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    Summary
    EudraCT Number:2017-002932-18
    Sponsor's Protocol Code Number:42756493-BLC3001
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-06-17
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2017-002932-18
    A.3Full title of the trial
    A Phase 3 Study of Erdafitinib Compared with Vinflunine or Docetaxel or Pembrolizumab in Subjects with Advanced Urothelial Cancer and Selected FGFR Gene Aberrations
    Studio di fase 3 su erdafitinib a confronto con vinflunina o docetaxel o pembrolizumab in soggetti con tumore uroteliale avanzato e aberrazioni selezionate del gene FGFR
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study of Erdafitinib Compared with Vinflunine or Docetaxel or Pembrolizumab in Subjects with Advanced Urothelial Cancer
    Studio su erdafitinib a confronto con vinflunina o docetaxel o pembrolizumab in soggetti con tumore uroteliale avanzato
    A.3.2Name or abbreviated title of the trial where available
    THOR
    THOR
    A.4.1Sponsor's protocol code number42756493-BLC3001
    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.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 – 2333 CM Leiden – Paesi Bassi
    B.5.3.2Town/ cityLeiden
    B.5.3.3Post code2333
    B.5.3.4CountryNetherlands
    B.5.4Telephone number0031715242166
    B.5.5Fax number0031715242110
    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 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.3.9.4EV 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: 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.3.9.4EV 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: 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.3.9.4EV 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: 4
    D.1.2 and D.1.3IMP RoleComparator
    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 JAVLOR® MAH n EU/1/09/550/011-012
    D.2.1.1.2Name of the Marketing Authorisation holderPierre Fabre Médicament
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 nameVinflunine
    D.3.2Product code [--]
    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 INNVINFLUNINA DITARTRATO
    D.3.9.1CAS number 162652-95-1
    D.3.9.2Current sponsor code--
    D.3.9.4EV Substance CodeSUB00063MIG
    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 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 RoleComparator
    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 TAXOTERE® MAH n EU/1/95/002/004
    D.2.1.1.2Name of the Marketing Authorisation holderAventis Pharma S.A.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 name--
    D.3.2Product code [--]
    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 INNDOCETAXEL
    D.3.9.1CAS number 114977-28-5
    D.3.9.2Current sponsor code--
    D.3.9.4EV Substance CodeSUB12492MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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: 6
    D.1.2 and D.1.3IMP RoleComparator
    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 KEYTRUDA MAH n EU/1/15/1024/002
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme Limited
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 name---
    D.3.2Product code [----]
    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 INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor code---
    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 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 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
    Advanced Urothelial Cancer
    tumore uroteliale avanzato
    E.1.1.1Medical condition in easily understood language
    Advanced Urothelial Cancer
    tumore uroteliale avanzato
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10077840
    E.1.2Term Urothelial cancer of renal pelvis
    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
    The primary objective of this study is to evaluate efficacy of erdafitinib versus chemotherapy or pembrolizumab in subjects with advanced urothelial cancer harboring selected FGFR aberrations who have progressed after one prior treatment. The primary endpoint of overall survival will be evaluated in 2 cohorts:
    - Cohort 1: erdafitinib versus chemotherapy (docetaxel or vinflunine) [subjects who have received prior anti-PD(L)1 agent]
    - Cohort 2: erdafitinib versus pembrolizumab [subjects who have not received prior antiPD-(L)1 agent]
    L’obiettivo primario di questo studio è valutare l’efficacia di erdafitinib rispetto a chemioterapia o pembrolizumab in soggetti con tumore uroteliale avanzato portatore di aberrazioni selezionate di FGFR che siano progrediti dopo un precedente trattamento. L’endpoint primario della sopravvivenza complessiva (OS) sarà valutato nell’ambito di 2 coorti:
    Coorte 1: erdafitinib rispetto a chemioterapia (docetaxel o vinflunina) (soggetti che hanno ricevuto un precedente agente anti-proteina 1/ligando 1 della morte programmata [PD-1/PD-L1])
    Coorte 2: erdafitinib rispetto a pembrolizumab (soggetti che non hanno ricevuto un precedente agente anti-PD-1/PD-L1). Coorte 2: erdafitinib rispetto a pembrolizumab (soggetti che non hanno ricevuto un precedente agente anti-PD-1/PD-L1)
    E.2.2Secondary objectives of the trial
    - To evaluate progression-free survival (PFS) of subjects treated with erdafitinib versus chemotherapy or pembrolizumab
    - To evaluate the objective response rate (ORR) of subjects treated with erdafitinib versus chemotherapy or pembrolizumab
    - To evaluate the health-related quality of life of subjects treated with erdafitinib versus chemotherapy or pembrolizumab
    - To evaluate the duration of response (DOR) for subjects treated with erdafitinib versus chemotherapy or pembrolizumab
    - To characterize the safety profile of subjects treated with erdafitinib versus chemotherapy or pembrolizumab
    - To evaluate the population PK of erdafitinib
    - Valutare la sopravvivenza libera da progressione (PFS) dei soggetti trattati con erdafitinib rispetto a chemioterapia o pembrolizumab
    - Valutare il tasso di risposta obiettiva (ORR) dei soggetti trattati con erdafitinib rispetto a chemioterapia o pembrolizumab
    - Valutare la qualità della vita correlata alla salute dei soggetti trattati con erdafitinib rispetto a chemioterapia o pembrolizumab
    - Valutare la durata della risposta (DOR) dei soggetti trattati con erdafitinib rispetto a chemioterapia o a pembrolizumab
    - Caratterizzare il profilo di sicurezza dei soggetti trattati con erdafitinib rispetto a chemioterapia o pembrolizumab
    - Valutare la farmacocinetica di popolazione di erdafitinib
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. >=18 years of age (or the legal age of consent in the jurisdiction in which the study is taking place)
    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 surgically unresectable cancer
    4. Documented progression of disease, defined as any progression that requires a change in treatment, prior to randomization
    5. Only one line of prior treatment for metastatic urothelial cancer. Subjects who received neoadjuvant or adjuvant chemotherapy and showed disease progression (as defined in criterion 4), within 12 months of the last dose are considered to have received chemotherapy in the metastatic setting
    Cohort 1: prior chemotherapy and anti-PD(L)1 [in combination or in maintenance setting] (anti-PD(L)1 alone is allowed only for subjects with documented cisplatin ineligibility)
    Cohort 2: prior chemotherapy (no prior anti-PD(L)1 treatment)
    6. Subjects must meet appropriate molecular eligibility criteria (as determined by central laboratory screening): Tumors must have at least 1 of the following translocations: FGFR2-BICC1, FGFR2-CASP7, FGFR3-TACC3, FGFR3-BAIAP2L1; or 1 of the following FGFR3 gene mutations: R248C, S249C, G370C, Y373C
    7. ECOG performance status Grade 0, 1, or 2 (Attachment 1)
    8. Adequate bone marrow, liver, and renal function:
    a. Bone marrow function (without the support of cytokines or erythropoiesis-stimulating agent in preceding 2 weeks):
    Absolute neutrophil count (ANC) >1,500/mm3
    Platelet count >75,000/mm3
    Hemoglobin >8.0 g/dL (without transfusion or demonstrate stability, i.e., no significant decline in hemoglobin, for 2 weeks after transfusion)
    b. Liver function:
    Total bilirubin <1.5 x institutional upper limit of normal (ULN), unless known to have Gilbert's disease [=1xULN for Cohort 1 subjects at sites choosing docetaxel chemotherapy]
    Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <2.5 x institutional ULN [ALT and AST both =1.5xULN and alkaline
    phosphatase =2.5xULN for Cohort 1 subjects at sites choosing docetaxel chemotherapy]
    c. Renal function: Creatinine clearance >30 mL/min/1.73 m2 either directly measured via 24-hour urine collection or calculated using Cockcroft-Gault (Attachment 2)
    d. Electrolytes: Potassium within institutional normal limits
    e. Phosphate: <ULN within 14 days of treatment and prior to Cycle 1 Day 1 (medical management allowed)
    9. Must sign an informed consent form (ICF) (or their legally acceptable representative must sign) indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study
    10. A woman of childbearing potential who is sexually active must have a negative pregnancy test (ß-human chorionic gonadotropin [ß-hCG]) at Screening (urine or serum)
    11. Contraceptive use by men or women should be consistent with local regulations regarding the use of contraceptive methods for subject participating in clinical studies
    For women of childbearing potential:
    • practicing a highly effective method of contraception (failure rate of <1% per year when used consistently and correctly)
    Examples of highly effective contraceptives include
    - user-independent methods:
    implantable progestogen-only hormone contraception associated with inhibition of ovulation; intrauterine device (IUD); intrauterine hormonereleasing system (IUS); vasectomized partner; sexual abstinence.
    - user-dependent methods:
    combined (estrogen- and progestogen-containing) hormonal contraception associated with inhibition of ovulation: oral, intravaginal, and transdermal; progestogen-only hormone contraception associated with inhibition of ovulation: oral and injectable
    • agrees to remain on a highly effective method during the study and for at least 6 months after the last dose ......
    1. >=18 anni di età (o l’età legale per il consenso nella giurisdizione in cui viene condotto lo studio)
    2. Dimostrazione istologica di carcinoma uroteliale a cellule transizionali. Componenti minori (< 50% in totale) di istologia variante, quali la differenziazione ghiandolare o squamosa oppure l’evoluzione a fenotipi più aggressivi quali la modifica a sarcomatoide o micropapillare, sono accettabili
    3. Tumore metastatico o chirurgicamente non resecabile
    4. Progressione documentata della malattia, definita come qualsiasi progressione richiedente una modifica al trattamento, prima della randomizzazione
    5. Solo una linea di trattamento precedente per il tumore uroteliale metastatico. I soggetti, che hanno ricevuto chemioterapia neoadiuvante o adiuvante e che hanno mostrato progressione della malattia (così come definita nel criterio 4) entro 12 mesi dall’ultima dose, sono considerati come trattati con chemioterapia nel contesto metastatico Coorte 1: chemioterapia precedente e anti-PD(L)1 [nel contesto di combinazione o di mantenimento] (l’anti-PD(L)1 da solo è consentito solo per i soggetti con inidoneità documentata al cisplatino) Coorte 2: chemioterapia precedente (nessun trattamento anti-PD(L)1 precedente)
    6. I soggetti devono soddisfare i corretti criteri di idoneità (determinati allo screening dal laboratorio centrale): I tumori devono presentare almeno 1 delle seguenti traslocazioni: FGFR2-BICC1, FGFR2-CASP7, FGFR3-TACC3, FGFR3-BAIAP2L1, oppure 1 delle seguenti mutazioni del gene FGFR3: R248C, S249C, G370C, Y373C
    7. Stato di validità ECOG di Grado 0, 1 o 2 (Allegato 1)
    8. Adeguata funzionalità midollare, epatica e renale:
    a. Funzionalità midollare (senza il supporto di citochine o agente stimolante l’eritropoiesi nelle 2 settimane precedenti):
    Conta assoluta dei neutrofili (ANC) > 1.500/mm3
    Conta piastrinica > 75.000/mm3
    Emoglobina > 8,0 g/dl (senza trasfusioni o con stabilità dimostrata, ovvero, senza alcun declino significativo dell’emoglobina per 2 settimane dopo la trasfusione)
    b. Funzionalità epatica:
    Bilirubina totale < 1,5 x limite superiore della norma (ULN) istituzionale, a meno sia noto avere la malattia di Gilbert [= 1 x ULN per i soggetti della Coorte 1 nei centri che scelgono la chemioterapia con docetaxel] Alanina aminotransferasi (ALT) e aspartato aminotransferasi (AST) < 2,5 x ULN istituzionale [sia ALT che AST = 1,5 x ULN e fosfatasi alcalina = 2,5 x ULN per i soggetti della Coorte 1 nei centri che scelgono la chemioterapia con docetaxel]
    c. Funzionalità renale: Clearance della creatinina > 30 ml/min/1,73 m2, sia misurata direttamente tramite la raccolta delle urine delle 24 ore sia calcolata utilizzando la formula di Cockcroft-Gault (Allegato 2)
    d. Elettroliti: Potassio entro i limiti normali istituzionali
    e. Fosfato: < ULN entro 14 giorni di trattamento e prima del Giorno 1 del Ciclo 1 (gestione medica consentita)
    9. Il soggetto (o il suo rappresentante legale) deve firmare un modulo di consenso informato (ICF), indicando che comprende lo scopo dello studio e le procedure da esso richieste e che desidera parteciparvi
    10. Una donna in età fertile, sessualmente attiva, deve presentare un test di gravidanza (ß-gonadotropina corionica umana [ß-hCG]) negativo allo screening (urine o siero)
    11. L’uso di metodi contraccettivi da parte di ambo i sessi deve essere conforme alle normative locali relative all’uso dei metodi contraccettivi per i soggetti che partecipano agli studi clinici
    Per le donne in età fertile:
    • il soggetto deve adottare un metodo contraccettivo altamente efficace (tasso di fallimento < 1% all’anno se utilizzato in modo costante e corretto) Gli esempi di contraccettivi altamente efficaci includono:
    - metodi indipendenti dall’utente: contraccezione ormonale a base di solo progestinico impiantabile associata a inibizione
    dell’ovulazione; dispositivo intrauterino (IUD); sistema di rilascio ormonale intrauterino (IUS); partner vasectomizzato; astinenza
    sessuale
    - metodi dipendenti ........
    E.4Principal exclusion criteria
    For All Subjects
    1. Treatment with any other investigational agent or participation in another clinical study with therapeutic intent within 30 days prior to randomization
    2. Active malignancies (ie, requiring treatment change in the last 24 months) other than urothelial cancer (except skin cancers within the last 24 months that is considered completely cured)
    3. Symptomatic central nervous system metastases
    4. Received prior FGFR inhibitor treatment
    5. Known allergies, hypersensitivity, or intolerance to erdafitinib or its excipients
    6. Corneal or retinal abnormality likely to increase the risk of eye toxicity, i.e.:
    a. History of central serous retinopathy (CSR) or retinal vascular occlusion (RVO)
    b. Active wet, age-related macular degeneration (AMD)
    c. Diabetic retinopathy with macular edema (non-proliferative)
    d. Uncontrolled glaucoma (per local standard of care)
    e. Corneal pathology such as keratitis, keratoconjunctivitis, keratopathy, corneal abrasion, inflammation or ulceration.
    7. History of uncontrolled cardiovascular disease including:
    a. unstable angina, myocardial infarction, ventricular fibrillation, Torsades de Pointes, cardiac arrest, or known congestive heart failure Class III-V (Attachment 3) within the preceding 3 months; cerebrovascular accident or transient ischemic attack within the preceding 3 months
    b. QTc prolongation as confirmed by triplicate assessment at screening (Fridericia; QTc >480 milliseconds)
    c. Pulmonary embolism or other venous thromboembolism (VTE) within the preceding 2 months
    8. Known active AIDS (human immunodeficiency virus (HIV) infection), unless the subject has been on a stable anti retroviral therapy regimen for the last 6 months or more, has had no opportunistic infections in the last 6 months, and has CD4 count >350
    9. Known active hepatitis B or C infection (subjects with history of hepatitis C infection but negative hepatitis C virus polymerase chain reaction[(PCR] test and subjects with JNJ42756493 (Erdafitinib) hepatitis B with positive hepatitis B surface antibody are allowed)
    10. Not recovered from reversible toxicity of prior anticancer therapy (except toxicities which are not clinically significant such as alopecia, skin discoloration, Grade 1 neuropathy, Grade 1-2 hearing loss)
    11. Impaired wound healing capacity defined as skin/decubitus ulcers, chronic leg ulcers, known gastric ulcers, or unhealed incisions
    12. Major surgery within 4 weeks before randomization
    13. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments. Examples include poorly controlled diabetes (hemoglobin A1c >8), or ongoing active infection requiring intravenous antibiotics.

    For Cohort 1 Subjects
    14. Depending on the chemotherapy regimen to be used at the participating site, has a history of severe hypersensitivity reaction (eg, generalized rash/erythema, hypotension, bronchospasm, angioedema or anaphylaxis) to either docetaxel or to other drugs formulated with polyoxyethylated castor oil, or to vinflunine or other vinca alkaloids.

    For Cohort 2 Subjects
    15. Active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic or immunosuppressive agents. Subjects with vitiligo, diabetes Type I, or resolved childhood asthma/atopy would be an exception to this rule. Subjects who require intermittent use of bronchodilators, inhaled steroids, or local steroid injections are not excluded from the study. Subjects with hypothyroidism stable on hormone replacement or Sjøgren's syndrome will not be excluded from the study
    16. Diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study treatment. ......
    Per tutti i soggetti
    1. Trattamento con altri agenti sperimentali o partecipazione a un altro studio clinico con intento terapeutico nei 30 giorni precedenti la randomizzazione
    2. Tumori maligni attivi (ovvero, richiedenti una modifica del trattamento negli ultimi 24 mesi) oltre al tumore uroteliale ( ad eccezione del tumore cutaneo trattato negli ultimi 24 mesi che è considerato completamente curato)
    3. Metastasi sintomatiche al sistema nervoso centrale
    4. Trattamento precedente con inibitore FGFR
    5. Allergie, ipersensibilità o intolleranza note a erdafitinib o ai relativi eccipienti
    6. Anomalia corneale o retinica con probabile aumento del rischio di tossicità oculare, ovvero:
    a. Anamnesi di retinopatia sierosa centrale (RSC) o occlusione vascolare retinica (OVR)
    b. Degenerazione maculare legata all’età (DMLE) umida attiva
    c. Retinopatia diabetica con edema maculare (non proliferativa)
    d. Glaucoma non controllato (in base allo standard di cura locale)
    e. Patologia corneale quale cheratite, cheratocongiuntivite, cheratopatia, abrasione corneale, infiammazione o ulcerazione.
