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    Summary
    EudraCT Number:2017-001980-19
    Sponsor's Protocol Code Number:42756493BLC2002
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-06-15
    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 number2017-001980-19
    A.3Full title of the trial
    A Phase 1b-2 Study to Evaluate Safety, Efficacy, Pharmacokinetics, and Pharmacodynamics of Various Regimens of Erdafitinib in Subjects with Metastatic or Locally Advanced Urothelial Cancer
    Studio di fase 1b-2 per valutare la sicurezza, l’efficacia, la farmacocinetica e la farmacodinamica di vari regimi di erdafitinib in pazienti con carcinoma uroteliale metastatico o localmente avanzato
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the safety, the distribution and elimination of the compound in the body, and the effectiveness of Erdafitinib by itself, in combination with JNJ-63723283 (Cetrelimab) or in combination with JNJ- 63723283 (Cetrelimab) and chemotherapy, in patients with metastatic or Locally Advanced urothelial cancer.
    Studio di fase 1b-2 per valutare la sicurezza, l’efficacia, la farmacocinetica e la farmacodinamica di vari regimi di erdafitinib in pazienti con carcinoma uroteliale metastatico o localmente avanzato
    A.3.2Name or abbreviated title of the trial where available
    NORSE
    NORSE
    A.4.1Sponsor's protocol code number42756493BLC2002
    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 SponsorJANSSEN CILAG INTERNATIONAL NV
    B.1.3.4CountryBelgium
    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 supportJanssen Research & Development
    B.4.2CountryUnited States
    B.4.1Name of organisation providing supportJanssen-Cilag SpA
    B.4.2CountryItaly
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationJanssen-Cilag International NV
    B.5.2Functional name of contact pointClinical Registry Group
    B.5.3 Address:
    B.5.3.1Street AddressArchimedesweg 29
    B.5.3.2Town/ cityLeiden
    B.5.3.3Post code2333 CM
    B.5.3.4CountryNetherlands
    B.5.4Telephone number+31715242166
    B.5.5Fax number+31715242110
    B.5.6E-mailClinicalTrialsEU@its.jnj.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 nameCetrelimab
    D.3.2Product code [JNJ-63723283]
    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.3.9.2Current sponsor codeJNJ-63723283
    D.3.9.4EV Substance CodeSUB183887
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 nameErdafitinib
    D.3.2Product code [JNJ-42756493]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNErdafitinib
    D.3.9.1CAS number 1346242-81-6
    D.3.9.2Current sponsor codeJNJ-42756493
    D.3.9.3Other descriptive nameERDAFITINIB
    D.3.9.4EV Substance CodeSUB167731
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3
    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 nameErdafitinib
    D.3.2Product code [JNJ-42756493]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNErdafitinib
    D.3.9.1CAS number 1346242-81-6
    D.3.9.2Current sponsor codeJNJ-42756493
    D.3.9.3Other descriptive nameERDAFITINIB
    D.3.9.4EV Substance CodeSUB167731
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    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: 4
    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 nameErdafitinib
    D.3.2Product code [JNJ-42756493]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNErdafitinib
    D.3.9.1CAS number 1346242-81-6
    D.3.9.2Current sponsor codeJNJ-42756493
    D.3.9.3Other descriptive nameERDAFITINIB
    D.3.9.4EV Substance CodeSUB167731
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    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: 5
    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 nameCetrelimab
    D.3.2Product code [JNJ-63723283]
    D.3.4Pharmaceutical form Lyophilisate for 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.3.9.2Current sponsor codeJNJ-63723283
    D.3.9.3Other descriptive nameCetrelimab
    D.3.9.4EV Substance CodeSUB183887
    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 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 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: 6
    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 nameCetrelimab
    D.3.2Product code [JNJ-63723283]
    D.3.4Pharmaceutical form Lyophilisate for 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.3.9.2Current sponsor codeJNJ-63723283
    D.3.9.4EV Substance CodeSUB183887
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number240
    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 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
    Metastatic or locally advanced Urothelial Cancer
    Tumore Uroteliale Metastatico o localmente avanzato
    E.1.1.1Medical condition in easily understood language
    Metastatic or locally advanced Urothelial Cancer
    Tumore Uroteliale Metastatico o localmente avanzato
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10005003
    E.1.2Term Bladder cancer
    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 1b (Dose Escalation)
    - To characterize the safety and tolerability of erdafitinib in combination with cetrelimab, and to identify the recommended Phase 2 dose(s) (RP2D) and schedule for erdafitinib
    - To characterize the safety and tolerability of erdafitinib in combination with cetrelimab and platinum (cisplatin or carboplatin) chemotherapy, and to identify the recommended Phase 2 dose(s) (RP2D) and schedule for erdafitinib with cetrelimab and platinum (cisplatin or carboplatin) chemotherapy

    Phase 2 (Dose Expansion)
    - To evaluate the safety and clinical activity of erdafitinib alone and in combination with cetrelimab in cisplatin-ineligible subjects with metastatic or locally advanced urothelial cancer with select FGFR gene alterations and no prior systemic therapy for metastatic disease
    Fase 1b (incremento graduale della dose):
    -caratterizzare sicurezza e tollerabilità di erdafitinib in combinazione con cetrelimab ed identificare la dose raccomandata per la fase 2 e lo schema di somministrazione per erdafitinib
    - caratterizzare sicurezza e tollerabilità di erdafitinib in combinazione con cetrelimab e platino (cisplatino o carboplatino) ed identificare la dose raccomandata per la fase 2 e lo schema di somministrazione per erdafitinib con cetrelimab e platino (cisplatino o carboplatino)

    Fase 2:
    - valutare sicurezza ed attività clinica di erdafitinib sa dolo e in combiazione con cetrelimab in pazienti non eleggibili per terapia con cisplatino, con tumore uroteliale metastatico o localmente avanzato con alcune mutazioni selezionate del gene FGFR senza precedente terapia sistemica per le metastasi
    E.2.2Secondary objectives of the trial
    Phase 1b (Dose Escalation)
    - To characterize the PK of erdafitinib and cetrelimab
    - To assess the immunogenicity of cetrelimab
    - To characterize the PK of erdafitinib in combination with cetrelimab,
    and platinum (cisplatin or carboplatin) chemotherapy
    Phase 2 (Dose Expansion)
    - To characterize the PK of erdafitinib and cetrelimab
    - To assess the immunogenicity of cetrelimab
    - To further assess safety at the R2PD of erdafitinib alone and in combination with cetrelimab
    - To further characterize the clinical activity of erdafitinib alone and in combination with cetrelimab
    Fase 1b (dose escalation)
    - Caratterizzare il profilo di farmacocinetica di erdafitinib e cetrelimab
    - Valutare il profilo di immunogenicità di cetrelimab
    - caratterizzare il profilo di PK di erdafitinib in combinazione con cetrelimab e platino (carboplatino o cisplatino)

    Fase 2:(dose expansion)
    - caratterizzare la PK di erdafitinib e cetrelimab;
    - valutare l'immunogenicità di cetrelimab;
    - Valutare ulteriormente la sicurezza della dose raccomandata per la fase 2 (RP2D) di erdafitinib in monoterapia e in combinazione con cetrelimab
    - Caratterizzare ulteriormente l'attività clinica di erdafitinib in monoterapia e in combinazione con cetrelimab
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.>=18 years of age
    2.Histologic demonstration of transitional cell carcinoma of the urothelium. Minor components(<50%overall)of variant histology such as glandular or squamous differentiation, or evolution to more aggressive phenotypes such as sarcomatoid or micropapillary change are acceptable
    3.Metastatic or locally advanced urothelial cancer (Stage IV disease per AJCC Staging Guidelines)
    4. Meet appropriate molecular eligibility criteria. Tumors must have at least one gene fusion or gene mutation.
    5.Must have measurable disease by radiological imaging according to the response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) at baseline..
    6.Prior systemic therapy:
    Phase1b + any cetrelimab cohort:
    – Any number of lines of prior therapy
    – Renal function for subjects must have a creatinine clearance (CrCl) >30 mL/min as calculated by Cockcroft-Gault
    Phase 1b erdafitinib + cetrelimab + platinum chemotherapy cohort:
    – No prior systemic therapy for metastatic disease. Note: Subjects who received neoadjuvant or adjuvant chemotherapy and showed disease progression, within 12 months of the last dose are considered to have received systemic chemotherapy in the metastatic setting
    – Renal function for subjects must have a CrCl >50 mL/min as calculated by Cockcroft-Gault.

    Phase2: Progressed after 1 or 2 lines of prior chemotherapy
    Phase 2:
    – No prior systemic therapy for metastatic disease. Note: Subjects who received neoadjuvant or adjuvant chemotherapy and showed disease progression, within 12 months of the last dose are considered to have received systemic chemotherapy in the metastatic setting.
    – Cisplatin-ineligible based on:
    – ECOG PS 0-1 AND at least one of the following criteria:
    – Renal function defined as CrCl ¿60 mL/min as calculated by Cockcroft- Gault (Galsky 2011)
    – Grade 2 or higher peripheral neuropathy per NCI-CTCAE version 5.0.
    – Grade 2 or higher hearing loss per NCI-CTCAE version 5.0,
    OR
    – ECOG PS 2.
    7. ECOG PS Grade as defined below:
    Phase 1b erdafitinib + cetrelimab cohort: ECOG 0-2
    Phase 1b erdafitinib + cetrelimab + platinum chemotherapy cohort:
    ECOG 0-1 for cisplatin and ECOG 0-2 for carboplatin.
    Phase 2: ECOG 0-2

    8.Adequate organ function at screening Please refer to protocol
    9.Phase 1b erdafitinib + cetrelimab cohort and Phase 2: Before the first dose of study drug:Women of childbearing potential (defined as: fertile, following menarche and until becoming post-menopausal unless permanently sterile as a result of hysterectomy, bilateral salpingectomy, or bilateral oophorectomy)and fertile men who are sexually active must agree to use a highly effective method of first dose of study drug:contraception (<1%/year failure rate) during the study and for5months after the last dose of study drug. For men who are sexually active with women of childbearing potential: agree to use a condom with spermicidal foam/gel/film/cream/suppository during the study and for5months after the last dose of study drug. Contraception must be consistent with local regulations regarding the use of birth control methods for subjects participating in clinical trials. Women and men must agree not to donate eggs (ova, oocytes) or sperm, respectively, during the study and for5months after the last dose of study drug.
    10.Women of childbearing potential must have a negative pregnancy test at screening within =7days of C1D1 (first dose of study drug) using a highly sensitive pregnancy test
    11.Sign Molecular and Full-Study ICF indicating that he/she understands the purpose of and procedures required for the study, and is willing and able to participate in the study. Consent is to be obtained prior to the initiation of any study-related tests or procedures that are not part of standard-of-care for the subject's disease.
    12 Willing and able to adhere to the prohibitions and restrictions specified in this protocol.
    Please refer to Sec.4.1 of the Protocol for the full list of Inclusion Criteria
    1.>=18 anni
    2.Dimostrazione istologica di carcinoma a cellule transizionali dell’urotelio. varianti istologiche , quali la differenziazione ghiandolare o squamosa, o di evoluzione in fenotipi più aggressivi, quali la variante sarcomatoide o micropapillare
    3.Tumore Uroteliale Metastatico o localmente avanzato (fase 4 per linee guida AJCC)
    4.Corrispondenza con i corretti criteri di idoneità molecolare . i tumori devono avere almneo una fusione genica o una mutazione genica.
    5.Progressione documentata tramite imaging radiologico della malattia secondo RECIST 1.1
    6.Precedente terapia sistemica:
    •Fase 1b + coorte con cetrelimab: qualsiasi numero di linee di terapia precedente.
    nessun trattamento precedente per tumore metastatico
    funzionalità renale con CCL> 50 ml/min con la formula Cockcroft- Gault
    •Fase 2: nessuna terapia precedente per la metastasi e non idoneità al cisplatino
    nessun trattamento precedente per tumore metastatico
    non eleggibilità a trattamento con cisplatino basato su
    ECOG PS0-1 e almeno uno dei seguenti:
    funzionalità renale con crcl >60 ml/min con la formula Cockcroft- Gault
    neuropatia di grado 2 o superiore per NCI-CTYCAE v5.0
    perdita di udito di grado 2 o superiore per NCI-CTYCAE v5.0
    o ECOG PS2

    7.Grado del performance status (PS) definito come sotto:
    fase1b erdafitinib + cetrelimab: ECOG 0-2
    fase 1b erdafitinib + cetrelimab + platino:
    ECOG 0-1 per cisplatino e ECOG 0-2 per carboplatino.
    Fase 2: ECOG 0-2

    8.funzione d'organo adeguata si faccia riferimento al protocollo
    9.Prima della prima dose di farmaco dello studio:Le donne potenzialmente fertili (fertile, dal menarca alla menopausa, se non sterile per isterectomia, salpingectomia bilaterale o ovoforectomia bilaterale) e gli uomini fertili che hanno rapporti sessuali devono acconsentire a utilizzare un metodo contraccettivo altamente efficace (tasso di fallimento <1%/anno) durante lo studio e per i 5 mesi successivi l’ultima dose di farmaco dello studio. Gli uomini sessualmente attivi con donne potenzialmente fertili devono acconsentire a utilizzare un profilattico con una schiuma, gel, pellicola, crema o supposta spermicida durante lo studio e per i 5 mesi successivi l’ultima dose di farmaco dello studio. I metodi contraccettivi utilizzati devono essere in linea con le normative locali sull’impiego di metodi contraccettivi per i soggetti partecipanti a sperimentazioni cliniche. I partecipanti di entrambi i sessi devono impegnarsi a non donare ovuli (ovociti) o sperma durante lo studio e per i 5 mesi successivi l’ultima dose di farmaco dello studio
    10.Le donne potenzialmente fertili devono presentare un test di gravidanza negativo allo screening entro =7 giorni dal Giorno1 del Ciclo1 (prima dose di farmaco dello studio) eseguito con un metodo altamente sensibile
    11.Firma di un modulo di consenso informato (ICF per l’idoneità a livello molecolare e lo studio completo) indicante che il soggetto ha compreso lo scopo e le procedure dello studio ed è intenzionato e capace di partecipare allo studio. Il consenso deve essere ottenuto prima dell’inizio di qualsiasi test o procedura correlato allo studio che non sia previsto dalla terapia standard somministrata per la malattia del soggetto.
    12.Volontà e capacità di conformarsi ai divieti e alle restrizioni specificati nel protocollo.
    Per i criteri di inclusione completi si faccia riferimento alla Sez.4.1 del Protocollo
    E.4Principal exclusion criteria
    1.Treatment with any other investigational agent or participation in other clinical study with therapeutic intent within 30days prior toC1D1.For Ph1b, pt who have received the following prior antitumor therapy:- Received nitrosoureas and mitomycin C within6weeks
    2.Chemotherapy within3weeks ofC1D1
    3.Prior anti-PD-1, anti-PD-L1, or anti-PD-L2 therapy. Prior neoadjuvant/ adjuvant checkpoint inhibitor therapy is allowed if the last dose was given >12 months prior to recurrent disease progression and did not result in drug-related toxicity leading to treatment discontinuation
    4.Active malignancies requiring concurrent therapy other than urothelial cancer
    5.Symptomatic CNS metastases
    6.Prior FGFR inhibitor treatment
    7.RT=30days prior to plannedC1D1
    8.History of uncontrolled cardiovascular disease including:a.Unstable angina, myocardial infarction, ventricular fibrillation,Torsades de Pointes, cardiac arrest, or known congestive heart failure ClassIII-Vwithin the preceding3months;cerebrovascular accident or transient ischemic attack within the preceding3months.b.Corrected QTc interval prolongation as confirmed by triplicate assessment at screening(QTcF>480ms).c.Pulmonary embolism or other venous thromboembolism within the preceding2months
    9.Known to be seropositive for HIV or AIDS
    10.-Evidence of serious active viral, bacterial, or uncontrolled systemic fungal infection.-Active autoimmune disease or a documented history of autoimmune
    disease that requires systemic steroids or immunosuppressive agents-Grade3or higher toxicity effects from previous treatment with immunotherapy-Psychiatric conditions, dementia, or altered mental status.-Any other issue that would impair the ability of the subject to partecipate to the study
    11.Pulmonary compromise requiring supplemental oxygen use to maintain adequate oxygenation
    12.Active or HBV or HCV disease
    13.Not recovered from reversible toxicity of prior anticancer therapy Phase 2: Not recovered from reversible toxicity of prior anticancer therapy (except toxicities which are considered by the investigator as not clinically significant such as alopecia, or skin discoloration).
    14.Impaired wound healing capacity defined as skin/decubitus ulcers, chronic leg ulcers, known gastric ulcers, or unhealed incisions
    15.Allergies, hypersensitivity, or intolerance to protein-based therapies or with a history of any significant drug allergy (such as anaphylaxis, hepatotoxicity, or immune-mediated thrombocytopenia or anemia), or to excipients of erdafitinib or cetrelimab
    16.Current central serous retinopathy (CSR) or retinal pigment epithelial detachment of any grade
    17.Use of oral or parenteral CYP3A4 inhibitor
    18 Use of immunosuppressant agents, including, but not limited to: systemic corticosteroids at doses exceeding 10 mg/day of prednisone or its equivalent, methotrexate, cyclosporine, azathioprine, and tumor necrosis factor a (TNF-a)blockers, within 2 weeks before the planned first dose of study drug.
    19.Vaccinated with a live attenuated vaccine within28days prior to the first dose of study drug and for 3 months after receiving the last dose of study drug. Annual inactivated influenza vaccine is permitted
    20.Pregnant or breast-feeding, or planning to become pregnant while enrolled in this study or within 5 months after receiving the last dose of study drug
    21.Plans to father a child while enrolled in this study or within 5months after receiving the last dose of study drug
    22.Major surgery within 4 weeks of enrollment, or inadequate recovery from the toxicity and/or complications from the intervention prior to starting therapy, or has surgery planned during the
    time the subject is expected to participate in the study or within 2 weeks after the last dose of study drug administration
    Please refer to Sec.4.2 of the Protocol for the complete list of Exclusion Criteria
    1.Trattamento con qualsiasi altro agente sperimentale o partecipazione a un altro studio clinico con intento terapeutico nei30gg precedenti al Giorno1C1. Per Fase 1b, i pt che hanno ricevuto la seguente terapia antitumorale precedente:•Nitrosouree e mitomicina C entro 6sett
    2.Chemio entro3set da Giorno1C1
    3.Precedente terapia anti-PD-1, anti-PD-L1 o anti-PD-L2 terapia precedente con adiuvanti o neoadiuvanti di inibitori dei checkpoint ammessa solo se la dose è stata prima di 12 mesi dalla progressione e non è risultata in tossicità correlata al farmaco che ha portato a discontinuazione della terapia
    4.terapia concomitante per neoplasie maligne attive diverse dal cancro uroteliale
    5.Metastasi sintomatiche al SNC
    6.Precedente trattamento con un inibitore di FGFR
    7.RT=30gg prima del Giorno1C1 programmato
    8.Storia di patologia cardiovascolare non controllata; embolia polmonare o tromboembolia nei tre mesi precedenti
    9.Sieropositività nota al HIV o AIDS
    10.•Evidenza di infezione seria attiva di tipo virale o batterico o di infezione fungina sistemica non controllata.•Malattia autoimmune attiva o storia documentata di una malattia autoimmune che richiede steroidi sistemici o agenti immunosoppressivi.•Effetti di tossicità g3 o superiore del precedente trattamento con l’immunoterapia.•Condizioni psichiatriche, demenza o stato mentale alterato.•Qualsiasi altro problema che comprometterebbe la capacità del soggetto a partecipare allo studio
    11.Compromissione polmonare che richiede la somministrazione di ossigeno supplementare per mantenere un’ossigenazione adeguata
    12.HBV o HCV attiva o cronica
    13.Mancata guarigione da una tossicità reversibile di una precedente terapia oncologica (a meno che non sia tossicità non clinicalmente significativa, come alopecia o decolorazione della pelle)
    14.Compromissione della capacità di cicatrizzazione delle ferite definita come ulcere cutanee o da decubito, ulcere croniche degli arti inferiori, ulcere gastriche note o incisioni non cicatrizzate
    15.Allergie, ipersensibilità o intolleranza a terapie con farmaci a base proteica, storia di allergia ai farmaci (anafilassi epatotossicità anemia o trombocitopenia immunomediata) a erdafitinib o cetrelimab o ai relativi eccipienti
    16.Anomalia della cornea o distacco del pigmento dell'epitelio retinico di qualsiasi tipo
    17.Uso di inibitori di CYP3A4 per via orale o parenterale
    18.Assunzione di dosi immunosoppressive di farmaci sistemici, quali i corticosteroidi(dosi >10 mg/giorno di prednisone (metotrexate, ciclosporine, azatioprine o TNFbloccanti), entro2sett dalla prima dose programmata di farmaco dello studio.
    19.Vaccinazione con un vaccino vivo attenuato entro i 28gg precedenti alla prima dose di farmaco dello studio o nei 3 mesi successivi all’ultima dose di farmaco dello studio. Il vaccino inattivato annuale contro l’influenza è consentito.
    20.Donne in gravidanza o che allattano al seno o che intendono concepire un figlio durante l’arruolamento in questo studio o nei 5mesi successivi all’assunzione dell’ultima dose di farmaco dello studio.
    21.Uomini che intendono concepire un figlio durante l’arruolamento in questo studio o nei 5mesi successivi all’assunzione dell’ultima dose di farmaco dello studio.
    22.Intervento di chirurgia maggiore entro4sett dall'arruolamento o recupero inadeguato dalla tossicità e/o complicazioni dell’intervento prima dell’inizio della terapia oppure intervento chirurgico programmato durante il periodo in cui il soggetto dovrà partecipare allo studio o nelle2sett successive all’assunzione dell’ultima dose di farmaco dello studio
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1b (Dose Escalation)
    - Frequency and type of dose-limiting toxicity (DLT)
    Phase 2 (Dose Expansion)
    - Overall response rate (ORR) (partial response [PR] or better) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 by
    investigator assessment
    - Incidence of AEs
    Fase 1b (incremento graduale della dose):
    - frequenza delle tossicità limitanti la dose (DLT)

    Fase 2:
    - Tasso di risposta globale (ORR) (risposta parziale [PR] o migliore) per RECIST) 1.1 in base a valutazione dello sperimentatore
    - Incidenza degli eventi avversi (EA)
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the study
    Durante il corso dello studio
    E.5.2Secondary end point(s)
    Phase 1b (Dose Escalation)
    - Concentration and PK parameters of erdafitinib and cetrelimab
    - Detection of antibodies to cetrelimab and effects on serum cetrelimab levels
    - Concentration and PK parameters of erdafitinib, cetrelimab, and platinum (cisplatin or carboplatin) chemotherapy

    Phase 2 (Dose Expansion)
    - Plasma erdafitinib and serum cetrelimab concentrations
    - Detection of antibodies to cetrelimab and effects on serum cetrelimab levels
    - Incidence of AEs, serious adverse events (SAEs) and laboratory values
    - Duration of response (DoR)
    - Time to response (TTR)
    - Progression-free survival (PFS)
    - OS
    Fase 1b (dose escalation)
    - Concentrazione plasmatica di erdafitinib e concentrazione sierica di cetrelimab
    - Identificazione di anticorpi contro cetrelimab e effetti sul livello sierico di cetrelimab
    - Parametri di farmacocinetica di popolazione e metriche di esposizione sistemica di erdafitinib e cetrelimab e platino

    Fase 2:
    - concentrazioni sieriche di erdafitinib e cetrelimab
    - Identificazione di anticorpi contro cetrelimab e effetti sul livello sierico di cetrelimab
    - Incidenza di AE, SAE e valori di laboratorio
    - Durata della Risposta (DoR)
    - Tempo alla Risposta (TTR)
    - Sopravvivenza libera da progressione (PFS)
    - OS
    E.5.2.1Timepoint(s) of evaluation of this end point
    Throughout the study
    Durante il corso dello studio
    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 No
    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 Yes
    E.6.13.1Other scope of the trial description
    Immunogenicity, Biomarker, Exploratory
    Immunogenicità, Biomarcatori, Esplorativo
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Phase 1b (Dose Escalation) and Phase 2 (Dose Expansion)
    Fase 1b (incremento graduale della dose) e Fase 2 (espansione della dose)
    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 Yes
    E.8.2.3.1Comparator description
    Lo studio non è controllato, ma è randomizzato e in aperto
    The study is not controlled, but it is randomized and in open label
    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 concerned35
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA66
    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
    Belarus
    Korea, Republic of
    Russian Federation
    Belgium
    France
    Italy
    Spain
    United Kingdom
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study is defined as the last study assessment for the last subject on study or anytime the sponsor terminates the study, whichever comes first
    Il termine dello studio è definito come l'ultimo esame previsto dallo studio effettuato all'ultimo soggetto in studio o qualsiasi momento in cui lo sponsor terminerà lo studio, il primo di questi eventi che avverrà in ordine temporalmente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months2
    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: 57
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 58
    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 77
    F.4.2.2In the whole clinical trial 115
    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)
    If the treating physician strongly believes that continuation of study treatment is in the best interest of a subject for whom imaging-based progression (RECIST-defined disease progression) has been observed, the sponsor's medical monitor should be consulted for possible continuation of treatment. This clinical judgment decision should be based on the subject's overall clinical condition, including performance status, clinical symptoms, and laboratory data
    Se il medico curante crede fortemente che continuare il trattamento di studio sia nel miglior interesse per un soggetto per cui viene osservata una progressione strumentale (definita in base ai criteri RECIST), il medical monitor dello Sponsor dovrebbe essere consultato per una possibile continuazione del trattamento. Questa decisione dovrebbe basarsi sulle condizioni cliniche generali del soggetto, incluso il performance status, i sintomi clinici e valori di laboratorio.
    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 Decision2019-03-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-02-22
    P. End of Trial
    P.End of Trial StatusCompleted
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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