electrophoresis (uPEP): sPEP ≥ 0.5 g/dL or uPEP ≥ 200 mg/24 hours)
    and/or
    b. Light chain MM without measurable disease in the serum or the urine:
    serum immunoglobulin free light chain ≥10 mg/dL and abnormal serum
    immunoglobulin kappa lambda free light chain ratio
    4. Subject achieved a response (minimal response [MR] or better) to at
    least 1 prior treatment regimen.
    5. Subject has an Eastern Cooperative Oncology Group (ECOG)
    Performance Status score of 2 or less.
    6. Subject's toxicities resulting from previous therapy (including
    peripheral neuropathy) have resolved or stabilized to ≤ Grade 1.
    7. Subject is at least 18 years of age at the time of signing the informed
    consent form (ICF).
    8. Subject must understand and voluntarily sign an ICF prior to any
    study-related assessments/procedures being conducted.
    9. Subject is willing and able to adhere to the study visit schedule and
    other protocol requirements.
    10. Females of childbearing potential (FCBP) must:
    a. Have 2 negative pregnancy tests as verified by the investigator prior
    to starting study treatment. This applies even if the subject practices
    true abstinence from heterosexual contact.
    i. Negative serum pregnancy test at screening
    ii. Negative serum or urine pregnancy test (investigator's discretion)
    within 72 hours prior to starting study treatment (Cycle 1, Day 1), and
    before beginning each subsequent cycle of treatment, and after end of
    study treatment.
    Note: Pregnancy testing does not need to be repeated prior to Cycle 1 if
    the serum pregnancy test for screening was performed within 72 hours
    of the first dose of study treatment.
    b. Either practice true abstinence from heterosexual contact (which must
    be reviewed on a monthly basis and source documented) or agree to
    use, and be able to comply with, effective contraception without
    interruption (eg, oral, injectable, or implantable hormonal contraceptive;
    tubal ligation; intra-uterine device; barrier contraceptive with
    spermicide; true abstinence; or vasectomized partner), 28 days prior to
    starting study treatment, during the study therapy (including dose
    interruptions), and for at least 90 days after discontinuation of study
    treatment.
    c. Agree to abstain from breastfeeding during study participation and for
    at least 90 days after the last dose of DARA or DURVA, whichever is
    later.
    d. Refrain from egg cell donation for at least 90 days after the final dose
    of DURVA or DARA, whichever is later.
    11. Male subjects must:
    a. Either practice true abstinence (which must be reviewed on a monthly
    basis) or agree to use a condom during sexual contact with a pregnant
    female or a female of childbearing potential while participating in the
    study, during dose interruptions and for at least 90 days following study
    treatment discontinuation, even if he has undergone a successful
    vasectomy.
    b. Refrain from sperm donation for at least 90 days after the final dose
    of DURVA or DARA, whichever is later.
    1. Il soggetto ha ricevuto almeno 3 precedenti regimi terapeutici anti-mieloma comprendenti un PI e un agente immunomodulatore, o è doppiamente refrattario/a ad un PI e ad un agente immunomodulatore.
    • Induzione, trapianto di midollo osseo con o senza terapia di mantenimento sono considerati schemi terapeutici.
    • Per refrattaria si intende una malattia che non risponde a terapia o progredisce entro 60 giorni dall’ultima terapia. Per malattia che non risponde si intende il mancato raggiungimento della risposta minima o lo sviluppo di malattia progressiva durante la terapia.
    • Per i soggetti che hanno ricevuto più di 1 regime terapeutico contenente un PI, la loro malattia deve essere refrattaria al più recente regime terapeutico contenente PI.
    • Per i soggetti che hanno ricevuto più di 1 regime terapeutico contenente un agente immunomodulatore, la loro malattia deve essere refrattaria al più recente regime terapeutico contenente un agente immunomodulatore.
    2. Tutti i soggetti devono avere fallito con terapia con DARA come agente singolo o in combinazione con l’ultima terapia per MM. L’insuccesso viene definito come PD durante l’assunzione di DARA o come agente singolo o in combinazione.
