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    Summary
    EudraCT Number:2016-005039-34
    Sponsor's Protocol Code Number:ASTX660-01
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-06-17
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2016-005039-34
    A.3Full title of the trial
    Phase 1-2 Study of the Safety, Pharmacokinetics, and Preliminary Activity of ASTX660 in Subjects with Advanced Solid Tumors and Lymphomas
    Studio di fase 1-2 della sicurezza, farmacocinetica e attività preliminare di ASTX660 in soggetti con tumori solidi e linfomi in stadio avanzato
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of the safety, activity, and effect on the body of ASTX660 in people with advanced cancers.
    Studio di sicurezza, attività e effetti sull'organismo di ASTX660 in soggetti con tumori avanzati
    A.3.2Name or abbreviated title of the trial where available
    na
    na
    A.4.1Sponsor's protocol code numberASTX660-01
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT02503423
    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 SponsorASTEX PHARMACEUTICALS
    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 supportAstex Pharmaceuticals, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAstex Pharmaceuticals, Inc
    B.5.2Functional name of contact pointASTX660-01 Clinical Team
    B.5.3 Address:
    B.5.3.1Street Address4420 Rosewood Drive, Suite 200
    B.5.3.2Town/ cityPleasanton, CA
    B.5.3.3Post code94588
    B.5.3.4CountryUnited States
    B.5.4Telephone number0019255602913
    B.5.5Fax number0019255513226
    B.5.6E-mailASTX660-01MM@astx.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 nameASTX660
    D.3.2Product code [ASTX660]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNASTX660
    D.3.9.1CAS number 1799328-87-2
    D.3.9.2Current sponsor codeASTX660
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number180
    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 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 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 nameASTX660
    D.3.2Product code [ASTX660]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNASTX660
    D.3.9.1CAS number 1799328-87-2
    D.3.9.2Current sponsor codeASTX660
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    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 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 No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation 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 nameASTX660
    D.3.2Product code [ASTX660]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNASTX660
    D.3.9.1CAS number 1799328-87-2
    D.3.9.2Current sponsor codeASTX660
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 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 No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Advanced Solid Tumors and Lymphomas that are metastatic or unresectable:
    cohort 1:Recurrent/metastatic head and neck squamous cell carcinoma;
    cohort 2:Relapsed or refractory diffuse large B-cell lymphoma;
    cohort 3:Progressive, refractory or relapsed peripheral T-cell lymphoma;
    cohort 4:Relapsed or refractory cutaneous T-cell lymphoma;
    cohort 5: Other tumor types that may have sensitivity to ASTX660:
    cohort 6: Cervical carcinoma not responsive or relapsed after standard therapy
    Tumori solidi/linfomi, stadio avanzato, metastatici o non resecabili
    • Coorte 1: carcinoma a cellule squamose della testa e del collo ricorrente/metastatico
    • Coorte 2: linfoma diffuso a grandi cellule B recidivante o refrattario
    • Coorte 3: linfoma delle cellule T periferiche progressivo, refrattario o recidivante
    • Coorte 4: linfoma cutaneo a cellule T recidivante o refrattario
    • Coorte 5: altri tipi tumorali sensibili ad ASTX660
    • Coorte 6: carcinoma cervice non responsivo o recidivante
    E.1.1.1Medical condition in easily understood language
    multiple tumour types (solid and liquid)
    tumore multipla tipologia (solido o liquido)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10012818
    E.1.2Term Diffuse large B-cell 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 22.0
    E.1.2Level PT
    E.1.2Classification code 10011677
    E.1.2Term Cutaneous T-cell 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 21.1
    E.1.2Level PT
    E.1.2Classification code 10067821
    E.1.2Term Head and neck cancer
    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 21.1
    E.1.2Level LLT
    E.1.2Classification code 10008229
    E.1.2Term Cervical cancer
    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 21.1
    E.1.2Level PT
    E.1.2Classification code 10034623
    E.1.2Term Peripheral T-cell lymphoma unspecified
    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
    • Phase 1: To assess safety, and to identify the maximum tolerated dose (MTD), the recommended Phase 2 dose (RP2D), and the recommended dosing regimen of ASTX660 (Completed).
    • Phase 2: To assess preliminary efficacy, as determined by response rate in certain tumor types.
