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    Summary
    EudraCT Number:2017-004754-42
    Sponsor's Protocol Code Number:PP06490
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2018-04-09
    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 number2017-004754-42
    A.3Full title of the trial
    A Phase 3, double-blind, multicenter, placebo-controlled study of PledOx used on top of modified FOLFOX6 (5 FU/FA and Oxaliplatin) to prevent chemotherapy induced peripheral neuropathy (CIPN) in patients with first-line metastatic colorectal cancer
    Estudio de fase III, doble ciego, multicéntrico, controlado con placebo de PledOx usado junto con FOLFOX6 modificado (5 FU/FA y oxaliplatino) para prevenir la neuropatía periférica inducida por quimioterapia (NPIQ) en pacientes con cáncer colorrectal metastásico en tratamiento de primera línea
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 3, double-blind, multicenter, placebo-controlled study of a new drug, PledOx used on top of standard therapy to prevent damages to nerves of the peripheral nervous system, induced by chemotherapy, in patients suffering from cancer of the large intestine that have spread to other parts of the body
    Estudio de fase III, doble ciego, multicéntrico, controlado con placebo de un nuevo medicamento, PledOx usado junto con el tratamiento estándar para prevenir el daño los nervios del sistema nervioso periférico, inducido por la quimioterapia, en pacientes que sufren de cáncer de intestino grueso que se ha extendido a otras partes del cuerpo
    A.3.2Name or abbreviated title of the trial where available
    POLAR-M
    POLAR-M
    A.4.1Sponsor's protocol code numberPP06490
    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 SponsorPledPharma AB
    B.1.3.4CountrySweden
    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 supportPledPharma AB
    B.4.2CountrySweden
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPledPharma AB
    B.5.2Functional name of contact pointChief Medical Officer
    B.5.3 Address:
    B.5.3.1Street AddressGrev Turegatan 11c
    B.5.3.2Town/ cityStockholm
    B.5.3.3Post codeSE 114 46
    B.5.3.4CountrySweden
    B.5.4Telephone number+46709641 009
    B.5.5Fax number+468663 57 25
    B.5.6E-mailstefan.carlsson@pledpharma.se
    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 namePledOx 50mM
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNnot available
    D.3.9.1CAS number 1401243-67-1
    D.3.9.2Current sponsor codeCalmangafodipir
    D.3.9.3Other descriptive nameCa4Mn(DPDP)5
    D.3.10 Strength
    D.3.10.1Concentration unit mmol/kg millimole(s)/kilogram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.005
    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.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Chemotherapy induced peripheral neuropathy
    Neuropatía periférica inducida por quimioterapia (NPIQ)
    E.1.1.1Medical condition in easily understood language
    Damages to nerves of the peripheral nervous system, induced by chemotherapy
    Daño a los nervios del sistema nervioso periférico inducido por quimioterapia.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level LLT
    E.1.2Classification code 10079545
    E.1.2Term Chemotherapy induced peripheral neuropathy
    E.1.2System Organ Class 100000004852
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare each dose of PledOx (2 and 5 µmol/kg) vs placebo with respect to the proportion of patients with moderate or severe chronic CIPN
    Comparar cada dosis de PledOx (2 y 5 µmol/kg) frente a placebo con respecto a la proporción de pacientes con NPIQ crónica moderada o grave.
