E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Stage III B or stage IV non-small cell lung cancer (not a candidate for local therapies with curative intent) |
Carcinoma polmonare non a piccole cellule di stadio III B (non candidabile a terapie locali con intento curativo) o di stadio IV |
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E.1.1.1 | Medical condition in easily understood language |
Non-Small Cell Lung Cancer |
Tumore al polmone non a piccole cellule |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061873 |
E.1.2 | Term | Non-small cell lung cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061873 |
E.1.2 | Term | Non-small cell lung cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the efficacy in term of response rate (RR) of Cabozantinib in NSCLC patients with MET amplification or MET exon 14 skipping mutation pretreated or not with MET inhibitors. |
Valutare l'efficacia in termini di Response Rate (RR) del Cabozantinib in una coorte di pazienti NSCLC con amplificazione di MET o con mutazione attivante di MET a carico dell'esone 14, pre-trattati o no con inibitori di MET |
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E.2.2 | Secondary objectives of the trial |
Not applicable |
Non applicabile |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Citological or histological diagnosis of NSCLC non-small-cell-lung cancer (NSCLC) stage III B (notn suitable for local treatments with curative intent) or stage IV. 2. Tissue samples available for MET analysis (archivial tissue or tissue collected at study entry); patients without archival tumor tissue or refusing new biopsy at study entry, are eligible if MET mutation is detected in cf-DNA 3. Presence of MET mutations (exon 14 skipping mutation ONLY) detected in tissue or cf-DNA at the local lab or in the central lab or MET amplification (MET/CEP7 ratio > 2.2) detected in the central lab ONLY. 4. Measurable disease according to RECIST criteria version 1.1 5. At least 1 prior line of standard therapy (chemotherapy and/ or immunotherapy) 6. Performance status 0-1 (ECOG) 7. Age =18 years 8. Patients potentially fertile using adequate methods of contraception in order to avoid childbearing. Contraceptive methods must be respected by male and female patients and their partners during study treatment period and at least 4 months after completing therapy 9. Adequate hematologic and end organ function, defined by the following laboratory results obtained within 14 days prior to enrollment: 7.a. ANC = 1500 cells/µL without granulocyte colony-stimulating factor support 8.b. Platelet count = 100,000/µL without transfusion 9.c. Hemoglobin = 9.0 g/dL Patients may be transfused to meet this criterion d. AST, ALT, and alkaline phosphatase = 2.5 × ULN, with the following exceptions: - Patients with documented liver metastases: AST and/or ALT = 5 × ULN Patients with documented liver or bone metastases: alkaline phosphatase = 5 × ULN. e. Serum bilirubin = 1.25 × ULN f. Patients with known Gilbert disease who have serum bilirubin level = 3 × ULN may be enrolled g. Calculated creatinine clearance (CRCL) = 45 mL/min or, if using cisplatin, calculated CRCL must be = 60 mL/min 10. Patient compliance to the study procedure 11. Written informed consent |
1. Diagnosi citologica o istologica di carcinoma polmonare non a piccole cellule (NSCLC) di stadio III B (non candidabile a terapie locali con intento curativo) o di stadio IV 2. Disponibilità di campione di tessuto per le analisi di MET (tessuto di archivio o tessuto fresco raccolto all’ingresso nello studio); i pazienti per i quali non sia disponibile tessuto tumorale di archivio o che rifiutino di sottoporsi alla biopsia all’arruolamento, sono eleggibili se la mutazione di MET è rilevata nel cf-DNA 3. Presenza di mutazioni di MET (solo skipping mutation di MET a carico dell’esone 14) rilevate in tessuto o cf-DNA nel laboratorio locale o nel laboratorio centralizzato o amplificazione di MET (MET/CEP7 ratio> 2.2) rilevata esclusivamente presso il laboratorio centralizzato 4. Malattia misurabile in accordo ai criteri RECIST versione 1.1 5. Almeno 1 linea precedente di terapia standard (chemioterapia e/o immunoterapia) 6. Performance status 0-1 (ECOG) 7. Età =18 anni 8. Pazienti potenzialmente fertili che usano adeguati metodi di contraccezione allo scopo di evitare gravidanze. I metodi contraccettivi devono essere rispettati da pazienti di sesso maschile e femminile e dai loro partner durante il periodo di trattamento sperimentale ed almeno fino a 4 mesi dopo il completamento della terapia 9. Adeguata funzionalità ematologica e d’organo, definita dai seguenti esami di laboratorio ottenuti entro 14 giorni precedenti l’arruolamento: a. ANC = 1500 cell/ µL in assenza di supporto del fattore stimolante la colonia di granulociti b. Conta piastrinica = 100,000/µL in assenza di trasfusione c. Emoglobina = 9.0 g/dL I pazienti possono essere trasfusi per soddisfare questo criterio d. AST, ALT, e fosfatasi alcalina = 2.5 × ULN, con le seguenti eccezioni: -pazienti con metastasi al fegato documentate: AST e/o ALT = 5 × ULN -pazienti con metastasi al fegato o alle ossa: fosfatasi alcalina = 5 × ULN e. Bilirubina sierica = 1.25 × ULN f. Pazienti con Sindrome di Gilbert nota che hanno livelli di bilirubina sierica = 3 × ULN possono essere arruolati g. Clearance della creatinina calcolata (CRCL) = 45 mL/min o la CRCL calcolata deve essere = 60 mL/min 10. Compliance del paziente alle procedure di studio 11. Consenso informato scritto |