    7. Anamnesi di malattia cardiovascolare non controllata, tra cui:
    a. angina instabile, infarto miocardico, fibrillazione ventricolare, torsione di punta, arresto cardiaco o insufficienza cardiaca congestizia nota di Classe III-V (Allegato 3) nei 3 mesi precedenti; ictus cerebrovascolare o attacco ischemico transitorio nei 3 mesi precedenti
    b. Prolungamento del QTc confermato da valutazione tripla allo screening (Fridericia; QTc > 480 millisecondi)
    c. Embolia polmonare o altra tromboembolia venosa (TEV) nei 2 mesi precedenti
    8. AIDS (infezione da virus dell’immunodeficienza umana, HIV) attiva nota, a meno che il soggetto non abbia ricevuto un regime di terapia antiretrovirale stabile negli ultimi 6 mesi o più, oppure non abbia contratto infezioni opportunistiche negli ultimi 6 mesi e presenti una conta CD4 > 350
    9. Infezione da epatite B o C attiva nota (i soggetti con anamnesi di infezione da epatite C ma negativi al test di reazione a catena della polimerasi [PCR] per il virus dell’epatite C, e i soggetti con epatite B JNJ42756493 (Erdafitinib) con anticorpo di superficie dell’epatite B positivo sono consentiti)
    10. Ripresa non completa da tossicità reversibile di terapia antitumorale precedente (ad eccezione delle tossicità non clinicamente significative quali alopecia, decolorazione della pelle, neuropatia di Grado 1, perdita dell’udito di Grado 1-2)
    11. Capacità di guarigione delle ferite compromessa, definita come ulcere cutanee/di decubito, ulcere croniche alle gambe, ulcere gastriche note o incisioni non guarite
    12. Intervento chirurgico importante nelle 4 settimane precedenti la randomizzazione
    13. Qualsiasi condizione per la quale, a giudizio dello sperimentatore, la partecipazione non sarebbe nel migliore interesse del soggetto (ad es., ne comprometterebbe il benessere) o che potrebbe impedire, limitare o confondere le valutazioni specifiche del protocollo. Gli esempi comprendono diabete scarsamente controllato (emoglobina A1c > 8) o infezione attiva in corso richiedente antibiotici per vie endovenosa.
    Per i soggetti della Coorte 1
    14. A seconda del regime chemioterapico impiegato dal centro partecipante, anamnesi di grave reazione di ipersensibilità (ad es., eruzione cutanea/eritema generalizzato, ipotensione, broncospasmo, angioedema o anafilassi) a docetaxel o ad altri farmaci formulati con olio di ricino poliossietilato, a vinflunina o ad altri alcaloidi della vinca.
    Per i soggetti della Coorte 2
    15. Malattia autoimmune attiva, richiedente trattamento sistemico negli ultimi 3 mesi, anamnesi documentata di malattia autoimmune clinicamente grave o sindrome richiedente agenti sistemici o immunosoppressivi.
    I soggetti con vitiligine, diabete di Tipo I o asma/atopia infantile risolta rappresentano un’eccezione a questa regola. I soggetti, che richiedono l’uso intermittente di broncodilatatori, steroidi .....
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is overall survival (OS). Overall survival is measured from the date of randomization to the date of the subject's death. If the subject is alive or the vital status is unknown, the subject will be censored at the date the subject was last known to be alive
    L'endpoint primario è la sopravvivenza globale (OS). La sopravvivenza globale è misurato dalla data di randomizzazione alla data del decesso del soggetto . Se il soggetto è vivo o lo stato vitale è sconosciuto, il soggetto sarà censurato alla data in cui è stato conosciuto essere vivo
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the study
    Durante lo studio
    E.5.2Secondary end point(s)
    - PFS: duration in days from the date of randomization to the date of disease progression (assessed per RECIST v1.1 by the investigator) or relapse from CR or death, whichever is reported first. For subjects who
    do not have disease progression and are alive, as well as for subjects with unknown disease progression or unknown survival status as of the clinical cutoff date, PFS will be censored at the date of the last adequate disease assessment. If there is no postbaseline tumor assessment for a subject, PFS will be censored on the date of randomization. Refer to the Statistical Analysis Plan (SAP) for further details regarding censoring rules. Adequate disease assessment is defined as having sufficient evidence to indicate correctly that progression has or has not occurred
    - ORR: the proportion of subjects who achieve complete response or partial response, as assessed per RECIST v1.1 by the investigator
    - Change from baseline in patient-reported health status and physical functioning scales of the Functional Assessment of Cancer Therapy –
    Bladder Cancer (FACT-Bl), Patient-Global Impression of Severity (PGIS), and utility and visual analog scale of the European Quality of Life-5 Dimensions-5 Levels Questionnaire (EQ-5D-5L)
    - DOR: for responders, duration in days from the date of initial documentation of a response to the date of first documented evidence of progressive disease (or relapse for subjects who experience CR during
    the study) or death. The censoring is similar to PFS
    - Safety: collection of adverse event, clinical laboratory values,electrocardiograms, vital signs, ophthalmologic evaluations, physical examinations
    - Oral clearance, area under the plasma concentration-time curve (and other parameters, as needed and as data permits) will be estimated using a population approach

    - PFS: durata in giorni dalla data di randomizzazione alla data di progressione della malattia (valutata per RECIST v1.1 dallo sperimentatore) o recidiva da CR o morte, a seconda di quale dei due è segnalato per primo. Per i soggetti che non hanno la progressione della malattia e sono vivi, così come per i soggetti con una progressione della malattia sconosciuta o uno stato di sopravvivenza sconosciuto alla data di cutt off clinico, PFS sarà censurato alla data dell'ultima valutazione adeguata della malattia. Se non esiste una valutazione del tumore post-basale per un soggetto, PFS sarà censurato sulla data di randomizzazione. Per ulteriori dettagli sulle regole di censura, fare riferimento al Statistical Analysis Plan (SAP). La valutazione adeguata della malattia è definita come la prova sufficiente per indicare correttamente che la progressione è avvenuta o non è avvenuta; - ORR: la proporzione di soggetti che ottengono una risposta completa o risposta parziale, valutata per RECIST v1.1 dallo sperimentatore - Cambiamento rispetto al basale nello stato di salute segnalato dal paziente e dalle scale di funzionamento fisico del Questionario di valutazione funzionale della terapia antitumorale-Modulo per il tumore vescicale (FACT-Bl), la Scala di impressione globale di gravità da parte del paziente (PGIS), e il Questionario europeo per misurare la qualità della vita a 5 dimensioni e 5 livelli (EQ-5D-5L) - DOR: per i responder, durata in giorni dalla data di documentazione iniziale di una risposta alla data della prima prova documentata di malattia progressiva (o recidiva per soggetti che hanno esperienza di CR durante lo studio) o la morte. La censura è simile alla PFS.- Sicurezza: raccolta di eventi avversi, valori clinici di laboratorio, elettrocardiogrammi, segni vitali, valutazioni oftalmologiche, esami fisici- clearance orale, area sotto la curva concentrazione del plasma -tempo (e altri parametri, se necessario e in base ai dati) saranno stimati utilizzando una popolazione approccio.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Throughout the study
    Durante lo 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 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 No
    E.6.12Pharmacoeconomic No
    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 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) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    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 concerned14
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA105
    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
    Australia
    Brazil
    Canada
    China
    India
    Israel
    Japan
    Korea, Republic of
    Mexico
    Russian Federation
    Taiwan
    Turkey
    Ukraine
    United States
    Austria
    Belgium
    France
    Germany
    Greece
    Hungary
    Italy
    Netherlands
    Portugal
    Spain
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    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 months5
    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 months5
    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: 315
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 315
    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 state47
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 237
    F.4.2.2In the whole clinical trial 630
    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)
    The Sponsor will ensure that subjects benefiting from treatment will be able to continue treatment after the end of the study
    Il Promotore garantirà che i soggetti che beneficiano del trattamento possano continuare ad essere trattati dopo la fine dello studio.
    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 Decision2018-03-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-04-10
    P. End of Trial
    P.End of Trial StatusOngoing
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