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    Summary
    EudraCT Number:2018-000392-33
    Sponsor's Protocol Code Number:AML1718
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Trial now transitioned
    Date on which this record was first entered in the EudraCT database:2021-06-17
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2018-000392-33
    A.3Full title of the trial
    A Safety Run-in and phase II, open-label, multicentre, study investigating safety, tolerability and effectiveness of Venetoclax add in combination at Fludarabine, Cytarabine and Idarubicine in induction therapy of new onset non-m3 acute myeloid leukemia.
    Run-in di Sicurezza e Studio di Fase II in Aperto, Multicentrico, su Sicurezza, Tollerabilità ed Efficacia del Venetoclax in combinazione con Fludarabina, Citarabina e Idarubicina in induzione nella Leucemia Mieloide Acuta non-M3 di nuova diagnosi
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to determine safety, efficacy and tolerability of Venetoclax in combination with Fludarabine, Citarabine and Idarubicin to achieve "the absence of disease" in newly diagnosed Acute Myeloid Leukemia not classified as low risk that is there is an intermediate risk or high that the disease recurs
    Studio per determinare la sicurezza, l'efficacia e la tollerabilità di Venetoclax in combinazione con Fludarabina, Citarabina e Idarubicina per ottenere "l'assenza di malattia" nella Leucemia Mieloide Acuta di nuova diagnosi classificata non a basso rischio cioè che esiste un rischio intermedio o alto che la malattia si ripresenti.
    A.3.2Name or abbreviated title of the trial where available
    V-FIRST
    V-FIRST
    A.4.1Sponsor's protocol code numberAML1718
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN00000000
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03455504
    A.5.3WHO Universal Trial Reference Number (UTRN)U0000-0000-0000
    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 SponsorFONDAZIONE GIMEMA (GRUPPO ITALIANO MALATTIE EMATOLOGICHE DELL' ADULTO) FRANCO MANDELLI ONLUS
    B.1.3.4CountryItaly
    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 supportAbbVie S.r.l
    B.4.2CountryItaly
    B.4.1Name of organisation providing supportA.I.L. Associazione Italiana contro le Leucemie
    B.4.2CountryItaly
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationFondazione G.I.M.EM.A Franco Mandelli Onlus
    B.5.2Functional name of contact pointCentro Dati
    B.5.3 Address:
    B.5.3.1Street AddressVia Casilina 5
    B.5.3.2Town/ cityRoma
    B.5.3.3Post code00182
    B.5.3.4CountryItaly
    B.5.4Telephone number0670390526
    B.5.5Fax number0670390540
    B.5.6E-mailgimema@gimema.it
    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 VENCLYXTO - 100 MG - COMPRESSA RIVESTITA CON FILM - USO ORALE - BLISTER (PVC/PE/PCTFE-ALU) - 14 (7X2) COMPRESSE (DOSE UNITARIA)
    D.2.1.1.2Name of the Marketing Authorisation holderABBVIE LTD
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEMA/OD/205/15
    D.3 Description of the IMP
    D.3.1Product nameVenclyxto
    D.3.2Product code [NA]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.9.2Current sponsor codeNA
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number600
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Acute Myeloid Leukemia
    Leucemia Mieloide Acuta
    E.1.1.1Medical condition in easily understood language
    Disease that originates from bone marrow and progresses rapidly (acute). White and red blood cells and platelets becoming "adults" can undergo a transformation in a tumor sense.
    Malattia che origina dal midollo osseo e che progredisce velocemente (acuta). I globuli bianchi, rossi e piastrine diventando "adulti" possono andare incontro a una trasformazione in senso tumorale.
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10000880
    E.1.2Term Acute myeloid leukaemia
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objectives of the study are:
    - To determine efficacy of Venetoclax added in combination with chemotherapy in obtaining
    Complete remission (CR + CRi + CRp) in new onset, non ELN Low risk AML (safety run-in,
    part1, and part2).
    Co-primary objectives:
    - Determine safety of combination of Venetoclax and FLAI scheme (safety run-in)
    - Determine best dose of the tested compound in combination (part 1)
    Gli obiettivi primari dello studio sono:
    - Determinare l’efficacia di Venetoclax in combinazione con chemioterapia per l’ottenimento della remissione completa (CR + CRi + CRp) nella AML di nuova diagnosi, non a basso rischio ELN (Run-in di sicurezza, parte1 e parte 2).
    Obiettivi co-primari:
    - Determinare la sicurezza della combinazione di Venetoclax con lo schema FLAI (Run in di sicurezza)
    - Determinare la dose ottimale del farmaco testato in combinazione (parte 1).
    E.2.2Secondary objectives of the trial
    -Establish survival of the treatment population (run-in, part1, and part 2) in term of: 1) Overall Survival as the time between diagnosis and death or last follow-up 2)Disease Free Survival as the time between complete remission and relapse or death for any cause or last follow-up visit
    - Define treatment safety and incidence of adverse events (run-in, part1, and part 2)
    - Define the number of patient that will have a transplant (run-in, part1, and part2)
    - Determine the pharmacokinetic parameters of the tested compound in combination with chemotherapy (run-in and part 1)
    - Determine the pharmacodynamics parameters of the tested compound in combination with chemotherapy (run-in and part 1)
    - Determine safety and effectiveness of long term maintenance with venetoclax (run-in, part1 and part 2)
    -Describe the role of MRD determination with specific fusion genes or specific gene mutation (run-in, part 1 and part 2)
    -Stabilire la sopravvivenza della popolazione di trattamento (run-in, parte 1 e parte 2) in termini di: 1) Sopravvivenza generale come il tempo tra diagnosi e morte o ultimo follow-up 2) Sopravvivenza libera da malattia come il tempo tra remissione completa e ricaduta o morte per qualsiasi causa o ultima visita di controllo
    -Definire la sicurezza del trattamento e l'incidenza di eventi avversi (run-in, parte 1 e parte 2)
    - Definire il numero di pazienti che avranno un trapianto (run-in, parte1 e parte2)
    - Determinare i parametri farmacocinetici del composto testato in combinazione con
    chemioterapia (run in e parte 1)
    - Determina i parametri farmacodinamici del composto testato in combinazione con la chemioterapia (run in e parte 1)
    - Determinare la sicurezza e l'efficacia della manutenzione a lungo termine con Venetoclax (run-in, parte 1 e parte 2)
    - Descrivere il ruolo della determinazione MRD con specifici geni di fusione o specifiche mutazioni geniche (run-in, parte 1 e parte 2)
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Pharmacogenetics
    Version: V. 1.0
    Date: 27/02/2018
    Title: Translational Reseach

    Objectives: To identify and/or evaluate PD biomarkers and other biomarkers that may help predict patient subpopulations that are more likely to respond to the therapies in this study. These assessments may be performed onprotein, nucleic acid and other tissue derived markers related to the mechanism of action of the study drug, which include, but are not limited to markers of BCL-2 and IDH2 alterations. Additional markers will be measured in case strong scientific rationale for these analyses develops.

    Life quality
    Version: 1.0
    Date: 27/02/2018
    Title: Quality of Life and Health Technology Assessment
    Objectives: The primary objective of the QoL assessment is the description of QoL profile over time.
    The secondary objectives of the analysis will be: 1) to investigate the baseline (i.e. pre-treatment)
    predictive and prognostic value for CR and OS respectively; 2) To depict the baseline patients’ QoL
    profile in relation to clinical and laboratory values (including cytogenetic data).

    Farmacogenetica
    Versione: V. 1.0
    Data: 27/02/2018
    Titolo: Ricerca Traslazionale
    Obiettivi: Identificare e/o valutare i biomarcatori PD e altri biomarker che possono aiutare a predire le sottopopolazioni dei pazienti più propensi a rispondere alle terapie in questo studio. Queste valutazioni possono essere eseguite su proteine, acido nucleico e altri marcatori derivati ¿¿dal tessuto correlati al meccanismo di azione delfarmaco in studio, che includono, ma non sono limitati a marcatori di alterazioni BCL-2 e IDH2. Markers addizionali saranno misurati nel caso in cui si sviluppino forti motivazioni scientifiche per queste analisi.

    Qualita' della vita
    Versione: 1.0
    Data: 27/02/2018
    Titolo: Valutazione della Qualità della vita e della Tecnologia Sanitaria
    Obiettivi: L'obiettivo principale della valutazione della QoL è la descrizione del profilo QoL nel tempo.
    Gli obiettivi secondari dell'analisi saranno: 1) studiare al baseline (cioè il pre-trattamento)
    il valore predittivo e prognostico rispettivamente per CR e OS; 2) Rappresentare al baseline il profilo di QoL dei pazienti in relazione ai valori clinici e di laboratorio (compresi i dati citogenetici).
    E.3Principal inclusion criteria
    - Patients with newly diagnosed non-m3 acute myeloid leukemia documented / confirmed according to WHO 2017 diagnostic criteria
    - The haematological pathology must be classified as intermediate or high risk according to the ELN criteria
    - Patients between the ages of 18 and 65
    - ECOG Performance Status = 2
    - Patients with life expectancy> 12 weeks
    - Patients may have Acute Myeloid Leukemia arising after previous treatment or other antecedent pathology
    - Adequate hepatic function as established by the following criteria: 1) Total serum bilirubin = 2 above the normal limit, if not considered for Gilbert's syndrome or a hepatic infiltration of leukemia 2) Alanine aminotransferase (ALT) =2.5 higher at the normal limit (or below the limit of normality of the reference laboratory, in the case of hepatic leukemia infiltration) 3) Aspartate aminotransferase (AST) =2.5 higher than the normal limit (or = 5 higher than the normal limit of the reference case, in case of hepatic infiltration of leukemia) 4) Adequate pancreatic function as established by the following criterion: serum lipase and amylase =2 higher than the normal limit
    - Adequate renal function, principle based on: serum creatinine in the reference laboratory or creatinine clearance (based on the Cockcroft Gault formula) = 50 ml / min for patients in whom, according to the Investigator's judgment, the level of serum creatinine may not reflect renal function
    - All non-haematological adverse events should be resolved to = 2 NCI-CTCAE, prior to initiation of therapy.
    - Patients should be considered suitable by the Investigator to receive the chemotherapy combination.
    - The chemotherapy combination should not be considered toxic without waiting for a benefit for the patient
    - For women of child-bearing potential, a negative pregnancy test must be documented within 72 hours prior to the first study drug administration
    - All patients should be willing to use effective contraception during the treatment period and for the next 100 days after the last dose of Venetoclax. Women must be post-menopausal (= 1 year of amenorrhea), surgically sterile, or have to consent to the use of 2 contraceptive methods with at least one method with a failure rate = 1% per year (eg hormonal devices, contraceptives combined oral, partners with vasectomies) and as a second, preferably a contraceptive barrier method. Oral or injectable contraceptive instruments can not be used as the only method. Male patients must be surgically sterile to consent to use an acceptable method of contraception.
    - Ability to understand and availability to sign informed consent.
    - The subject must voluntarily sign and date informed consent, approved by an Independent Ethics Committee (IEC) / Institutional Review Board (IRB), prior to the start of any screening or study-specific procedure
    -Pazienti con leucemia mieloide acuta non-m3 di nuova diagnosi documentata/confermata, secondo i criteri diagnostici WHO 2017
    - La patologia ematologica deve essere classificata come intermedia o ad alto rischio in accordo con i criteri ELN
    - Pazienti di età compresa tra i 18 ed i 65 anni
    - ECOG performance status = 2
    - Pazienti con aspettativa di vita > 12 settimane
    - I pazienti possono avere una Leucemia Mieloide Acuta insorta dopo precedenti terapie o altra patologia antecedente
    - Adeguata funzionalità epatica come stabilito dai seguenti criteri: 1) Bilirubina sierica totale =2 superiore al limite di normalità, se non considerata dovuta alla Sindrome di Gilbert o ad un’infiltrazione epatica della leucemia 2) Alanina aminotransferasi (ALT) =2.5 superiore al limite di normalità (o = 5 superiore al limite di normalità del range del laboratorio di riferimento, nel caso di infiltrazione epatica della leucemia) 3) Aspartato aminotransferasi (AST) =2.5 superiore al limite di normalità (o = 5 superiore al limite di normalità del range del laboratorio di riferimento, nel caso di infiltrazione epatica della leucemia) 4) Adeguata funzionalità pancreatica come stabilito dal seguente criterio: lipasi e amilasi sieriche =2 superiore al limite di normalità
    - Adeguata funzionalità renale, valutata in base a: creatinina sierica all’interno dei range del laboratorio di riferimento o clearance della creatinina (in base alla formula di Cockcroft Gault) = 50 mL/min per i pazienti nei quali, in base al giudizio dello Sperimentatore, il livello di creatinina sierica può non riflettere adeguatamente la funzionalità renale
    - Tutti gli eventi avversi non-ematologici devono essere risolti fino al Grado = 2 NCI-CTCAE, prima dell’inizio della terapia.
    - I pazienti devono essere ritenuti idonei dallo Sperimentatore a ricevere la combinazione chemioterapica.
    - La combinazione chemioterapica non deve essere considerata tossica senza l’attesa di un beneficio per il paziente
    - Per le donne in età fertile, deve essere documentato un test di gravidanza negativo nelle 72 ore antecedenti la prima somministrazione di farmaco in studio
    - Tutti i pazienti devono essere disposti ad utilizzare metodi contraccettivi efficaci durante il periodo di trattamento e per i successivi 100 giorni dopo l’ultima dose di Venetoclax. Le donne devono essere in post menopausa (= 1 anno di amenorrea), chirurgicamente sterili, oppure devono acconsentire all’uso di 2 metodi contraccettivi con almeno un metodo con una percentuale di fallimento = 1% all’anno (per esempio dispositivi ormonali, contraccettivi orali combinati, partner con vasectomia) e come secondo preferibilmente un metodo anticoncezionale di barriera. Strumenti contraccettivi orali o iniettabili non possono essere adottati come unico metodo. I pazienti maschi devono essere chirurgicamente sterili ed acconsentire ad utilizzare un metodo contraccettivo accettabile.
    - Capacità di intendere e disponibilità a firmare il consenso informato.
    - Il soggetto deve firmare e datare volontariamente il consenso informato, approvato da un Comitato Etico Indipendente (IEC)/Institutional Review Board (IRB), prima dell’inizio di qualsiasi procedura di screening o studio-specifica.
    E.4Principal exclusion criteria
    - Patients with low risk AML according ELN criteria
    - Patients with current clinical evidence of CNS leukemia.
    -Patients with myeloproliferative syndromes assessed by bone marrow biopsy
    -AML supervening after antecedent myelodysplastic syndromes of more than 6 months duration
    -Any patient with an history of neoplastic disease with the exception of:
    a. patients with non-melanoma skin cancer or stage I cancer who do not received systemic chemotherapy or radiation whom cancer where completely removed from at least 1 year
    a.b. patients who are alive, in complete remission and with no evidence of the neoplasia from at least 5 years

    - Patients receiving any other investigational or commercial agents or therapies administered with the intention to treat their malignancy with the exception of Hydroxyurea (HU) or 6-Mercaptopurine (6MP) in patients who need to continue this agent to maintain WBC count =10,000/mm3. HU and 6MP must be discontinued at the time of initiation of study medications.
    - Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study including but not limited at: unstable angina, symptomatic or otherwise uncontrolled arrhythmia requiring medication (does not include stable, lone atrial fibrillation), QTcF = 480 msecs based on the average of 3 screening ECG’s, uncontrolled hypertension, symptomatic congestive heart failure (NYHA III, IV), ejection fraction <40, serious uncontrolled cardiac arrhythmia, cerebrovascular accidents = 6 months before study treatment start, any active (acute or chronic) or uncontrolled infection/disorders that impair the ability to evaluate the patient or for the patient to complete the study.
    - Patients who are on anti-microbial agents with therapeutic intent for the following conditions: Fungal infection with visceral involvement, other than mucosal candidiasis, with = 2 weeks of appropriate systemic antifungal therapy, Bacterial infection with positive blood cultures in the 7 days prior to dosing or with= 5 days of appropriate therapeutic antibiotic therapy, Neutropenic fever considered infection-related within 72h prior to dosing, Infection considered by the investigator to be clinically uncontrolled or at unacceptable risk to the patient upon induction of neutropenia
    - Patients with nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by this study treatment, such as, severe diabetes mellitus that is not controlled with medical management.
    - Patients with evidence of electrolyte imbalance such as hypokalemia,
    hyperkalemia, hypocalcemia, hypercalcemia (corrected for serum albumin
    level), hypomagnesemia, and hypomagnesemia of Grade = 2, as per NCICTCAE,
    version 5 which cannot be corrected prior to study initiation.
    - Patients with creatinine clearance <40ml/min (crokoft-grault calculation will
    be consider reliable for patients <65 years and with no history of renal
    diseases)
    - Patients who must receive strong CYP3A4 inducers or moderate/strong
    CYP3A4 inhibitors while on study except for antifungal prophylaxis.
    - HIV-positive patients receiving combination anti-retroviral therapy.
    - Patients who refuse to potentially receive blood products and/or have
    a hypersensitivity to blood products.
    - Patients with a history of active or chronic infectious hepatitis unless serology
    demonstrates clearance of infection.
    - Patients who have a history of liver cirrhosis by radiologic, clinical or
    laboratory data, or biopsy despite normal liver function tests.
    - Patients who have had prior BCL-2 antagonists.
    - Pregnant or breast feeding patients.
    - Patients with reproductive potential not willing to use effective methods of contraception.
    - Pt a basso rischio AML in accordo con i criteri ELN
    - Pt con evidenza clinica di leucemia nel SNC in corso.
    - Pt con sindromi mieloproliferative diagnosticata mediante biopsia del midollo osseo
    - AML secondarie a precedenti sindromi mielodisplastiche di durata maggiore di 6 mesi
    - Pt con una storia di malattia neoplastica con l’eccezione di:
    - pt con cancro della pelle (eccetto il melanoma) o cancro in stadio I che non abbiano ricevuto chemioterapia sistemica o radiazioni e il cui cancro sia stato completamente rimosso da almeno 1 anno
    - pt vivi, in remissione completa e senza evidenza della neoplasia da almeno 5 anni
    - Pt che stanno ricevendo farmaci sperimentali o in commercio o terapie somministrate con lo scopo di trattare la loro patologia ad eccezione di Idrossiurea (HU) o 6-Mercaptopurina (6MP) nei pazienti che necessitano di mantenere il numero di globuli bianchi =10,000/mm3. HU e 6MP devono essere interrotti nel momento in cui inizia il trattamento con i farmaci in studio
    - Pt che hanno condizioni mediche gravi e/o non controllate o altre condizioni che possano influenzare la loro partecipazione allo studio, a titolo esemplificativo ma non esaustivo:
    - Angina instabile, aritmia sintomatica o comunque non controllata, che richieda trattamento (escluso la fibrillazione atriale isolata, stabile), QTcF = 480 msec sulla base della media di 3 screening con ECG , ipertensione non controllata, insufficienza cardiaca congestizia sintomatica (NYHA III, IV), frazione di eiezione < 40, aritmia cardiaca grave non controllata, evento cerebrovascolare nei 6 mesi prima dell’inizio del trattamento in studio, qualsiasi infezione/disordine in corso (acuto o cronico) o non controllato che comprometta la possibilità di valutare il paziente o che impedisca al paziente di completare lo studio.
    - Pt che assumono farmaci antimicrobici per trattare le seguenti condizioni: Infezione fungina con coinvolgimento viscerale, oltre a candidosi della mucosa, con terapia antifungina appropriata per via sistemica inferiore o uguale alle due settimane, Infezione batterica con colture ematiche positive nei 7 giorni prima del dosaggio o con = 5 giorni di terapia antibiotica appropriata, febbre neutropenica ritenuta infezione-correlata nelle 72 ore prima del dosaggio, infezione valutata dallo sperimentatore come non controllata o ad un rischio inaccettabile per il paziente dopo induzione della neutropenia
    - Pt con patologie non maligne che sono non controllate o il cui controllo può essere compromesso dal trattamento in studio, come ad esempio diabete mellito grave che non è controllato dalla terapia medica
    - Pt con evidenza di squilibrio elettrolitico come ipokaliemia, iperkaliemia, ipocalcemia, ipercalcemia (corretta per il livello di albumina sierica), ipomagnesemia, e ipomagnesemia di grado = 2, secondo NCI-CTCAE, versione 5 che non può essere corretta prima dell’inizio dello studio
    - Pt con la clearance della creatinina <40ml/min (il calcolo Cockcroft-Gault sarà considerato affidabile per pazienti con età <65 anni e senza una storia clinica di patologie renali)
    - I pt che devono ricevere forti induttori del CYP3A4 o inibitori moderati/forti del CYP3A4 nel corso dello studio ad eccezione della profilassi antifungina
    - I pt HIV-positivi che ricevono una terapia anti-retrovirale combinata
    - Pazienti che rifiutano la possibilità di ricevere emoderivati e/o hanno un’ipersensibilità agli emoderivati
    - Pazienti con una storia di epatite attiva o cronica a meno che gli esami sierologici dimostrino l’eliminazione dell’infezione
    - Pazienti che hanno una storia di cirrosi epatica evidenziata dai dati radiologici, clinici o di laboratorio o dalla biopsia, nonostante i test di funzionalità epatica siano normali
    - Pazienti che hanno ricevuto in precedenza BCL-2 antagonisti
    - Pazienti in gravidanza o allattamento
    - Pazienti potenzialmente fertili che non acconsentano all’uso di metodi contraccettivi efficaci.
    E.5 End points
    E.5.1Primary end point(s)
    Primary end point is % of CR (CR + CRi + CRp) after course 1 or course 2 if course 2 is administered
    L’Endpoint primario è la percentuale di CR dopo il il ciclo 1 o il ciclo 2, nel caso in cui il ciclo 2 sia effettuato (CR + CRi + CRp).
    E.5.1.1Timepoint(s) of evaluation of this end point
    After course 1 or course 2 if course 2 is administered
    Dopo il il ciclo 1 o il ciclo 2, nel caso in cui il ciclo 2 sia effettuato (CR + CRi + CRp).
    E.5.2Secondary end point(s)
    - Incidence time and nature of any adverse event.
    - Severe effect related to treatment safety is defined as an adverse event occurring within the first
    cycle, judged to be related to treatment and meeting any of the following criteria: 1) Grade 3 non- hematological toxicity lasting more than 7 days.
    2) Grade 4 non- hematological toxicity.
    -DLT as any grade 4 non-infective and non-hematologic adverse event that for the experience of
    the investigator cannot be due to FLAI chemotherapy alone and any grade 5 adverse event
    -Incidence, severity, seriousness and treatment-causality of Treatment Emergent Signs and
    Symptoms.
    -Frequency of clinically significant abnormalities in physical examination, safety laboratory tests,
    vital signs and 12-Lead ECG.
    -TLS occurred during or after protocol or transplant procedures for up to 1 years.
    -Description of patient-reported QoL over time; -Overall Survival (OS), defined as the number of days between the first study drug administration
    and death from any cause.
    -Event Free Survival (EFS), defined as the number of days between the first study drug
    administration and any event including disease progression or death
    -Cumulative incidence of relapse
    -MRD negativity after each course; -Plasma concentration of Venetoclax
    -The PD outcome measure for the study is the pharmacodynamics effects of venetoclax in
    combination with chemotherapy.
    -Incidenza del tempo e della natura di qualsiasi evento avverso.
    -L'effetto indesiderato correlato alla sicurezza del trattamento è definito come un evento avverso che si verifica entro il primo ciclo, giudicato correlato al trattamento e conforme a uno dei seguenti criteri: 1) tossicità non ematologica di grado 3 di durata superiore a 7 giorni. 2) Tossicità non ematologica di grado 4.
    -DLT come evento avverso non infettivo e non ematologico di grado 4 che per l'esperienza dello sperimentatore non può essere dovuto alla chemioterapia FLAI da sola e ad alcun evento avverso di grado 5
    -Incidenza, gravità, gravità e trattamento-causalità del trattamento Segni emergenti e Sintomi.
    -Frequenza di anomalie clinicamente significative nell'esame fisico, test di laboratorio di sicurezza, segni vitali e ECG a 12 derivazioni.
    -TLS che si verifica durante o dopo il protocollo o fino ad un anno dopo le procedure di trapianto
    -Descrizione della QoL segnalata dal paziente nel tempo; - Overall Survival (OS), definito come il numero di giorni tra la prima somministrazione di un farmaco in studio e la morte per qualsiasi causa.
    -Event Free Survival (EFS), definito come il numero di giorni tra la somministrazione del primo farmaco in studio e qualsiasi evento inclusa la progressione della malattia o la morte
    -Incidenza cumulativa di recidiva
    - Negatività dell' MRD dopo ogni corso; -Concentrazione plasmatica di Venetoclax
    -La misura dell'outcome PD per lo studio è gli effetti farmacodinamici di venetoclax in combinazione con chemioterapia.
    E.5.2.1Timepoint(s) of evaluation of this end point
    During the study; -After every courses
    -At the end of the study; During the whole study
    Durante lo studio; -Dopo ogni corso
    -Alla fine dello studio; Durante tutto lo studio
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    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) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Safety run-in
    Run-in di sicurezza
    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 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 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) 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 concerned12
    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 No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    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
    LVLS Ultimo paziente che avrà completato il follow-up
    LVLS Ultimo paziente che avrà completato il follow-up
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    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: 118
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 6
    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 state124
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 124
    F.4.2.2In the whole clinical trial 124
    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)
    Patients will be followed as normal clinical practice
    I pazienti continueranno ad essere seguito come da normale pratica clinica
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation Centro Dati Fondazione GIMEMA
    G.4.3.4Network Country Italy
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-07-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-08-29
    P. End of Trial
    P.End of Trial StatusTrial now transitioned
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