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    Summary
    EudraCT Number:2018-000347-60
    Sponsor's Protocol Code Number:TTD-18-01
    National Competent Authority:Portugal - INFARMED
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2018-09-07
    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 ConcernedPortugal - INFARMED
    A.2EudraCT number2018-000347-60
    A.3Full title of the trial
    Phase III randomized sequential open-label study to evaluate the efficacy of FOLFOX + panitumumab followed by FOLFIRI + bevacizumab (Sequence 1) versus FOLFOX + bevacizumab followed by FOLFIRI + panitumumab (Sequence 2) in untreated patients with wild-type RAS metastatic, primary left-sided, unresectable colorectal cancer: The CR-SEQUENCE
    Estudo de fase 3, aleatorizado, sequencial, aberto, para avaliar a eficácia de FOLFOX + panitumumab seguido de FOLFIRI + bevacizumab (Sequência 1) versus FOLFOX + bevacizumab seguido de FOLFIRI + panitumumab (Sequência 2) em doentes previamente não tratados, com cancro colorretal metastático não ressecável, com RAS tipo selvagem, com o tumor primário no lado esquerdo: CR-SEQUENCE
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Clinical trial to compare the efficacy of two treatment sequencing schemes with chemotherapy (the regime called FOLFOX and FOLFIRI) in combination with biologic drugs (panitumumab and bevacizumab).
    Ensaio clínico para comparar a eficácia de dois esquemas de sequenciamento de tratamento com quimioterapia (o regime denominado FOLFOX e FOLFIRI) em combinação com medicamentos biológicos (panitumumab e bevacizumab).
    A.3.2Name or abbreviated title of the trial where available
    CR-SEQUENCE
    CR-SEQUENCE
    A.4.1Sponsor's protocol code numberTTD-18-01
    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 SponsorGrupo de Tratamiento de los Tumores Digestivos
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportTTD
    B.4.2CountrySpain
    B.4.1Name of organisation providing supportAMGEN
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGrupo de Tratamiento de los Tumores Digestivos (TTD)
    B.5.2Functional name of contact pointInmaculada Ruiz de Mena
    B.5.3 Address:
    B.5.3.1Street AddressTéllez 30. First floor, office 4.2./4.3
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28007
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491 378 82 75
    B.5.5Fax number+3491 378 82 76
    B.5.6E-mailttd@ttdgroup.org
    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 Yes
    D.2.1.1.1Trade name Vectibix 20mgr/ml concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderAmgen Europe B.V
    D.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 INNPANITUMUMAB
    D.3.9.1CAS number 339177-26-3
    D.3.9.3Other descriptive nameVectibix
    D.3.9.4EV Substance CodeSUB25390
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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 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 Yes
    D.3.11.13.1Other medicinal product typeMonoclonal Antibody IgG2
    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.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 INNBEVACIZUMAB
    D.3.9.1CAS number 216974-75-3
    D.3.9.4EV Substance CodeSUB16402MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 INNOXALIPLATIN
    D.3.9.1CAS number 61825-94-3
    D.3.9.4EV Substance CodeSUB09490MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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: 4
    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.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 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 INNFolinic Acid
    D.3.9.1CAS number 1492-18-8
    D.3.9.4EV Substance CodeSUB13910MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    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: 5
    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.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 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 INN5- Fluorouracil
    D.3.9.1CAS number 51-21-8
    D.3.9.4EV Substance CodeSUB07721MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    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: 6
    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.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 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 INNIRINOTECAN
    D.3.9.1CAS number 97682-44-5
    D.3.9.4EV Substance CodeSUB08295MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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: 7
    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 Vectibix 20mgr/ml concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderAmgen Europe B.V
    D.2.1.2Country which granted the Marketing AuthorisationPortugal
    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 INNPanitumumab
    D.3.9.1CAS number 339177-26-3
    D.3.9.3Other descriptive nameVectibix
    D.3.9.4EV Substance CodeSUB25390
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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 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 Yes
    D.3.11.13.1Other medicinal product typeMonoclonal Antibody IgG2
    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
    metastatic colorectal cancer
    cancro colorretal metastático
    E.1.1.1Medical condition in easily understood language
    Cancer colorectal metastasico
    cancro colorretal metastático
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    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
    To compare the progression free survival rate (PFSR) at 36 months of FOLFOX + panitumumab followed by FOLFIRI + bevacizumab (Sequence 1) versus FOLFOX + bevacizumab followed by FOLFIRI + panitumumab (Sequence 2) in patients with wild-type RAS, primary left-sided, mCRC.
    Comparar a taxa de sobrevida sem progressão (PFSR - progression free survival rate) ao fim de 36 meses de FOLFOX + panitumumab seguido de FOLFIRI + bevacizumab (Sequência 1) com FOLFOX + bevacizumab seguido de FOLFIRI + panitumumab (Sequência 2) em doentes com CCRm com RAS tipo selvagem, com o tumor primário no lado esquerdo.
    E.2.2Secondary objectives of the trial
    To compare the overall survival rate at 36 months, the overall survival, total progression-free survival from randomization to second progression or death. To determine PFS in first-line and second-line treatment in each Sequence arm, time to first-line treatment failure and to second-line treatment failure in each Sequence arm. To evaluate the objective response rate in first and in second-line treatment in each Sequence arm. To determine the proportion of patients with Early Tumour in first and in second-line treatment. To evaluate Depth of Response in first and in second-line treatment in each Sequence arm, the disease control rate and the duration of disease control in first and in second-line treatment. To assess the duration of response in first and in second-line treatment in each Sequence arm, the time to response in first-line treatment and in second-line treatment in each Sequence arm, the safety and tolerability of both Sequence arms as first and as second line treatment.
    Comparar a taxa de sobrevida global ao fim de 36 meses,a sobrevida global, a sobrevida sem progressão total desde a aleatorização até à segunda progressão ou morte .Determinar a PFS no tratamento de primeira e de segunda linha em cada braços , tempo até à falha do tratamento de primeira até à falha do de segunda linha em cada braço das Sequências.Avaliar a taxa de resposta objetiva no tratamento de primeira e no de segunda linha.Determinar a proporção de doentes com redução precoce do tamanho do tumor no tratamento de primeira e no de segunda linha . Avaliar a profundidade da resposta no tratamento de primeira e no de segunda linha em cada braço, a taxa de controlo da doença e a duração do controlo da doença no tratamento de primeira e no de segunda linha, a duração da resposta no tratamento de primeira e no de segunda linha, o tempo até à resposta no tratamento de primeira e no de segunda linha, a segurança e a tolerabilidade dos braços como primeira e como de segunda linha.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1)Man or woman of at least 18 years old.
    2)Capable to understand, sign and date an informed consent approved by an IEC.
    3)Histologically confirmed adenocarcinoma of the left colon or rectum (originate in the splenic flexure, descending colon, sigmoid colon, or rectum) in patients with unresectable or non-potentially resectable (not amenable to radical surgery of metastases at the study inclusion) metastatic (M1) disease.
    4)Patients who had wild-type RAS status confirmed as per standard of care according to international guidelines prior to first-line initiation.
    *RAS analysis should include at least KRAS exons 2, 3 and 4 (codons 12, 13, 59, 61, 117 and 146) and NRAS exons 2, 3 and 4 (codons 12, 13, 59, 61 and 117).
    5)At least one measurable lesion per RECIST criteria (version 1.1).
    6)ECOG performance status < 2.
    7)Adequate bone marrow function: neutrophils ≥1.5 x109/ L; platelets ≥100 x109/L; haemoglobin ≥9 g/dL.
    8)Hepatic, renal and metabolic function as follows:
    -Total bilirubin count ≤1.5 x upper limit of normal (ULN), serum glutamic pyruvic transaminase/alanine aminotransferase (SGPT/ALT) and serum glutamic oxaloacetic transaminase/aspartate aminotransferase (SGOT/AST). ≤ 2.5 x ULN (5 x ULN for subjects with liver involvement of their cancer).
    -Renal function, calculated as creatinine clearance or 24-hour creatinine clearance ≥ 50 mL/min.
    1)Homem ou mulher pelo menos com 18 anos de idade.
    2)Capaz de compreender, assinar e datar um consentimento esclarecido aprovado por uma CEI.
    3)Adenocarcinoma, confirmado histologicamente, do cólon esquerdo ou do reto (com origem na flexura esplénica, cólon descendente, cólon sigmoide ou reto) em doentes com doença metastática (M1) não ressecável ou não potencialmente ressecável (a cirurgia radical de metástases na inclusão do estudo não é propícia).
    4)Doentes que tinham o estado do RAS tipo selvagem confirmado, com um padrão de cuidados de acordo com as normas de orientação internacionais antes do início do tratamento de primeira linha.
    *A análise do RAS deverá incluir pelo menos os exões 2, 3 e 4 do gene KRAS (codões 12, 13, 59, 61, 117 e 146) e os exões 2, 3 e 4 do gene NRAS (codões 12, 13, 59, 61 e 117).
    5)Pelo menos uma lesão mensurável segundo os critérios RECIST (versão 1.1).
    6)Estudo de desempenho segundo o ECOG < 2.
    7)Função adequada da medula óssea: neutrófilos ≥1,5x109/l; plaquetas ≥100x109/l; hemoglobina ≥9 g/dl.
    8)Função hepática, renal e metabólica como se segue:
    -Bilirrubina total ≤1,5 x o limite superior dos valores normais (LSN), transaminase glutâmico-pirúvica/alanina aminotransferase sérica (SGPT/ALT) e transaminase glutâmico-oxalacética/aspartato aminotransferase sérica (SGOT/AST). ≤2,5 x LSN (5 x LSN em indivíduos com envolvimento hepático do cancro).
    -Função renal calculada em função da depuração da creatinina ou da depuração da creatinina nas 24 horas ≥50 ml/min.

    E.4Principal exclusion criteria
    1) History of prior or concurrent central nervous system metastases.
    2) History of another primary cancer, except: curatively treated in situ cervical cancer, or curatively resected non-melanoma skin cancer, or other primary solid tumour curatively treated with no known active disease present and no treatment administered for ≥ 5 years before randomization.
    3) Prior chemotherapy or other systemic anticancer therapy for treatment of metastatic colorectal carcinoma (including adjuvant QT for resected stage IV disease).
    4) Prior adjuvant chemotherapy for colorectal cancer (stage I, II or III) terminated less than 6 months before metastatic disease was diagnosed.
    5) Unresolved toxicities of a previous systemic treatment that, in the opinion of the Investigator, make the patient unfit for inclusion.
    6) Prior use (as monotherapy or adjuvant treatment) of anti-EGFR antibody therapy (e.g. cetuximab), anti-VEGF or small-molecule tyrosine kinase inhibitors (e.g. regorafenib).
    7) Prior approved or experimental antitumoral treatment ≤ 30 days before inclusion. Hormonal sustitutive treatment is allowed
    8) Significant cardiovascular disease including unstable angina or myocardial infarction within 12 months before initiating study treatment; or history of ventricular arrhythmia.
    9) Uncontrolled hypertension.
    10) History of interstitial pneumonitis or pulmonary fibrosis or evidence of interstitial pneumonitis or pulmonary fibrosis on baseline chest computed tomography (CT).
    11) Treatment for systemic infection <14 days before the start of study treatment.
    12) Active acute or subacute intestinal occlusion and/or active inflammatory bowel disease or another bowel disease that causes chronic diarrhoea (defined as grade ≥ 2 diarrhoea according to NCICTCAE (version 4.03).
    13) Clinically significant peripheral sensory neuropathy.
    14) Evidence of previous acute hypersensitivity reaction, of any grade, to any component of the treatment.
    15) Known mutation in the UGT1A1 gene or known dihydropyrimidine deficiency syndrome.
    16) Recent (<6 months before the start of study treatment) gastroduodenal ulcer to be active or uncontrolled.
    17) Recent (<6 months before the start of study treatment) pulmonary embolism, deep vein thrombosis, or another significant thromboembolic
    event.
    18) Pre-existing bleeding diathesis and/or coagulopathy with exception of well-controlled anticoagulation therapy (<6 months before the start
    of study treatment)
    19) Recent (< 28 days prior to inclusion in the study)major surgical procedure (excluding diagnostic biopsy, placement of a central catheter, colonic stents, or any minor surgery), open biopsy, or significant traumatic injury not yet recovered from prior major surgery
    20) History of any disease that may increase the risks associated with study participation or may interfere with the interpretation of study results.
    21) Known positive test for human immunodeficiency virus infection, hepatitis C virus, and chronic active hepatitis B infection.
    22) Any disorder that compromises the patient's ability to provide written informed consent and/or comply with study procedures.
    23) Any investigational agent <30 days prior to inclusion.
    24) Pregnant or breastfeeding women.
    25) Full dose radiotherapy <28 days prior to inclusion in the study. Short course radiotherapy for local control of primary tumor or other
    palliative indication is allowed.
    26) Male or female of childbearing age who do not agree with taking adequate contraceptive precautions, i.e. use contraception double
    barrier (e.g. diaphragm plus condoms) or abstinence during the course of the study and for 6 months after the last administration of study drug
    for women and men.
    27) The patient is unwilling or unable to meet the requirements of the study.
    28) Psychological, geographical, familial or sociological conditions that potentially prevent compliance with the study protocol and follow-up schedule
    1)Antecedentes de metástases do sistema nervoso central anteriores ou coexistentes.
    2)Antecedentes de outro cancro primário exceto: cancro do colo do útero in situ submetido a tratamento curativo, cancro da pele, de tipo não melanoma, submetido a resseção curativa ou outro tumor sólido primário submetido a tratamento curativo sem doença ativa conhecida no momento presente e sem tratamento administrado no período de 5 anos ou mais antes da aleatorização.
    3)Quimioterapia ou outra terapêutica antineoplásica sistémica administrada anteriormente para o tratamento do carcinoma colorretal metastático (incluindo QT adjuvante para doença em estádio IV ressecada).
    4)Quimioterapia adjuvante anterior para o cancro colorretal (estadio I, II ou III) que terminou menos de 6 meses antes de ser diagnosticada a doença metastática.
    5)Toxicidades não resolvidas de um tratamento sistémico anterior que, no parecer do Investigador, tornam o doente inapto para inclusão.
    6)Utilização anterior (como monoterapia ou como tratamento adjuvante) de uma terapêutica com anticorpos anti-EGFR (p. ex. cetuximab), anti-VEGF ou com pequenas moléculas inibidoras de tirosina quinase (p. ex. regorafenib).
    7)Tratamento antitumoral anterior aprovado ou experimental, administrado ≤ 30 dias antes da inclusão. É permitido o tratamento hormonal de substituição.
    8)Doença cardiovascular significativa incluindo angina instável ou enfarte do miocárdio no período de 12 meses antes do início do tratamento do estudo ou antecedentes de arritmia ventricular.
    9)Hipertensão não controlada.
    10)Antecedentes de pneumonite intersticial ou de fibrose pulmonar ou sinais de pneumonite intersticial ou de fibrose pulmonar na tomografia axial computorizada (TAC) torácica inicial.
    11)Tratamento de uma infeção sistémica 14 dias antes do início do tratamento do estudo.
    12)Oclusão intestinal aguda ou subaguda ativa e/ou doença intestinal inflamatória ativa ou outra doença intestinal que causa diarreia crónica (definida como diarreia de grau ≥2 de acordo com a NCI-CTCAE versão 4.03).
    13)Neuropatia sensorial periférica clinicamente significativa.
    14)Evidência de reação anterior de hipersensibilidade aguda de qualquer grau, a qualquer um dos componentes do tratamento.
    15)Mutação conhecida no gene UGT1A1 ou síndrome de deficiência de di-hidropirimidina conhecida
    16)Úlcera gastroduodenal recente (< 6 meses antes do início do tratamento do estudo) ativa ou não controlada.
