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    Summary
    EudraCT Number:2016-004718-90
    Sponsor's Protocol Code Number:UTX-TGR-205
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2017-12-21
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2016-004718-90
    A.3Full title of the trial
    A Phase 2b Randomized Study to Assess the Efficacy and Safety of the Combination of Ublituximab + TGR-1202 with or without Bendamustine and TGR-1202 alone in Patients with Previously Treated Non-Hodgkin’s Lymphoma.
    Estudio aleatorizado de fase IIb para evaluar la eficacia y la seguridad de la combinación de ublituximab + TGR-1202 con o sin bendamustina y TGR-1202 en monoterapia en pacientes con linfoma no Hodgkin tratados previamente.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2b Randomized Study to Assess the Efficacy and Safety of the Combination of Ublituximab + TGR-1202 with or without Bendamustine and TGR-1202 alone in Patients with Previously Treated Non-Hodgkin's lymphoma (Non-Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body).
    Estudio aleatorizado de fase IIb para evaluar la eficacia y la seguridad de la combinación de ublituximab + TGR-1202 con o sin bendamustina y TGR-1202 en monoterapia en pacientes con linfoma no Hodgkin tratados previamente (El linfoma no Hodgkin es un cáncer poco común que se desarrolla en el sistema linfático, que es una red de vasos y glándulas diseminados por todo el cuerpo).
    A.3.2Name or abbreviated title of the trial where available
    UNITY
    UNITY
    A.4.1Sponsor's protocol code numberUTX-TGR-205
    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 SponsorTG Therapeutics
    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 supportTG Therapeutics
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCambridge Regulatory Services
    B.5.2Functional name of contact pointPallav Shah
    B.5.3 Address:
    B.5.3.1Street Address2 Cabot House, Compass Point Business Park, Stocksbridge Way
    B.5.3.2Town/ citySt Ives
    B.5.3.3Post codePE27 5JL
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+441480465755
    B.5.5Fax number+441480463984
    B.5.6E-mailpallavshah@cambreg.co.uk
    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 nameUblituximab
    D.3.2Product code TG-1101
    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 INNUBLITUXIMAB
    D.3.9.2Current sponsor codeTG-1101
    D.3.9.3Other descriptive nameIgG1 immunoglobulins
    D.3.9.4EV Substance CodeSUB182428
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    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 No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameTGR-1202
    D.3.2Product code TGR-1202
    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 INNTGR-1202
    D.3.9.2Current sponsor codeTGR-1202
    D.3.9.3Other descriptive name(S)-2-(1-(4-amino-3-(3-fluoro-4-isopropoxyphenyl)-1H-pyrazolo [3, 4-d] pyrimidin-1- yl)-ethyl)-6-fluoro-3-(3-fluorophenyl)-4H-chromen-4-one 4 methylbenzenesulfonate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    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 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 Bendamustine Hydrochloride 2.5mg/ml Powder for Concentrate for Solution for Infusion
    D.2.1.1.2Name of the Marketing Authorisation holderActavis Group PTC ehf.
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 nameBendamustine Hydrochloride 2.5mg/ml Powder for Concentrate for Solution for Infusion
    D.3.4Pharmaceutical form Powder for concentrate for solution for infusion
    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 INNBENDAMUSTINE HYDROCHLORIDE
    D.3.9.1CAS number 3543-75-7
    D.3.9.2Current sponsor codeBendamustine
    D.3.9.3Other descriptive nameBendamustine Hydrochloride
    D.3.9.4EV Substance CodeSUB00696MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number90
    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
    Non-Hodgkin lymphoma
    Linfoma no Hodgkin
    E.1.1.1Medical condition in easily understood language
    Non-Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body
    El linfoma no Hodgkin es un cáncer poco común que se desarrolla en el sistema linfático, que es una red de vasos y glándulas diseminados por todo el cuerpo.
    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 10012821
    E.1.2Term Diffuse large B-cell lymphoma recurrent
    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 10029547
    E.1.2Term Non-Hodgkin's lymphoma
    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 10012822
    E.1.2Term Diffuse large B-cell lymphoma refractory
    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 10077534
    E.1.2Term Marginal zone lymphoma refractory
    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 LLT
    E.1.2Classification code 10029473
    E.1.2Term Nodular (follicular) lymphoma
    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 HLT
    E.1.2Classification code 10012819
    E.1.2Term Diffuse large B-cell lymphomas
    E.1.2System Organ Class 100000004851
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10003912
    E.1.2Term B-cell small lymphocytic lymphoma refractory
    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 10003911
    E.1.2Term B-cell small lymphocytic lymphoma recurrent
    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
    Follicular, Small Lymphocytic and Diffuse Large B-Cell Lymphoma Cohorts: To assess the efficacy of (1) TGR-1202 alone, (2) TGR-1202 plus ublituximab, and (3) TGR-1202 plus ublituximab plus bendamustine as measured by Overall Response Rate (ORR)
    Marginal Zone Lymphoma Cohort: To assess the efficacy of TGR-1202 alone as measured by Overall Response Rate (ORR)
    Cohortes de linfoma folicular, linfocítico de células pequeñas y linfoma difuso de células B grandes: Evaluar la eficacia de (1) TGR-1202 en monoterapia, (2) TGR-1202 más ublituximab y (3) TGR-1202 más ublituximab más bendamustina, medida mediante la tasa de respuesta global (TRG).
    Cohorte de linfoma de la zona marginal: Evaluar la eficacia de TGR-1202 en monoterapia, medida mediante la tasa de respuesta global (TRG).
    E.2.2Secondary objectives of the trial
    Key Secondary Objectives
    Diffuse Large B-Cell Lymphoma Cohort: To assess the efficacy of TGR-1202 alone and in combination with ublituximab +/- bendamustine in patients with previously treated DLBCL as measured by Progression-Free Survival (PFS) at Month 6
    Follicular and Small Lymphocytic Lymphoma Cohort: To assess the efficacy of TGR-1202 alone and in combination with ublituximab +/- bendamustine as measured by Complete Response (CR) rate
    To assess safety, tolerability and other efficacy outcomes.
    To analyze population pharmacokinetics and any other potential drug-drug interactions of ublituximab and TGR-1202

