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    Summary
    EudraCT Number:2018-000309-21
    Sponsor's Protocol Code Number:UCa-001
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2018-07-17
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2018-000309-21
    A.3Full title of the trial
    An Open-Label, Multi-Center Trial of INO-5401 + INO-9012 in Combination with Atezolizumab in Subjects with Locally Advanced Unresectable or Metastatic/Recurrent Urothelial Carcinoma
    Ensayo abierto y multicéntrico de INO-5401 + INO-9012 en combinación con atezolizumab en sujetos con carcinoma urotelial (CU) localmente avanzado irresecable o metastásico/recidivante
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to investigate INO-5401 + INO-9012 in Subjects Locally Advanced Unresectable or Metastatic/Recurrent Urothelial Carcinoma
    Estudio para investigar INO-5401 + INO-9012 en sujetos con carcinoma urotelial (CU) localmente avanzado irresecable o metastásico/recidivante
    A.4.1Sponsor's protocol code numberUCa-001
    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 SponsorInovio Pharmaceuticals, 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 supportInovio Pharmaceuticals, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationInovio Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointUCa-001 Trial Development
    B.5.3 Address:
    B.5.3.1Street Address660 W. Germantown Pike, Suite 110
    B.5.3.2Town/ cityPennsylvania
    B.5.3.3Post code19462
    B.5.3.4CountryUnited States
    B.5.6E-mailUCa001trial@inovio.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 nameINO-5401
    D.3.2Product code INO-5401
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntramuscular use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNpGX1108
    D.3.9.2Current sponsor codepGX1108
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNpGX1404
    D.3.9.2Current sponsor codepGX1404
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNpGX1434
    D.3.9.2Current sponsor codepGX1434
    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 No
    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) Yes
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product Yes
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Yes
    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) Yes
    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: 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 nameINO-9012
    D.3.2Product code INO-9012
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntramuscular use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNpGX6001
    D.3.9.2Current sponsor codepGX6001
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) Yes
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product Yes
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Yes
    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) Yes
    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 Atezolizumab
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Limited
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    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 nameAtezolizumab
    D.3.2Product code Atezolizumab
    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 INNATEZOLIZUMAB
    D.3.9.1CAS number 1380723-44-3
    D.3.9.4EV Substance CodeSUB178312
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4.4
    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) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) Yes
    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
    Locally advanced unresectable or metastatic/recurrent Urothelial Cancer
    Carcinoma urotelial localmente avanzado irresecable o metastásico/recidivante
    E.1.1.1Medical condition in easily understood language
    Locally advanced unresectable or metastatic/recurrent Urothelial Cancer
    Carcinoma urotelial localmente avanzado irresecable o metastásico/recidivante
    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 10077056
    E.1.2Term Urothelial carcinoma recurrent
    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
    1. To determine the safety and tolerability of INO-5401 + INO-9012 delivered by IM injection followed by EP with CELLECTRA™ 2000 device in combination with atezolizumab among subjects with locally advanced unresectable or metastatic/recurrent UCa

    2. To evaluate preliminary immune response to INO-5401 + INO-9012 in combination with atezolizumab in subjects with locally advanced unresectable or metastatic/recurrent UCa

    3. To evaluate objective response rate of INO-5401 + INO-9012 in combination with atezolizumab in subjects who have received and/or progressed on anti-PD-1/PD-L1 based therapy previously (cohort A)
    1. Determinar la seguridad y tolerabilidad de INO-5401 + INO-9012 administrados mediante inyección i.m. seguidos de EP con el equipo CELLECTRA™ 2000 en combinación atezolizumab en sujetos con carcinoma urotelial (CU) irresecable localmente avanzado o metastásico/recidivante.

    2. Evaluar la respuesta inmunitaria preliminar a INO-5401 + INO-9012 en combinación con atezolizumab en sujetos con carcinoma urotelial (CU) irresecable localmente avanzado o metastásico/recidivante.

    3. Evaluar la tasa de respuesta objetiva de INO-5401 + INO-9012 en combinación con atezolizumab en sujetos que han recibido tratamiento anti-PD-1/PD-L1 anterior o cuya enfermedad ha evolucionado con este tratamiento (cohorte A).
    E.2.2Secondary objectives of the trial
    To evaluate the anti-tumor activity of INO-5401 + INO-9012 in combination with atezolizumab in subjects with locally advanced unresectable or metastatic/recurrent UCa
    Evaluar la actividad antitumoral de INO-5401 + INO-9012 en combinación con atezolizumab en sujetos con carcinoma urotelial (CU) irresecable localmente avanzado o metastásico/recidivante.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Provide signed IRB approved informed consent in accordance with institutional guidelines.

    2. Be 18 years of age or older on the day of signing the informed consent, and able and willing to comply with all trial procedures.

    3. Have histologically or cytologically documented locally advanced unresectable or metastatic/recurrent urothelial carcinoma (including renal pelvis, ureters, urinary bladder, and urethra).
    a) For Cohort A: Subjects who have radiographically confirmed disease progression during or following treatment with an anti-PD-1/PD-L1 based therapy.
    b) For Cohort B:
    i. No prior chemotherapy for inoperable locally advanced or metastatic or recurrent UCa
    - For subjects who received prior adjuvant/neoadjuvant chemotherapy or chemoradiation for UCa, a treatment-free interval greater than 12 months between the last treatment administration and the date of recurrence is required in order to be considered treatment naive in the metastatic setting.
    - Prior local intervesical chemotherapy or intravesical immunotherapy is allowed if completed at least 4 weeks prior to the initiation of trial treatment.
    ii. Ineligible (“unfit”) for cisplatin-based chemotherapy as defined by any one of the following criteria:
    - Impaired renal function (glomerular filtration rate [GFR] > 30 but < 60 mL/min); GFR should be assessed by direct measurement (i.e., creatinine clearance or ethyldediaminetetra-acetate) or, if not available, by calculation from serum/plasma creatinine (Cockcroft-Gault formula)
    - A hearing loss (measured by audiometry) of 25 dB at two contiguous frequencies
    - Grade 2 or greater peripheral neuropathy (i.e., sensory alteration or parasthesias including tingling)

    4. Have measurable disease, as defined by RECIST version 1.1 (investigator assessment). Target lesions must not have been previously treated with surgery, radiation therapy, or radiofrequency ablation unless there is documented progression in the lesion after such therapy and no other lesions are available for selection as target lesions;

    5. Have a performance status of 0 or 1 on Eastern Cooperative Oncology Group (ECOG)
    Performance Scale;

    6. Have a life expectancy of ≥ 3 months;

    7. Be willing to provide a tissue sample for pre-treatment intra-tumoral assessment of
    proinflammatory and immunosuppressive factors. Preferably, tumor biopsies will be
    collected at the time of screening or newly obtained tissue can be used (no intervening
    treatment [local or systemic] involving the site of tissue biopsy once tissue biopsy is
    obtained up to the time of trial enrollment).

    Note: For cohort A, this refers to tissue obtained during fresh biopsy or archived postanti-
    PD-1/PD-L1 based therapy progression. For cohort B, this refers to newly diagnosed, all treatment naïve archival or fresh tissue. Additionally, for cohort A subjects, an archival sample (ideally treatment naïve) will be requested as well, however, enrollment is allowed for subjects unable to provide newly obtained or lacking tissue specimens after consultation with the Sponsor (see Table 7 of the protocol);

    8. Have ECG with no clinically significant findings as assessed by the investigator
    performed within 28 days prior to first dose;

    9. Demonstrate adequate organ function: hematological, renal, hepatic, coagulation
    parameters as defined in Table 3 of the protocol and obtained within 28 days prior to the first trial treatment.

    10. For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 5 months after the last dose of study treatment:
    - A woman is considered to be of childbearing potential if she is postmenarcheal,
    has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus).
    - Examples of contraceptive methods with a failure rate of < 1% per year include bilateral tubal ligation, male sterilization, established, proper use of hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices.
    - The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception.

    For male subjects: Agree that during the period specified above, men will not father a child. Subjects must be surgically sterile (e.g, vasectomy) or use contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 5 months after the last dose of study treatment.
    1. Proporcionar un consentimiento informado aprobado por el CEIC conforme a las directrices de la institución;

    2. Tener 18 años de edad o más el día de la firma del consentimiento informado, y poder cumplir todos los procedimientos del ensayo;

    3. Tener carcinoma urotelial (CU) irresecable localmente avanzado o metastásico/recidivante (incluidos pelvis renal, uréteres, vejiga urinaria y uretra) documentado mediante histología o citología.
    a) Para la cohorte A: sujetos en los que se haya confirmado evolución de la enfermedad radiográficamente durante o después del tratamiento con un fármaco anti-PD-1/PD-L1.
    b) Para la cohorte B:
    i. sujetos que no hayan recibido quimioterapia anteriormente para tratar el CU localmente avanzado o metastásico o recidivante irresecable:
    - Es necesario que en los sujetos que hayan recibido radioquimioterapia o quimioterapia coadyuvante/neoadyuvante anteriormente para el CU exista un intervalo sin tratamiento superior a 12 meses entre la última administración del tratamiento y la fecha de la recidiva para que pueda considerarse que no han recibido tratamiento con anterioridad en un contexto metastásico.
    - Se permite la quimioterapia intravesical o la inmunoterapia intravesical anterior si finalizó al menos 4 semanas antes de iniciarse el tratamiento del ensayo.
    ii. Sujetos no elegibles («no aptos») para recibir quimioterapia con cisplatino según la definición de alguno de los criterios siguientes:
    - Afectación renal (tasa de filtración glomerular [TFG] > 30 pero < 60 ml/min); la TFG debe evaluarse con medición directa (es decir, aclaramiento de creatinina o ácido etilendiaminotetraacético) o, si no está disponible, mediante el cálculo de la creatinina en suero o plasma (fórmula de Cockcroft-Gault).
    - Pérdida auditiva (media por audiometría) de 25 dB en dos frecuencias adyacentes.
    - Neuropatía periférica de grado 2 o superior (es decir, alteración sensorial o parestesia, incluido hormigueo).
    4. Tener una enfermedad cuantificable, según la definición de los criterios RECIST versión 1.1 (evaluación del investigador). Las lesiones indicadoras no deben haberse tratado anteriormente con cirugía, radioterapia ni ablación por radiofrecuencia, a menos que exista una evolución documentada en la lesión después de dichos tratamientos y que no puedan seleccionarse otras lesiones como lesiones indicadoras;
    5. Tener un estado funcional de 0 o 1 según la escala del Grupo Oncológico Cooperativo de la Costa Este (ECOG);
    6. Tener una esperanza de vida de ≥ 3 meses.
    7. Estar dispuesto a proporcionar muestras de tejido para las evaluaciones intratumorales antes del tratamiento de los factores proinflamatorios e inmunosupresores. Preferiblemente, las biopsias del tumor se recogerán en el momento de la selección o podrá usarse tejido obtenido recientemente (sin que exista tratamiento [local o sistémico] que intervenga en el lugar de la biopsia del tejido, una vez que la biopsia del tejido se haya obtenido y hasta el momento de la inclusión en el ensayo).
    Nota: para la cohorte A, esto hace referencia al tejido obtenido durante una biopsia en fresco o de archivo después de la evolución del tratamiento anti-PD-1/PD-L1. Para la cohorte B, esto hace referencia a tejido de archivo o fresco diagnosticado recientemente o que nunca haya recibido ningún tipo de tratamiento. Asimismo, para los sujetos de la cohorte A, se solicitará también una muestra de archivo (preferiblemente que no haya recibido tratamiento); sin embargo, se permitirá la inclusión de sujetos que no puedan proporcionar muestras de tejido obtenidas recientemente o que no las tengan tras haberlo consultado con el promotor;
    8. Haberse sometido a un ECG sin hallazgos clínicamente significativos según la evaluación del investigador que se hayan realizado en los 28 días anteriores a la primera administración;
    9. Demostrar una función adecuada de los órganos: hematológica, renal, hepática, parámetros de coagulación según se define a continuación y obtenida en los 28 días anteriores al primer tratamiento del ensayo. Función hematológica y orgánica específica adecuada:
    10. Para mujeres fértiles: acceder a mantenerse en abstinencia (abstenerse de mantener relaciones heterosexuales completas) o a utilizar métodos anticonceptivos que ofrezcan una tasa de fallos de <1 % anual durante el período de tratamiento y durante al menos 5 meses después de la última dosis del tratamiento del estudio:
    - Una mujer se considera fértil si ya ha pasado la menarquía, no ha llegado a la menopausia (≥ 12 meses continuos de amenorrea sin otra causa identificada que la menopausia) y no se ha sometido a una esterilización quirúrgica (extirpación de los ovarios o el útero).

    Véase el protocolo para una descripción completa de los criterios de inclusión.
    E.4Principal exclusion criteria
    Cancer-specific Exclusion Criteria:
    1. Any approved anti-cancer therapy including chemotherapy, targeted small molecule therapy or radiation therapy within 2 weeks prior to trial Day 0; or if subject has not recovered (ie., Less than or equal to grade 1 or returned to baseline level) from adverse events due to a previously administered agent; the following exceptions are
    allowed:
    - Palliative radiotherapy for bone metastases or soft tissue lesions should be
    completed > 7 days prior to baseline imaging;
    - Hormone-replacement therapy or oral contraceptives;
    - Subjects with grade 2 neuropathy or grade 2 alopecia;

    2. Currently participating and receiving trial therapy or has participated in a trial of an investigational agent and/or has used an investigational device within 28 days prior to Day 0;

    Note: Subjects who have entered the follow-up phase of an investigational trial may participate as long as it has been 28 days since the last dose of the previous investigational agent or device.

    3. Documented active or untreated central nervous system (CNS) metastases and/or carcinomatous meningitis. For suspected neurological involvement, CT or MRI evaluation is recommended during screening to rule out CNS metastases. Subjects with previously treated brain metastases may participate provided they are stable
    (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurological symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous
    meningitis which is excluded regardless of clinical stability.

    4. Uncontrolled tumor-related pain
    - Subjects requiring pain medication must be on a stable regimen at trial entry.
    - Symptomatic lesions amenable to palliative radiotherapy (e.g., bone metastases or metastases causing nerve impingement) should complete treatment at least 7 days prior to enrollment.
    - Asymptomatic metastatic lesions whose further growth would likely cause functional deficits or intractable pain (e.g., epidural metastasis that is not currently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to enrollment.

    5. Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly and more frequently) o Subjects with indwelling catheters (e.g., PluerX) are allowed.

    6. Uncontrolled hypercalcemia (> 1.5 mmol/L ionized calcium or Ca > 12 mg/dL or corrected serum calcium > ULN) or symptomatic hypercalcemia requiring continued
    use of bisphosphonate therapy or denosumab:
    - Subjects who are receiving bisphosphonate therapy or denosumab specifically to prevent skeletal events and do not have a history or clinically significant hypercalcemia are eligible.
    - Subjects who are receiving denosumab prior to enrollment must be willing and eligible to receive a bisphosphonate instead while in the trial.

    7. Malignancies other than UCa within 3 years prior to Day 0, with the exception of those with negligible risk of metastasis or death treated with expected curative outcome (such as adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, or ductal carcinoma in situ treated surgically with curative intent) or
    localized prostate cancer treated with curative intent and absence of prostate-specific antigen (PSA) relapse or incidental prostate cancer (T1/T2a, Gleason score ≤ 3 + 4,
    and PSA ≤ 0.5 ng/mL undergoing active surveillance and treatment naïve);

    Please refer to the protocol for a full description of the exclusion criteria
    Criterios de exclusión específicos del cáncer:
    1. Cualquier tratamiento contra el cáncer aprobado, incluidos quimioterapia, tratamiento dirigido de moléculas pequeñas o radioterapia en las 2 semanas anteriores al día 0 del ensayo; o si el sujeto no se ha recuperado (es decir, tiene un nivel inferior o igual al grado 1 o ha regresado al nivel basal) de los acontecimientos adversos debido a un fármaco administrado anteriormente; se permiten las excepciones siguientes:
    - La radioterapia paliativa para metástasis óseas o lesiones en los tejidos blandos debe finalizar > 7 días antes de la obtención de imágenes en el momento basal;
    - Hormonoterapia de reposición o anticonceptivos orales;
    - Sujetos con neuropatía de grado 2 o alopecia de grado 2;
    2. Sujetos que estén participando en el ensayo y que estén recibiendo tratamiento del ensayo o que hayan participado en un ensayo de un fármaco en fase de investigación o hayan utilizado un dispositivo en fase de investigación en los 28 días anteriores al día 0;
    Nota: los sujetos que hayan entrado en la fase de seguimiento de un ensayo de investigación, podrán participar siempre que hayan transcurrido 28 días desde la última dosis del fármaco en investigación o del uso del dispositivo en investigación.
    3. Metástasis del sistema nervioso central (SNC) o meningitis carcinomatosa documentada y que esté activa o no haya recibido tratamiento. Si se sospecha que existe afectación neurológica, se recomienda una evaluación por TAC o RM durante la selección para descartar una metástasis del SNC. Los sujetos con metástasis cerebrales anteriores podrán participar siempre que sean estables (sin pruebas de evolución mediante imágenes durante al menos cuatro semanas antes de la primera administración del tratamiento del ensayo y con cualquier síntoma neurológico que haya retrocedido hasta el valor basal), que se demuestre que no existe una nueva metástasis cerebral ni que la existente ha aumentado, y que no hayan usando esteroides durante al menos 7 días antes del tratamiento del ensayo. Esta excepción no incluye la meningitis carcinomatosa, que se excluye independientemente de la estabilidad clínica.
    4. Dolor no controlado relacionado con el tumor.
    - Los sujetos que requieran analgésicos deben estar siguiendo un régimen estable en el momento de entrar a formar parte del ensayo.
    - El tratamiento de las lesiones sintomáticas susceptibles de radioterapia paliativa (p. ej., metástasis óseas o metástasis que produzcan un pinzamiento nervioso) debe finalizar al menos 7 días antes de la inclusión.
    - Las lesiones metastásicas asintomáticas, cuyo crecimiento adicional probablemente provocaría deficiencias funcionales o un dolor intratable (p. ej., una metástasis epidural que no se asocia actualmente a una compresión medular), se deberían tener en consideración para un tratamiento locorregional, si es adecuado antes de la inclusión en el estudio.
    5. Derrame pleural incontrolado, derrame pericárdico o ascitis que requieran procedimientos de drenaje recurrentes (una vez al mes y con más frecuencia)  Los sujetos con sondas permanentes (por ej., PleurX) podrán participar.
    6. Hipercalciemia no controlada (calcio ionizado > 1,5 mmol/l o calcio >12 mg/dl o calcio sérico corregido > LSN) o hipercalciemia sintomática que requiera el uso continuado de tratamiento con bisfosfonato o denosumab.
     Los sujetos que reciban tratamiento con bisfosfonatos o denosumab para prevenir específicamente complicaciones óseas y que no tengan antecedentes de hipercalciemia significativa desde un punto de vista clínico, podrán participar en el estudio.
     Los sujetos que están siendo tratados con denosumab antes de la inclusión, deben estar dispuestos y ser elegibles para recibir un bisfosfonato en su lugar durante el ensayo.
    7. Tumores malignos distintos del CU en los 3 años anteriores al día 0, con la excepción de aquellos con un riesgo insignificante de metástasis o muerte y tratados con un desenlace clínico previsto de curación (como el carcinoma de cuello de útero localizado, el carcinoma epidermoide o espinocelular, o el carcinoma ductal localizado tratado quirúrgicamente con intención curativa) o con un cáncer de próstata localizado tratado con intención curativa y ausencia de recidiva a causa del antígeno prostático específico (PSA) o un cáncer de próstata fortuito (T1/T2a, puntuación de Gleason ≤ 3 + 4, y PSA ≤ 0,5 ng/ml, que esté siendo supervisado activamente y sin tratamiento anterior);
    E.5 End points
    E.5.1Primary end point(s)
    - All adverse events (AEs) including adverse events of special interest (AESI) classified by system organ class (SOC), preferred term (PT), severity and relationship to drug

    - Clinically significant changes in safety laboratory parameters from baseline: CBC with Differential; Chemistry Panel; Urinalysis; T3, Free T4 and TSH; creatine phosphokinase (CPK)

    - Antigen-specific cellular immune responses that may be assessed by but not limited to:
    o Interferon-γ secreting T lymphocytes in peripheral blood mononuclear cells (PBMCs) by ELI Spot - T-cell activation and cytolytic cell phenotype in PBMCs by Flow Cytometry or secretion of immune molecules

    - B cell activation/antibody secretion;

    - Assessment of Myeloid Derived Suppressor Cells (MDSC)

    - TCR sequencing of PBMCs for diversity and putative antigen specificity

    - Immune gene transcript profiling of PBMCs

    - Assessment of proinflammatory and immunosuppressive elements in neoplastic and adjacent normal tissue, where feasible

    - Objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by investigator review in subjects who have received and/or progressed on anti-PD- 1/PD-L1 based therapy previously (cohort A)
    - Todos los acontecimientos adversos (AA), incluidos los acontecimientos adversos de interés especial (AAIE) clasificados por órgano, aparato o sistema (SOC), término preferido (TP), gravedad y relación con el fármaco.
    - Cambios clínicamente significativos en los parámetros de laboratorio de seguridad en comparación con el momento basal: HC con fórmula leucocitaria; bioquímica; análisis de orina; T3, TSH y T4 libre; creatina cinasa (CPK).
    - Respuestas inmunitarias celulares específicas del antígeno que puedan evaluarse, pero que no se limiten a:
    o interferón gamma que secrete linfocitos T en células mononucleares en sangre periférica (CMSP) mediante ELISpot.
    - Activación de linfocitos T y fenotipo de células citolíticas en CMSP mediante citometría de flujo o secreción de moléculas inmunitarias.
    - Activación de linfocitos B o secreción de anticuerpos.
    - Evaluación de las células supresoras de origen mieloide (CSOM).
    - Secuenciación RTL de CMSP para diversidad y supuesta especificidad de antígenos.
    - Perfil de transcripción de genes inmunitarios de CMSP.
    - Evaluación de elementos proinflamatorios e inmunosupresores en tejido neoplásico y tejido sano adyacente, si es factible.
    - Tasa de respuesta objetiva (TRO) conforme a los criterios de evaluación de la respuesta en tumores sólidos (RECIST) versión 1.1, según la revisión del investigador, en sujetos que han recibido tratamiento anti-PD-1/PD-L1 anterior o cuya enfermedad ha evolucionado con este tratamiento (cohorte A).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Please refer to Table 1: Trial Schedule of Events of Protocol, where it summarizes the trial procedures to be performed at each visit
    Véase la Tabla 1 del Protocolo: Calendario de eventos del estudio, dónde se recumen los procedimientos del estudio que se realizan en cada visita
    E.5.2Secondary end point(s)
    - Objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by investigator review for treatment naïve, cisplatin-ineligible subjects (cohort B)
    - ORR by immune RECIST (iRECIST) for both cohorts

    - Duration of Response (DoR) for both cohorts

    - Progression Free Survival (PFS) as assessed by RECIST version 1.1 and iRECIST for both cohorts
    - Overall Survival (OS) for both cohorts
    - Tasa de respuesta objetiva (TRO) conforme a los criterios de evaluación de la respuesta en tumores sólidos (RECIST) versión 1.1, según la revisión del investigador, para el tratamiento de sujetos que no pueden recibir cisplatino y sin tratamiento previo (cohorte B).
    - TRO conforme a los criterios RECIST inmunológicamente modificados (iRECIST) para ambas cohortes.
    - Duración de la respuesta (DdR) para ambas cohortes.
    - Supervivencia sin progresión (SSP) según los criterios RECIST versión 1.1 e iRECIST para ambas cohortes.
    - Supervivencia general (SG) para ambas cohortes.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Please refer to Table 1: Trial Schedule of Events of Protocol, where it summarizes the trial procedures to be performed at each visit
    Véase la Tabla 1 del Protocolo: Calendario de eventos del estudio, dónde se recumen los procedimientos del estudio que se realizan en cada visita
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Immunogenicity
    Inmunogenicidad
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans Yes
    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) 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 trial2
    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 concerned8
    E.8.5The trial involves multiple Member States No
    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
    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
    LPLV
    UVUS
    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 months11
    E.8.9.1In the Member State concerned days3
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months11
    E.8.9.2In all countries concerned by the trial days3
    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: 85
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 43
    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 state28
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 28
    F.4.2.2In the whole clinical trial 85
    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)
    N/A
    N/A
    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 Decision2018-10-31
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-10-22
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2019-07-16
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