    17)Embolia pulmonar, trombose venosa profunda ou outro acontecimento tromboembólico significativo recentes (< 6 meses antes do início do tratamento do estudo).
    18)Diátese hemorrágica e/ou coagulopatia preexistentes com exceção de terapêutica anticoagulante bem controlada (< 6 meses antes do início do tratamento do estudo).
    19)Intervenção de grande cirurgia, (excluindo biópsia de diagnóstico, colocação de um cateter venoso central, stents de cólon ou qualquer cirurgia menor), biópsia aberta ou lesão traumática significativa que ainda não recuperou de grande cirurgia anterior, que ocorreram recentemente (< 28 dias antes da inclusão no estudo).
    20)Antecedentes de qualquer doença que pode aumentar os riscos associados à participação no estudo ou que pode interferir com a interpretação dos resultados do estudo.
    21)Teste positivo conhecido de infeção pelo vírus da imunodeficiência humana, pelo vírus da hepatite C e de infeção ativa crónica de hepatite B.
    22)Qualquer perturbação que comprometa a capacidade do doente para fornecer um consentimento esclarecido por escrito e/ou o cumprimento dos procedimentos do estudo.
    23)Qualquer agente em investigação administrado < 30 dias antes da inclusão.
    24)Mulheres grávidas ou a amamentar.
    25)Tratamento de dose completa de radioterapia <28 dias antes da inclusão no estudo. É permitido um ciclo curto de radioterapia para controlo local do tumor primário ou outra indicação paliativa.
    26)Homens ou mulheres em idade fértil que não concordam com a utilização de precauções contracetivas adequadas, isto é, utilização de dupla barreira contracetiva (p. ex., diafragma mais preservativos) ou abstinência durante o período do estudo, e durante 6 meses após a última administração do medicamento do estudo em mulheres e homens.
    27)O doente não deseja ou não é capaz de satisfazer os requisitos do estudo.
    28)Condições psicológicas, geográficas, familiares ou sociológicas que impedem potencialmente o cumprimento do protocolo do estudo e o programa de seguimento.

    E.5 End points
    E.5.1Primary end point(s)
    •36-month PFSR defined as the number of patients, who at 36 months after randomization, have nothad second† or first†† disease progression nor died (due to any cause), over the total number of evaluable patients.
    † In patients who have initiated the second line-treatment after a first progression
    †† In patients who have not initiated the second line-treatment because a first disease progression has not been observed or patients who for medical reason have initiated the second line-treatment without a first progression
    •PFSR aos 36 meses, definida como o número de doentes que, 36 meses após a aleatorização, não tiveram segunda† ou primeira†† progressão da doença nem morreram (devido a qualquer causa), no número total de doentes avaliáveis.
    † Em doentes que iniciaram a segunda linha de tratamento após a primeira progressão
    †† Em doentes que não iniciaram a segunda linha de tratamento porque não se observou uma primeira progressão da doença ou em doentes que, por razões médicas, iniciaram a segunda linha de tratamento sem uma primeira progressão
    E.5.1.1Timepoint(s) of evaluation of this end point
    75 months
    75 meses
    E.5.2Secondary end point(s)
    36-month OSR defined as the number of patients who at 36 months after randomization have not died over the total number of evaluable patients.
    OS defined as the time from randomization to the date of death (due to any cause), with patients alive or lost to follow-up at the analysis data cut-off date censored at their last contact date.
    Total PFS defined as the time from randomization to second disease progression (i.e. progression during the second-line treatment)* or death (due to any case). Patients who start a new antitumoral treatment different to specified in the protocol will be considered censored at date of last tumor assessment. Patients with surgery of tumor will be follow to PFS until documented progression disease or death for any cause. Patients lost to follow will be censored at date of last tumor assessment.
    *Total PFS will be defined as the sum of PFSs in first-line treatment and in second-line treatments. If a patient does not initiate second-line treatment, the Total PFS for that patient will be equal to the PFS in first-line treatment.
    PFS in first-line treatment defined as the time from randomization to disease progression or death (due to any cause) during first-line treatment. Patients who start a new antitumoral treatment different to specified in the protocol will be considered censored at date of last tumor assessment. Patients with surgery of tumor or other therapeutic procedures with curative intent will be followed for PFS until documented progression disease or death for any cause. Patients lost to follow up will be censored at date of last tumor assessment .
    PFS in second-line treatment defined as the time from the date of second-line treatment initiation to disease progression or death (due to any cause) during second-line treatment.
    Patients who start a new antitumoral treatment different to what is specified in the protocol will be considered censored at the date of last tumor assessment. Patients undergoing surgery with curative intent will be followed for PFS until documented progression disease or death for any cause. Patients lost to follow up will be censored at the date of last tumor assessment.
    Time to first-line treatment failure defined as the time form randomization to disease progression, death (due to any cause) or discontinuation due to toxicity during first-line treatment.
    Time to second-line treatment failure defined as the time from the date of second-line treatment initiation to disease progression, death (due to any cause) or discontinuation due to toxicity during second-line treatment.
    Proportion of patients with an objective response (complete or partial response) per Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 criteria in first-line treatment and in second-line treatment.
    Proportion of patients with ETS in first-line treatment and in second-line treatment. ETS will be defined as a reduction in tumour size ≥30% (RECIST 1.1 criteria) at the first evaluation (i.e. week 12)
    DpR measured as the maximum decrease in target measurement (RECIST 1.1 criteria) during the complete course of evaluation in first-line treatment and in second-line treatment.
    Proportion of patients with disease control (complete, partial response or stable disease) in first-line treatment and in second-line treatment.
    Duration of disease control defined as time from first confirmed disease control to disease progression per RECIST 1.1 criteria or death (due to any cause) in first-line treatment and in second-line treatment. For patients with disease control who have not progressed or died at last observation, duration of disease control will be censored at their last evaluable disease assessment date.
    Duration of response defined as time from first confirmed objective response to disease progression per RECIST 1.1 criteria or death in first-line treatment and in second-line treatment. For patients with response who have not progressed or died at last observation, duration of response will be censored at their last evaluable disease assessment date.
    Time to response in first-line treatment defined as the time from randomization to the date of first confirmed objective response per RECIST 1.1 criteria during first-line treatment.
    Time to response in second-line treatment defined as the time from the date of second-line treatment initiation to the date of first confirmed objective response per RECIST 1.1 criteria during second-line treatment.
    Safety assessment will consist of monitoring adverse events (AEs), including AEs of special interest, serious AEs (SAEs) and laboratory safety parameters. AEs will be graded according to National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4.03.
    OSR aos 36 meses, definida como o nº doentes que 36 meses após a aleatorização não morreram, no nº total doentes avaliáveis.
    OS, definida como o tempo desde a aleatorização até à data da morte (por qualquer causa), com doentes vivos ou perdidos para o seguimento na data limite do fecho dados para análise, recenseados na última data contacto.
    PFS total, definida como o tempo desde a aleatorização até à 2ª progressão doença (isto é, progressão durante o tratamento 2ª linha)* ou morte (por qualquer causa). Os doentes que iniciam um novo tratamento antitumoral diferente do especificado no protocolo serão considerados censurados na data da última avaliação tumoral. Os doentes com cirurgia ao tumor serão seguidos quanto à PFS até progressão doença documentada ou morte por qualquer causa. Os doentes perdidos no seguimento serão censurados na data da última avaliação tumoral. A PFS total será definida como a soma das PFS nos tratamentos de 1ª e de 2ª linha. Se um doente não iniciar o tratamento 2ª linha, a PFS total desse doente será igual à PFS do tratamento 1ª linha.
    PFS no tratamento 1ª linha, definida como o tempo desde a aleatorização até à progressão da doença ou morte (por qualquer causa) durante o tratamento 1ª linha. Os doentes que iniciam um novo tratamento antitumoral diferente do especificado no protocolo serão considerados censurados na data da última avaliação tumoral. Os doentes com cirurgia ao tumor ou outros procedimentos terapêuticos com intenção curativa serão seguidos quanto à PFS até progressão da doença documentada ou morte por qualquer causa. Os doentes perdidos no seguimento serão censurados na data da última avaliação tumoral.
    PFS no tratamento de 2ª linha, definida como o tempo desde a data do início do tratamento 2ª linha até à progressão doença ou morte (por qualquer causa) durante o tratamento 2ª linha. Os doentes que iniciam um novo tratamento antitumoral diferente do especificado no protocolo serão considerados censurados na data da última avaliação tumoral. Os doentes submetidos a cirurgia com intenção curativa serão seguidos quanto à PFS até progressão da doença documentada ou morte por qualquer causa. Os doentes perdidos no seguimento serão censurados na data da última avaliação tumoral.
    Tempo até à falha do tratamento 1ª linha, definido como o tempo desde a aleatorização até à progressão da doença, morte (por qualquer causa) ou descontinuação devida a toxicidade durante o tratamento 1ª linha.
    Tempo até à falha do tratamento 2ª linha, definido como o tempo desde a data do início do tratamento 2ª linha até à progressão doença, morte (por qualquer causa) ou descontinuação devida a toxicidade durante o tratamento 2ª linha.
    Proporção de doentes com uma resposta objetiva (resposta completa ou parcial) segundo os critérios de avaliação da resposta em tumores sólidos (RECIST) 1.1 no tratamento 1ª linha e de 2ª linha.
    Proporção de doentes com ETS no tratamento 1ª linha e de 2ª linha. A ETS será definida como uma redução do tamanho do tumor ≥30% (critérios RECIST 1.1) na 1ª avaliação (isto é, semana 12)
    DpR, medida como a diminuição máxima da medição predefinida (critérios RECIST 1.1) durante o procedimento completo de avaliação no tratamento 1ª linha e 2ª linha.
    Proporção de doentes com controlo da doença (resposta completa, resposta parcial ou doença estável) no tratamento 1ª linha e 2ª linha.
    Duração do controlo da doença, definida como o tempo desde o 1º controlo confirmado da doença até à progressão doença segundo os critérios RECIST 1.1 ou até à morte (por qualquer causa) no tratamento 1ª linha e de 2ª linha. No caso de doentes com controlo da doença que não progrediram ou morreram na altura da última observação, a duração do controlo da doença será determinada na última data de avaliação da doença estimável.
    Duração da resposta, definida como o tempo desde a 1ª resposta objetiva confirmada até à progressão doença segundo os critérios RECIST 1.1 ou até à morte no tratamento 1ª linha e 2ª linha. No caso de doentes com resposta que não progrediram ou morreram na altura da última observação, a duração da resposta será determinada na última data de avaliação da doença estimável.
    O tempo até à resposta no tratamento primeira linha, definido como o tempo desde a aleatorização até à data da 1ª resposta objetiva confirmada segundo os critérios RECIST 1.1 durante o tratamento 1ª linha.
    Tempo até à resposta no tratamento 2ª linha, definido como o tempo desde a data de início do tratamento 2ª linha até à data da 1ª resposta objetiva confirmada segundo os critérios RECIST 1.1 durante o tratamento de 2ª linha.
    A avaliação da segurança consistirá na monitorização de acontecimentos adversos (AAs), incluindo AAs de interesse especial, graves (AAGs) e nos parâmetros laboratoriais da segurança. Os AAs serão classificados de acordo com os critérios de terminologia comuns para os AA do National Cancer Institute - Common Terminology Criteria for Adverse Events) versão 4.03.
    E.5.2.1Timepoint(s) of evaluation of this end point
    75 months
    75 meses
    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 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 No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the 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 concerned11
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA64
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    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
    The trial will end 36 months after the inclusion of the last patient
    O julgamento terminará 36 meses após a inclusão do último paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years
    E.8.9.1In the Member State concerned months75
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial months75
    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: 316
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 100
    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 state100
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 416
    F.4.2.2In the whole clinical trial 416
    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 Decision2019-01-16
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-12-10
    P. End of Trial
    P.End of Trial StatusOngoing
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