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    Summary
    EudraCT Number:2017-000958-19
    Sponsor's Protocol Code Number:MK-3475-590
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2017-05-17
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2017-000958-19
    A.3Full title of the trial
    A Randomized, Double-Blind, Placebo-Controlled Phase III Clinical Trial of Pembrolizumab (MK-3475) in Combination with Cisplatin and 5-Fluorouracil versus Placebo in Combination with Cisplatin and 5-Fluorouracil as First-Line Treatment in Subjects with Advanced/Metastatic Esophageal Carcinoma (KEYNOTE-590)
    Ensayo clínico de fase III, aleatorizado, doble ciego y controlado con placebo, de Pembrolizumab (MK-3475) en combinación con Cisplatino y 5-Fluorouracilo en comparación con Placebo en combinación con Cisplatino y 5-Fluorouracilo como tratamiento de primera línea en sujetos con carcinoma de esófago avanzado o metastásico (KEYNOTE-590)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    First-line Esophageal Carcinoma Study with Chemo vs. Chemo + Pembrolizumab
    Estudio del tratamiento de primera línea del carcinoma de esófago con
    quimioterapia frente a quimioterapia + pembrolizumab
    A.3.2Name or abbreviated title of the trial where available
    First-line Esophageal Carcinoma Study with Chemo vs. Chemo + Pembrolizumab
    Estudio del tratamiento de primera línea del carcinoma de esófago con
    A.4.1Sponsor's protocol code numberMK-3475-590
    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 SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    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 supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España S.A.
    B.5.2Functional name of contact pointInvestigación Clínica
    B.5.3 Address:
    B.5.3.1Street AddressCalle Josefa Valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491321 06 22
    B.5.5Fax number+3491321 05 90
    B.5.6E-mailensayos_clinicos@merck.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 namePembrolizumab
    D.3.2Product code MK-3475
    D.3.4Pharmaceutical form 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 INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    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 Yes
    D.2.1.1.1Trade name Cisplatin Accord 1 mg/mL
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare S.L.U.
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    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 nameCisplatin
    D.3.4Pharmaceutical form 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 INNCISPLATIN
    D.3.9.1CAS number 15663-27-1
    D.3.9.3Other descriptive nameCISPLATIN
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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 RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Fluorouracil
    D.2.1.1.2Name of the Marketing Authorisation holderHospira UK Limited
    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 nameFluorouracil
    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 INNFLUOROURACIL
    D.3.9.1CAS number 51-21-8
    D.3.9.3Other descriptive nameFLUOROURACIL
    D.3.9.4EV Substance CodeSUB07721MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    First-line treatment of subjects with locally advanced unresectable or metastatic adenocarcinoma or squamous cell carcinoma of the esophagus or advanced/metastatic Siewert type 1 adenocarcinoma of the esophagogastric junction
    Tratamiento de primera línea de sujetos con adenocarcinoma o carcinoma epidermoide de esófago localmente avanzado e irresecable o metastásico o con adenocarcinoma de la unión esofagogástrica de tipo 1 de Siewert avanzado o metastásico
    E.1.1.1Medical condition in easily understood language
    Cancer of esophagus or junction between esophagus and stomach
    Cáncer de esófago o unión entre esófago y estómago
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10015366
    E.1.2Term Esophageal carcinoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To compare progression-free survival (PFS) per RECIST 1.1, as determined by blinded independent central review, between treatment arms in all subjects
    2.To compare PFS per RECIST 1.1, as determined by blinded independent central review, between treatment arms in subjects whose tumors are GEP biomarker-positive
    3.To compare overall survival (OS) between treatment arms in all subjects
    4.To compare OS between treatment arms in subjects whose tumors are GEP biomarker-positive
    1.- Comparar la SSP conforme a los criterios RECIST 1.1, determinada
    mediante la revisión central independiente y enmascarada, entre los grupos de tratamiento en todos los sujetos.
    2.- Comparar la SSP conforme a los criterios RECIST 1.1, determinada
    mediante la revisión central independiente y enmascarada, entre los grupos de tratamiento en los sujetos cuyos tumores tengan el biomarcador de PEG positivo.
    3.- Comparar la SG entre los grupos de tratamiento en todos los sujetos.
    4.- Comparar la SG entre los grupos de tratamiento en los sujetos cuyos
    tumores tengan el biomarcador de PEG positivo.
    E.2.2Secondary objectives of the trial
    1.Evaluate ORR per RECIST 1.1, as determined by blinded independent central review, between treatment arms in all subjects
    2.Evaluate ORR per RECIST 1.1, as determined by blinded independent central review, between treatment arms in subjects whose tumors are GEP biomarker-positive
    3.Evaluate PFS per irRECIST, as determined by blinded independent central review, between treatment arms in all subjects and in subjects whose tumors are GEP biomarker-positive
    4.Evaluate duration of response (DOR) per RECIST 1.1, as determined by blinded independent central review, between treatment arms in all subjects and in subjects whose tumors are GEP biomarker-positive
    5.Evaluate the safety and tolerability profile

    Please refer to the protocol for the complete list
    1. Comparar la TRO conforme a los criterios RECIST 1.1, determinada
    mediante la revisión central independiente y enmascarada, entre los grupos detratamiento en todos los sujetos.
    2.- Comparar la TRO conforme a los criterios RECIST 1.1, determinada
    mediante la revisión central independiente y enmascarada, entre los grupos de tratamiento en los sujetos cuyos tumores tengan el biomarcador de PEG positivo.
    3-Comparar la SSP conforme a los criterios irRECIST, determinada
    mediante la revisión central independiente y enmascarada, entre los grupos de tratamiento en todos los sujetos y en los sujetos cuyos tumores tengan el biomarcador de PEG positivo.
    4. Comparar la duración de la respuesta (DR) conforme a los criterios
    RECIST 1.1, determinada mediante la revisión central independiente y enmascarada, entre los grupos de tratamiento en todos los sujetos y en los sujetos cuyos tumores tengan el biomarcador de PEG positivo.

    Para la lista completa por favor acudir al protocolo.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Merck will conduct Future Biomedical Research on DNA (blood and/or tissue ) specimens collected during this clinical trial. Such research is for biomarker testing to address emergent questions not described elsewhere in the protocol (as part of the main trial) and will only be conducted on specimens from appropriately consented subjects. The objective of collecting specimens for Future Biomedical Research is to explore and identify biomarkers that inform the scientific understanding of diseases and/or their therapeutic treatments. The overarching goal is to use such information to develop safer, more effective drugs, and/or to ensure that subjects receive the correct dose of the correct drug at the correct time.
    Merck realizará investigaciones biomédicas futuras con las muestras obtenidas para tal finalidad durante este ensayo clínico. Dichas investigaciones podrán incluir análisis genéticos (ADN), determinación de perfiles de expresión génica (ARN), proteómica, metabolómica (suero, plasma) y/o determinación de otros analitos, en función de las muestras que se obtengan para investigaciones biomédicas futuras.
    Estas investigaciones tendrán por objeto el análisis de biomarcadores con el fin de abordar aspectos nuevos que no se describen en otras partes del protocolo (como parte del ensayo principal) y solo se llevarán a cabo en muestras de los sujetos que hayan otorgado el consentimiento correspondiente. El objetivo de la obtención/ conservación de muestras para investigaciones biomédicas futuras consiste en estudiar e identificar biomarcadores que proporcionen información a los científicos sobre las enfermedades y/o sus tratamientos. El objetivo último es utilizar tal información para desarrollar vacunas/fármacos más seguros y eficaces y/o para garantizar que los sujetos reciban la dosis correcta del fármaco o la vacuna adecuados en el momento preciso.
    E.3Principal inclusion criteria
    1.Be willing and able to provide written informed consent for the trial. The subject may also provide consent for Future Biomedical Research. However, the subject may participate in the trial without participating in Future Biomedical Research
    2.Be ≥ 18 years of age on the day of signing informed consent
    3.Have histologically or cytologically confirmed diagnosis of locally advanced unresectable or metastatic adenocarcinoma or squamous cell carcinoma of the esophagus or advanced/metastatic Siewert type 1 adenocarcinoma of the EGJ. a)Subjects with direct invasion into adjacent organs such as the aorta or trachea (T4b disease) should be closely evaluated for bleeding risk prior to enrollment and a Sponsor consultation before enrollment is required. b)Subjects with Siewert type 1 adenocarcinoma of the EGJ with known human epidermal growth factor receptor-2/neu (HER-2/neu)-positive tumors are not eligible. If HER-2/neu status is unknown, site should follow local standards for HER-2/neu testing
    4.Have measurable disease per RECIST 1.1 as determined by the local site investigator/radiology assessment. A lesion(s) situated in a previously irradiated area can be considered a target lesion(s) if progression has been demonstrated and the lesion(s) is considered measurable per RECIST 1.1 criteria
    5.Have an ECOG performance status of 0 to 1
    6.Provide either a newly obtained or archival tissue sample for intratumoral immune-related GEP analysis and PD-L1 by immunohistochemistry analysis. Newly obtained tissue is preferred. Formalin-fixed, paraffin-embedded (FFPE) block specimens are preferred to slides. Repeat samples will be required if none of the samples submitted (archival or newly obtained) is adequate. For purposes of this study, newly obtained tissue refers to tissue that was collected between the last line of therapy and the first dose of study medication. a)Central laboratory confirmation of tumor tissue sample adequacy is required prior to subject randomization in the study. If multiple tumor samples are submitted, at least one of the samples must be confirmed to be adequate by the central laboratory prior to subject being enrolled. b)For subjects from whom newly obtained samples cannot be obtained (e.g., inaccessible or subject safety concern), an archival specimen may be submitted. c)If newly obtained tissue is provided and an archival tissue sample is available, it should also be provided to support evaluation of the clinical utility of immune-related GEP assessment and PD-L1 analysis by immunohistochemistry in newly obtained vs. archival tissue samples. However, a subject will not be excluded from participating in the study if he/she has provided newly obtained tissue and an archival tissue sample is not available or is otherwise insufficient for analysis
    7. Female subjects of childbearing potential must have a negative urine or serum pregnancy test within 72 hours prior to randomization. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required. If first dose is given > 72 hours post randomization, pregnancy test should be repeated within 72 hours of first dose
    8.Female subjects of childbearing potential must be willing to use an adequate method of contraception as outlined in Section 5.7.2 – Contraception, for the course of the study through 120 days after the last dose of study therapy
    9.Male subjects of childbearing potential must agree to use an adequate method of contraception as outlined in Section 5.7.2 – Contraception, starting with the first dose of study therapy through 120 days after the last dose of study therapy and refrain from donating sperm during this period
    10.Have adequate organ function as defined in the protocol. Specimens must be collected within 14 days prior to the start of study treatment.
    1. Estar dispuesto a otorgar su consentimiento informado por escrito para el ensayo y ser capaz de hacerlo. El sujeto también podrá otorgar su consentimiento para las investigaciones biomédicas futuras. No obstante, podrá participar en el ensayo sin necesidad de hacerlo en las investigaciones biomédicas futuras.
    2. Tener una edad mínima de 18 años el día de firma del consentimiento informado.
    3. Tener un diagnóstico confirmado mediante histología o citología de adenocarcinoma o carcinoma epidermoide de esófago localmente avanzado e irresecable o metastásico o de adenocarcinoma de la UEG de tipo 1 de Siewert avanzado o metastásico. a. Los sujetos que presenten invasión directa de los órganos adyacentes, como la aorta o la tráquea (enfermedad T4b) se someterán a una evaluación minuciosa para determinar el riesgo de hemorragia antes de su inclusión y será obligatorio consultar al promotor antes de proceder a su reclutamiento. b. No podrán participar sujetos con adenocarcinoma de la UEG de tipo 1 de Siewert con receptor del factor de crecimiento epidérmico humano-2/neu (HER-2/neu) positivo. En caso de desconocerse el estado relativo a HER-2/neu, el centro tendrá que seguir las normas locales en relación con el análisis de HER-2/neu.
    4. Tener enfermedad mensurable conforme a los criterios RECIST 1.1, según la evaluación radiológica o del investigador del centro local. Una lesión situada en una zona irradiada anteriormente se puede considerar una lesión diana si se demuestra que ha progresado y se considera que es mensurable conforme a los criterios RECIST 1.1.
    5. Tener un estado funcional del ECOG de 0 o 1.
    6. Proporcionar una muestra de tejido de obtención reciente o de archivo para el análisis intratumoral del PEG relacionado con el sistema inmunitario y el análisis inmunohistoquímico de PD-L1. Es preferible utilizar tejido de obtención reciente. Se prefiere el uso de bloques de tejido fijados en formol e incluidos en parafina (FFIP) a los cortes para microscopio. Se necesitarán nuevas muestras en caso de que ninguna
    de las facilitadas (de archivo o recientes) sea adecuada. Para los fines de este estudio, «tejido de obtención reciente» se refiere a tejido obtenido entre la última línea de tratamiento y la primera dosis de la medicación del estudio. a. El laboratorio central deberá confirmar la idoneidad de la muestra de tejido tumoral antes de la aleatorización del sujeto en el estudio. Si se proporcionan varias muestras tumorales, el laboratorio central deberá confirmar que al menos una es adecuada antes de la inclusión del sujeto. b. En el caso de los sujetos de los que no puedan obtenerse muestras recientes (por ejemplo, inaccesibilidad o problemas de seguridad del sujeto), podrá remitirse una muestra de archivo.
    c. Cuando se proporcione tejido de obtención reciente y se disponga de una muestra de tejido de archivo, también deberá facilitarse esta para respaldar la evaluación de la utilidad clínica de la determinación de PEG relacionados con la inmunidad y un análisis de PD-L1 mediante inmunohistoquímica en muestras de tejido de obtención reciente y de archivo. Sin embargo, un sujeto no será excluido de participar en el estudio si ha proporcionado tejido de obtención reciente y no se dispone de una muestra de tejido de archivo o es, por otro lado, insuficiente para el análisis.
    7. Las participantes en edad fértil deberán dar negativo en una prueba de embarazo en orina o suero realizada en las 72 horas previas a la aleatorización. Cuando el resultado de la prueba en orina sea positivo o no pueda confirmarse que es negativo, será necesario hacer una prueba de embarazo en suero. Si la primera dosis se administra más de 72 horas después de la aleatorización, se repetirá la prueba de embarazo en las 72 horas siguientes a la primera dosis.
    8. Las mujeres en edad fértil deberán estar dispuestas a utilizar un método anticonceptivo adecuado según se describe en la sección 5.7.2, Anticoncepción, durante todo el estudio y hasta 120 días después de la última dosis del tratamiento del estudio.
    9. Los varones en edad fértil deberán comprometerse a utilizar un método anticonceptivo adecuado tal como se indica en la sección 5.7.2, Anticoncepción, desde la administración de la primera dosis y hasta 120 días después de la última dosis del tratamiento del estudio, así como a abstenerse de donar semen durante este período.
    10. Presentar una función orgánica adecuada, tal como se define en la Tabla 1. Las muestras se obtendrán en los 14 días previos al comienzo del tratamiento del estudio
    E.4Principal exclusion criteria
    1.Has locally advanced esophageal carcinoma that is resectable or potentially curable with radiation therapy (as determined by local investigator)
    2.Has had previous therapy for advanced/metastatic adenocarcinoma or squamous cell cancer of the esophagus or advanced/metastatic Siewert type 1 adenocarcinoma of the EGJ. Subjects may have received prior neoadjuvant or adjuvant therapy as long as it was completed at least 6 months prior to randomization
    3.Has had major surgery, open biopsy, or significant traumatic injury within 28 days prior to randomization, or anticipation of the need for major surgery during the course of study treatment
    4.Has a known additional malignancy that is progressing or requires active treatment. Exceptions include early-stage cancers (carcinoma in situ or Stage 1) treated with curative intent, basal cell carcinoma of the skin, squamous cell carcinoma of the skin, in situ cervical cancer, or in situ breast cancer that has undergone potentially curative therapy
    5.Has known active central nervous system metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least 4 weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases confirmed by repeat imaging, and have not required steroids for at least 14 days before the first dose of trial treatment. This exception does not include carcinomatous meningitis, which is excluded regardless of clinical stability
    6.Has an active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease-modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed. Brief (i.e., < 7 days) use of systemic corticosteroids is allowed when use is considered standard of care by investigator
    7.Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment
    8.Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis
    9.Has an active infection requiring systemic therapy
    10.Has a history or current evidence of any condition (e.g., known deficiency of the enzyme dihydropyrimidine dehydrogenase), therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject’s participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator
    11.Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial
    12.Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 120 days after the last dose of trial treatment
    13.Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another co-inhibitory T-cell receptor (i.e., CTLA-4, OX-40, CD137) or has previously participated in a pembrolizumab (MK-3475) clinical trial
    14.Has severe hypersensitivity (≥ Grade 3) to any study treatment (pembrolizumab, cisplatin, or 5-FU) and/or any of its excipients
    15.Has a known history of active tuberculosis (Bacillus tuberculosis)
    16.Has a known history of human immunodeficiency virus (HIV) infection. No HIV testing is required unless mandated by local health authority
    17.Has known history of or is positive for hepatitis B (hepatitis B surface antigen reactive) or hepatitis C (hepatitis C virus RNA or hepatitis C antibody is detected). No hepatitis testing is required unless mandated by local health authority
    18.Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of trial treatment
    19.Has received a live vaccine within 30 days prior to the first dose of trial drug. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette–Guérin, and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed
    1. Presenta un carcinoma de esófago localmente avanzado que es resecable o potencialmente curable con radioterapia (según lo determinado por el investigador local).
    2. Ha recibido tratamiento previo para el adenocarcinoma o carcinoma epidermoide de esófago avanzado/ metastásico o el adenocarcinoma de la UEG de tipo 1 de Siewert avanzado o metastásico. Los sujetos podrán haber recibido tratamiento neoadyuvante o adyuvante previo siempre que haya finalizado al menos seis meses antes de la aleatorización.
    3. Se ha sometido a una intervención de cirugía mayor o una biopsia abierta o ha sufrido un traumatismo importante en los 28 días previos a la aleatorización, o hay previsión de que necesite una intervención de cirugía mayor durante el tratamiento del estudio.
    4. Tiene otro tumor maligno que está en progresión o requiere tratamiento activo. Son excepciones los cánceres en estadio incipiente (carcinoma in situ o estadio 1) tratados con intención curativa, el carcinoma basocelular de piel, el carcinoma espinocelular
    de piel, el cáncer de cuello uterino in situ y el cáncer de mama in situ sometido a tratamiento potencialmente curativo.
    5.Tiene metástasis activas conocidas en el sistema nervioso central y/o meningitis carcinomatosa. Los sujetos con metástasis cerebrales tratadas previamente podrán participar siempre que estén estables (sin signos de progresión en los estudios de imagen durante al menos 4 semanas antes de la primera dosis de tratamiento del estudio y con
    regreso de los síntomas neurológicos a la situación basal), no tengan indicios de metástasis cerebrales nuevas o en crecimiento confirmadas mediante estudios de imagen repetidos y no hayan necesitado esteroides durante al menos 14 días antes del tratamiento del estudio. Esta excepción no se aplica a la meningitis carcinomatosa, que
    será motivo de exclusión con independencia de la estabilidad clínica.
    6. Presenta una enfermedad autoinmunitaria activa que ha precisado tratamiento sistémico (es decir, fármacos modificadores de la enfermedad, corticosteroides o inmunodepresores) en los dos últimos años. El tratamiento de reposición (p. ej., tiroxina, insulina o corticoides en dosis fisiológicas por insuficiencia suprarrenal o hipofisaria) no se considera una forma de tratamiento sistémico y se permitirá su uso.
    Se permite el uso breve (< 7 días) de corticosteroides sistémicos cuando el investigador lo considere parte de la asistencia habitual.
    7. Tiene un diagnóstico de inmunodeficiencia o está recibiendo tratamiento sistémico crónico con esteroides (en dosis superiores a 10 mg diarios de un equivalente de prednisona) o ha recibido cualquier otra forma de tratamiento inmunodepresor en los siete días previos a la primera dosis del tratamiento del estudio.
    8. Tiene antecedentes de neumonitis (no infecciosa) que ha requerido esteroides o presenta una neumonitis activa.
    9. Presenta una infección activa que requiere tratamiento sistémico.
    10. Tiene antecedentes o indicios actuales de cualquier enfermedad o situación (p. ej., carencia conocida de la enzima dihidropirimidina deshidrogenasa), tratamiento o anomalía analítica que pueda confundir los resultados del ensayo, dificultar la participación del sujeto durante todo el estudio o motivar que la participación en el ensayo no sea lo mejor para el sujeto, en opinión del investigador responsable del
    tratamiento.
    11. Presenta un trastorno psiquiátrico o por abuso de sustancias que pueda dificultar el cumplimiento de los requisitos del ensayo.
    12. Está embarazada o en período de lactancia o tiene intención de concebir o engendrar un hijo durante el período previsto del ensayo, desde la visita de selección hasta 120 días después de la administración de la última dosis del tratamiento del estudio.
    13. Ha recibido tratamiento previo con un fármaco anti-PD-1, anti-PD-L1, anti-PD-L2 o dirigido contra otro receptor coinhibidor de los linfocitos T (es decir, CTLA-4, OX-40 o CD137) o ha participado antes en un ensayo clínico de Merck con pembrolizumab (MK-3475).
    14. Tiene hipersensibilidad grave (grado ≥ 3) a cualquier tratamiento del estudio (pembrolizumab, cisplatino o 5-FU) y/o a cualquiera de sus excipientes.
    15. Tiene antecedentes de tuberculosis activa (Bacillus tuberculosis).
    16. Tiene antecedentes de infección por el virus de la inmunodeficiencia humana (VIH). No es necesario realizar pruebas de VIH a menos que lo exijan las autoridades sanitarias locales.
    17. Tiene antecedentes conocidos o es seropositivo para hepatitis B (reactividad para el antígeno de superficie del virus de la hepatitis B) o C (se detecta ARN del virus de la hepatitis C). No es necesario realizar pruebas de hepatitis a menos que lo exijan las autoridades sanitarias locales.
    18. Está participando o ha participado en un estudio de un fármaco o dispositivo en investigación en las cuatro semanas previas a la administración de la primera dosis del tratamiento del estudio.

    Criterio 19 consultar protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    1.Progression-free survival (PFS) based o n RECIST 1.1 as assessed by blinded independent central review in all subjects
    2. PFS based o n RECIST 1.1 as assessed by blinded independent central review in subjects whose tumors are GEP biomarker-positive
    3. Overall survival (OS) in all subjects
    4. OS in subjects whose tumors are GEP biomarker-positive
    1.Supervivencia libre de progresión conforme a los criterios RECIST 1.1, determinada mediante la revisión central independiente y enmascarada realizada en todos los sujetos.
    2.SSP conforme a los criterios RECIST 1.1, determinada mediante la revisión central independiente y enmascarada realizada en los sujetos cuyos tumores tengan el biomarcador de PEG positivo.
    3.Supervivencia global en todos los sujetos
    4.SG en los sujetos cuyos tumores tengan el biomarcador de PEG positivo
    E.5.1.1Timepoint(s) of evaluation of this end point
    Main Progression-free survival (PFS) and interim overall survival (OS) at IA (~31 months after trial starts)
    OS at final analysis (~40 months after trial starts)
    Principal Supervivencia Libre de Progresión y provisional supervivencia global en el análisis intermedio. (aproximadamente 31 meses después del comienzo del ensayo)
    SG en el análisis final (aproximadamente 40 meses después del comienzo del ensayo)
    E.5.2Secondary end point(s)
    1.Objective response rate (ORR) based on RECIST 1.1 as assessed by blinded independent central review in all subjects
    2. ORR based on RECIST 1.1 as assessed by blinded independent central review in subjects whose tumors are GEP biomarker-positive
    1.Tasa de respuesta objetiva (TRO) conforme a los criterios RECIST 1.1, determinada mediante la revisión central independiente y enmascarada realizada en todos los sujetos
    2.TRO conforme a los criterios RECIST 1.1, determinada mediante la revisión central independiente y enmascarada realizada en los sujetos cuyos tumores tengan el biomarcador de PEG positivo.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Objective response rate (ORR), duration of response (DOR), Quality of Life, PD-L1 biomarker, and Safety at end of study
    Tasa de respuesta objetiva (TRO), duración de la respuesta, Calidad de Vida, biomarcador PD-L1, y Seguridad al final del ensayo.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic Yes
    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) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    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 Yes
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA20
    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
    Argentina
    Australia
    Brazil
    Canada
    Chile
    China
    France
    Germany
    Guatemala
    Hong Kong
    Japan
    Korea, Republic of
    Malaysia
    Russian Federation
    Spain
    Taiwan
    Thailand
    Turkey
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    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 months4
    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 months4
    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: 350
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 350
    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 state19
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 67
    F.4.2.2In the whole clinical trial 700
    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
    ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-07-07
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-06-30
    P. End of Trial
    P.End of Trial StatusOngoing
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