    3. Il soggetto ha malattia misurabile definita come:
    a. M-proteina (elettroforesi sieroproteica (sPEP) o elettroforesi proteica delle urine (uPEP): sPEP ≥ 0,5 g/dL o uPEP ≥ 200 mg/24 ore) e/o
    b. Catena leggera MM senza malattia misurabile nel siero o nelle urine: catena leggera libera dell’immunoglobulina del siero ≥10 mg/dL e rapporto anormale della catena leggera kappa lambda dell’immunoglobulina del siero
    4. Il soggetto ha ottenuto una risposta (risposta minima [minimal response, MR] o migliore) ad almeno 1 precedente regime di trattamento.
    5. Il soggetto presenta un punteggio del performance status dell’Eastern Cooperative Oncology Group (ECOG) di 2 o meno.
    6. Le tossicità del soggetto risultanti da terapia precedente (tra cui la neuropatia periferica) si sono risolte o stabilizzate a ≤ Grado 1.
    7. Il soggetto ha almeno 18 anni di età al momento della firma del modulo di consenso informato (IFC).
    8. Il soggetto deve capire e firmare volontariamente un Modulo di Consenso Informato [ICF] prima che siano condotte valutazioni/procedure connesse allo studio.
    9. Il soggetto è disposto ed in grado di attenersi al programma di visite dello studio e agli altri requisiti del protocollo.
    10. Le donne in età fertile (‘Females of childbearing potential’, FCBP) devono:
    a. Presentare 2 test di gravidanza negativi verificati dallo Sperimentatore prima di iniziare il trattamento in studio. Questo si applica anche se il soggetto pratica completa astinenza da contatti eterosessuali.
    i. Test di gravidanza sierico negativo allo screening
    ii. Test di gravidanza sierico o urinario negativo (a discrezione dello Sperimentatore) entro 72 ore prima di iniziare il trattamento in studio (Ciclo 1, Giorno 1), prima dell’inizio di ogni successivo ciclo di trattamento e dopo la fine del trattamento in studio.
    Nota: Il test di gravidanza non deve essere ripetuto prima del Ciclo 1 se il test di gravidanza sierico per lo screening è stato eseguito entro 72 ore dalla somministrazione della prima dose di trattamento in studio.
    b. Praticare completa astinenza da contatti eterosessuali (che deve essere riesaminata su base mensile e documentata all’origine) o decidere di
    utilizzare contraccezione efficace senza interruzione e di essere in grado di conformarsi alla stessa (ad esempio contraccettivo orale, iniettabile o ormonale impiantabile; legatura delle tube; dispositivo intrauterino; anticoncezionali a barriera con spermicida; completa astinenza; o partner vasectomizzato), 28 giorni prima di iniziare il trattamento in studio, durante la terapia dello studio (comprese le interruzioni di dose) e per almeno 90 giorni dopo la sospensione del trattamento in studio.
    c. Convenire di astenersi dall'allattamento durante la partecipazione allo studio e per almeno 90 giorni dopo l'ultima dose di DARA o DURVA, a seconda di quale data si verifichi per ultima.
    d. Astenersi dalla donazione di ovuli per almeno 90 giorni dall'ultima dose di DURVA o DARA, a seconda di quale data si verifichi per ultima.
    11. I soggetti di sesso maschile devono:
    a. Praticare completa astinenza (che deve essere valutata su base mensile) o acconsentire ad usare un preservativo durante il contatto sessuale con una donna in stato di gravidanza o con una donna in età fertile mentre partecipano allo studio, durante le interruzioni di dose e per almeno 90 giorni a seguito dell'interruzione del trattamento in studio, anche se il soggetto fosse stato sottoposto ad un intervento riuscito di vasectomia.
    b. Astenersi dalla donazione di sperma per almeno 90 giorni dall'ultima dose di DURVA o DARA, a seconda di quale data si verifichi per ultima.
    E.4Principal exclusion criteria
    1. Subject has had prior exposure to anti-CTLA-4, anti-PD-1, anti-PD-L1
    mAbs, or cancer vaccines
    2. Subject has received ASCT within 12 weeks before the date of
    randomization.
    3. History of organ or allogeneic stem cell transplantation
    4. Subject received any of the following within the last 14 days of
    initiating study treatment:
    a. Plasmapheresis
    b. Major surgery
    c. Radiation therapy other than local therapy for myeloma associated
    bone lesions
    d. Use of any systemic anti-myeloma drug therapy (except for DARA
    either alone or in combination with other agents given with it)
    5. Subject received prior treatment with a monoclonal antibody within 5
    half-lives of initiating study treatment, other than DARA.
    6. Subject is receiving concurrent chemotherapy or biologic or hormonal
    therapy for cancer treatment.
    7. Subject has any of the following laboratory abnormalities:
    a. ANC < 1,000/μL
    b. Platelet count: < 75,000/μL (it is not permissible to transfuse a
    subject to reach this level)
    c. Hemoglobin < 8 g/dL (< 4.9 mmol/L)(it is not permissible to
    transfuse a subject to reach this level)
    d. Creatinine clearance (CrCl) < 45 mL/min (calculated using the
    Cockcroft-Gault formula or directly calculated from the 24-hour urine
    collection method)
    e. Corrected serum calcium > 13.5 mg/dL (> 3.4 mmol/L)
    f. AST or ALT > 2.5 × ULN
    g. Serum total bilirubin > 1.5 × ULN or > 3.0 mg/dL for subjects with
    documented Gilbert's syndrome
    8. Subject has clinical evidence of CNS or pulmonary leukostasis,
    disseminated intravascular coagulation, or CNS MM
    9. Subject has known COPD with a FEV1 50% of predicted normal. Note
    that forced expiratory testing (FEV1)is required for subjects suspected
    of having COPD and subjects must be excluded if FEV1 is < 50% of
    predicted normal.
    10. Subject has known moderate or severe persistent asthma within the
    past 2 years or uncontrolled asthma of any classification. Note that
    subjects who currently have controlled intermittent asthma or controlled
    mild persistent asthma are allowed to participate in the study.
    11. Subject has plasma cell leukemia, Waldenstrom's
    macroglobulinemia, POEMS syndrome, or amyloidosis
    12. Subject has nonsecretory MM
    13. Subject has known allergy or hypersensitivity to study drug
    formulations
    14. Subject has active or prior documented autoimmune or inflammatory
    disorders within the past 3 years prior to the start of treatment. The
    following are exceptions to this criterion:
    a. Subjects with vitiligo or alopecia.
    b. Subjects with hypothyroidism (eg, following Hashimoto's disease)
    stable on hormone replacement.
    c. Psoriasis not requiring systemic treatment.
    15. Subject has history of primary immunodeficiency
    16. Subject is positive for HIV-1, chronic or active hepatitis B or active
    hepatitis A or C.
    17. Subject has received live, attenuated vaccine within 30 days prior to
    the first dose of DURVA.
    18. Subject is currently using or has used immunosuppressive
    medication within 14 days prior to the first study dose of study
    treatment. The following are exceptions to this criterion:a. Intranasal, topical, inhaled, or local steroid injections (eg, intraarticular
    injection).
    b. Systemic corticosteroids at physiologic doses not to exceed 10
    mg/day of prednisone or equivalent.
    c. Steroids as premedication for hypersensitivity reactions (eg, infusionrelated
    reactions, computed tomography [CT] scan premedication).
    19. Subject has any one of the following:
    a. Clinically significant abnormal ECG finding at screening
    b. Congestive heart failure (NYHA Class III or IV)
    c. Myocardial infarction within 12 months prior to starting study
    treatment
    d. Unstable or poorly controlled angina pectoris, including Prinzmetal
    variant angina pectoris
    20. Subject has prior history of malignancies, other than MM, unless the
    subject has been free of the disease for ≥ 5 years with the exception of
    the following noninvasive malignancies:
    a. Basal cell carcinoma of the skin
    b. Squamous cell carcinoma of the skin
    c. Carcinoma in situ of the cervix
    d. Carcinoma in situ of the breast
    e. Incidental histologic finding of prostate cancer (T1a or T1b using the
    TNM clinical staging system) or prostate cancer that is curative
    21. Subject is a female who is pregnant, nursing, or breastfeeding, or
    who intends to become pregnant during the participation in the study.
