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    Summary
    EudraCT Number:2017-002054-37
    Sponsor's Protocol Code Number:1000053649
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2019-11-11
    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 number2017-002054-37
    A.3Full title of the trial
    Pilot Study of Nivolumab in Pediatric Patients with Hypermutant Cancers
    Estudio piloto de nivolumab en pacientes pediátricos con cáncer hipermutante
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Early study to evaluate the effect of Nivolumab in children with cancers that grow/arise due to lot of abnormal DNA.
    Estudio temprano para evaluar el efecto de Nivolumab en niños con cánceres que crecen / surgen debido a la gran cantidad de ADN anormal.
    A.4.1Sponsor's protocol code number1000053649
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT02992964
    A.5.4Other Identifiers
    Name:Ozmosis Study numberNumber:OZM-075
    Name:SMS-oncology study numberNumber:SMS-0370
    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 SponsorHospital for Sick Children
    B.1.3.4CountryCanada
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportBristol-Myers Squibb-(BMS)
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationSMS-oncology
    B.5.2Functional name of contact pointAnuska Mohaboe
    B.5.3 Address:
    B.5.3.1Street AddressWalaardt Sacréstraat 401-403
    B.5.3.2Town/ citySchiphol
    B.5.3.3Post code1117 BM
    B.5.3.4CountryNetherlands
    B.5.4Telephone number00310204350580
    B.5.5Fax number00310204350589
    B.5.6E-mailregulatory@sms-oncology.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 Yes
    D.2.1.1.1Trade name Opdivo
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    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.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNivolumab
    D.3.9.3Other descriptive nameNIVOLUMAB
    D.3.9.4EV Substance CodeSUB122750
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product 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.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
    HYPERMUTANT CANCERS
    cánceres hipermutantes
    E.1.1.1Medical condition in easily understood language
    cancers with a lot of abnormal DNA
    cánceres con mucho ADN anormal
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 22.0
    E.1.2Level PT
    E.1.2Classification code 10078672
    E.1.2Term DNA mismatch repair protein gene mutation
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10038111
    E.1.2Term Recurrent cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10070308
    E.1.2Term Refractory 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 Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the objective response rate to Nivolumab in pediatric
    patients with refractory or recurrent hypermutated malignancies including patients with replication repair deficiencies (RRD), such as constitutional mismatch repair deficiency (CMMRD).
    Evaluar la tasa de respuesta objetiva (ORR) al nivolumab en pacientes pediátricos con neoplasias hipermutantes refractarias o recurrentes, incluidos los pacientes con deficiencias de reparación de replicación (RRD), tales como la deficiencia de reparación de desajuste constitutivo (CMMRD).
    E.2.2Secondary objectives of the trial
    1. To determine the PFS and OS of paediatric patients with progressive or recurrent hypermutated malignancies, including RRD patients such as CMMRD, treated with nivolumab.
    2. To evaluate safety and tolerability of nivolumab administered as a single agent at the adult recommended dose of 3 mg/kg every 2 weeks. To define and describe the toxicities in paediatric patients with progressive or recurrent hypermutated malignancies including RRD patients, such as CMMRD.
    Companion Biomarker Exploratory Objectives:
    1) To explore associations between tumour mutation burden (TMB) and response to nivolumab.
    2) To discover biomarkers predicting response of hypermutant cancers undergoing PD-1 blockade.
    3) To explore the use of minimally invasive methods to monitor and predict response to immune checkpoint inhibition in hypermutant cancers.
    1. Determinar la supervivencia sin progresión y la supervivencia general de los pacientes pediátricos con neoplasias hipermutantes progresivas o recurrentes, incluidos los pacientes con RRD tratamiento con nivolumab
    2. Evaluar la seguridad y la tolerabilidad al nivolumab administrado como agente único en la dosis recomendada para adultos de 3 mg/kg cada 2 semanas. Definir y describir las toxicidades en pacientes pediátricos con neoplasias hipermutantes progresivas o recurrentes, incluidos los pacientes con RRD, por ejemplo, pacientes con CMMRD
    Exploratorios con biomarcadores para fines terapéuticos:
    1 Explorar las asociaciones entre la carga mutacional tumoral y la respuesta al nivolumab
    2 Descubrir la respuesta de los biomarcadores predictivos de los cánceres hipermutantes que experimentan el bloqueo de PD-1
    3 Explorar el uso de métodos mínimamente invasivos para monitorear y predecir la respuesta a la inhibición del punto de control inmunológico en cánceres hipermutantes
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patient and LAR must be willing and able to provide written informed consent/assent for the trial as per local requirements
    2. patient must have completed and verified a sufficient TMB level or have proof of RRD diagnosed in the appropriate lab
    3. patients must be ≥ 12 months and < 25 years of age at the time of
    Part I/II enrollment
    3. Recurrent of relapse pediatric cancer patients suspected to be hypermutant.
    4. patients must have had histologic verification of malignancy at the time of initial diagnosis or at relapse
    5. patients must be able to provide specimen of a tumor lesion.
    5. patients must have either measurable or evaluable disease in accordance with criteria as outlined in Section 10
    6. patient's current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life. Chemotherapy-naïve patients will be eligible in cases where first-line therapy does not include chemotherapy
    7. Karnofsky ≥ 50% for patients > 16 years of age or Lansky ≥ 50 for patients ≤ 16 years of age
    8. patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy.
    a. Myelosuppressive chemotherapy: at least 21 days after the last dose
    (42 days if prior nitrosourea)
    b. Hematopoietic growth factors: at least 14 days after the last dose of a long-acting growth factor or 7 days for short-acting growth factor. For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur.
    c. Biologic (anti-neoplastic agent): at least 14 days after the last dose of a biologic agent. For agents that have known adverse events occurring beyond 14 days after administration, this period must be extended beyond the time during which adverse events are known to occur.
    d. Monoclonal antibodies: at least three (3) half-lives of the antibody after the last dose of a monoclonal antibody.
    e. Radiation Therapy (XRT): at least 14 days after local palliative XRT (small port). At least 150 days must have elapsed if prior Total Body Irradiation, craniospinal XRT or if ≥ 50% radiation of pelvis. At least 42 days must have elapsed if other substantial BM radiation.
    f. Stem Cell Infusion without Total Body Irradiation (TBI): no evidence ofactive graft vs. host disease and at least 56 days must have elapsed after transplant or stem cell infusion. Patients with prior allogeneic transplants (including solid organ) are not eligible.
    9. a. Adequate BM Function Defined as
    i. Peripheral ANC ≥0.75 x 109/L or 750/mm3. ii. Platelet count ≥75 x 109/L or 75,000/mm3. iii. Hemoglobin ≥ 90g/L (transfusion permitted). iv. Patients with known BM metastatic disease or haematological malignancies will be eligible for study provided they meet haematological criteria.
    b. Renal Function : serum creatinine based on age/gender as provided in
    Table 3
    c. Liver Function:
    i. Bilirubin (sum of conjugated + unconjugated or total bilirubin) ≤1.5x institutional ULN for age (except for patients with Gilbert's Syndrome, when bilirubin of < 51 μmol/L or 3.0 mg/dL is permitted). ii. ALT/AST:
    1. ≤ 2.5 x institutional ULN for patients without liver metastases.
    2. ≤ 5 x institutional ULN for patients with liver metastases.
    d. Adequate Pulmonary Function: No history of chronic pulmonary disease and no evidence of dyspnea at rest, no exercise intolerance due to pulmonary insufficiency and a pulse oximetry > 92% on room air. e. Adequate Pancreatic Function:
    Serum lipase ≤ ULN. Patients with glucose intolerance should be on a stable regiment and be monitored.
    10. For patients with brain tumors, debulking surgery prior to treatment with nivolumab should be considered when appropriate to reduce the risk of pseudoprogression-associated toxicities.
    1. El paciente o representante legalmente aceptable debe estar dispuesto a otorgar un consentimiento/una autorización informada por escrito para el ensayo y ser capaz de hacerlo según los requisitos locales.
    2. el paciente debe haber completado y verificado un nivel de TMB suficiente o contar con evidencia de RRD diagnosticado en un laboratorio pertinente
    3. los pacientes deben tener ≥ 12 meses y <25 años en el momento de la inscripción en la Parte I/II.
    4. Los pacientes con cáncer pediátrico recurrente o refractario que supuestamente es hipermutante
    5. los pacientes deben contar con una confirmación histológica o citológica de la neoplasia en el momento del diagnóstico inicial o la recaída
    6. los pacientes deben ser capaces de proporcionar muestras de una lesión tumoral
    7. Los pacientes deben tener una enfermedad medible o evaluable en conformidad con los criterios señalados en la Sección 10
    8. El estado actual de la enfermedad del paciente no debe contar con ninguna terapia curativa o terapia comprobada disponible para prolongar la supervivencia con un estilo de vida aceptable. Los pacientes que nunca han recibido quimioterapia cumplirán los requisitos en casos en los que la terapia de primera línea no incluya quimioterapia
    9. Karnofsky ≥50 % para pacientes de >16 años o Lansky ≥50 para pacientes de ≤16 años.
    10. los pacientes deben haberse recuperado completamente de los efectos tóxicos agudos de todas las terapias anticancerígenas anteriores.
    a. al menos 21 días después de la última dosis de quimioterapia de mielosupresión (42 días si se ha administrado nitrosourea anteriormente).
    b. al menos 14 días después de la última dosis de un factor de crecimiento de efecto prolongado (por ejemplo, Neulasta) o 7 días de dosis de un factor de crecimiento de efecto corto. En el caso de los agentes que producen efectos adversos más allá de los 7 días después de la administración, este periodo debe extenderse más allá del tiempo durante el cual se producen dichos efectos. Debe hablarse sobre la duración de este intervalo con el director o codirector del estudio.
    c. al menos 14 días después de la última dosis de un agente biológico. En el caso de los agentes que producen efectos adversos más allá de los 14 días después de la administración, este periodo debe extenderse más allá del tiempo durante el cual se producen dichos efectos. Debe hablarse sobre la duración de este intervalo con el director o codirector del estudio.
    d. al menos 3 periodos de semidesintegración del anticuerpo luego de la última dosis de un anticuerpo monoclonal.
    e. al menos 14 días después de la XRT paliativa local (cámara pequeña). Al menos deben haber pasado 150 días si se ha administrado irradiación corporal total, XRT craneoespinal o ≥ 50 % de radiación en la pelvis. Al menos deben haber pasado 42 días si se ha administrado otro tipo de radiación BM sustancial.
    f. sin evidencia de enfermedad de injerto activo contra huésped y al menos deben haber pasado 56 días luego de un trasplante o infusión de células madre. Los pacientes con trasplantes alogénicos (incluidos órganos sólidos) no cumplen con los requisitos.

    11. La función de la médula ósea adecuada se define como
    i. Recuento absoluto de neutrófilos (ANC) ≥0.75 x 109/L o 750/mm3.
    ii. Recuento de plaquetas ≥75 x 109/L o 75,000/mm3
    iii. Hemoglobina ≥ 90 g/L
    iv. Los pacientes con una enfermedad metastásica de la médula ósea o neoplasias hematológicas cumplirán los requisitos para el estudio, siempre y cuando cumplan los criterios hematológicos. Estos pacientes pueden recibir transfusiones, Siempre y cuando no tengan antecedentes de resistencia luego de transfusiones de plaquetas, pero no podrán ser evaluados para identificar toxicidad hematológica.
    g. La función renal adecuada se define como:
    Creatinina plasmática según la edad/el género conforme a lo indicado en la Tabla 3
    h. La función hepática adecuada se define como:
    i. Bilirrubina ≤1.5x límite máximo institucional de normal para la edad (con excepción de pacientes con el síndrome de Gilbert, si la bilirrubina de <51 µmol/L o 3.0 mg/dL está permitida).
    ii. ALT/AST
    1. ≤2.5 x ULN institucional para pacientes sin metástasis en el hígado.
    2. ≤5 x ULN institucional para pacientes con metástasis en el hígado.
    i. La función pulmonar adecuada se define como: Falta de antecedentes de enfermedad pulmonar crónica y falta de evidencia de disnea del sueño, ausencia de intolerancia al ejercicio debido a insuficiencia pulmonar y pulsioximetría de > 92 % en el aire ambiental.
    j. La función pancreática adecuada se define como:
    Lipasa plasmática ≤ULN. Los pacientes con intolerancia a la glucosa deben seguir un régimen estable y deben monitorearse.
    12. En el caso de los pacientes con tumor cerebral, debe considerarse una cirugía de reducción de peso antes del tratamiento con nivolumab, de ser conveniente, para reducir el riesgo de toxicidades asociadas a una pseudoprogresión.
    E.4Principal exclusion criteria
    1. Women who are pregnant or breastfeeding and men who are sexually active with women of childbearing potential (WOCBP)* who are not willing to use effective contraception, or to practice abstinence if this is the usual lifestyle and preferred contraception for the patient. **
    • Pregnant or breast-feeding women will not be entered on this study due to risks of fetal and teratogenic adverse events as there is yet no available information regarding human fetal or teratogenic toxicities.
    • WOCBP must have a negative pregnancy test every 4 weeks. During Part II screening, WOCBP must have a negative serum pregnancy test. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the start of nivolumab administration. WOCBP who are sexually active, must be willing to adhere to effective contraception during treatment and for 5 months after the last dose of nivolumab.
    • Men who are sexually active with WOCBP must be willing to adhere to effective contraception during treatment and for 7 months after the last dose of nivolumab.
    • Women who are surgically sterile, as well as azoospermic men do not require contraception.
    *"Women of childbearing potential" is defined as any female who has experienced menarche and who has not undergone surgical sterilization
    (hysterectomy or bilateral oophorectomy) or who is not postmenopausal.
    ** List of contraception methods is provided in the Appendix II
    2. Concomitant Medications
    a. Corticosteroids: Patients requiring systemic steroid therapy or any other form of immunosuppressive therapy within seven (7) days prior to first dose of trial therapy or while on trial are not eligible. The use of physiologic doses of corticosteroids (up to 5mg/m2/day prednisone equivalent) is permitted following discussion with the Study Chair or CoChair.
    Note: Use of topical, ocular, intra-articular, intra-nasal or inhaled corticosteroids will not render a patient ineligible. A brief course of corticosteroids for prophylaxis (e.g. contrast dye allergy) or for treatment of non-autoimmune conditions (e.g. delayed-type hypersensitivity reaction caused by contact allergen) is permitted if completed at least 7 days prior to initiation of therapy.
    b. Investigational Drugs: Patients who are currently receiving another investigational drug are not eligible.
    c. Anti-cancer Agents: Patients who are currently receiving other anti-cancer agents are not eligible.
    3. Patients with a History of Autoimmune Disease
    • Patients with a history of autoimmune disorder that has required systemic treatment in the previous two (2) years are not eligible. Asymptomatic laboratory abnormalities (e.g. ANA, rheumatoid factor, altered thyroid function studies) will not render a patient ineligible in the absence of a diagnosis of an autoimmune disorder. Replacement therapy
    (e.g. thyroxine, insulin or physiologic corticosteroid replacement therapy) is not considered a form of systemic treatment.
    4. Infection: Patients who have an uncontrolled infection are not eligible. 5. HIV and/or Hepatitis B/C patients: Patients with known HIV/AIDS or acute/chronic Hepatitis B or C are excluded.
    6. Transplant patients: Patients who have received prior allogeneic Bone Marrow (BM) transplants or prior solid organ transplantation are not eligible.
    7. Non-Compliance: Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible.
    8. Previous anti-PD-1 and/or anti-PD-L1 therapy: Patients who have received prior anti-PD-1 and/or anti-PD-L1 directed therapy (mAb or small molecule) are not eligible.
    9. Live vaccines: Patients who have received a live vaccine within 30 days of start of study treatment are not eligible.
    1. Las mujeres embarazadas o lactantes y los hombres sexualmente activos que mantienen relaciones con mujeres de potencial fértil (WOCBP)* que no estén dispuestos a usar métodos anticonceptivos eficaces, o practicar la abstinencia si este es el método anticonceptivo habitual y preferido del paciente. **
    • Las mujeres embarazadas o lactantes no podrán participar en este estudio debido a los riesgos de efectos fetales y teratogénicos adversos, puesto que aún no hay información disponible relacionada con toxicidades fetales o teratogénicas.
    • Las WOCBP deben realizarse una prueba de embarazo y obtener un resultado negativo cada 4 semanas. Durante la evaluación de la Parte II , las WOCBP deben realizarse una prueba de embarazo plasmática y obtener un resultado negativo. Las WOCBP deben realizarse una prueba de embarazo de plasma u orina (sensibilidad mínima de 25 IU/L o unidades equivalentes de HCG) y obtener un resultado negativo dentro de las 24 horas anteriores al inicio de la administración de nivolumab. Las WOCBP que sean sexualmente activas deben estar dispuestas a cumplir con un método anticonceptivo eficaz durante el tratamiento y durante 5 meses después de la última dosis de nivolumab.
    • Los hombres que sean sexualmente activos y mantengan relaciones con WOCBP deben estar dispuestos a utilizar un método anticonceptivo eficaz durante el tratamiento y durante 7 meses después de la última dosis de nivolumab.
    • Las mujeres que se hayan sometido a una cirugía de esterilización y los hombres azoospérmicos no necesitan utilizar métodos anticonceptivos.
    *“Mujeres de potencial fértil” se define como una mujer que ha experimentado la menarquía y que no se ha sometido a ninguna cirugía de esterilización (histerectomía u ooforectomía) o que no ha experimentado la menopausia.
    ** Se provee una lista de métodos anticonceptivos en el Apéndice II.
    2. Medicamentos concomitantes
    a. Corticoesteroides: Los pacientes que requieren una terapia esteroide sistémica o cualquier otra forma de terapia inmunosupresora en un periodo de siete (7) días antes de la primera dosis de terapia del ensayo o mientras participan en el ensayo no cumplen los requisitos. El uso de dosis fisiológicas de corticoesteroides (hasta 5 mg/m2 al día de un equivalente de la prednisona) está permitido si el director o codirector del estudio lo autoriza.
    Nota: El uso de corticoesteroides tópicos, oculares, intraarticulares, intranasales o de inhalación no constituye un motivo de exclusión del estudio. Está permitido llevar un tratamiento breve de corticoestroides para la profilaxis (por ejemplo, alergia al contraste) o para el tratamiento de enfermedades que no son autoinmunes (por ejemplo, reacción de hipersensibilidad de tipo retrasado causado por el contacto con un alérgeno) si finaliza al menos 7 días antes del inicio de la terapia.
    b. Medicamentos de investigación: Los pacientes que reciben actualmente otro medicamento de investigación no cumplen los requisitos.
    c. Agentes anticancerígenos: Los pacientes que reciben actualmente otros agentes anticancerígenos no cumplen los requisitos.
    3. Pacientes con antecedentes de enfermedad autoinmune
    • Los pacientes con antecedentes de un trastorno autoinmune que requirió un tratamiento sistémico en los dos (2) años anteriores no cumplen los requisitos. Las anormalidades de laboratorio asintomáticas (por ejemplo, estudios ANA, de factor reumatoide, de función tiroidea alterada) no constituyen un motivo de exclusión del estudio en ausencia de un diagnóstico de trastorno autoinmune. La terapia de reemplazo (por ejemplo, terapias de reemplazo con tiroxina, insulina o corticoesteroides fisiológicos) no se considera una forma de tratamiento sistémico.
    4. Infección: Los pacientes que tienen una infección no controlada no cumplen los requisitos.
    5. Pacientes con VIH o hepatitis B o C: Los pacientes con VIH/sida o hepatitis B o C aguda/crónica comprobada quedan excluidos.
    6. Pacientes con trasplantes: Los pacientes que han recibido trasplantes alogénicos de médula ósea (MO) o trasplantes de órganos sólidos anteriormente no cumplen los requisitos.
    7. No cumplimiento: Los pacientes que, en opinión del investigador, pueden no ser capaces de cumplir los requisitos de monitoreo de seguridad del estudio no pueden participar en el estudio.
    8. Terapia anti-PD-1 o anti-PD-L1 anterior: Los pacientes que han recibido una terapia anti-PD-1 o anti-PD-L1 dirigida anteriormente (mAb o molécula pequeña) no cumplen los requisitos.
    9. Vacunas vivas: Los pacientes que han recibido una vacuna viva en un periodo de 30 días posteriores al inicio del tratamiento del estudio no cumplen los requisitos.
    E.5 End points
    E.5.1Primary end point(s)
    Tumour disease evaluation, includes objective response rate (ORR = complete response [CR] and partial response [PR]) as defined by iRECIST response criteria for solid tumours (revised for neuroblastoma using the revised INRC), iRANO response criteria for CNS malignancies, RECIL 2017 response criteria for lymphomas, revised criteria according to Creutzig, et al. (2012) for acute myeloid leukemia (AML), and response criteria as specified for acute lymphoblastic leukemia (ALL). Patients with response of 'stable disease' (SD) will also be reported as part of the final analysis of clinical benefit, but will not contribute to the primary efficacy outcome measure.
    Evaluación de una enfermedad tumoral, incluye tasa de respuesta objetiva (ORR = respuesta completa [CR] y respuesta parcial [PR]) según lo definido por los criterios de respuesta iRECIST para tumores sólidos (modificados para el neuroblastoma mediante los INRC revisados), los criterios de respuesta iRANO para neoplasias del CNS, los criterios de respuesta RECIL 2017 para linfomas, los criterios revisados de acuerdo con Creutzig et al. (2012) para la leucemia mieloide aguda (AML; consultar la Sección 10.13), y los criterios de respuesta especificados en la Sección 10.14 para la leucemia linfoblástica aguda (ALL).
    Los pacientes con la respuesta "enfermedad estable" (SD) también se incluirán como parte del análisis final de beneficio clínico, pero no aportarán a la medición de resultados de eficacia primaria.
    E.5.1.1Timepoint(s) of evaluation of this end point
    After enrollment of 10 subjects and at the end of the study. The end of the study is defined as the date when the last patient, last visit (LPLV) occurs.
    Después de la inscripción de 10 sujetos y al final del estudio. El final del estudio se define como la fecha en que ocurre el último paciente, la última visita (LPLV).
    E.5.2Secondary end point(s)
    - PFS is defined as the time from the first dose of the study drug administration to the occurrence of disease progression or death from any cause during the study.
    - OS is defined as time from first dose of study drug to death from any cause.
    - A safety evaluation by the Safety Committee will be performed after Patient 1-Cycle 1, Patient 4-Cycle 1, Patient 7-Cycle 1, and Patient 10Cycle 1. Enrollment will be held after each time point until a safety evaluation of adverse events (AE) and serious adverse events (SAE) confirms it is safe to resume enrollment.
    - Toxicities will be described and defined in paediatric patients, focusing on SAEs, using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.03. Toxicities (drugrelated AEs) of any grade, plus all Grade ≥ 3 AEs, all Grade ≥ 3 laboratory toxicities and all SAEs will be collected for this study.
    - El PFS se define como el tiempo a partir de la primera dosis de administración del medicamento del estudio hasta la progresión de la enfermedad o muerte por cualquier causa durante el estudio.
    - El OS se define como el tiempo a partir de la primera dosis del medicamento del estudio hasta la muerte por cualquier causa.
    El Comité de Seguridad llevará a cabo una evaluación de seguridad después del ciclo 1 del paciente 1, ciclo 1 del paciente 4, ciclo 1 del paciente 7 y ciclo 1 del paciente 10. Se realizará la inscripción después de cada punto hasta que una evaluación de seguridad de eventos adversos (AE) y eventos adversos graves (SAE) confirme que es seguro retomar la inscripción.
    - Se describirán y se definirán las toxicidades en los pacientes pediátricos, con un enfoque en los SAE, aplicando los criterios terminológicos comunes para eventos adversos del Instituto Nacional del Cáncer (NCI CTCAE), versión 4.03. Para este estudio se registrarán toxicidades (AE relacionados con medicamentos) de cualquier grado, además de todos los AE de grado ≥3, todas las toxicidades de grado ≥3 y todos los SAE según lo definido en la Sección 12 .
    E.5.2.1Timepoint(s) of evaluation of this end point
    At the end of the study. The end of the study is defined as the date when the last patient, last visit (LPLV) occurs
    Al final del estudio. El final del estudio se define como la fecha en que ocurre el último paciente, la última visita (LPLV)
    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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Noninvasive methods (circulating tumour DNA in plasma) to monitor and predict response to immune checkpoint inhibition
    Métodos no invasivos (ADN tumoral circulante en plasma) para controlar y predecir la respuesta a la inhibición del punto de control inmunitario
    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
    PILOT STUDY
    Estudio piloto
    E.7.2Therapeutic exploratory (Phase II) No
    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 Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA8
    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
    Canada
    Denmark
    France
    Germany
    Israel
    Italy
    Netherlands
    Spain
    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 years4
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years5
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 44
    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) Yes
    F.1.1.4.1Number of subjects for this age range: 2
    F.1.1.5Children (2-11years) Yes
    F.1.1.5.1Number of subjects for this age range: 24
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 18
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 6
    F.1.3Elderly (>=65 years) No
    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 state3
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 36
    F.4.2.2In the whole clinical trial 50
    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
    nada
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-01-31
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-11-26
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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