    Exploratory objective
    To observe the impact of cell of origin, mutational status, and select other biomarkers on efficacy of the TGR-1202 and the ublituximab + TGR-1202 combination in patients with DLBCL
    Cohorte de linfoma difuso de células B grandes: Evaluar la eficacia de TGR-1202 en monoterapia y en combinación con ublituximab +/- bendamustina en pacientes con LDCBG tratado previamente determinada en función de la supervivencia sin progresión (SSP)
    en el sexto mes.
    Cohorte de linfoma linfocítico de células pequeñas y folicular: Evaluar la eficacia de TGR-1202 en monoterapia y en combinación con ublituximab +/- bendamustina medida mediante la tasa de respuesta completa (RC). Evaluar la seguridad, la tolerabilidad y otros criterios de valoración de la eficacia.
    Realizar un análisis de farmacocinética poblacional y cualquier otra posible interacción farmacológica de ublituximab y TGR-1202.

    OBJETIVOS EXPLORATORIOS
    Observar el impacto de la célula de origen, el estado mutacional y seleccionar otros biomarcadores de la eficacia para TGR-1202 y la combinación ublituximab + TGR-1202 en pacientes con LDCBG.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Histologically confirmed diagnosis of: B-cell NHL with histological subtype limited to the following based on criteria established by the World Health Organization (WHO) 2008 classification of tumors of hematopoietic and lymphoid tissues:
    a. Follicular Lymphoma (FL) of Grade 1, 2, or 3a;
    b. Small Lymphocytic Lymphoma (SLL);
    c. Marginal Zone Lymphoma (MZL) (splenic, nodal, or extranodal); or
    d. Diffuse Large B-Cell Lymphoma
    2. Treatment status:
    a. FL/SLL patients: prior treatment with one or more lines of standard therapy
    b. MZL patients: prior treatment with one or more lines of therapy including at least one CD20-directed regimen (either as monotherapy or as chemoimmunotherapy) with documented failure to achieve at least PR or documented PD after the most recent systemic treatment regimen;
    c. DLBCL patients: relapsed or refractory to any prior standard therapy AND who are non-candidates for high-dose therapy or autologous stem cell transplant.
    3. Measurable disease, defined as at least 1 measurable disease lesion >1.5 cm in at least one diameter by CT/CT-PET or magnetic resonance imaging (MRI) in an area of no prior radiation therapy, or in an area that was previously irradiated that has documented progression.
    4. Adequate organ system function, defined as follows:
    a. Absolute neutrophil count (ANC) > 1,000/mm3 (μL) & platelet count > 50,000/mm3 (μL)
    b. Total bilirubin ≤1.5 times the upper limit of normal (ULN)
    c. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 x ULN if no liver involvement or ≤5 x the ULN if known liver involvement
    d. Calculated creatinine clearance >30 mL/min (as calculated by the Cockcroft-Gault formula)
    5. ECOG performance status ≤ 2
    6. Male or female ≥ 18 years of age
    7. Ability to swallow and retain oral medication
    8. Female patients who are not of child-bearing potential (see Appendix B- Contraceptive Guidelines and Pregnancy), and female patients of child-bearing potential who have a negative serum pregnancy test within 3 days prior to Cycle 1, Day 1. Female patients of child-bearing potential, and male partners must consent to use a medically acceptable method of contraception throughout the study period and for 4 months after the last dose of either study drug, and 6 months after the last dose of bendamustine, if applicable.
    9. Willingness and ability to comply with trial and follow-up procedures, and give written informed consent
    1. Diagnóstico confirmado histológicamente de: LNH de células B con subtipo histológico limitado a los siguientes en función de criterios establecidos por la clasificación de 2008 de la Organización Mundial de la Salud (OMS) de los tumores hematopoyéticos y de tejidos linfoides:
    a. Linfoma folicular (LF) de grado 1, 2, o 3a
    b. Linfoma linfocítico de células pequeñas (LLP)
    c. Linfoma de la zona marginal (LZM) (esplénico, ganglionar o extraganglionar)
    d. Linfoma difuso de células B grandes (incluyendo linfoma de células B de alto grado).
    2. Estado de tratamiento:
    a. Pacientes con LF/LLP: en recaída o recidiva tras dos o más líneas de tratamiento. Los pacientes deben haber recibido un anti-CD20 y un agente alquilante.
    b. Pacientes con LZM: una o más líneas previas de tratamiento, incluyendo al menos un régimen dirigido a CD20 (ya sea en monoterapia o como quimioinmunoterapia), con fracaso
    documentado por no alcanzar al menos respuesta parcial (RP) o desarrollar progresión de la enfermedad (PE) después de la pauta de tratamiento sistémico más reciente
    c. Pacientes con LDCBG recidivante o resistente al tratamiento Y que no son candidatos a tratamiento con dosis altas o autotrasplante de células madre.
    3. La enfermedad medible definida como al menos 1 lesión medible mediante Tomografía computarizada (TC)/tomografía por emisión de positrones (PET-TAC) o resonancia magnética (RM), de > 1,5 cm en al menos uno de sus diámetros y localizada en una zona sin radioterapia
    previa, o en una zona previamente irradiada y con progresión documentada.
    4. Función orgánica aceptable, definida como se especifica a continuación:
    a. Recuento absoluto de neutrófilos (RAN) >1000/mm3 (μl) y número de plaquetas >50.000/mm3 (μl).
    b. Bilirrubina total ≤1,5 veces el límite superior de normalidad (LSN).
    c. Alanina-aminotransferasa (ALT) y aspartato-aminotransferasa (AST) ≤2,5 x LSN si no existe afectación hepática o ≤5 veces el LSN si se ha determinado afectación hepática.
    d. Aclaramiento de creatinina estimado (calculado segun la fórmula de Cockcroft y Gault) ≥30 ml/min en pacientes con LF, LLP o LZM, y ≥40 mL/min en pacientes con LDCGB.
    5. Estado funcional ECOG ≤2
    6. Pacientes de ambos sexos ≥18 años
    7. Capacidad de ingerir y retener medicación oral.
    8. Mujeres sin capacidad reproductiva y mujeres fértiles con un resultado negativo en la prueba de embarazo en suero en los 3 días previos al día 1 del ciclo 1 de tratamiento. Las mujeres con capacidad reproductiva y sus parejas masculinas deben aceptar el uso de un método anticonceptivo médicamente aceptable durante todo el periodo del estudio y durante los 4 meses posteriores a la última dosis de cualquiera de los fármacos del estudio.
    9. Disposición y capacidad para cumplir con los procedimientos del estudio y del seguimiento y dar su consentimiento informado por escrito.
    E.4Principal exclusion criteria
    1. Patients receiving cancer therapy (i.e., chemotherapy, radiation therapy, immunotherapy, biologic therapy, hormonal therapy, surgery and/or tumor embolization) or any investigational drug within 21 days of Day 1 of Cycle 1.
    a. Corticosteroid therapy started at least 7 days prior to study entry (prednisone ≤10 mg daily or equivalent) is allowed as clinically warranted. Topical or inhaled corticosteroids are permitted.
    2. Patients who have received autologous hematologic stem cell transplant within 6 months of study entry. Prior allogeneic hematologic stem cell transplant is excluded.
