| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Advanced or metastatic Non-small cell lung cancer (NSCLC) |
| Carcinoma polmonare non a piccole cellule (NSCLC) avanzato o metastatico |
|
| E.1.1.1 | Medical condition in easily understood language |
| Advanced or metastatic NSCLC is lung cancer that has spread to areas near the lungs or other organs |
| Il carcinoma polmonare non a piccole cellule (NSCLC) avanzato o metastatico ¿ un cancro ai polmoni che si ¿ diffuso alle aree vicine ai polmoni o ad altri organi |
|
| 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 | 21.1 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10029521 |
| E.1.2 | Term | Non-small cell lung cancer stage IIIB |
| E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 21.1 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10059515 |
| E.1.2 | Term | Non-small cell lung cancer metastatic |
| E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
• To evaluate the efficacy of multiple therapies in patients with NSCLC selected according to results from the FoundationOne Liquid Companion Diagnostic (F1LCDx): alectinib (ALK+; RET+); entrectinib (ROS1+); atezolizumab (atezo) + cobimetinib (cobi) + vemurafenib (vem) (BRAF V600+) • To evaluate the efficacy of atezo compared with platinum-based chemotherapy in treatment-naive patients with inoperable Stage IIIB or Stage IV NSCLC in patients who are blood tumor mutational burden positive according to F1LCDx (Cohort C) |
- Valutare l’efficacia di molteplici terapie in pazienti affetti da carcinoma polmonare non a piccole cellule (NSCLC) in accordo ai risultati ottenuti da FoundationOne Liquid Companion Diagnostic (F1LCDx): alectinib (ALK+; RET+); entrectinib (ROS1+); atezolizumab (atezo) + cobimetinib (cobi) + vemurafenib (vem) (BRAF V600+) - Valutare l’efficacia di atezolizumab rispetto a chemioterapia a base di platino in pazienti naïve alla chemioterapia affetti da NSCLC inoperabile in stadio IIIB o stadio IV positivi al test F1LCDX (Coorte C) |
|
| E.2.2 | Secondary objectives of the trial |
• To evaluate the safety and tolerability of alectinib, atezo, entrectinib, atezo + cobi + vem (Cohorts A, B, C, D, E) • To explore the pharmacokinetic (PK) characteristics of alectinib in RET+ patients (Cohort B), entrectinib in ROS1+ patients (Cohort D), atezo in BRAF V600+ patients (Cohort E) • To evaluate the impact of study treatment on patient-reported outcome (PROs) • To evaluate the efficacy of entrectinib in patients with ROS1+ advanced or metastatic NSCLC and atezo +cobi + vem in patients with BRAF V600+, as determined by the F1LCDx assay • To assess prognostic effect and pharmacodynamics of exploratory biomarkers in blood, and their association with disease status, mechanisms of resistance, and/or response to alectinib (Cohorts A, B), atezo (Cohort C), entrectinib (Cohort D) |
- Valutare la sicurezza e la tollerabilità di alectinib, atezolizumab, entrectinib, atezo+cobi+vem (Coorti A, B, C, D,E) - Indagare le caratteristiche farmacocinetiche di alectinib in pazienti RET+ (Coorte B), di entrectinib in pazienti ROS1+ (Coorte D), di atezo in pazienti BRAF V600+ (Coorte E) - Valutare l'impatto dei trattamenti sui PRO (outcome riferiti dai pazienti) - Valutare l’efficacia di entrectinib in pazienti affetti da NSCLC ROS1+ e atezo+cobi+vem in pazienticon BRAF V600+, in base a quanto stabilito dal test F1LCDx - Valutare l’effetto prognostico e la farmacodinamica dei biomarcatori esplorativi nel sangue, nonché la loro associazione con lo stato di malattia, i meccanismi di resistenza e/o la risposta a: alectinib (Coorte A, B), atezo (Coorte C), entrectinib (Coorte D) |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
- Histologically or cytologically confirmed diagnosis of unresectable Stage IIIb not amenable to treatment with combined modality chemoradiation (advanced) or Stage IV (metastatic) NSCLC - Age >=18 years - Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2 - Measurable disease (as defined by RECIST, v1.1) - Adequate recovery from most recent systemic or local treatment for cancer - Adequate organ function - Life expectancy >=12 weeks - For female patients of childbearing potential and male patients, willingness to use acceptable methods of contraception |