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E.4 | Principal exclusion criteria |
1. Tissue sample not available in patients without MET exon 14 skipping mutation detected in cf-DNA 2. No possibility to assess MET status 3. Absence of any measurable disease according to RECIST criteria 4. Co-existence of driver events, including EGFR mutations, KRAS mutations, ALK rearrangements or ROS-1 rearrangements 5. No prior therapy 6. Concomitant chemotherapy or immunotherapy or radiotherapy 7. Symptomatic brain metastasis 8. Uncontrolled significant inter-current or recent illness, including cardio-vascular disorders and gastro-intestinal disorders 9. Major surgery within 2 months before first dose of study treatment 10. Concomitant anti-coagulation with oral anti-coagulants or plated inhibitors 11. History of significant bleeding, trachea-bronchial tree/major blood vessels invading tumors, cavity pulmonary lesions and GI disorders associated with a risk of perforation or fistula formation 12. Diagnosis of another cancer in the last 3 years, except for in situ carcinoma of cervix, breast and bladder or skin carcinoma (squamous or basalioid) 13. Pregnancy or breastfeeding |
1. Tessuto non disponibile in pazienti nei quali non sia stata rilevata una skipping mutation di MET a carico dell’esone 14 nel cf-DNA 2. Nessuna possibilità di valutare lo status di MET 3. Assenza di malattia misurabile in accordo ai criteri RECIST 4. Concomitanza di eventi “driver”, incluse mutazioni EGFR, mutazioni KRAS, riarrangiamenti di ALK o ROS-1 5. Nessuna terapia precedente 6. Concomitante chemioterapia o immunoterapia o radioterapia 7. Metastasi all’encefalo sintomatiche 8. Malattia significativa incontrollata intercorrente o recente, inclusi disordini cardio-vascolari e gastro-intestinali 9. Chirurgia maggiore entro 2 mesi precedenti alla prima dose del trattamento di studio 10. Terapia concomitante con anti- coagulanti orali o antiaggregante piastrinica 11. Storia di emorragia significativa, tumori invasivi dei principali vasi sanguigni tracheobronchiali, lesioni alla cavità polmonare e disordini gastrointestinali associati a rischio di perforazione o di formazione di fistole 12. Diagnosi di un altro tumore negli ultimi 3 anni, eccetto carcinoma in situ della cervice, mammella e vescica o carcinoma della pelle (squamoso o basalioma) 13. Gravidanza o allattamento |
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E.5 End points |
E.5.1 | Primary end point(s) |
Response Rate (RR) (complete + partial responses) of Cabozantinib in NSCLC patients with MET amplification or MET exon 14 skipping mutation pre-treated or not with MET inhibitors. |
Response Rate (RR) (completa + risposta parziale) di Cabozantinib in pazienti NSCLC con amplificazione di MET o con skipping mutation di MET a carico dell’esone 14 pre-trattati o no con inibitori di MET |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Disease evaluation will be performed according to Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. every two months (8 weeks) until disease progression, unacceptable toxicity or patient refusal |
La valutazione di malattia sarà effettuata in accordo ai criteri RECIST 1.1 ogni 2 mesi (8 settimane) fino a progressione di malattia, tossicità inaccettabile o rifiuto del paziente |
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E.5.2 | Secondary end point(s) |
Progression free survival (PFS) - Overall survival (OS) - Disease Control Rate (DCR: malattia stabile + risposta parziale + risposta completa) - Biomarkers esploratori su sangue o tessuto (per ogni paziente arruolato nello studio potrà essere facoltativamente donato un campione di tessuto alla progressione di malattia)
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- Progression free survival (PFS) - Overall survival (OS) - Disease Control Rate (DCR: stable disease + partial response + complete response) - Exploratory biomarkers on blood and tissue samples (for each patient enrolled in the study optionally a tissue sample could be provided at disease progression)
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Disease evaluation will be performed according to Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. every two months (8 weeks) until disease progression, unacceptable toxicity or patient refusal |
La valutazione di malattia sarà effettuata in accordo ai criteri RECIST 1.1 ogni 2 mesi (8 settimane) fino a progressione di malattia, tossicità inaccettabile o rifiuto del paziente |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 21 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial 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
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Enrolment duration: 24 months Follow-up duration: at least 12 months |
Durata dell’arruolamento: 24 mesi Durata del Follow-up: almeno 12 mesi
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |