E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
newly diagnosed FLT3 mutated acute myeloid leukemia |
leucémie aiguë myéloïde (LAM )nouvellement diagnostiquée, FLT3 mutée documentée |
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E.1.1.1 | Medical condition in easily understood language |
newly diagnosed acute myeloid leukemia |
Leucémie aiguë myéloïde (LAM) nouvellement diagnostiquée |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10000886 |
E.1.2 | Term | Acute myeloid leukemia |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To further assess the safety of midostaurin in induction, consolidation and maintenance therapy, including, the “7+3” regimen, daunorubicin (60-90mg/m2/day), the substitution of daunorubicin by idarubicin and cytarabine (100-200 mg/m2/day) and also allowing the “5+2” reduced dose regimen. |
Compléter l’évaluation de la sécurité d’emploi de la midostaurine en induction, consolidation et entretien, incluant le protocole ‘7+3’, la daunorubicine (60-90 mg/m2/jour), la substitution de la daunorubicine par l’idarubicine (12 mg/m2/jour) et la cytarabine (100-200 mg/m2/jour), le protocole ‘5 +2’ étant également autorisé. |
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E.2.2 | Secondary objectives of the trial |
To assess the clinical efficacy of midostaurin in combination with chemotherapy regimens in induction and consolidation and the clinical efficacy of midostaurin maintenance phase (measured by CR/CRi rate). |
Evaluer l’efficacité clinique de la midostaurine en association avec la chimiothérapie standard d’induction et de consolidation, ainsi que son efficacité en maintenance (mesurée par le taux de rémission complète [RC]/ de rémission complète avec récupération hématologique incomplète [RCi]). |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Inclusion Criteria:
Patients eligible for inclusion in this study have to meet all of the following criteria:
1. Written informed consent must be obtained prior to any screening procedures.
2. Patients must be 18 years of age or older at the time of signing informed consent.
3. Patients must have a documented unequivocal diagnosis of AML according to WHO 2008 classification. A bone marrow or blood blast count of ≥20% is required, except for AML with t(15;17), t(8;21), inv(16) or t(16;16)) where blast count may be <20%, and excluding M3 (acute promyelocytic leukemia).
4. Patients with secondary AML are eligible, e.g. patients with antecedent history of treatment for prior malignancy. AML patients with a history of antecedent treatment for myelodysplasia (MDS), e.g. azacitidine or decitabine, remain eligible for treatment on this study. These agents must have been discontinued for a period of at least 30 days or 5 half-lives of the drug (whichever is greater) before midostaurin can be administered.
5. Patients must have started “7+3” or “5+2” first induction chemotherapy regimen.
6. Patients must have a documented FLT3 mutation (ITD or TKD).
7. Patients must have an ECOG Performance Status of ≤ 2
8. Patients requiring intrathecal chemotherapy must have a minimum washout of 48 hours prior to the first dose of midostaurin
9. Patients must have Total Bilirubin ≤ 2.5 x ULN.
10. Patients must have Serum Creatinine ≤ 2.5 x ULN.
11. Patients must be able to communicate well with the investigator to understand and comply with the requirements of the study.
12. Women of child-bearing potential must have a negative pregnancy test before starting use of midostaurin. |
Critères d’inclusion :
Tous les critères suivants devront être remplis :
1. Recueil du consentement éclairé par écrit avant toute procédure de sélection.
2. Patient âgé de plus de 18 ans au moment de la signature du consentement.
3. Diagnostic confirmé de LAM selon la classification OMS 2008. Un taux de blastes médullaires ou sanguins ≥ 20% est requis, excepté pour les LAM avec translocations t(15 ;17), t(8 ;21), inv(16) ou t(16 ;16) où le taux de blastes peut être < 20%.
Les LAM3 (leucémie aiguë promyélocytaire) seront exclues.
4. Les patients atteints de LAM secondaire seront éligibles (ex LAM secondaire à une chimiothérapie et LAM secondaire à un SMD traités par azacytidine ou décitabine) Ces médicaments devront avoir été arrêtés au moins 30 jours ou 5 demi-vies (selon la durée la plus longue) avant l’administration de la midostaurine.
5. Patient ayant débuté un premier cycle d’induction de chimiothérapie de type « 7+3 » ou « 5+2 ».
6. Une mutation ITD ou TKD du FLT3 devra avoir été confirmée.
7. Indice de performance ECOG ≤ 2.
8. Les patients nécessitant l’administration d’une chimiothérapie par voie intrathécale ne pourront recevoir la midostaurine qu’après un délai de 48 heures au minimum après l’injection intrathécale.
9. Bilirubine totale ≤ 2,5 fois la limite supérieure de la normale (LSN).
10. Créatinine plasmatique ≤ 2,5 fois la LSN.
11. Patients capables de comprendre et se conformer aux exigences de l’étude.
12. Les femmes en âge de procréer devront avoir un test de grossesse négatif avant
de commencer la midostaurine.
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E.4 | Principal exclusion criteria |
Patients eligible for this study must not meet any of the following criteria:
1. Prior therapy for AML with the following exceptions:
a. emergency leukapheresis
b. emergency treatment for hyperleukocytosis with hydroxyurea for ≤ 7 days
c. cranial RT for CNS leukocytosis (one dose only)
d. growth factor/cytokine support
2. Patients with Left Ventricular Ejection Fraction (LVEF) less than 45% (by echocardiogram or MUGA) or symptomatic congestive heart failure (Class III or IV) according to New York Heart Association (NYHA) classification
3. Patients with any pulmonary infiltrate including those suspected to be of infectious origin (unless resolved to < Grade 1 within screening timeframe)
4. Patients with any uncontrolled illness, including, but not limited to, acute or chronic pancreatitis or uncontrolled infection
5. QTc >470 msec on screening ECG.
6. History of hypersensitivity to any drugs or metabolites of similar chemical classes as the study treatment.
7. Participation in a prior investigational interventional (drug) study with administration of the investigational product within 30 days or 5 half-lives of the investigational product, whichever is longer.
8. Pregnancy statements and contraception requirements:
Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during dosing and for at least 4 months after stopping medication. Highly effective contraception methods include:
• Total abstinence (when this is in line with the preferred and usual lifestyle of the subject). Periodic abstinence (e.g. calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception
• Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment
• Male sterilization (at least 6 months prior to screening). The vasectomized male partner should be the sole partner for that subject.
• Use of oral, injected or implanted hormonal methods of contraception or placement of an intrauterine device or intrauterine system , or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception.
In case of use of oral contraception women should also add a barrier method of contraception, particularly as it is currently unknown whether midostaurin may reduce the effectiveness of hormonal contraceptives.
Sexually-active males unless they use a condom during intercourse with females of reproductive potential or pregnant women and for at least 4 months after stopping treatment to avoid conception or embryo-fetal harm.
9. Patients enrolled in this study are not permitted to participate in additional parallel study drug or device studies.
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Aucun des critères suivants ne devra être présent :
1. Traitement antérieur de la LAM à l’exception de :
a. leucaphérèse d'urgence
b. traitement d’urgence de l’hyperleucocytose par de l’hydroxyurée pour une durée ≤ 7 jours
c. radiothérapie du SNC pour atteinte méningée (une seule dose autorisée)
d. facteurs de croissance/cytokines.
2. Fraction d'éjection du ventricule gauche (FEVG) inférieure à 45% (à l’échocardiographie ou la ventriculographie isotopique) ou insuffisance cardiaque congestive de classe III ou IV de la NYHA.
3. Infiltrat pulmonaire, y compris d’origine infectieuse (sauf si résolu ou grade ≤ 1 durant la période de sélection).
4. Toute pathologie non contrôlée, incluant mais non limité à : pancréatite aigüe ou chronique ou infection non contrôlée.
5. Intervalle QT corrigé (QTc) allongé (> 470 ms) à l’ECG réalisé à la sélection.
6. Antécédents d’hypersensibilité à tout médicament ou métabolite appartenant à la même classe chimique que le traitement à l’étude.
7. Participation préalable à une étude clinique interventionnelle impliquant l’administration d’un traitement expérimental dans les 30 jours ou les 5 demivies du traitement expérimental, selon la durée la plus longue.
8. Les femmes en âge de procréer devront utiliser une méthode de contraception efficace pendant toute la durée du traitement et jusqu’à 4 mois suivant l’arrêt du traitement à l’étude (cf protocole).
Les hommes sexuellement actifs devront utiliser un préservatif lors des rapports sexuels avec des femmes en âge de procréer ou des femmes enceintes, durant l’étude et pour au moins 4 mois après l’arrêt du traitement à l’étude.
9. Les patients inclus dans cette étude n’auront pas le droit de participer en parallèle, à une autre étude portant sur un traitement ou un dispositif médical. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of patients with AEs, Grade 3&4 AEs, SAEs, AEs leading to discontinuation, and deaths.
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Proportion de patients présentant des EI, des EI de grade 3 et 4, des EI graves, des EI entrainant l’arrêt du traitement à l’étude et le décès |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
at end of study |
à la fin de l'étude |
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E.5.2 | Secondary end point(s) |
Proportion of patients with CR/CRi as per local assessment |
Proportion de patients présentant une RC/RCi selon l’évaluation locale. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
at end of study |
à la fin de l'étude |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 16 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 98 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial 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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 7 |
E.8.9.2 | In all countries concerned by the trial days | 0 |