- Diagnosi di NSCLC in stadio IIIb non candidabile a trattamento con chemioradioterapia in modalità combinata (avanzato) o in stadio IV (metastatico), confermata mediante esame istologico o citologico. - Età >= 18 anni - Performance status secondo l’Eastern Cooperative Oncology Group (ECOG) pari a 0-2 - Malattia misurabile (secondo i criteri RECIST v1.1) - Recupero adeguato dal trattamento antitumorale sistemico o locale più recente - Adeguata funzionalità d’organo - Aspettativa di vita >= 12 settimane - Per le donne in età fertile e gli uomini, disponibilità a utilizzare metodi contraccettivi accettabili |
|
| E.4 | Principal exclusion criteria |
- Inability to swallow oral medication - Women who are pregnant or lactating - Symptomatic, untreated CNS metastases Patients with treated and/or asymptomatic brain metastases may still be eligible for treatment on the study depending on individual cohort requirements; see the cohort specific appendices for details regarding eligibility - History of malignancy other than NSCLC within 5 years prior to screening, with the exception of malignancies with a negligible risk of metastasis or death (e.g., 5 year OS rate >= 90%), such as adequately treated carcinoma in situ of the cervix, non melanoma skin carcinoma, localized prostate cancer, ductal carcinoma in situ of breast, or Stage I uterine cancer -Significant cardiovascular disease -Known HIV positivity or AIDS-related illness -Either a concurrent condition or history of a prior condition that places the patient at unacceptable risk if he/she were treated with the study drug or confounds the ability to interpret data from the study -Inability to comply with other requirements of the protocol |
- Incapacità di ingerire i medicinali per via orale - Donne in gravidanza o allattamento - Metastasi sintomatiche non trattate a carico del sistema nervoso centrale (SNC). I pazienti con metastasi cerebrali trattate e/o asintomatiche potranno essere comunque ritenuti idonei al trattamento nello studio in base ai requisiti delle singole coorti; per maggiori dettagli sull’idoneità, consultare le appendici specifiche delle coorti. - Anamnesi positiva per neoplasia maligna diversa dall’NSCLC nei 5 anni precedenti allo screening, fatta eccezione per quelle soggette a un rischio trascurabile di metastasi o decesso (per es. tasso di OS a 5 anni >= 90%), quali forme adeguatamente trattate di carcinoma in situ della cervice, carcinoma cutaneo non melanomatoso, carcinoma localizzato della prostata, carcinoma duttale in situ della mammella o carcinoma uterino in stadio I. - Cardiovasculopatia significativa - Positività nota al virus dell’immunodeficienza umana (HIV) o malattia correlata a sindrome da immunodeficienza acquisita (AIDS) - Condizione concomitante o anamnesi positiva per condizioni pregresse che esporrebbero il paziente a un rischio inaccettabile qualora venisse trattato con il farmaco in studio o che comprometterebbero la capacità di interpretare i dati della ricerca - Incapacità di rispettare altri requisiti del protocollo |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
1. Investigator-assessed ORR based on confirmed objective response (Cohorts A, B and D) 2. Investigator-assessed PFS according to RECIST v1.1 (Cohort C) in bTMB the primary population of patients with a bTMB level equal to or greater than the higher validated cutoff (PP1) 3. Investigator-assessed 12-month time in response (TIR) per RECIST v1.1 (Cohort E) |
1. ORR valutato dallo sperimentatore in base alla risposta obiettiva confermata (Coorti A, B e D) 2. Valutazione della PFS da parte del medico secondo i criteri RECIST v1.1 (Coorte C) in bTMB la popolazione primaria di pazienti con un livello di bTMB uguale o maggiore rispetto cutoff più alto validato (PP1) 3. TIR a 12 mesi valutato dallo sperimentatore secondo i criteri RECIST v1.1 (Coorte E) |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
| 1-3. Up to 6 years |
| 1-3. Fino a 6 anni |
|
| E.5.2 | Secondary end point(s) |