    E.2.2Secondary objectives of the trial
    Compare each dose of PledOx vs placebo

    Efficacy
    • Proportion of patients with mild, moderate or severe chronic CIPN
    • Sensitivity to touching cold items
    • Cumulative dose of oxaliplatin during chemotherapy
    • Vibration sensitivity on the lateral malleolus
    • Worst pain in hands or feet
    • Functional impairment (non-dominant hand)
    • Sustained efficacy on prevention of CIPN during LTFU

    Safety
    • Overall response rate
    • Progression-free survival
    • Overall survival
    • Safety and tolerability

    Exploratory
    • Chronic CIPN by supporting analysis using full FACT/GOG NTX-13
    • Cumul. dose of 5-FU during chemo
    • Both oxaliplatin and 5-FU: number of cycles, dose intensity & reductions (reason for reduction), dose delays (length of delay)
    • PK profile of PledOx with multiple dosing*
    • QT/QTc interval using a 12-lead ECG*
    • QoL/health status
    • Functional impairment (LTFU)
    • Worst pain in hand or feet during LTFU
    • Health eco impact

    *42 patients in preselected sites only
    Comparar cada dosis de PledOx frente a placebo en relación:
    -Eficacia
    Proporción pacientes con NPIQ crónica leve, moderada o grave
    Sensib. tocar objetos fríos
    Dosis acumulada oxaliplatino durante la quimiot.
    Sensib. vibración maléolo ext.
    Peor dolor posible manos/pies
    Deterioro funcional (mano no dominante)
    Eficacia sostenida en prevención NPIQ seguimiento largo plazo (LP)
    -Seguridad
    Tasa de resp. global
    Superviv. sin progresión
    Superviv. global
    Seguridad/tolerabilidad
    -Exploratorios
    NPIQ crónica-análisis complement.-escala FACT/GOG NTX-13 completa
    Dosis acumulada 5-FU durante quimiot.
    Oxaliplatino y 5-FU: intensidad dosis, nº ciclos, reducc. dosis (motivo/s), retrasos dosis (duración)
    Perfil FC PledOx dosis múltiples*
    Intervalo QT/QTc-ECG 12 derivaciones*
    Calidad de vida/estado de salud
    Deterioro funcional (mano no dominante)-seguim. a LP
    Peor dolor posible en manos/pies-seguim. a LP
    Impacto económico-sanitario
    *solo centros preseleccionados y 42 pacientes
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Signed informed consent form before any study related assessments and willing to follow all study procedures.
    2. Male or female aged ≥18 years.
    3. Metastatic (stage IV) CRC, pathologically confirmed adenocarcinoma of the colon or rectum.
    4. No prior systemic chemotherapy (within the previous 12 months) and/or biologic/targeted therapy for metastatic CRC.
    5. Measurable disease according to RECIST 1.1.
    6. Patient indicated for at least 3 months of oxaliplatin-based chemotherapy (without any pre-planned treatment breaks) and without any clinically observed neurological disorders.
    7. ECOG performance status of 0 or 1.
    8. Adequate hematological parameters: hemoglobin ≥100 g/L, absolute neutrophil count (ANC) ≥1.5 x 10^9/L, platelets ≥100 x 10^9/L.
    9. Adequate renal function: creatinine clearance >50 cc/min using the Cockroft and Gault formula or measured.
    10. Adequate hepatic function: total bilirubin ≤1.5 times the upper limit of normal (ULN) (except in the case of known Gilbert’s syndrome); AST and ALT ≤3 times ULN (AST and ALT ≤5 times ULN in case of liver metastases).
    11. Baseline blood manganese level <2.0 times ULN.
    12. For patients with a history of diabetes mellitus, HbA1c ≤7%.
    13. Negative pregnancy test for females of child-bearing potential.
    14. For men and females of childbearing potential, use of adequate contraception (oral contraceptives, intrauterine device or barrier method of contraception in conjunction with spermicidal jelly or surgically sterile) while on study drug and for at least 6 months after completion of study therapy.
    1. Formulario de consentimiento informado firmado antes de cualquier evaluación relacionada con el estudio y estar dispuesto a realizar todos los procedimientos del estudio.
    2. Varones o mujeres de edad ≥ 18 años.
    3. CCR metastásico (fase IV), adenocarcinoma de colon o recto confirmado patológicamente.
    4. Sin quimioterapia previa (en los 12 meses anteriores) y/o tratamiento biológico/específico para el CCRm.
    5. Enfermedad mensurable según los criterios RECIST 1.1.
    6. Al paciente se le recomienda un mínimo de 3 meses de quimioterapia basada en oxaliplatino (sin ninguna interrupción del tratamiento planificada previamente) y sin ningún trastorno neurológico observado clínicamente.
    7. Estado funcional del Eastern Cooperative Oncology Group (ECOG) de 0 ó 1.
    8. Parámetros hematológicos adecuados: hemoglobina ≥ 100 g/l, recuento absoluto de neutrófilos (RAN) ≥ 1,5 x 109/l, plaquetas ≥ 100 x 109/l.
    9. Función renal adecuada: aclaramiento de creatinina >50 cc/min. usando la fórmula de Cockcroft y Gault o medida.
    10. Función hepática adecuada: bilirrubina total ≤ 1,5 veces el límite superior de la normalidad (LSN) (excepto en caso de síndrome de Gilbert conocido); aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) ≤ 3 veces el LSN (AST y ALT ≤ 5 veces el LSN en caso de metástasis hepática).
    11. Nivel basal de manganeso (Mn) en sangre < 2,0 veces el LSN.
    12. Para pacientes con antecedentes de diabetes mellitus, HbA1c ≤ 7 %.
    13. Resultado negativo en una prueba de embarazo en las mujeres potencialmente fértiles.
    14. Para hombres y para mujeres potencialmente fértiles, uso de métodos anticonceptivos adecuados (anticonceptivos orales, dispositivo intrauterino o métodos anticonceptivos de barrera en conjunto con gel espermicida o esterilización quirúrgica) mientras toman el medicamento del estudio y durante un mínimo de 6 meses después de finalizar el tratamiento del estudio.
    E.4Principal exclusion criteria
    1. Any unresolved toxicity by Common Terminology Criteria for Adverse Events Version (CTCAE v4.03) > Grade 1 from previous anti-cancer therapy (including radiotherapy), except alopecia.
    2. Any grade of neuropathy from any cause.
    3. Any prior oxaliplatin-based chemotherapy <1 year before the randomization.
    4. Any evidence of severe or uncontrolled systemic diseases (e.g., unstable or uncompensated respiratory, cardiac, unresolved bowel obstruction, hepatic or renal disease).
    5. Chronic infection or uncontrolled serious illness causing immunodeficiency.
    6. Recent (<28 days) surgery prior to entry into the study or a surgical incision that is not fully healed.
    7. Significant hemorrhage (>30 mL/bleeding episode in previous 3 months), hemoptysis (>5 mL fresh blood in previous 4 weeks) or thrombotic event (including transient ischemic attack) in the previous 12 months if the patient is expected to receive anti-VEGF/VEGFR therapy.
    8. Known hypersensitivity to any of the components of mFOLFOX6 and, if applicable, biological therapies to be used in conjunction with the chemotherapy regimen or any of the excipients of these products.
    9. History of other malignancies (except for adequately treated basal or squamous cell carcinoma or carcinoma in situ) within 5 years, unless the patient has been disease free for that other malignancy for at least 2 years.
    10. Known dihydropyrimidine dehydrogenase deficiency.
    11. Pre-existing neurodegenerative disease (e.g., Parkinson’s, Alzheimer’s, Huntington’s) or neuromuscular disorder (e.g., multiple sclerosis, amyotrophic lateral sclerosis, polio, hereditary neuromuscular disease).
    12. Major psychiatric disorder (major depression, psychosis), alcohol and/or drug abuse.
    13. Patients with a history of second or third degree atrioventricular block or a family heredity.
    14. A history of a genetic or familial neuropathy.
    15. Treatment with any investigational drug within 30 days prior to randomization.
    16. Pregnancy, lactation or reluctance to using contraception.
    17. Any other condition that, in the opinion of the investigator, places the patient at undue risk.
    18. Previous exposure to mangafodipir or calmangafodipir.
    19. Welders, mine workers or other workers in occupations (current or past) where high manganese exposure is likely.
    1. Cualquier toxicidad no resuelta según la versión de los Criterios terminológicos comunes para acontecimientos adversos (CTCAE v4.03) > grado 1 derivada de un tratamiento antineoplásico previo (incluida la radioterapia), a excepción de la alopecia.