    22. Subject has any significant medical condition, laboratory
    abnormality, or psychiatric illness that would prevent the subject from
    participating in the study
    23. Subject has any condition including the presence of laboratory
    abnormalities, which places the subject at unacceptable risk if he/she
    were to participate in the study
    24. Subject has any condition that confounds the ability to interpret data
    from the study
    1. Il sogg è stato precedentemente esposto a vaccini anti-CTLA-4, anti-PD-1, anti- mAb PD-L1 o anti-tumorali
    2. Il sogg ha ricevuto ASCT [trapianto autologo di cellule staminali] entro 12 settimane prima della data di randomizzazione
    3. Anamnesi di trapianto di organo o allogenico di cellule staminali
    4. Il sogg ha ricevuto uno qualsiasi dei seguenti trattamenti entro gli ultimi 14 giorni dall’inizio del trattamento in studio:
    a. Plasmaferesi
    b. Intervento chirurgico significativo
    c. Terapia a base di radiazioni che non fosse terapia locale per mieloma associata a lesioni ossee
    d. Uso di qualsiasi terapia sistemica a base di farmaco anti-mieloma (tranne per DARA sia da solo che in combinazione con altri agenti somministrati con lo stesso)
    5. Il sogg ha ricevuto precedente trattamento con un anticorpo monoclonale entro 5 emivite dall’inizio del trattamento in studio, che non fosse DARA
    6. Il sogg riceve chemioterapia concomitante o terapia biologica o ormonale per il trattamento del cancro
    7. Il sogg presenta una qualunque delle seguenti alterazioni dei test di laboratorio:
    a. ANC < 1.000/µL
    b. Conta piastrinica: < 75.000/µL (non è ammissibile la trasfusione di un soggetto per raggiungere questo livello)
    c. Emoglobina < 8 g/dL (< 4,9 mmol/L)non è ammissibile la trasfusione di un soggetto per raggiungere questo livello
    d. Clearance della creatinina (CrCl) < 45 mL/min (calcolata utilizzando la formula Cockcroft-Gault o calcolata direttamente dal metodo di raccolta delle urine delle 24 ore)
    e. Calcio sierico corretto >13,5 mg/dL (>3,4 mmol/L)
    f. AST o ALT > 2,5 × ULN
    g. Bilirubina totale sierica > 1,5 × ULN o > 3,0 mg/dL per soggetti con documentata sindrome di Gilbert
    8. Il sogg presenta evidenza clinica di leucostasi del SNC o polmonare coagulazione intravascolare disseminata o MM del SNC
    9. Il sogg presenta nota BPCO con un FEV1 50% del normale predetto. Si prega di notare che il test espiratorio forzato (FEV1) è richiesto ai soggetti con sospetta BPCO e i soggetti devono essere esclusi se FEV1 è < 50% del normale predetto.
    10. Il sogg presenta asma persistente moderata o grave negli ultimi 2 anni o asma non controllata di qualsiasi classificazione. Si prega di notare che i soggetti che attualmente presentano asma intermittente controllata o asma persistente lieve controllata sono ammessi a partecipare allo studio
    11. Il sogg presenta leucemia plasmacellulare, macroglobulinemia di Waldenstrom, sindrome POEMS o amiloidosi
    12. Il sogg presenta MM non secernente
    13. Il sogg presenta nota allergia o ipersensibilità alle formulazioni del farmaco in studio
    14. Il sogg presenta disturbi documentati autoimmuni o infiammatori attivi o precedenti entro gli ultimi 3 anni prima di avviare il trattamento. Di seguito sono riportate le eccezioni a questo criterio:
    a. Sogg con vitiligine o alopecia
    b. Sogg con ipotiroidismo per esempio in seguito a malattia di Hashimoto, stabili con terapia ormonale sostitutiva.
    c. Psoriasi che non richiede un trattamento sistemico
    15. Il sogg ha un anamnesi di immunodeficienza primaria
    16. Il sogg è positivo per HIV-1 epatite B cronica o attiva o epatite A o C attiva.
    17. Il sogg ha ricevuto vaccino vivo, attenuato entro i 30 giorni precedenti la prima dose di DURVA
    18. Il sogg sta attualmente usando o ha utilizzato farmaci immunosoppressivi entro i 14 giorni precedenti la prima dose dello studio del trattamento sperimentale. Di seguito sono riportate le eccezioni a questo criterio:
    a. Steroidi per via intranasale, topica, inalati o mediante iniezioni locali ad es. iniezione intra-articolare
    b. Corticosteroidi sistemici a dosi fisiologiche che non superino 10 mg/die di prednisone o equivalente
    c. Steroidi come pretrattamento per reazioni di ipersensibilità ad es. reazioni correlate all’infusione, pretrattamento tomografia computerizzata TC
    19. Il sogg presenta almeno uno dei seguenti:
    a. ECG anormale clinicamente significativo rilevato allo screening
    b. Insufficienza cardiaca congestizia (classe NYHA III o IV)
    c. Infarto del miocardio entro 12 mesi prima di iniziare il trattamento in studio
    d. Angina pectoris instabile o scarsamente controllata, compresa angina pectoris variante di Prinzmetal
    20. Il sogg presenta anamnesi precedente di neoplasie maligne, diverse da MM, a meno che il soggetto sia libero/a da malattia da ≥ 5 anni, ad eccezione delle seguenti neoplasie maligne non invasive:
    a. Carcinoma cutaneo basocellulare
    b. Carcinoma cutaneo a cellule squamose
    c. Carcinoma in situ della cervice
    d. Carcinoma in situ della mammella
    e. Rilevamento istologico incidentale del cancro della prostata (T1a o T1b utilizzando il sistema di staging clinico TNM) o cancro della prostata che sia curativo
    21. Il sogg è una donna in stato di gravidanza, allattamento, o che intende iniziare una gravidanza durante la partecipazione allo studio
    22. Il sogg ha una qualsiasi patologia medica significativa, anomalia di test di laboratorio o malattia psichiatrica che gli/le impedirebbe di partecipare allo stud
    E.5 End points
    E.5.1Primary end point(s)
    Overall response rate (ORR) - Tumor response (partial response [PR] or
    better), and the rate of progressive disease (PD) according to the
    International Myeloma Working Group (IMWG) Uniform Response
    Criteria
    Tasso di risposta globale (‘Overall response rate’, ORR) - Risposta del tumore (risposta parziale [‘partial response’, PR] o migliore), e tasso di progressione della malattia (malattia progressiva ‘progressive disease’, PD) secondo i Criteri di risposta uniformi del Gruppo di lavoro internazionale sul mieloma (International Myeloma Working Group, IMWG)
    E.5.1.1Timepoint(s) of evaluation of this end point
    ORR will be assessed throughout the study.
    Il tasso di risposta globale sarà valutato nel corso dell’intero studio
    E.5.2Secondary end point(s)
    Safety - Type, frequency, seriousness and severity of adverse events
    (AEs), and relationship of AEs to study treatment
    Time-to-response (TTR) - Time from treatment initiation to the first
    documentation of response (PR or greater)
    Duration of response (DOR) - Time from the first documentation of
    response (PR or greater) to the first documentation of PD or death,
    whichever is earlier, based on the investigator assessments according to
    the IMWG Uniform Response Criteria
    Progression-free survival (PFS) - Time from treatment initiation to the
    first documentation of PD or death from any cause during study, whichever occurs earlier
    Overall survival (OS) - Time from treatment initiation to death due to
    any cause
    Pharmacokinetic (PK) parameters - Typical serum/plasma PK
    parameters for DURVA and DARA, such as maximum observed
    concentration (Cmax), area under the concentration-time curve (AUC),
    time to maximum concentration (Tmax), terminal elimination half-life
    (t1/2), clearance (CL/F), and volume of distribution (Vz/F)
    Sicurezza - tipo, frequenza, serietà e gravità degli eventi avversi (‘adverse events’, AE), e il rapporto tra gli AE e trattamento in studio

    Tempo di risposta (‘Time-to-response’, TTR) - tempo dall’inizio del trattamento alla prima documentazione di risposta (PR o superiore)
    Durata della risposta (‘Duration of response’, DOR) - tempo dalla prima documentazione di risposta (PR o superiore) alla la prima documentazione di PD o decesso, a seconda di quale evento si verifichi per primo, in base alle valutazioni dello Sperimentatore secondo i Criteri di risposta uniformi IMWG
    Sopravvivenza libera da progressione (‘progression-free survival’, PFS) - tempo dall’inizio del trattamento alla prima documentazione di PD o di decesso per qualsiasi causa durante lo studio, a seconda di quale evento si verifichi per primo
    Sopravvivenza globale (‘overall survival’, OS) - tempo dall’inizio del trattamento al decesso per qualsiasi causa
    Parametri di farmacocinetica (PK) - Parametri PK tipici siero/plasma per DURVA e DARA, quali la massima concentrazione osservata (Cmax), area sotto la curva concentrazione-tempo (AUC), tempo fino alla concentrazione massima (Tmax), emivita di eliminazione terminale (t1/2), clearance (CL/F) e volume di distribuzione (Vz/F)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Safety, TTR, DOR, PFS and OS will be assessed throughout the study.
    DURVA PK sample time points Part 1 Stage 1:
    • C1D2: pre dose (-30 to -5 mins prior to dose), end of infusion (EOI)
    (+5 mins),
    • C1D8: 144 hrs post C1D2 dose (± 1 hr)
    • C1D15: 312 hrs post C1D2 dose (± 1 hr),
    • C1D22: 480 hours post C1D2 dose (± 1 hr).
    • Predose on C2D1, C4D1, C6D1, C10D1, and C14D1.
    DARA PK time points Part 1 Stage 1:
    · C1D1: predose (-30 to -5 mins prior to dose), and EOI (+5 mins)
    · C1D8: predose (-30 to -5 mins prior to dose), and EOI (+5 mins)
    · C1D15: predose (-30 to -5 mins prior to dose), and EOI (+5 mins)
    · C1D22: predose (-30 to -5 mins prior to dose), and EOI (+5 mins)
    · EOT
    · 28 days after EOT,
    · 90 days after last DARA or DURVA dose
    Sicurezza, TTR, DOR, PFS e OS saranno valutati per tutta la durata dello studio.

    Intervalli temporali campione PK DURVA Parte 1 Stadio 1:
    · C1G2: pre-dose (da -30 a -5 minuti prima della dose), fine dell'infusione (‘end of infusion’, EOI) (+5 minuti),
    · C1G8: 144 ore post-dose C1G2 (± 1 ora)
    · C1G15: 312 ore post-dose C1G2 (± 1 ora),
    · C1G22: 480 ore post-dose C1G2 (± 1 ora).
    · Predose al C2G1, C4G1, C6G1, C10G1 e C14G1.

    Intervalli temporali campione PK DARA Parte 1 Stadio 1:
    · C1G1: pre-dose (da -30 a -5 minuti prima della dose), e EOI (+5 minuti)
    · C1G8: pre-dose (da -30 a -5 minuti prima della dose), e EOI (+5 minuti)
    · C1G15: pre-dose (da -30 a -5 minuti prima della dose), e EOI (+5 minuti)
    · C1G22: pre-dose (da -30 a -5 minuti prima della dose), e EOI (+5 minuti)
    · EOT (fine trattam
    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 Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Immunogenicity
    Immunogenicità
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Information not present in EudraCT
    E.8.1.6Cross over Information not present in EudraCT
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.3 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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA17
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Austria
    Canada
    Germany
    Greece
    Italy
    Netherlands
    Spain
    Sweden
    United Kingdom
    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
    The End of Trial is defined as either the date of the last visit of the last
    subject to complete the post-treatment follow-up, or the date of receipt
    of the last data point from the last subject that is required for primary,
    secondary and/or exploratory analysis, as pre specified in the protocol, whichever is the later date.
    Il termine dello studio è definito come la data dell’ultima visita dell’ultimo soggetto che completa il follow-up post-trattamento, oppure la data di ricevimento dell’ultimo punto dati dell’ultimo soggetto, richiesto per l’analisi primaria, secondaria e/o esplorativa, come predefinito nel protocollo, qualunque sia la data che si verifica più tardi.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months6
    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.1.1Number of subjects for this age range: 1
    F.1.1.1In Utero Information not present in EudraCT
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) Information not present in EudraCT
    F.1.1.3Newborns (0-27 days) Information not present in EudraCT
    F.1.1.4Infants and toddlers (28 days-23 months) Information not present in EudraCT
    F.1.1.5Children (2-11years) Information not present in EudraCT
    F.1.1.6Adolescents (12-17 years) Information not present in EudraCT
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 100
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 20
    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 Yes
    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 state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 60
    F.4.2.2In the whole clinical trial 120
    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 - patients will revert to standard of care as per treating physician.
    Nessuno - i pazienti continueranno la loro normale pratica clinica.
    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 Decision2017-07-12
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-05-05
    P. End of Trial
    P.End of Trial StatusCompleted
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