    • Fase 1: Valutare la sicurezza e identificare la dose massima tollerata (MTD), la dose raccomandata per la fase 2 (RP2D) e il regime di dosaggio raccomandato di ASTX660 (completato).
    • Fase 2: Valutare l’efficacia preliminare determinata in base al tasso di risposta in alcuni tipi di tumore.
    E.2.2Secondary objectives of the trial
    • To determine the pharmacokinetic (PK) parameters of orally administered ASTX660 in humans.
    • To evaluate other efficacy parameters, such as duration of response and progression-free survival.
    • To evaluate relevant pharmacodynamic (PD) targets and potential biomarkers of ASTX660 activity.
    • Determinare i parametri farmacocinetici (PK) di ASTX660 somministrato per via orale negli esseri umani.
    • Valutare altri parametri di efficacia, come durata della risposta (DOR) e sopravvivenza libera da progressione (PFS).
    • Valutare i bersagli farmacodinamici (PD) rilevanti e i potenziali biomarcatori dell’attività di ASTX660.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Able to understand and comply with the protocol and study procedures, understand the risks involved in the study, and provide written informed consent before any study-specific procedure is performed.
    2. Men and women 18 years of age or older.
    3. Subjects with histologically or cytologically confirmed advanced solid tumors or lymphoma that is metastatic or unresectable, and for whom standard life-prolonging measures are not available.
    a) For Phase 2 Cohort 3, subjects must have histologically confirmed PTCL (local pathology report) as defined by 2016 World Health Organization (WHO) classification. The following subtypes are eligible for the study: adult T-cell lymphoma/leukemia, extranodal natural killer (NK)/T-cell lymphoma nasal type, enteropathy-associated T-cell lymphoma, monomorphic epitheliotropic intestinal T-cell lymphoma, hepatosplenic T-cell lymphoma, subcutaneous panniculitis-like T-cell lymphoma, peripheral T-cell lymphoma not otherwise specified, angioimmunoblastic T-cell lymphoma, follicular T-cell lymphoma, nodal peripheral T-cell with T-follicular helper (THF) phenotype, and anaplastic large-cell lymphoma.
    4. For Phase 2 Cohorts 3 and 4, subjects must have evidence of documented progressive disease and must have received at least two prior systemic therapies.
    a) Subjects with CD30-positive lymphoma must have received, be ineligible for, or intolerant to brentuximab vedotin, provided that brentuximab vedotin is locally approved and available.
    b) Subjects with mycosis fungoides or Sezary syndrome must have received, be ineligible, or intolerant to mogamulizumab, provided that mogamulizumab is locally approved and available.
    5. In the Phase 2 portion of the protocol only, subjects must have measurable disease according to response criteria appropriate to their type of cancer (as explained in Section 9.1).
    a) For Phase 2 Cohort 3 (PTCL), measurable disease by contrastenhanced diagnostic CT (at least 1 nodal lesion >1.5 cm or extranodal lesions >1.0 cm) is required.
    6. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
    7. Acceptable organ function, as evidenced by the following laboratory data:
    a. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =2.0 × upper limit of normal (ULN).
    b. Total serum bilirubin =1.5 × ULN.
    c. Absolute neutrophil count (ANC):
    o Phase 1 and 2 (except subjects with known lymphoma (i.e. not applicable for Cohorts 3 or 4)): =1500 cells/mm3.o Phase 2 subjects with known lymphoma: =1000 cells/mm3 (=750 cells/mm3 for subjects with lymphoma in bone marrow) (Administration of myeloid growth factors within 14 days prior to study entry are not allowed).
    d. Platelet count:
    o Phase 1 and 2 (except subjects with known lymphoma (i.e. not applicable for Cohorts 3 or 4)): =100,000 cells/mm3.
    o Phase 2 subjects with known lymphoma: =50,000 cells/mm3 (=25,000 cells/mm3 for subjects with lymphoma in bone marrow) (transfusion within 21 days prior to study entry are not allowed).
    e. Serum creatinine levels =1.5 × ULN, or calculated (by Cockcroft-Gault formula or other accepted formula) or measured creatinine clearance = 50 mL/min.
    f. Amylase and lipase =ULN. [Applies to Phase 2].
    8. Women of child-bearing potential (according to recommendations of the Clinical Trial Facilitation Group [CTFG]; see protocol for details) must not be pregnant or breastfeeding and must have a negative pregnancy test at screening. Women of child-bearing potential and men with female partners of child-bearing potential must agree to practice 2 highly effective contraceptive measures of birth control (as described in the protocol) and must agree not to become pregnant or father a child while receiving treatment with study drug and for at least 3 months after completing treatment.
    1. Capacità di comprendere e conformarsi al protocollo e alle procedure dello studio, comprendere i rischi connessi allo studio e fornire il consenso informato prima dell’esecuzione di qualsiasi procedura specifica dello studio.
    2. Soggetti ambosesso che abbiano compiuto 18 anni di età.
    3. Soggetti con diagnosi istologica o citologica confermata di tumori solidi o linfomi in stadio avanzato, metastatici o non resecabili, per i quali non sono disponibili misure standard di prolungamento della vita.
    a) Per la Coorte 3 di Fase 2, i soggetti devono presentare una diagnosi istologica confermata di PTCL (referto patologico locale), come definito dalla classificazione 2016 dell’Organizzazione Mondiale della Sanità (OMS). I seguenti sottotipi sono idonei allo studio: linfoma/leucemia a cellule T adulte, tipo nasale di linfoma extranodale delle cellule natural killer (NK)/cellule T, linfoma a cellule T associato a enteropatia, linfoma intestinale a cellule T epiteliotropico monomorfico, linfoma a cellule T epatosplenico, linfoma sottocutaneo a cellule T simil-panniculite, linfoma a cellule T periferiche non altrimenti specificato, linfoma a cellule T angioimmunoblastico, linfoma follicolare a cellule T, linfoma nodale a cellule T periferiche con fenotipo T-helper follicolare (THF) e linfoma anaplastico a grandi cellule.
    4. Per le Coorti 3 e 4 della Fase 2, i pazienti devono presentare evidenza di progressione della malattia documentata e devono aver ricevuto almeno due precedenti terapie sistemiche (Coorti 3 e 4 di Fase 2).
    a) I soggetti con linfoma CD30-positivo devono aver ricevuto, essere inidonei o intolleranti a brentuximab vedotin, purché brentuximab vedotin sia approvato e disponibile a livello locale.
    b) I soggetti con micosi fungoide o sindrome di Sezary devono aver ricevuto, essere inidonei o intolleranti a mogamulizumab, purché mogamulizumab sia approvato e disponibile a livello locale.
    5. Solo nella porzione di Fase 2 del protocollo, i soggetti devono presentare malattia misurabile secondo i criteri di risposta appropriati per il loro tipo di tumore (come spiegato nel paragrafo 9.1).
    a) Per la Coorte 3 (PTCL) di Fase 2, è richiesta la malattia misurabile per mezzo di TC diagnostica a intensificazione del contrasto (almeno 1 lesione nodale > 1,5 cm o lesioni extranodali > 1,0 cm).
    6. Stato di validità dell’Eastern Cooperative Oncology Group (ECOG) pari a 0, 1 o 2.
    7. Funzione d’organo accettabile, come evidenziato dai seguenti parametri di laboratorio:
    a) Aspartato aminotransferasi (AST) e alanina aminotransferasi (ALT) = 2,0 x il limite superiore alla norma (ULN).
    b) Bilirubina sierica totale = 1,5 × ULN.
    c) Conta assoluta dei neutrofili (ANC):
    o Fase 1 e 2 (esclusi i soggetti di Fase 2 con linfomi noti (na per coorti 3 o 4)): >= 1.500 cellule/mm3.
    o Soggetti di Fase 2 con linfomi noti: = 1.000 cellule/mm3 (= 750 cellule/mm3 per i soggetti con linfomi nel midollo osseo) (non è consentita la somministrazione di fattori di crescita mieloidi nei 14 giorni precedenti l’ingresso nello studio).
    d) Conta piastrinica:
    o Fase 1 e 2 (esclusi i soggetti di Fase 2 con linfomi noti (na per coorti 3 o 4)): = 100.000 cellule/mm3.
    o Soggetti di Fase 2 con linfomi noti: = 50.000 cellule/mm3 (= 25.000 cellule/mm3 per i soggetti con linfomi nel midollo osseo) (non sono consentite trasfusioni nei 21 giorni precedenti l’ingresso nello studio).
    e) Livelli sierici di creatinina = 1,5 × ULN, oppure clearance della creatinina calcolata (usando la formula di Cockcroft-Gault o altra formula accettata) o misurata = 50 ml/min.
    f) Livelli di amilasi e lipasi = ULN [si applica alla Fase 2].
    Le donne in età fertile (conformemente alle raccomandazioni del Gruppo di facilitazione delle sperimentazioni cliniche [CTFG]; per informazioni dettagliate, si veda il protocollo) non devono essere in gravidanza né in allattamento e devono risultare negative al test di gravidanza allo screening.
    (vedi protocollo)
    E.4Principal exclusion criteria
    1. Hypersensitivity to ASTX660, excipients of the drug product, or other components of the study treatment regimen.
    2. Poor medical risk because of systemic diseases (eg, active uncontrolled infections) in addition to the qualifying disease under study.
    3. Life-threatening illness, significant organ system dysfunction, or other condition that, in the investigator's opinion, could compromise subject safety or the integrity of the study outcomes, or interfere with the absorption or metabolism of ASTX660.
    4. History of, or at risk for, cardiac disease, as evidenced by 1 or more of the following conditions:
    a) Abnormal left ventricular ejection fraction (LVEF; <50%) on echocardiogram (ECHO) or multiplegated acquisition scan (MUGA). [Applies to both Phase 1 and Phase 2].
    b) Congestive cardiac failure of = Grade 3 severity according to New York Heart Association (NYHA) functional classification defined as subjects with marked limitation of activity and who are comfortable only at rest.
    c) Unstable cardiac disease including unstable angina or hypertension as defined by the need for overnight hospital admission within the last 3 months (90 days).
    d) History or presence of complete left bundle branch block, third-degree heart block, cardiac pacemaker or clinically significant arrhythmia.
    e) Concurrent treatment with any medication that prolongs QT interval and may induce torsades de pointes, and which cannot be discontinued at least 2 weeks before treatment with ASTX660. [Applies to Phase 1 only.]
    f) Personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy.
    g) Screening 12-lead ECG with measurable QTc interval (according to either Fridericia's or Bazett's correction) of =470 msec).
    h) Any other condition that, in the opinion of the investigator, could put the subject at increased cardiac risk.
    5. Known history of human immunodeficiency virus (HIV) infection, or seropositive results consistent with active hepatitis B virus (HBV) or active hepatitis C virus (HCV) infection.
    6. Grade 2 or greater neuropathy. [Applies to Phase 1 ]. Grade 3 or greater neuropathy [Applies to Phase 2].
    7. Known brain metastases, unless stable or previously treated.
    8. Known significant mental illness or other conditions such as active alcohol or other substance abuse that, in the opinion of the investigator, predisposes the subject to high risk of noncompliance with the protocol treatment or assessments.
    9. Prior anticancer treatments or therapies within the indicated time window prior to first dose of study treatment (ASTX660), as follows:
    a) Cytotoxic chemotherapy or radiotherapy within 3 weeks prior (6 weeks if nitrosoureas). Palliative radiotherapy to a single lesion within 2 weeks prior. Any encountered treatment-related toxicities (excepting alopecia) must be stabilized or resolved to Grade 1 or less [Phase 1] or Grade 2 or less [Phase 2].
    b) Skin directed treatments, including topicals and radiation within 2 weeks prior.
    c) Monoclonal antibodies within 4 weeks prior. Any encountered treatment-related toxicities must be stabilized or resolved to Grade 1 or less [Phase 1] or Grade 2 or less [Phase 2].
    d) At least 6 weeks must have elapsed since CAR-T infusion and subjects must have experienced disease progression, and not have residual circulating CAR-T cells in peripheral blood (based on local assessment). Any encountered treatment-related toxicities must have resolved to Grade =1.
    e) Investigational drugs (small molecules or biologics) within the longer of 2 weeks or 5 half-lives prior to study treatment. Any encountered treatment-related toxicities must be stabilized or resolved to Grade 1 or less [Phase 1] or Grade 2 or less [Phase 2].
    10. Concurrent second malignancy currently requiring active therapy, except breast or prostate cancer stable on or responding to endocrine therapy or superficial bladder cancer [Phase 2].
    11. Known central nervous system (CNS) lymphoma [Phase 2].
    (see protocol)
    1. Ipersensibilità ad ASTX660, agli eccipienti del prodotto farmaceutico o ad altri componenti del regime di trattamento dello studio.
    2. Elevato rischio medico a causa di malattie sistemiche (per es. infezioni attive non controllate) in aggiunta alla malattia idonea oggetto di studio.
    3. Malattia potenzialmente letale, disfunzione organo-sistemica significativa o altra patologia che, secondo il parere dello sperimentatore, potrebbe compromettere la sicurezza del soggetto o l’integrità degli esiti dello studio, o che potrebbe interferire con l’assorbimento o il metabolismo di ASTX660.
    4. Anamnesi di, o a rischio di, malattia cardiaca, come evidenziato da 1 o più delle seguenti condizioni:
    a) Anomalie nella frazione di eiezione ventricolare sinistra (FEVS; < 50%) all’ecocardiogramma (ECO) o alla scansione con acquisizione a gate multipli (MUGA) [applicabile a entrambe le Fasi 1 e 2].
    b) Insufficienza cardiaca congestizia con gravità di grado = 3 secondo la classificazione funzionale della New York Heart Association (NYHA), definita come soggetti con notevole limitazione dell’attività e che si trovano a proprio agio solo a riposo.
    c) Malattia cardiaca instabile, comprese angina instabile o ipertensione, definita in base alla necessità di ricovero ospedaliero notturno entro gli ultimi 3 mesi (90 giorni).
    d) Anamnesi o presenza di blocco completo di branca sinistra, blocco cardiaco di terzo grado, pacemaker cardiaco o aritmia clinicamente significativa.
    e) Trattamento concomitante con qualsiasi farmaco che prolunga l’intervallo QT, che potrebbe causare torsade de pointes e che non può essere interrotto almeno 2 settimane prima dell’arruolamento con ASTX660 [vale solo per la Fase 1].
    f) Anamnesi personale di sindrome del QTc lungo o aritmie ventricolari, compresa la bigeminia ventricolare.
    g) ECG a 12 derivazioni di screening con intervallo QTc misurabile (secondo la correzione di Fridericia o Bazett) = 470 ms.
    h) Qualsiasi altra condizione che, secondo il parere dello sperimentatore, potrebbe esporre il soggetto a un maggior rischio cardiaco.
    5. Nota anamnesi di infezione da virus dell’immunodeficienza umana (HIV) o risultati di sieropositività coerenti con un’infezione attiva da virus dell’epatite B (HBV) o virus dell’epatite C (HCV).
    6. Neuropatia di grado = 2 [esclusivamente applicabile alla Fase 1]. Neuropatia di grado = 3 [esclusivamente applicabile alla Fase 2].
    7. Metastasi cerebrali note, salvo se stabili o trattate in precedenza.
    8. Nota malattia mentale significativa o altre condizioni come abuso in corso di alcol o altre sostanze che, secondo il parere dello sperimentatore, predispone il soggetto a un elevato rischio di non aderenza al trattamento o alle valutazioni del protocollo.
    Trattamenti o terapie antitumorali pregressi, somministrati entro la finestra temporale indicata prima della prima dose del trattamento in studio (ASTX660), come segue:
    a) Chemioterapia o radioterapia citotossica nelle ultime 3 settimane (6 settimane in caso di nitrosuree). Radioterapia palliativa di una singola lesione nelle ultime 2 settimane. Eventuali tossicità correlate al trattamento riscontrate (alopecia esclusa) devono essersi stabilizzate o risolte a grado = 1 [Fase 1] o grado = 2 [Fase 2].
    b) Trattamenti mirati alla cute, compresi agenti topici e radiazione nelle precedenti 2 settimane.
    c) Anticorpi monoclonali nelle precedenti 4 settimane. Eventuali tossicità correlate al trattamento riscontrate devono essersi stabilizzate o risolte a grado = 1 [Fase 1] o grado = 2 [Fase 2].
    d) Devono essere trascorse almeno 6 settimane dall’infusione delle cellule T esprimenti il recettore antigenico chimerico (CAR-T) e i soggetti devono aver manifestato progressione della malattia e non avere cellule CAR-T residue in circolazione nel sangue periferico (sulla base della valutazione locale). Eventuali tossicità correlate al trattamento riscontrate devono essersi risolte a grado = 1.
    (vedi protocollo)
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1: Incidence of DLTs and other adverse events (AEs) to determine
    the MTD, RP2D, and recommended dosing regimen of ASTX660.
    Phase 2: Antitumor activity assessed by objective response rate (ORR)
    and disease control rate (DCR) as assessed by the Investigator using the
    following criteria:
    - Cohort 1, 5, and 6: RECIST 1.1 criteria
    - Cohort 2: 2014 Lugano Classification
    - Cohort 3: 2014 Lugano Classification and LYRIC criteria
    - Cohort 4: Global Response Score (skin, blood and node using Olsen
    classification and viscera using lugano and LYRIC criteria)
    Fase 1: incidenza di DLT e altri eventi avversi (EA) per determinare la MTD, la RP2D e il regime di dosaggio di ASTX660 raccomandato.
    Fase 2: attività antitumorale valutata in base al tasso di risposta obiettiva (ORR) e al tasso di controllo della malattia (DCR) secondo la valutazione dello sperimentatore utilizzando i seguenti criteri:
    o Coorti 1, 5 e 6: criteri RECIST 1.1
    o Coorti 2 : Classificazione di Lugano 2014
    o Coorti 3: Classificazione di Lugano 2014 e criteri LYRIC
    o Coorte 4: Risultato della risposta globale (pelle, sangue e linfonodi utilizzando la classificazione di Olsen e viscere utilizzando i criteri di Lugano e LYRIC [rispettivamente
    E.5.1.1Timepoint(s) of evaluation of this end point
    Safety will be monitored at each study visit by recording of AEs, SAEs, DLTs, and concomitant medications; additional assessments that may be performed at selected visits include complete or symptom-directed physical examinations, recording of weight and height, vital signs, ECOG
    performance status, 12-lead ECGs, and clinical laboratory tests.
    Phase 1: echocardiogram (ECHO)/multiple-gated acquisition scans will be performed.
    Phase 2: Every 2 months for the first 6 months (6 cycles), and then every 3 months hereafter until clinical and/or radiographic disease progression, or death, or the subject withdraws consent
    Ad ogni visita dello studio, la sicurezza sarà monitorata registrando eventi avversi (EA), eventi avversi seri (SAE), DLT e farmaci concomitanti; ulteriori misure di sicurezza in occasione di visite selezionate includono esami obiettivi completi o mirati ai sintomi, registrazione di peso e altezza, segni vitali, stato di validità ECOG, elettrocardiogrammi (ECG) a 12 derivazioni e test clinici di laboratorio
    Fase 1: le scansioni di acquisizione con ecocardiogramma (ECHO) / a porte multiple essere eseguito.
    Fase 2: ogni 2 mesi per i primi 6 mesi (6 cicli), quindi in seguito ogni 3 mesi fino progressione clinica e / o radiografica di malattia, morte, o ritiro del consenso
    E.5.2Secondary end point(s)
    1. PK parameters of ASTX660, including area under the concentrationtime curve (AUC), maximum concentration (Cmax), minimum
    concentration (Cmin), time to maximum concentration (Tmax), elimination half-life (t½), and other secondary PK parameters of
    ASTX660 if data permit; analysis of ASTX660 metabolites if applicable.
    2. Overall survival.
    3. Percentage degradation of cIAP1 protein in PBMCs from baseline, in response to ASTX660 treatment [applies to Phase 1 only].
    4. Antitumor activity (ORR, DOR, and PFS) based on independent review committee (IRC) assessment: Phase 2 Cohort 3 Expansion using 2014 Lugano Classification with LYRIC criteria and Phase 2 Cohort 4 Expansion using Global Response Score (skin, blood and node using Olsen classification and viscera using Lugano classification with LYRIC criteria)
    5. Antitumor activity (DOR, and PFS) based on investigator assessment using the Lugano classification with LYRIC criteria (Phase 2 Cohort 4 Expansion) using Global Response Score (skin, blood and node using
    Olsen classification and viscera using Lugano classification with LYRIC criteria)
    6. Antitumor activity (ORR, DOR, and PFS) based on IRC assessment using the Lugano classification alone (Phase 2 Cohort 3 Expansion)
    • Parametri PK di ASTX660, compresi area sotto la curva concentrazione-tempo (AUC), concentrazione massima (Cmax), concentrazione minima (Cmin), tempo alla concentrazione massima (Tmax), emivita di eliminazione (t½) e altri parametri PK secondari di ASTX660 qualora i dati lo consentano; analisi dei metaboliti di ASTX660, se pertinente.
    • sopravvivenza complessiva.
    • Degradazione percentuale della proteina cIAP1 PBMC rispetto al basale, in risposta al trattamento con ASTX660 [esclusivamente applicabile alla Fase 1].
    • Attività antitumorale (ORR, DOR e PFS) basata sulla valutazione del comitato di revisione indipendente (IRC) utilizzando la Classificazione di Lugano 2014 con i criteri LYRIC (rispettivamente ed Espansione della Coorte 4 di Fase 2 utilizzando il risultato della risposta globale (pelle, sangue e linfonodi utilizzando la classificazione di Olsen eviscere utilizzando la classificazione di Lugano con i criteri LYRIC
    • Attività antitumorale (ORR, DOR e PFS) basata sulla valutazione dello sperimentatore utilizzando la classificazione di Lugano con i criteri LYRIC (Espansione della Coorte 4 di Fase 2) utilizzando il risultato della risposta globale (pelle, sangue e linfonodi utilizzando la classificazione di Olsen e viscere utilizzando la classificazione di Lugano con i criteri LYRIC [rispettivamente,
    • Attività antitumorale (ORR, DOR e PFS) basata sulla valutazione dell’IRC utilizzando la sola classificazione di Lugano (Espansione della Coorte 3 di Fase 2)
    E.5.2.1Timepoint(s) of evaluation of this end point
    1.At specified study visits, blood samples for PK will be collected predose for assessment of ASTX660 concentration in plasma. In
    addition, serial samples will be collected predose and at several specified time points after dosing on C1D1, C1D7, C2D1, and C2D7. Additionally, in Phase 2 for Cohorts 3 [PTCL] and 4 [CTCL], blood will be collected for PK analysis in Cycle 1 only.
    2.Every 2 months for the first 6 months (6 cycles), and then every 3 months hereafter until clinical and/or radiographic disease progression,
    or death, or the subject withdraws consent
    3. Blood samples will be collected at screening and at prespecified times after dosing for the assessment of cIAP1 protein degredation in PBMCs (Phase 1: on several study days during Cycles 1 and 2).
    1. In specifiche visite di studio, saranno raccolti campioni di sangue per PK predose per la valutazione della concentrazione di ASTX660 nel plasma. Inoltre, i campioni seriali saranno raccolti prima e in diversi specifici punti temporali dopo il dosaggio su C1D1, C1D7, C2D1 e C2D7. Inoltre, nella fase 2 per le coorti 3 [PTCL] e 4 [CTCL], verrà raccolto sangue per Analisi PK solo nel ciclo 1.
    2. Ogni 2 mesi per i primi 6 mesi (6 cicli) e poi ogni 3 mesi successivi fino alla progressione della malattia clinica e / o radiografica,
    o morte, o il soggetto ritira il consenso
    3. I campioni di sangue saranno raccolti allo screening e in tempi prestabiliti dopo il dosaggio per la valutazione della degradazione della proteina cIAP1 nei PBMC
    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 Yes
    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) Yes
    E.7.1.1First administration to humans Yes
    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 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 trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA30
    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
    Canada
    United States
    Belgium
    France
    Hungary
    Italy
    Spain
    United Kingdom
    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
    6 months from last subject treatment visit
    6 mesi dall'ultima visita di trattamento del soggetto
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years6
    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 years6
    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.1.1.1In 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: 184
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 46
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 46
    F.4.2.2In the whole clinical trial 230
    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
    nessuno
    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 Decision2020-05-15
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-03-24
    P. End of Trial
    P.End of Trial StatusOngoing
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