    3. Evidence of chronic active Hepatitis B (HBV, not including patients with prior hepatitis B vaccination; or positive serum Hepatitis B antibody) or chronic active Hepatitis C infection (HCV), cytomegalovirus (CMV), or known history of HIV. If HBc antibody, HCV antibody or CMV is positive the subject must be evaluated for the presence of HBV, HCV, or CMV by DNA (PCR) - See Appendix D.
    4. Known history of Central Nervous System (CNS) lymphoma; patients with symptoms of CNS disease must have a negative CT scan and negative diagnostic lumbar puncture.
    5. Known histological transformation from chronic lymphocytic leukemia to large cell lymphoma (i.e. Richter’s transformation)
    6. Evidence of ongoing systemic bacterial, fungal or viral infection, except localized fungal infections of skin or nails.
    7. Live virus vaccines within 4 weeks prior to enrollment, during therapy, or for 6 weeks post-treatment.
    8. History of anaphylaxis (excluding infusion related reactions) in association with previous anti-CD20 administration.
    9. Prior exposure to idelalisib (CAL-101), duvelisib (IPI-145), or any drug that specifically inhibits phosphoinositide-3-kinase (PI3K)
    10. Any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:
    a. Symptomatic, or history of documented congestive heart failure (NY Heart Association functional classification III-IV [see Appendix C – NYHA Classifications])
    b. Significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of randomization
    c. Concomitant use of medication known to cause QT prolongation or torsades de pointes.
    d. Poorly controlled or clinically significant atherosclerotic vascular disease including cerebrovascular accident (CVA), transient ischemic attack (TIA), angioplasty, cardiac/vascular stenting within 6 months of enrollment
    11. Malignancy within 3 years of study enrollment except for adequately treated basal, squamous cell carcinoma or non-melanomatous skin cancer, carcinoma in situ of the cervix, superficial bladder cancer not treated with intravesical chemotherapy or BCG within 6 months, localized prostate cancer and PSA <1.0 mg/dL on 2 consecutive measurements at least 3 months apart with the most recent one being within 4 weeks of study entry.
    1. Pacientes que reciban tratamiento antineoplásico (es decir, quimioterapia, radioterapia, inmunoterapia, tratamiento biológico, hormonoterapia, cirugía y/o embolización tumoral) o cualquier fármaco en fase de investigación en los 21 días anteriores al día 1 del ciclo 1 del tratamiento en estudio.
    a. Se permite el tratamiento con corticosteroides (≤10 mg de prednisona al día o equivalente) en pacientes en los que esté clínicamente indicado, siempre que éste haya iniciado al menos 7
    días antes de la inclusión en el estudio. Están permitidos los corticosteroides tópicos o inhalados.
    2. Pacientes que han recibido un autotrasplante de células madre hematopoyéticas en los 6 meses previos a la inclusión en el estudio. Se excluye el alotrasplante de células madre hematopoyéticas.
    3. Signos de hepatitis B crónica activa (VHB, sin incluir los pacientes que han recibido la vacuna contra la hepatitis B; o positividad para anticuerpos contra la hepatitis B en suero), o infección crónica activa por el virus de la hepatitis C (VHC), citomegalovirus (CMV), o
    antecedentes conocidos de infección por el VIH. Si es positivo para anticuerpos contra el HBc, VHC o IgM+ para CMV, se debe evaluar en el paciente la presencia de VHB, VHC o CMV mediante ADN (PCR).
    4. Antecedentes conocidos de linfoma del sistema nervioso central (SNC); los pacientes con síntomas de enfermedad del SNC deben tener un resultado negativo en una tomografía computarizada y un resultado negativo en una punción lumbar diagnóstica.
    5. Transformación histológica conocida de leucemia linfocíática crónica a linfoma de células grandes (es decir, transformación de Richter).
    6. Signos de infección sistémica bacteriana, fúngica o vírica persistente, excepto infecciones fúngicas cutáneas o ungueales.
    7. Antecedentes de anafilaxia (excepto reacciones relacionadas con la infusión) en asociación con la administración previa de anti-CD20.
    8. Exposición previa a idelalisib (CAL-101), duvelisib (IPI-145), o algún fármaco que inhiba específicamente la fosfoinositida 3-cinasa (PI3K).
    9. Cualquier enfermedad grave y/o no controlada u otra enfermedad que pueda afectar a la participación en el estudio como:
    a. Insuficiencia cardíaca congestiva sintomática o con antecedentes documentados (clase funcional III-IV de la NY Heart Association).
    b. Enfermedad cardiovascular significativa, como arritmias no controladas o sintomáticas, insuficiencia cardíaca congestiva o infarto de miocardio en los 6 meses anteriores a la aleatorización.
    c. El uso concomitante de medicación que se sabe que causa prolongación del intervalo QT o Torsades de pointes deberá realizarse con precaución y a la discreción del investigador.
    d. Vasculopatía aterosclerótica mal controlada o clínicamente significativa, incluyendo antecedentes de accidente cerebrovascular (ACV), accidente isquémico transitorio (AIT),
    angioplastia, colocación de endopró tesis cardíaca/vascular en los 6 meses previos a la inclusión.
    10. Neoplasia maligna en los 3 años anteriores a la inclusión en el estudio, excepto carcinomas de células escamosas, de células basales o cáncer de piel no melanoma convenientemente tratados, carcinoma in situ de cérvix, cáncer superficial de vejiga no tratado con quimioterapia
    intravesical o BCG (bacilo de Calmette-Gueárin) en los 6 meses previos, cáncer de próstata localizado y PSA < 1,0 mg/dl en 2 mediciones consecutivas realizadas y con al menos 3 meses de diferencia respecto a la más reciente y determinada en las 4 semanas previas a la inclusión
    en el estudio.
    E.5 End points
    E.5.1Primary end point(s)
    Efficacy Endpoints
    Overall response rate (ORR) : ORR is defined as sum of CR and PR rates.
    Tasa de respuesta global (TRG)
    La TRG se define como la suma de las tasas de RC y RP.
    E.5.1.1Timepoint(s) of evaluation of this end point
    During the study period, all patients will be evaluated for response by CT, PET-CT and/or MRI during cycles 3 and 6, and every 3 cycles thereafter. All baseline assessments to characterize disease will be performed within 30 days of Cycle 1 Day 1, prior to initiation of therapy. During the treatment period, all efficacy assessments have a +/- 14 day window.
    Durante el periodo del estudio, se evaluará la respuesta en todos los pacientes mediante TC, TC-PET y/o RM al finalizar el ciclo 3, durante los 14 días previos al día 1 del ciclo 6 y cada 3 ciclos a partir de entonces. Todas las evaluaciones iniciales para caracterizar la enfermedad se realizarán dentro de los 30 días posteriores al Ciclo 1 Día 1, antes del inicio de la terapia. Durante el período de tratamiento, todas las evaluaciones de eficacia tienen una ventana de +/- 14 días.
    E.5.2Secondary end point(s)
    Progression-free survival (PFS)
    PFS is defined as the interval from randomization to the earlier of the first documentation of definitive disease progression or death from any cause. Definitive disease progression based on standard criteria (Cheson et al., 2007)

    Complete Response (CR) Rate
    CR rate is defined as the proportion of patients who achieve a CR

    Overall survival (OS)
    OS is defined as the interval from randomization to death from any cause

    Duration of Response (DOR)
    Duration of response is defined as the time from documentation of a response to treatment to the first documentation of tumor progression or death due to any cause whichever comes first

    Safety
    All Adverse Events (AE’s) will be reported and evaluated using National Cancer Institute’s Common Terminology Criteria (CTCAE) v4.0.
    Supervivencia libre de progresión (SLP) a los 6 meses
    La SLP en el sexto mes se define como el porcentaje de pacientes que no hayan experimentado progresión (es decir, progresión manifiesta de la enfermedad o muerte por cualquier causa) a los 6 meses.

    Supervivencia libre de progresión (SLP)
    La SLP se define como el intervalo de tiempo transcurrido desde la aleatorización hasta la primera evidencia documentada de progresión manifiesta de la enfermedad o muerte por cualquier causa. Se definirá “evidencia documentada de progresión” basada en los criterios estándares de referencia (Cheson et al., 2007).

    Tasa de respuesta completa (RC)
    La tasa de RC se define como el porcentaje de pacientes que logran RC.

    Supervivencia global (SG)
    La SG se define como el intervalo de tiempo transcurrido desde la aleatorización hasta la muerte por cualquier causa.

    Duración de la respuesta (DR)
    La duración de la respuesta se define como el tiempo transcurrido desde la primera documentación de respuesta hasta la primera documentación de progresión del tumor o muerte por cualquier causa, lo que suceda primero.

    Seguridad
    Todos los eventos adversos (EAs) se reportarán y evaluarán utilizando como referencia los criterios del National Cancer Institute’s Common Terminology Criteria (CTCAE) v4.0.
    E.5.2.1Timepoint(s) of evaluation of this end point
    During the study period, all patients will be evaluated for response by CT, PET-CT and/or MRI during cycles 3 and 6, and every 3 cycles thereafter. All baseline assessments to characterize disease will be performed within 30 days of Cycle 1 Day 1, prior to initiation of therapy. During the treatment period, all efficacy assessments have a +/- 14 day window
    Durante el periodo del estudio, se evaluará la respuesta en todos los pacientes mediante TC, TC-PET y/o RM al finalizar el ciclo 3, durante los 14 días previos al día 1 del ciclo 6 y cada 3 ciclos a partir de entonces. Todas las evaluaciones iniciales para caracterizar la enfermedad se realizarán dentro de los 30 días posteriores al Ciclo 1 Día 1, antes del inicio de la terapia. Durante el período de tratamiento, todas las evaluaciones de eficacia tienen una ventana de +/- 14 días.
    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) 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 Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other 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.8.2.4Number of treatment arms in the trial3
    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 concerned10
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA25
    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
    Italy
    Poland
    Russian Federation
    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
    Last Visit of Last Subject
    Última visita del último paciente
    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 months0
    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 months0
    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: 225
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 220
    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 No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state60
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 250
    F.4.2.2In the whole clinical trial 550
    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)
    For subjects subsequent treatment should be available at the discretion of their treating physician.
    Los tratamientos subsecuentes de los sujetos (participantes) deberán estar disponibles a la discreción de su médico tratante
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-03-16
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-03-09
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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