    2. Cualquier grado de neuropatía por cualquier causa.
    3. Quimioterapia basada en oxaliplatino previa < 1 año antes de la aleatorización.
    4. Cualquier indicio de enfermedades sistémicas graves o incontroladas (p. ej.: enfermedad respiratoria, cardíaca, hepática o renal inestable o descompensada, obstrucción intestinal no resuelta).
    5. Infección crónica o enfermedad grave incontrolada que provoca inmunodeficiencia.
    6. Cirugía reciente (< 28 días) antes de la admisión en el estudio o una incisión quirúrgica que no esté completamente curada.
    7. Hemorragia importante (> 30 ml/episodio hemorrágico en los 3 meses anteriores), hemoptisis (expectoración reciente de > 5 ml de sangre en las 4 semanas anteriores) o episodio trombótico (incluido un accidente isquémico transitorio) en los 12 meses anteriores si se espera que el paciente reciba tratamiento con el anti-factor de crecimiento endotelial vascular (FCEV) / el receptor del factor de crecimiento endotelial vascular (receptor del FCEV).
    8. Hipersensibilidad conocida a cualquiera de los componentes de mFOLFOX6 y, si procede, tratamientos biológicos que se usan de forma conjunta con el régimen de quimioterapia o cualquiera de los excipientes de estos productos.
    9. Antecedentes de otras neoplasias malignas (excepto el carcinoma basocelular o de células escamosas o el carcinoma in situ tratados adecuadamente) en los 5 años anteriores, a menos que el paciente haya estado libre de esa otra neoplasia maligna durante al menos 2 años.
    10. Deficiencia conocida de dihidropirimidina deshidrogenasa.
    11. Enfermedad neurodegenerativa preexistente (p. ej.: enfermedad de Parkinson, enfermedad de Alzheimer, enfermedad de Huntington) o trastorno neuromuscular (p. ej.: esclerosis múltiple, esclerosis lateral amiotrófica, polio, enfermedad neuromuscular hereditaria).
    12. Trastorno psiquiátrico importante (depresión grave, psicosis), abuso de alcohol o drogas.
    13. Pacientes con antecedentes de bloqueo auriculoventricular de segundo o tercer grado o herencia familiar.
    14. Antecedentes de neuropatía genética o hereditaria.
    15. Tratamiento con un fármaco en investigación en los 30 días anteriores a la aleatorización.
    16. Embarazo, lactancia o renuencia al uso de métodos anticonceptivos.
    17. Cualquier otra afección que, en opinión del investigador, suponga un riesgo excesivo para el paciente.
    18. Exposición previa a mangafodipir o calmangafodipir.
    19. Soldadores, trabajadores de las minas u otros trabajadores en profesiones (presentes o pasadas) en las que es probable que se produzca una alta exposición al manganeso.
    E.5 End points
    E.5.1Primary end point(s)
    Proportion of patients (with moderate or severe chronic CIPN) scoring 3 or 4 in at least 1 of the first 4 items of the FACT/GOG-NTX-13 (i.e., FACT/GOG-NTX-4), targeting numbness, tingling or discomfort in hands and/or feet, 9 months after the first dose of IMP (i.e. PledOx or placebo administered on Day 1, Cycle 1 of mFOLFOX6 chemotherapy).
    Proporción de pacientes (con NPIQ crónica moderada o grave) con puntuación 3 ó 4 en al menos 1 de los 4 primeros elementos del cuestionario FACT/GOG-NTX-13 (esto es, FACT/GOG-NTX-4), sobre el entumecimiento, hormigueo o molestias en las manos y/o en los pies, 9 meses después de la primera dosis del PEI (esto es, PledOx o placebo administrado el día 1 del ciclo 1 de quimioterapia con mFOLFOX6).
    E.5.1.1Timepoint(s) of evaluation of this end point
    9 months after first dose of IMP
    9 meses después de la primera dosis del PEI
    E.5.2Secondary end point(s)
    Secondary Endpoints
    Efficacy
    • Proportion of patients (with mild, moderate or severe chronic CIPN) scoring 2, 3, or 4, in at least 1 of the first 4 items of the FACT/GOG-NTX-13 (i.e. FACT/GOG-NTX-4), targeting numbness, tingling or discomfort in hands and/or feet, 9 months after the first dose of IMP.
    • Mean change from baseline in sensitivity to touching cold items on day 2, Cycle 4 of mFOLFOX6 chemotherapy, as assessed by the Cold Sensitivity questionnaire.
    • Mean cumulative dose of oxaliplatin administered per patient during mFOLFOX6 chemotherapy, 9 months after the first dose of IMP.
    • Mean change from baseline in vibration sense, on the lateral malleolus (left and right), using a graduated tuning fork, at 9 months after the first dose of IMP.
    • Mean change from baseline in worst pain in hands or feet in the past week, using a numerical rating scale (NRS), at 9 months after the first dose of IMP.
    • Mean change from baseline in the time to complete the grooved Pegboard with the non-dominant hand, at 9 months after the first dose of IMP.
    • Proportion of patients scoring 3 or 4 in at least 1 of the first 4 items of the FACT/GOG-NTX-13 (i.e. FACT/GOG-NTX-4), targeting numbness, tingling or discomfort in hands and/or feet, 12, 15, 18, 21 and 24 months after the first dose of IMP.

    Safety
    • PFS
    • Time to death (OS)
    • Safety and tolerability as assessed by adverse events (AEs), laboratory variables and vital signs

    Exploratory Endpoints
    • Frequency and proportion of patients with any CIPN scoring 1, 2, 3 or 4, in any of the first 4 items of the FACT/GOG-NTX-13 (i.e. FACT/GOG-NTX-4), targeting numbness, tingling or discomfort in hands and/or feet, at all other timepoints after the first dose of IMP.
    • Mean score of the first 4 items of the FACT/GOG-NTX-13 (i.e. FACT/GOG-NTX-4), at 9 months after the first dose of IMP.
    • Mean score of the 13 items of the FACT/GOG-NTX-13, at 9 months after the first dose of IMP.
    • Mean cumulative dose of 5-FU administered per patient during mFOLFOX6 chemotherapy, 9 months after the first dose of IMP.
    • For both oxaliplatin and 5-FU: Dose intensity, mean number of cycles per patient, proportion of patients with any dose reduction, reason(s) for dose reductions, proportion of patients with any dose delay, and mean duration of dose delay.
    • PK parameters including Cmax, tmax, AUC0-last of PledOx (only at pre-selected sites and in 42 patients in total), at all measured time points.
    • Mean QT/QTc interval using a 12-lead ECG (only at pre-selected sites and in 42 patients in total), at all measured time points.
    • Mean health index and mean VAS score, using the EQ-5D-5L, at 9, 12, 15, 18, 21, and 24 months after the first dose of IMP.
    • Mean health index, using the FACT/GOG, at 9, 12, 15, 18, 21, and 24 months after the first dose of IMP.
    • Mean time to complete the grooved Pegboard, with the non-dominant hand, at 12, 15, 18, 21, and 24 months after the first dose of IMP.
    • Mean change from baseline in worst pain in hands or feet in the past week, using a NRS, at 12, 15, 18, 21, and 24 months after the first dose of IMP.
    • The proportion of patients with a 2-point, 3-point and 4-point increase in worst pain in hands or feet in the past week, using a NRS, at 9, 12, 15, 18, 21, and 24 months after the first dose of IMP.
    • Health economic impact, measured by the combined impact of medical resource utilization (hospitalizations, outpatient visits, medical procedures and medical use), patient impact (AEs, fall accidents, functional loss) and indirect societal costs (loss of ability to work), up to 24 months after the first dose of IMP.
    Eficacia:
    • Proporción de pacientes (con NPIQ crónica leve, moderada o grave) con puntuación 2, 3 ó 4 en al menos 1 de los 4 primeros elementos del cuestionario FACT/GOG-NTX-13 (esto es, FACT/GOG-NTX-4), sobre el entumecimiento, hormigueo o molestias en las manos y/o en los pies, 9 meses después de la primera dosis del PEI.
    • Cambio medio respecto al valor basal en la sensibilidad al tocar objetos fríos el día 2 del ciclo 4 de la quimioterapia con mFOLFOX6, evaluada según el cuestionario sobre sensibilidad al frío.
    • Dosis media acumulada de oxaliplatino administrada por paciente durante la quimioterapia con mFOLFOX6, 9 meses después de la primera dosis del PEI.
    • Cambio medio respecto al valor basal en la sensación de vibración, en el maléolo externo (izquierdo y derecho), determinado mediante un diapasón graduado, 9 meses después de la primera dosis del PEI.
    • Cambio medio respecto al valor basal en el peor dolor posible en las manos o en los pies durante la última semana, determinado mediante una escala de valoración numérica (EVN), 9 meses después de la primera dosis del PEI.
    • Cambio medio respecto al valor basal en el tiempo necesario para completar el test de destreza manual Grooved Pegboard con la mano no dominante, 9 meses después de la primera dosis del PEI.
    • Proporción de pacientes con puntuación 3 ó 4 en al menos 1 de los 4 primeros elementos del cuestionario FACT/GOG-NTX-13 (esto es, FACT/GOG-NTX-4), sobre el entumecimiento, hormigueo o molestias en las manos y/o en los pies, 12, 15, 18, 21 y 24 meses después de la primera dosis del PEI.

    Seguridad:
    • TRG, según los criterios RECIST v1.1
    • SSP
    • Tiempo hasta la muerte (SG)
    • Seguridad y tolerabilidad evaluada según los acontecimientos adversos (AA), las variables analíticas y las constantes vitales

    Criterios exploratorios de valoración:
    • Frecuencia y proporción de pacientes con puntuación 1, 2, 3 ó 4 para la NPIQ en cualquiera de los 4 primeros elementos del cuestionario FACT/GOG-NTX-13 (esto es, FACT/GOG-NTX-4), sobre el entumecimiento, hormigueo o molestias en las manos y/o en los pies, en todos los demás puntos temporales después de la primera dosis del PEI.
    • Puntuación media de los 4 primeros elementos del cuestionario FACT/GOG-NTX-13 (esto es, FACT/GOG-NTX-4), 9 meses después de la primera dosis del PEI.
    • Puntuación media de los 13 elementos del cuestionario FACT/GOG-NTX-13, 9 meses después de la primera dosis del PEI.
    • Dosis media acumulada de 5-FU administrada por paciente durante la quimioterapia con mFOLFOX6, 9 meses después de la primera dosis del PEI.
    • Tanto para oxaliplatino como para 5-FU: intensidad de la dosis, número medio de ciclos por paciente, proporción de pacientes con cualquier reducción de la dosis, motivo(s) de la reducción de la dosis, proporción de pacientes con cualquier retraso de la dosis, y duración media del retraso de la dosis.
    • Parámetros farmacocinéticos que incluyen Cmáx., tmáx., AUC0-últ. de PledOx (solo en centros preseleccionados y en 42 pacientes en total), en todos los puntos temporales especificados.
    • Intervalo QT/QTc medio determinado mediante un ECG de 12 derivaciones (solo en centros preseleccionados y en 42 pacientes en total), en todos los puntos temporales especificados.
    • Índice de salud medio y puntuación media en la escala EVA, determinado mediante el cuestionario EQ-5D-5L, 9, 12, 15, 18, 21 y 24 meses después de la primera dosis del PEI.
    • Índice de salud medio, determinado mediante el cuestionario FACT/GOG, 9, 12, 15, 18, 21 y 24 meses después de la primera dosis del PEI.
    • Tiempo medio necesario para completar el test de destreza manual Grooved Pegboard, con la mano no dominante, 12, 15, 18, 21 y 24 meses después de la primera dosis del PEI.
    • Cambio medio respecto al valor basal en el peor dolor posible en las manos o en los pies durante la última semana, usando una escala de valoración numérica (EVN), 12, 15, 18, 21 y 24 meses después de la primera dosis del PEI.
    • La proporción de pacientes con un aumento de 2 puntos, 3 puntos y 4 puntos en el peor dolor posible en las manos o en los pies durante la última semana, mediante una escala de valoración numérica (EVN), 9, 12, 15, 18, 21 y 24 meses después de la primera dosis del PEI.
    • Impacto económico-sanitario, determinado mediante el impacto combinado de la utilización de recursos sanitarios (hospitalizaciones, visitas ambulatorias, procedimientos médicos y uso médico), el impacto para el paciente (AA, accidentes de caídas, pérdidas funcionales) y los costes sociales indirectos (pérdida de la capacidad para trabajar), hasta 24 meses después de la primera dosis del PEI.
    E.5.2.1Timepoint(s) of evaluation of this end point
    - FACT/GOG-NTX-13, Grooved pegboard, Grad. Tuning fork, Pain NRS: treatment visits 1-12 (D1 of each Cyc), assessment visits M3, 6, 9, 12, 15, 18, 21 & 24, EoT (D14 last cycle)
    - AEs: treatment V1-12, assessment visits M3 & 6, EoT
    - PFS & OS: assessment M3, 6, 9, 12, 15, 18, 21 & 24, EoS (OS only)
    - Biochem & Blood Mn: Screen, treatment V1, 4, 8, 12, EoT
    - Hemato, Vital sign, ECOG: Screen, treatment V1-12, M3, 6, 9, 12, 15, 18, 21 & 24, EoT
    - Cold sensitivity: Screen, treatment V2, 4 & 8
    - QoL/health status: treatment V1, 4, 8 & 12, M9-24
    - Physical exam: Screen, treatment V6, assesment M6-24, EoT
    - MRI of CNS and Blood Mn incl. neuro exam: treatment visits 1-12, M3, EoT
    - ECG: Screen
    - PK patients: PK & ECG: treatment V1, 4 & 8
    - Health eco: treament V1, EoT, M12 & M24
    - FACT/GOG-NTX-13, test destreza manual, test sensibilidad vibración, ENV dolor: visitas de tratamiento (VT) 1-12 (D1 de cada ciclo), visitas de evaluación (VE) M3, 6, 9, 12, 15, 18, 21 y 24, FdT (D14 último ciclo)
    - AAs: VT 1-12, VE M3 y 6, FdT
    - SSP y SG:VE M3, 6, 9, 12, 15, 18, 21 y 24, FdE (solo SG)
    - Bioquim y Mn en sangre: Selecc., VT 1, 4, 8, 12, FdT
    - Hemato, Signos vitales, ECOG: Selecc., VT 1-12, M3, 6, 9, 12, 15, 18, 21 y 24, FdT
    - Sensib al frio: Selecc., VT 2, 4 y 8
    - Calidad de vida/estado de salud: VT 1, 4, 8 y 12, M9-24
    - Examen físico: Selecc., VT 6, VE M6-24, FdT
    - RM de SNS y Mn en sangre incl. exam neurolog: VT 1-12, M3, FdT
    - ECG: Selecc.
    - PK pacientes: PK y ECG: VT 1, 4 y 8
    - Impacto económico-sanitario: VT 1, FdT, M12 y M24
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis Yes
    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 Yes
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    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 Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    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 concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA57
    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
    Czech Republic
    France
    Germany
    Italy
    Spain
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last patient reaching End of Study: Overall Survival assessment at approximately month 36 (by telephone or any available medical source)
    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 months10
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months10
    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: 150
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 150
    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 state27
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 161
    F.4.2.2In the whole clinical trial 300
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    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 Decision2018-05-09
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-04-18
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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