1. Investigator-assessed DOR, CBR, and PFS per RECIST v1.1 (Cohorts A, B and D) 2. IRF-assessed ORR, DOR, CBR, and PFS per RECIST v1.1 (Cohorts A and B) 3. IRF-assessed PFS, ORR, and DOR according to RECIST v1.1 (Cohort C) 4. Investigator-assessed ORR, and DOR according to RECIST v1.1 (Cohort C) 5. Investigator- and IRF-assessed time to CNS progression according to RECIST v1.1 (Cohort D) 6. Investigator-assessed intracranial tumor response rate by RECIST 1.1 in patients with measurable CNS disease at baseline (Cohort D) 7. OS (Cohorts A, B, D and E) 8. Investigator-assessed PFS rates at 6-month and 1-year landmark timepoints (Cohort C) 9. Incidence, type, and severity of adverse events (based on the NCI CTCAE v4.0), including SAEs and AEs of special interest (Cohorts A, B, C and D) 10. Changes in vital signs, physical findings, and clinical laboratory results during and following administration of protocol-specified IMPs (Cohorts A, B and D) 11. DLTs, if any, associated with alectinib at escalating doses in RET+ patients (Cohort B) 12. PK parameters of alectinib in RET+ patients (Cohort B) 13. Population PK analysis for entrectinib (Cohort D) 14. Proportion of patients who improved compared with baseline in patient-reported lung cancer symptoms of cough, dyspnea, and chest pain and TTD as measured by SILC (Cohorts A, B, C, D and E) 15. Proportion of patients presenting with measurable CNS disease at baseline who improve compared with baseline in patient-reported cognitive function, fatigue, health-related quality of life (HRQoL), headache, and vision disorder per the corresponding scales of the EORTC QLQ-C30 and BN20 (Cohort D) 16. Mean change from baseline in HRQoL, patient functioning, and symptoms as measured by the EORTC QLQ-C30 (Cohorts A, B, C, D and E) 17. Health status as assessed by the EQ-5D-5L questionnaire (Cohorts A, B, C, D and E) 18. Relationship between circulating biomarkers related to alectinib exposure and efficacy (Cohorts A and B), to atezolizumab efficacy (Cohort C) to entrectinib efficacy (Cohort D), and atezo + cobi + vem efficacy (Cohort E) 19. OS in bTMB PP1 (Cohort C) 20. Investigator-assessed PFS according to RECIST v1.1 in bTMB the secondary population of all patients who are bTMB-positive, which is the intent-to-treat (ITT) population in this cohort (PP2) [Cohort C] 21. OS in bTMB PP2 (Cohort C) 22. Investigator and IRF-assessed -assessed ORR, DOR, and PFS per RECIST v1.1 (Cohort E) 23. 9-month TIR (Cohort E) 24. 12-month TIR (Cohort E) 25. Serum concentration of atezo at specified timepoints (Cohort E) 26. Presence of ADAs against atezo during the study relative to the presence of ADAs at baseline (Cohort E) |
1. DOR, CBR e PFS valutati dallo sperimentatore secondo i criteri RECIST v1.1 (Coorti A, B e D) 2. ORR, DOR, CBR e PFS valutati dall'IRF secondo i criteri RECIST v1.1 (Coorti A e B) 3. PFS, ORR e DOR valutati dall¿IRF secondo i criteri RECIST v1.1 (Coorte C) 4. ORR e DOR valutati dallo sperimentatore secondo i criteri RECIST v1.1 (Coorte C) 5. Tempo alla progressione SNC valutato dallo sperimentatore e dall’IRF secondo i criteri RECIST v1.1 (Coorte D) 6. Tasso di risposta tumorale intracranica valutato dallo sperimentatore secondo i criteri RECIST v1.1 in pazienti con malattia dell’SNC misurabile al basale (Coorte D) 7. OS (Coorti A, B, D, e E) 8. Tassi di PFS valutati dallo sperimentatore agli intervalli di riferimento a 6 mesi e 1 anno (Coorte C) 9. Incidenza, tipologia e severità degli eventi avversi (secondo i criteri NCI CTCAE v4.0), ivi compresi SAE ed eventi avversi di interesse particolare (Coorti A, B, C e D) 10. Variazioni di segni vitali, obiettività e risultati clinici di laboratorio durante e dopo la somministrazione degli IMP specificati dal protocollo (Coorti A, B e D) 11. Eventuali DLT associate ad alectinib a dosi incrementali progressive (Coorte B) 12. Parametri farmacocinetici di alectinib nei pazienti RET (Coorte B) 13. Analisi farmacocinetica di popolazione su entrectinib (Coorte D) 14. Percentuale di soggetti che registrano un miglioramento rispetto al basale nei seguenti sintomi del carcinoma polmonare riferiti dai pazienti valutati secondo la scala SILC: tosse, dispnea e dolore toracico e TTD (Coorti A, B,C, D e E) 15. Percentuale di soggetti con malattia dell’SNC misurabile al basale che registrano un miglioramento rispetto al basale nella funzione cognitiva, nell’affaticamento, nella HRQoL, nel mal di testa e nei problemi alla vista riferiti dai pazienti secondo le scale corrispondenti dei questionari QLQ-C30 e BN20 dell’EORTC (Coorte D) 16. Variazione media rispetto