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    Summary
    EudraCT Number:2017-003464-12
    Sponsor's Protocol Code Number:ARRAY-162-202
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2017-10-13
    Trial results View 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 number2017-003464-12
    A.3Full title of the trial
    An Open-label Phase 1b/2 Study of Binimetinib Administered in Combination with Nivolumab or Nivolumab Plus Ipilimumab in Patients with Previously Treated Microsatellite-stable (MSS) Metastatic Colorectal Cancer with RAS Mutation
    Estudio abierto en fase 1b/2 de binimetinib administrado en combinación con nivolumab o nivolumab más ipilimumab en pacientes con cáncer colorrectal metastásico con microsatélite estable (MSE) con mutación RAS previamente tratado.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Clinical Trials with a Combination of Investigational Products in Patients with Colorectal Cancer
    Ensayo Clínico con una combinación de medicamentos en investigación en pacientes con cáncer colorrectal metastásico.
    A.4.1Sponsor's protocol code numberARRAY-162-202
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03271047
    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 SponsorArray BioPharma Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportArray Biopharma Inc.
    B.4.2CountryUnited States
    B.4.1Name of organisation providing supportBristol-Myers Squibb Company
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationArray BioPharma Inc.
    B.5.2Functional name of contact pointMargaret Vargo
    B.5.3 Address:
    B.5.3.1Street Address3200 Walnut Street
    B.5.3.2Town/ cityBoulder
    B.5.3.3Post codeCO80301
    B.5.3.4CountryUnited States
    B.5.4Telephone number+34900834223
    B.5.6E-mailRegistroEspanolDeEstudiosClinicos@druginfo.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 nameBinimetinib
    D.3.2Product code MEK162
    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 INNBINIMETINIB
    D.3.9.1CAS number 606143-89-9
    D.3.9.2Current sponsor codeMEK162
    D.3.9.3Other descriptive nameARRY-438162
    D.3.9.4EV Substance CodeSUB179942
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Opdivo
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    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.3.4Pharmaceutical 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.3.9.1CAS number 946414-94-4
    D.3.9.3Other descriptive nameNIVOLUMAB
    D.3.9.4EV Substance CodeSUB122750
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Yervoy
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    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.3.4Pharmaceutical 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 INNIpilimumab
    D.3.9.1CAS number 477202-00-9
    D.3.9.3Other descriptive nameIpilimumab
    D.3.9.4EV Substance CodeSUB29397
    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 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
    Microsatellite-stable (MSS) Metastatic Colorectal Cancer with RAS Mutation
    Cáncer colorrectal metastásico con microsatélite estable (MSE) con mutación RAS previamente tratado
    E.1.1.1Medical condition in easily understood language
    Metastatic Colorectal Cancer
    Cáncer colorrectal metastásico
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10052362
    E.1.2Term Metastatic colorectal cancer
    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
    Phase 1b:
    Determine the MTD and RP2D of binimetinib administered in combination with nivolumab
    Determine the MTD and RP2D of binimetinib administered in combination with nivolumab plus ipilimumab
    Phase 2:
    Assess the preliminary antitumor activity of the treatment combinations
    Fase 1b:
    o Determinar la dosis máxima tolerada (DMT) y la dosis recomendada para la fase 2 (DRF2) de binimetinib administrado en combinación con nivolumab
    o Determinar la DMT y la DRF2 de binimetinib administrada en combinación con nivolumab más ipilimumab

    Fase 2:
    Evaluar la actividad antitumoral preliminar de las combinaciones de tratamiento
    E.2.2Secondary objectives of the trial
    Phase 1b only:
    Assess the activity of the treatment combinations
    Both Phases:
    Characterize the safety profile of the treatment combinations
    Characterize the PK of binimetinib in both treatment combinations
    Fase 1b solo:
    Evaluar la actividad antitumoral preliminar de las combinaciones de tratamiento basadas en RECIST versión 1.1
    Ambas fases:
    Caracterizar el perfil de seguridad de las combinaciones de tratamiento
    Caracterizar la farmacocinética (FC) de binimetinib en ambas combinaciones de tratamiento
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Prescreening Inclusion Criteria:
    1. Provide a signed and dated Prescreening ICF.
    2. Male or female ≥ 18 years of age at the time of signing the Screening ICF.
    3. Measurable, histologically/cytologically confirmed mCRC.
    4. Have willingness or ability to participate in the study.
    5. Able to provide a sufficient amount (tumor block or minimum of 6 slides) of representative tumor specimen (primary or metastatic, archival or newly obtained) for central laboratory testing of RAS mutation status and MSS.
    a. If a fresh tissue sample is provided, a blood sample is required.
    6. Have received no more than 2 prior lines of therapy (maintenance therapy given in the metastatic setting will not be considered a separate regimen). Generally, treatments that are separated by an event of progression are considered different regimens.
    7. No known contraindications to study treatment.

    Screening Inclusion Criteria:
    1. Patients must meet all Prescreening inclusion criteria.
    2. Provide a personally signed and dated Screening ICF.
    3. mCRC categorized as MSS by polymerase chain reaction (PCR) per local assay at any time prior to Screening or by the central laboratory.
    4. RAS mutation per local assay at any time prior to Screening or by the central laboratory.
    5. Have received at least 1 prior line of therapy and meets at least one of the following criteria:
    a. were unable to tolerate the prior first-line regimen
    b. experienced disease progression during or after prior first-line regimen for metastatic disease
    c. progressed during or within 3 months of completing adjuvant chemotherapy
    Note: Generally, treatments that are separated by an event of progression are considered different regimens.
    6. Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1.
    7. Female patients are either postmenopausal for at least 1 year, are surgically sterile for at least 6 weeks; if a female patient is of childbearing potential, she must agree to follow instructions for acceptable or highly effective method(s) of contraception for the duration of study treatment and for 5 months after the last dose of study treatment with nivolumab (i.e., 30 days [duration of ovulatory cycle] plus the time required for the investigational drug to undergo approximately 5 half-lives)
    8. Non-sterile male patients who are sexually active with female partners of childbearing potential must agree to follow instructions for acceptable or highly effective method(s) of contraception for the duration of study treatment and for 7 months after the last dose of study treatment with nivolumab (i.e., 90 days [duration of sperm turnover] plus the time required for the investigational drug to undergo approximately 5 half-lives) (Section 5.3).
    9. Adequate renal and bone marrow function as measured by the following Screening laboratory values:
    a. White blood cells (WBC) ≥ 2000/μL
    b. Neutrophils ≥ 1500/μL
    c. Platelets ≥ 100 ×103/μL
    d. Hemoglobin ≥ 9.0 g/dL
    e. Serum creatinine ≤ 1.5 × upper limit of normal (ULN) or calculated creatinine clearance > 50 mL/min (using the Cockcroft Gault formula)
    10. Adequate hepatic function characterized by the following Screening laboratory values:
    a. Serum total bilirubin ≤ 1.5 × ULN and < 2 mg/dL Note: Patients who have a total bilirubin level > 1.5 × ULN will be allowed if their indirect bilirubin level is ≤ 1.5 × ULN.
    b. ALT and/or AST ≤ 2.5 × ULN, or ≤ 5 × ULN in presence of liver metastases
    11. Adequate cardiac function as follows:
    a. LVEF ≥ 50% or above institutional normal value as determined by a MUGA scan or ECHO
    b. QTcF interval ≤ 480 msec (preferably the mean from triplicate electrocardiograms (ECGs)
    12. Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures including computed tomography (CT)/magnetic resonance imaging (MRI) scans.
    Las pacientes deben cumplir todos los criterios de inclusión siguientes para poder participar en el periodo de preselección:
    1. Proporcionar un formulario de consentimiento informado (FCI) firmado y fechado.
    2. Ser hombres o mujeres de ≥18 años de edad en el momento de la firma del FCI de selección.
    3. CCRm medible, confirmado histológicamente/citológicamente.
    4. Mostrar disposición o capacidad para participar en el estudio.
    5. Capacidad para proporcionar una cantidad suficiente (bloque tumoral o mínimo de 6 portaobjetos) de una muestra tumoral representativa (principal o metastásica, de archivo o nueva) para pruebas del laboratorio central del estado de la mutación RAS y MSE.
    a. Si se facilita una muestra de tejido fresca, se requiere una muestra de sangre.
    6. Haber recibido no más de 2 líneas de tratamiento previas (el tratamiento de mantenimiento administrado en el escenario metastásico no se considerará un régimen separado). Por lo general, los tratamientos separados por un acontecimiento de progresión se consideran pautas distintas.
    7. Ausencia de contraindicaciones conocidas al tratamiento del estudio.

    Criterios de selección de la selección
    Los pacientes deberán cumplir todos los siguientes criterios de inclusión para poder inscribirse en el estudio:
    1. Los pacientes deben cumplir todos los criterios de inclusión preselección.
    2. Proporcionar un FCI de preselección firmado y fechado personalmente.
    3. CCRm categorizado como MSE mediante la reacción de las cadenas de polimerasa (RCP) según un ensayo local en cualquier momento antes de la selección o por el laboratorio central.
    4. Mutación RAS según ensayo local en cualquier momento antes de la selección o por el laboratorio central.
    5. Haber recibido al menos una línea previa de tratamiento y cumplir al menos uno de los siguientes criterios:
    a. no eran capaces de tolerar el régimen previo de primera línea
    b. experimentó progresión de la enfermedad durante o con posterioridad al régimen previo de primera línea para enfermedad metastásica
    c. progresión durante o dentro de los 3 meses desde la finalización de la quimioterapia adyuvante
    Nota: Por lo general, los tratamientos separados por un acontecimiento de progresión se consideran pautas distintas.
    6. Estado funcional del Grupo Oncológico Cooperativo del Este (Eastern Cooperative Oncology Group, ECOG) de 0 o 1
    7. Las pacientes son posmenopáusicas desde hace, al menos, 1 año, son quirúrgicamente estériles desde hace, al menos, 6 semanas; si una paciente está en edad fértil, debe aceptar seguir las instrucciones para el empleo de métodos anticonceptivos aceptables o altamente eficaces durante el tiempo que dure el tratamiento del estudio y durante 5 meses después de la última dosis de tratamiento del estudio con nivolumab (es decir, 30 días [duración del ciclo de ovulación] más el tiempo requerido para que el fármaco en investigación experimente aproximadamente 5 semividas).
    8. Los pacientes varones que no sean estériles y que sean sexualmente activos con parejas de sexo femenino en edad fértil deben aceptar seguir las instrucciones de uso de métodos anticonceptivos aceptables o altamente eficaces durante el tiempo que dure el tratamiento del estudio y durante 7 meses después de la última dosis del tratamiento del estudio con nivolumab (es decir, 90 días [duración de la producción de esperma] más el tiempo requerido para que el fármaco en investigación se somete a aproximadamente 5 semividas) (Sección 5.3).
    9. Función renal y de la médula ósea adecuadas medidas mediante los siguientes valores analíticos de selección:
    a. Leucocitos (LEU) ≥2000/µl
    b. Neutrófilos ≥1500/µl
    c. Plaquetas ≥100 ×103/µl
    d. Hemoglobina ≥9,0 g/dl
    e. Creatinina sérica 1,5 veces el límite superior de la normalidad (LSN) o aclaramiento de la creatinina calculado >50 ml/min (utilizando la fórmula de Cockcroft Gault)
    10. Función hepática adecuada caracterizada por los siguientes valores analíticos de selección:
    a. Bilirrubina sérica total ≤1,5 veces el LSN y <2 mg/dl
    Nota: Los pacientes que tengan un nivel de bilirrubina total >1,5 veces el LSN serán admitidos si su nivel de bilirrubina indirecta es ≤1,5 veces el LSN.
    b. Alanina aminotransferasa (ALT) y/o aspartato aminotransferasa (AST) ≤2,5 veces el LSN, o ≤5 veces el LSN en presencia de metástasis hepática
    11. Función cardiaca adecuada, según el siguiente criterio:
    a. Fracción de eyección del ventrículo izquierdo (FEVI) ≥50 % o por encima del valor normal de la institución, según se determine mediante una ventriculografía o un ecocardiograma
    b. Intervalo QTcF ≤480 ms (preferiblemente la media de 3 electrocardiogramas [ECG])
    12. Predisposición y capacidad para cumplir con las visitas programadas, el plan de tratamiento, las pruebas analíticas y otros procedimientos del estudio, incluidas exploraciones por tomografía computarizada (TC)/resonancia magnética (RM).
    E.4Principal exclusion criteria
    Prescreening Exclusion Criteria:
    1. Prior treatment with any MEK inhibitor.
    2. Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways.
    3. Any untreated central nervous system (CNS) lesion. However, patients are eligible if: a) all known CNS lesions have been treated with radiotherapy or surgery, and b) patients remained without evidence of CNS disease progression ≥ 4weeks after treatment, and c) patients must be off corticosteroid therapy for ≥ 3 weeks.
    4. Patients with an active, known or suspected autoimmune disease. Patients with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
    5. Partial or complete bowel obstruction.
    6. Impaired gastrointestinal function or disease that may significantly alter the absorption of binimetinib (e.g., ulcerative diseases, uncontrolled vomiting, malabsorption syndrome, small bowel resection with decreased intestinal absorption) or baseline diarrhea ≥ Grade 1.
    7. Known history of RVO.
    8. Concurrent or previous other malignancy within 5 years of study entry, except cured basal or squamous cell skin cancer, superficial bladder cancer, prostate intraepithelial neoplasm, carcinoma in-situ of the cervix, or other noninvasive or indolent malignancy
    9. Known history of Gilbert’s syndrome.
    10. Severe uncontrolled medical illness.
    11. Psychiatric illness inhibiting informed consent or protocol compliance.
    12. Pregnant or breastfeeding females.
    13. History of severe hypersensitivity reactions to mAbs.
    14. History of allergy or intolerance (unacceptable AEs) to study drug components or polysorbate-80-containing infusions.

    Screening Exclusion Criteria:
    1. Patients must not meet any of the Prescreening exclusion criteria.
    2. Treatment with systemic immunosuppressive medications (including but not limited to prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) within 2 weeks prior to first day of study treatment:
    a. The use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) and topical steroids are allowed. Patients who have received acute and/or low-dose systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea or chronic use of ≤ 10 mg/day of prednisone or dose-equivalent corticosteroid) may be enrolled in the study after discussion with and approval by the Sponsor’s Medical Monitor.
    3. Impaired gastrointestinal function or disease that may significantly alter the absorption of binimetinib (e.g., ulcerative diseases, uncontrolled vomiting, malabsorption syndrome, small bowel resection with decreased intestinal absorption) or baseline diarrhea ≥ Grade 1.
    4. History of thromboembolic or cerebrovascular events ≤ 6 months prior to starting study treatment, including transient ischemic attacks, cerebrovascular accidents, deep vein thrombosis or pulmonary emboli.
    5. Uncontrolled hypertension defined as persistent systolic blood pressure ≥ 150 mmHg or diastolic blood pressure ≥ 100 mmHg despite current therapy.
    6. Concurrent neuromuscular disorder that is associated with the potential of elevated CK (e.g., inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy).
    7. History or current evidence of RVO or current risk factors for RVO (e.g., uncontrolled glaucoma or ocular hypertension, history of hyperviscosity or hypercoagulability syndromes).
    8. Clinically significant cardiac disease, including, but not limited to, any of the following:
    a. Congestive heart failure requiring treatment (New York Heart Association Grade ≥ 2).
    b. Clinically significant and uncontrolled atrial fibrillation.
    c. History of acute coronary syndromes including myocardial infarction, unstable angina, coronary artery bypass grafting, coronary angioplasty, or stenting < 6 months prior to screening.
    d. Symptomatic chronic heart failure, history or current evidence of clinically significant cardiac arrhythmia and/or conduction abnormality < 6 months prior to screening except controlled atrial fibrillation and paroxysmal supraventricular tachycardia.
    9. Residual CTCAE ≥ Grade 2 toxicity from any prior anticancer therapy, with the exception of Grade 2 alopecia or Grade 2 neuropathy.
    10. Known history of positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS).
    11. Any positive test for hepatitis B virus or hepatitis C virus indicating acute or chronic infection, and/or detectable virus.
    Criterios de exclusión preselección
    1. Tto. previo con cualq. inhibidor de MEK.
    2. Tto. previo con antic. anti-muerte programada (PD-1), anti-PD-L1, anti-PD-L2, anti-CD137 o anti-antígeno-4 asociado al linf. T citotóxico (CTLA-4), o cualq. otro antic. o fárm. dirigido específ. a la coestim. de los linf. T o a las vías de control.
    3. Cualq. lesión no tratada del sist. nerv. central (SNC). Sin embargo, los pac. son aptos si: a) todas las lesiones del SNC conocidas han sido tratadas con radiot. o cirugía, y b) los pac. permanecieron sin evidencia de progr. de la enf. del SNC ≥4 sem. después del tto., y c) los pac. no reciben tto. con corticost. durante ≥3 sem.
    4. Pac. con una enf. autoinm. activa, supuesta o conocida. Se permite la inclusión de pac. con diabetes mellitus tipo 1, hipotiroid. que solo necesita hormonot. restitutiva, trast. cutáneos (vitíligo, la psoriasis o la alopecia) q no requieran un tto. sistém. o las afecc. q no se prevé que reaparezcan sin un desencadenante externo.
    5. Obstrucción intest. parcial o completa.
    6. Alt. de la fón gastrointestinal o enf. q podría alterar de forma signific. la abs. de binimetinib (p. ej., enf. ulcerativas, vómitos incontrolados, sínd. de mala abs., resección del intest. delgado con dism. de la abs. intest.) o diarrea inicial de grado ≥1.
    7. Antec. conocidos de oclusión de la vena retiniana (RVO).
    8. Neoplasia maligna simultánea o previa dentro de los 5 años de la entrada en el estudio, excepto cáncer de piel de células basales o escamosas curado, cáncer de vejiga superficial, neoplasia intraepitelial de próstata, carcinoma in situ del cuello del útero u otra neoplasia maligna no invasiva o indolente
    9. Anteced. conocido de sínd. de Gilbert.
    10. Enf. médica grave no controlada.
    11. Enf. psiquiát. q inhibe el cumplim. del protocolo o la validez del consent. inform.
    12. Muj. embarazadas o en período de lactancia.
    13. Anteced. de reacciones de hipersens. graves a anticuerpos monoclonales (Acm).
    14. Anteced. de alergia o intolerancia (AA inaceptables) a los comp. del fármaco del estudio o inf. q contienen polisorbato-80.

    Criterios de exclusión de la selección
    1. Los pac. no deben cumplir ninguno de los sig. criterios de excl. antes de la selección.
    2. Tto. con inmunodep. sistém. (incluidos, prednisona, ciclofosfamida, azatioprina, metotrexato, talidomida y antag. del factor de necrosis tumoral [antiTNF]) en las 2 sem. previas al primer día de tto. del estudio.
    a. El uso de corticost. inhalados y mineralocort. (p. ej., fludrocortisona) y esteroides tópicos está permitido. Los pac. que han recibido inmunosup. sistém. agudos y/o de dosis baja (p. ej., una dosis puntual de dexametasona para nauseas o uso crónico de ≤10 mg/día de prednisona o corticost. de dosis equiv.) pueden inscrib. en el estudio después de comentarlo con el supervisor médico del promotor y que lo apruebe.
    3. Alt. de la función gastroint. o enf. q podría alterar de forma signif. la abs. de binimetinib (p. ej., enf. ulcerativas, vómitos incontrolados, sínd. de mala abs., resección del intest. delg. con dism. de la abs. int.) o diarrea inicial de grado ≥1.
    4. Antec. de acont. tromboemb. o cerebrov. ≤6 meses antes del inicio del tto. del estudio, incluidos ataques isquém. trans., acc. cerebrovasc., trombosis venosa prof. o embolia pulm.
    5. Hipert. no controlada, definida como presión art. sist. persistente ≥150 mmHg o presión art. diastólica ≥100 mmHg a pesar del tto. actual.
    6. Trast. neurom. simultáneo asociado al potencial de creat. cinasa (CC) elevada (p. ej., miopatías inflam., distrofia musc., esclerosis lateral amiot., atrofia musc. espinal).
    7. Anteced. de evidencia simult. de RVO o factores de riesgo actuales para RVO (p. ej., glaucoma no controlado o hipert. ocular, antec. de hipervisc. o sínd. de hipercoagul.).
    8. Cardiop. clínic. signif., incluida, entre otras, cualq. de las siguientes:
    a. Insuf. card. congest. que requiera tto. (New York Heart Association grado ≥ 2).
    b. Fibr. auric. clínicamente signif. y no controlada.
    c. Anteced. de sínd. coronarios agudos, incluido infarto de mioc., angina inestable, colocación de injerto de derivación de la arteria coronaria, angiopl. coronaria o colocación de stent <6 meses antes de la selección.
    d. Insuf. card. crónica sintom., antec. o sufrir actualmente arrit. cardiaca clínic. significativa y/o anomalía en la conducción <6 meses antes de la selección, excepto fib. auric. controlada y taq. supravent. paroxísmica.
    9. Tox. residual de grado ≥2 según los CTCAE por cualq. tto. antineop., con la excepción de alopecia de grado 2 o neuropatía de grado 2.
    10. Antec. conocidos de prueba posit. para el virus de la inmunod. hum. (VIH) o sínd.de inmunodef. adq. (SIDA). NOTA: Las pruebas del VIH se deben realizar en los centros en los que sea obligatorio a nivel local.
    11. Cualq. resultado positivo para el virus de la hepatitis B o de la hepatitis C que indique una inf. aguda o crónica, y/o virus detectable.
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1b:
    Incidence of dose-limiting toxicities (DLTs) resulting from binimetinib in combination with nivolumab
    Incidence of DLTs resulting from binimetinib in combination with nivolumab plus ipilimumab
    Phase 2:
    ORR per RECIST v1.1
    Fase 1b:
    o Incidencia de toxicidades limitadoras de la dosis (TLD) provocadas por binimetinib en combinación con nivolumab
    o Incidencia de TLD provocadas por binimetinib en combinación con nivolumab más ipilimumab

    Fase 2:
    Tasa de respuesta objetiva (TRO) según RECIST v1.1
    E.5.1.1Timepoint(s) of evaluation of this end point
    Phase 1b:
    At each dose level after the first 3 evaluable patients have completed Cycle 1, the Sponsor’s Medical Monitor and the Investigators will meet to clinically assess the available data from the dose cohort. An End-of-Cohort meeting between the Sponsor’s Medical Monitor and the Investigators will occur after the last patient in each cohort has completed at least 1 treatment cycle (28 days) for careful assessment of AEs before escalating to the next dose.
    Phase 2:
    In addition to end-of-study evaluations, safety meetings between the Sponsor’s Medical Monitor and the Investigators will be scheduled periodically during Phase 2 of the study to review safety data for ongoing patients and patients who are being monitored during the follow-up period.
    Fase 1b:
    El supervisor médico del promotor y los investig. se reunirán para evaluar clínic. los datos disponibles de la cohorte de dosis, en cada nivel de dosis una vez que los 3 primeros pac. evaluables hayan completado el Ciclo 1. Se llevará a cabo una reunión de fin de la cohorte entre el supervisor méd. del prom. y los investig. después de que el últ. pac. de cada cohorte haya completado al menos 1 ciclo de tto. (28 días) para una eval. cuidadosa de los AEs antes de escalar a la sig. dosis.
    Fase 2:
    Además de las eval. de fin de estudio, las reuniones de seguridad entre el supervisor méd. del prom. y los investig. se programarán periód. durante la Fase 2 del estudio para revisar los datos de seg. de los pac. en curso y los pac. q están siendo monit. durante el período de seg.
    E.5.2Secondary end point(s)
    Phase 1b only:
    ORR per RECIST v1.1
    Both Phases:
    DOR per RECIST v1.1
    Rate of CR per RECIST v1.1
    Incidence and severity of AEs graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03, and changes in clinical laboratory parameters
    Sparse plasma concentrations for binimetinib
    Fase 1b solo:
    TRO según RECIST v1.1
    Ambas fases:
    • Duración de la respuesta (DR) per RECIST v1.1
    • Tasa de respuesta completa (RC) según RECIST v1.1
    • Incidencia y gravedad de los acontecimientos adversos (AA) clasificados según los Criterios terminológicos comunes para acontecimientos adversos del National Cancer Institute [CTCAE del NCI]) v4.03, y cambios en los parámetros analíticos clínicos
    • Concentraciones plasmáticas dispersas para binimetinib
    E.5.2.1Timepoint(s) of evaluation of this end point
    In addition to end-of study evaluations, safety meetings between the Sponsor’s Medical Monitor and the Investigators will be scheduled periodically during Phase 2 of the study to review safety data for ongoing patients and patients who are being monitored during the follow-up period.
    Además de las evaluaciones de fin de estudio, se programarán periódicamente reuniones de seguridad entre el Medical Monitor del Sponsor y los investigadores durante la fase 2 del estudio para revisar los datos de seguridad para los pacientes ongoing y para los pacientes que han sido monitorizados durante el periodo de seguimiento.
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    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
    Determination of maximum tolerated dose and recommended phase 2 dose
    Determinación de la dosis máxima tolerada y la dosis recomendada para la fase 2
    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 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.8.2.4Number 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 concerned1
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA18
    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
    Belgium
    France
    Germany
    Netherlands
    Spain
    United Kingdom
    United States
    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
    End of study will be defined as the point when all patients have the opportunity to be followed for at least 1 year after the randomization date of the last patient enrolled. The Sponsor will notify all applicable regulatory agencies in accordance with local requirements when the study has ended. After the end of the study, access to study drugs will be provided only in accordance with local regulations and requirements.
    Se hará una supervisión de los pacientes para su SG hasta 1 año después de la fecha de aleatorización del último paciente inscrito, o hasta la retirada del consentimiento para este seguimiento, pérdida para el seguimiento o muerte.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days10
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months4
    E.8.9.2In all countries concerned by the trial days10
    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: 90
    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 40
    F.4.2.2In the whole clinical trial 90
    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)
    After the end of the study, access to study drugs will be provided only in accordance with local regulations and requirements.
    Tras el fin del estudio, se permitirá el acceso a la medicación únicamente de acuerdo a la regulación y requerimientos locales.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-12-21
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-11-07
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2021-02-25
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