al basale di HRQoL, capacità dei pazienti di svolgere attività e sintomi, valutati secondo il questionario QLQ-C30 dell’EORTC (Coorti A, B, C, D e E) 17. Condizioni di salute valutate secondo il questionario EQ-5D-5L (Coorti A, B, C, D e E) 18. Correlazione tra i biomarcatori circolanti connessi all'esposizione e all'efficacia di alectinib (Coorti A e B), all’efficacia di atezo (Coorte C), all'efficacia di entrectinib (Coorte D), all’efficacia di atezo+cobi+vem (Coorte E) 19. OS in bTMB PP1 (Coorte C) 20. Valutazione della PFS da parte del medico secondo i criteri RECIST v1.1 in bTMB PP2 (Coorte C) 21. OS in bTMB PP2 (Coorte C) 22. ORR valutato dall’IRF, DOR e PFS secondo i criteri RECIST v1.1 (Coorte E) 23. TIR a 9 mesi (Coorte E) 24. TIR a 12 mesi (Coorte E) 25. Concentrazione sierica di atezolizumab a specifici timepoint (Coorte E) 26. Presenza di ADA diretti contro atezolizumab durante lo studio rispetto alla presenza di ADA al basale (Coorte E) |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-7. Up to 6 years 8. At 6 month and 1 year 9-10. Up to 6 years 11. From Day 1 (D1) to D28 of Cycle 1 (C1) 12. Dose-Finding Phase: C1D1, C1D8, C2D1, C3D1, C4D1 Expansion Phase: C1D1, C2D1, C3D1, C4D1 13. C1D1, C2D1, C3D1, C4D1, C5D1 and all subsequent D1 of each treatment cycle until the end of treatment 14- 17. At 3 and 6 months following disease progression up to 6 years 18-22. Up to 6 years 23. 9 months 24. 12 months 25-26. C1D1, C2D1, C3D1, C4D1, C8D1, C12D1, C16D1 and at treatment discontinuation visit |
1-7. Fino a 6 anni 8. Al mese 6 e ad 1 anno 9-10. Fino a 6 anni 11. Dal Giorno 1 (D1) al Giorno 28 del Ciclo 1 (C1) 12. Fase di determinazione della dose: C1D1, C1D8, C2D1, C3D1, C4D1 Fase con espansione della dose: C1D1, C2D1, C3D1, C4D1 13. C1D1, C2D1, C3D1, C4D1, C5D1 e e tutti i successivi D1 di ciascun ciclo di trattamento fino alla fine del trattamento 14- 17. Al mese 3 e 6 siccessivi la progression di malattia fino a 6 anni 18-22. Fino a 6 anni 23. Mese 9 24. Mese 12 25-26. C1D1, C2D1, C3D1, C4D1, C8D1, C12D1, C16D1 e alla visita di fine trattamento |
|
| 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 | Yes |
| E.6.7 | Pharmacodynamic | Yes |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | Yes |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | No |
| E.6.13 | Others | Yes |
| E.6.13.1 | Other scope of the trial description |
|
| 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) | Yes |
| 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 | No |
| 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) | No |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 5 |
| 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 | 9 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 70 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
| E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
| Australia |
| Brazil |
| Canada |
| Chile |
| Costa Rica |
| Hong Kong |
| Israel |
| Korea, Republic of |
| Mexico |
| New Zealand |
| Peru |
| Russian Federation |
| Serbia |
| Singapore |
| Taiwan |
| Thailand |
| Turkey |
| United States |
| Belgium |
| France |
| Germany |
| Italy |
| Poland |
| Spain |
| Argentina |
|
| 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
|
The end of this study is defined as the date when the last patient, last visit (LPLV) or assessment occurs for the collection of the last data point for the last treatment cohort.
The umbrella nature of this protocol may provide for an extension of the overall duration of this study to meet the objectives of additional cohorts and/or additional therapies added through protocol amendments
|
| La fine dello studio coincide con la data in cui ha luogo l’ultima visita dell’ultimo paziente (LPLV) o la valutazione per la raccolta dell’ultima osservazione nell’ultima coorte di trattamento. Le singole coorti potranno concludersi prima della fine dello studio una volta interamente completati il trattamento, il follow-up e la raccolta dei dati predefiniti. |
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 7 |
| E.8.9.1 | In the Member State concerned months | 0 |
| E.8.9.1 | In the Member State concerned days | 0 |
| E.8.9.2 | In all countries concerned by the trial years | 7 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |