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    Summary
    EudraCT Number:2018-000588-99
    Sponsor's Protocol Code Number:BLU-285-2203
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2020-10-07
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2018-000588-99
    A.3Full title of the trial
    A 3-Part, Randomized, Double-Blind, Placebo-Controlled Phase 2 Study to Evaluate Safety
    and Efficacy of Avapritinib (BLU-285), a Selective KIT Mutation-Targeted Tyrosine Kinase
    Inhibitor, in Indolent and Smoldering Systemic Mastocytosis with Symptoms Inadequately
    Controlled with Standard Therapy
    Studio di Fase 2, randomizzato, in doppio cieco, controllato con placebo, in 3 parti per
    valutare la sicurezza e l’efficacia di avapritinib (BLU 285), un inibitore tirosin-
    chinasico selettivo mirato contro la mutazione KIT, nella mastocitosi sistemica
    indolente e “smoldering” con sintomi non adeguatamente controllati con la terapia
    standard.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study of Avapritinib in Patients with Indolent and Smoldering Systemic Mastocytosis
    Studio su Avapritinib in pazienti con Mastocitosi Sistemica Indolente e "Smoldering".
    A.3.2Name or abbreviated title of the trial where available
    Pioneer
    Pioneer
    A.4.1Sponsor's protocol code numberBLU-285-2203
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN03731260
    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 SponsorBLUEPRINT MEDICINES CORPORATION
    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 supportBluprint Medicines Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationINC Research
    B.5.2Functional name of contact pointProject Director, Global Oncology
    B.5.3 Address:
    B.5.3.1Street Address3201 Beechleaf Ct, Suite 600
    B.5.3.2Town/ cityRaleigh
    B.5.3.3Post codeNC 27604
    B.5.3.4CountryUnited States
    B.5.4Telephone number15129044317
    B.5.5Fax number15129044317
    B.5.6E-mailsara.hoffman@syneoshealth.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 Yes
    D.2.5.1Orphan drug designation numberEU/3/18/2074
    D.3 Description of the IMP
    D.3.1Product nameAvapritrinib
    D.3.2Product code [BLU-285, C-366, C366, 70C366, X720776, BLU11
    D.3.4Pharmaceutical form 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 codeBLU-285
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 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.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 Yes
    D.2.5.1Orphan drug designation numberEU/3/18/2074
    D.3 Description of the IMP
    D.3.1Product nameAvapritinib
    D.3.2Product code [BLU-285, C-366, C366, 70C366, X720776, BLU11
    D.3.4Pharmaceutical form 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 codeBLU-285
    D.3.9.4EV Substance CodeSUB178877
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Indolent and Smoldering Systemic Mastocytosis (ISM & SSM)
    Mastocitosi Sistemica Indolente e "Smoldering" (ISM & SSM)
    E.1.1.1Medical condition in easily understood language
    Mastocytosis
    Mastocitosi
    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 10042949
    E.1.2Term Systemic mastocytosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level LLT
    E.1.2Classification code 10056452
    E.1.2Term Indolent systemic mastocytosis
    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
    Part 1 - to determine the RP2D in patients with ISM for use in Part 2 and Part 3 of
    the study.
    Part 2 - to determine the effect of avapritinib in reducing symptoms in ISM and SSM
    patients, as compared to placebo.
    Part 3 - to assess the long-term safety and efficacy of avapritinib in ISM and SSM
    patients.
    Parte 1 - determinare la RP2D nei pazienti con ISM, da utilizzarsi nella Parte 2 e
    nella Parte 3 dello studio.
    Parte 2 - determinare l’efficacia di avapritinib nel ridurre i sintomi nei pazienti
    con ISM ed SSM rispetto al placebo.
    Parte 3 - valutare la sicurezza e l’efficacia a lungo termine di avapritinib nei
    pazienti con ISM ed SSM.
    E.2.2Secondary objectives of the trial
    Part 1 and Part 2, assess:
    Change in measures of MC burden, cutaneous disease and BSC usage; Change from baseline
    to wk 12 for ISM-SAF "lead symptom" score, proportion of patients with and time to
    achieve 5, 10 and 15-pt reductions in TSS and domain scores, and change in individual
    symptom scores; Change in other PROs based on the MC-QoL, PGIS, SF-12, PGIC and the EQ
    5D-5L questionnaires; Change in the frequency of anaphylactic episodes; Safety and
    tolerability of avapritinib, as assessed by AEs, vital signs, ECGs and lab tests; PK
    of avapritinib; Correlate exposure with safety and efficacy endpoints.
    Part 3, assess:
    Change in the measures of MC burden, cutaneous disease and BSC usage; Change in ISM-SAF "lead symptom" score, TSS, domain scores and individual symptom from Part 3
    baseline to wk 12, 24, 36 and 52; Time to achieve those reductions; Change in other
    PROs as in part 2; Change in the frequency of anaphylactic episodes; Safety and
    tolerability of avapritinib, as in part 2.
    Parte 1 e Parte 2
    Valutare le variazioni dei seguenti parametri relativi al carico di MC, la malattia e
    l’utilizzo di farmaci BSC concomitanti , il “sintomo cardine” nello ISM-SAF dal Basale
    alla Settimana 12, le riduzioni di 5, 10 e 15 punti nei punteggi TSS e nei domini
    dello ISM-SAF e il tempo necessario al raggiungimento di queste riduzioni , altri
    parametri relativi agli Eventi Riferiti dal Paziente (PRO) e alla QoL , MC-QoL, PGIS,
    SF-12, PGIC e EQ 5D-5L, gli episodi anafilattici, Valutare la sicurezza e la
    tollerabilità.
    Parte 3
    Valutare le variazioni dei parametri relativi al carico di MC, la malattia cutanea e
    utilizzo di farmaci BSC concom., il “sintomo cardine” nello ISM-SAF, TSS, i domini e
    i singoli sintomi dello ISM-SAF dal Basale della Parte 3 alle Sett. 12, 24, 36 e 52, e
    il tempo necessario per queste riduzioni; variazioni di altri parametri relativi a
    PRO come nella Parte 2; variazione degli episodi anafilattici, sicurezza e la
    tollerabilità, come nella Parte 2.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patients who are = 18 years of age.
    2. Patient must have SM, confirmed by Central Pathology Review of BM biopsy, and ISM or
    SSM subtype, as confirmed by WHO diagnostic criteria. In Part 1 of the study, only
    patients with a diagnosis of ISM are eligible.
    3. Patient must have moderate-to-severe symptoms based on minimum mean TSS over the 14-
    day eligibility screening period for assessment of TSS and = 1 symptom in skin or GI
    domains of the ISM-SAF at Baseline. Minimum TSS for eligibility is = 28.
    4. Patient must have failed to achieve symptom control for 1 or more Baseline symptoms
    measured by ISM-SAF, as determined by the Investigator, with at least 2 of the following
    symptomatic therapies administered at optimal (approved) dose and for a minimum of 28
    days before starting the ISM-SAF for determination of eligibility: H1 blockers, H2
    blockers, proton-pump inhibitors, leukotriene inhibitors, cromolyn sodium,
    corticosteroids, or omalizumab.
    5. Patient must have symptom management optimized with symptomatic therapies (eg, H1 and
    H2 blockers) and the dose must be stable for = 14 days before starting the ISM-SAF for
    determination of eligibility.
    6. If the patient is receiving corticosteroids, the dose must be = 20 mg/d prednisone or
    equivalent, and the dose must be stable for = 14 days before starting the ISM-SAF for
    determination of eligibility.
    7. Patient must have an Eastern Cooperative Oncology Group Performance Status of 0 to 2.
    8. Patient must give written informed consent.
    1. Pazienti di età =18 anni.
    2. Pazienti con SM, confermata mediante revisione della biopsia midollare da parte del
    Laboratorio Centrale di Patologia, e sottotipo ISM o SSM, confermati dai criteri
    diagnostici dell’OMS. Solo i pazienti con diagnosi di ISM sono considerati idonei alla
    Parte 1 dello studio.
    3. Il paziente deve presentare sintomi da moderati a gravi, sulla base di un TSS medio
    minimo nell’arco del periodo di screening di 14 giorni per la valutazione del TSS, e =1
    sintomo nei domini cutaneo o GI dello ISM-SAF al Basale. Il TSS minimo per l’idoneità è
    =28.
    4. Il paziente non deve aver raggiunto il controllo dei sintomi per 1 o più sintomi al
    Basale misurati dallo ISM-SAF, come determinato dallo sperimentatore, con almeno 2 delle
    seguenti terapie sintomatiche somministrate a una dose ottimale (approvata) e per un
    minimo di 28 giorni prima dell’inizio dello ISM-SAF per la determinazione dell’idoneità:
    H1-antagonisti, H2-antagonisti, inibitori della pompa protonica, inibitori dei
    leucotrieni, cromolina sodica, corticosteroidi od omalizumab.
    5. La gestione dei sintomi del paziente deve essere ottimizzata con terapie
    sintomatiche (ad es. H1 e H2 antagonisti) e la dose deve essere stabile da =14 giorni
    prima dell’inizio dello ISM-SAF per la determinazione dell’idoneità
    6. Se il paziente riceve corticosteroidi, la dose deve essere =20 mg/die di prednisone
    o equivalente, e la dose deve essere stabile da =14 giorni prima dell’inizio dello ISM-
    SAF per la determinazione dell’idoneità.
    7. Il paziente deve avere uno stato di validità secondo l’Eastern Cooperative Oncology
    Group (Gruppo Orientale Cooperativo di Oncologia) da 0 a 2.
    8. Il paziente deve aver fornito il consenso informato scritto.
    E.4Principal exclusion criteria
    1. Patient has been diagnosed with any of the following WHO SM subclassifications: CM
    only, SM-AHN, ASM, MCL, MC sarcoma.
    2. Patient has been diagnosed with another myeloproliferative disorder.
    3. Patient has any of the following organ damage C-findings attributable to SM:
    Cytopenia, Hepatomegaly with ascites and impaired liver function, Palpable splenomegaly
    with hypersplenism, Malabsorption with hypoalbuminemia and significant weight loss,
    Skeletal lesions: large osteolytic lesions with pathologic fractures, Life-threatening
    organ damage in other organ systems that is caused by MC infiltration in tissues.
    4. Patient meets any of the following laboratory criteria: Aspartate aminotransferase or
    alanine aminotransferase > 3.0 × ULN, Total bilirubin > 1.5 × ULN; > 3.0 × ULN if due to
    Gilbert's disease, Albumin < 1 × LLN, eGFR < 30 mL/min/1.73 m^2 or creatinine clearance
    calculated by Cockcroft-Gault equation < 40 mL/min, Absolute neutrophil count < 1.5 ×
    10^9/L, Hemoglobin < 10 g/dL, Platelet count < 100 × 10^9/L.
    5. Patient has received any of the following medications, therapies, or procedures in
    the timeframes listed: Any prior treatment with avapritinib, Any TKI, including but not
    limited to masitinib and midostaurin, or investigational agent < 14 days before starting
    the ISM-SAF for determination of eligibility, Any antineoplastic drug therapy < 28 days
    before starting the ISM-SAF for determination of eligibility, Radiotherapy or psoralen
    and ultraviolet A (PUVA) therapy < 14 days before starting the ISM-SAF for determination
    of eligibility, Any hematopoietic growth factor < 14 days before starting the ISM-SAF
    for determination of eligibility, Any major surgical procedure < 14 days before starting
    the ISM-SAF for determination of eligibility.
    6. Patient requires therapy with a concomitant medication that is a strong inhibitor,
    strong inducer, or moderate inducer of cytochrome P450 3A4 (CYP3A4).
    7. Patient has a history of a malignancy that has been diagnosed or required therapy
    within 3 years before the first dose of study drug. The following are exempt from the 3-
    year limit: completely resected basal cell and squamous cell skin cancer, curatively
    treated localized prostate cancer, and completely resected carcinoma in situ of any
    site.
    8. Patient has a QTcF > 450 msec.
    9. Patient has a history of a seizure disorder (eg, epilepsy) or requires antiseizure
    medication.
    10. Patient has a history of a cerebrovascular accident or transient ischemic attacks
    within 12 months before the first dose of study drug.
    11. Patient has a known risk or recent history (12 months before the first dose of study
    drug) of intracranial bleeding (eg, brain aneurysm).
    12. Patient has a primary brain malignancy or metastases to the brain.
    13. Patient has clinically significant, uncontrolled cardiovascular disease, including
    Grade III or IV congestive heart failure according to the New York Heart Association
    classification; myocardial infarction or unstable angina within the previous 6 months;
    clinically significant, uncontrolled arrhythmias, or uncontrolled hypertension.
    14. Patient is unwilling or unable to comply with scheduled visits, drug administration
    plan, laboratory tests, or other study procedures, including mandatory BM and skin
    biopsies, and study restrictions.
    15. Female patients who are unwilling, if not postmenopausal or surgically sterile, to
    abstain from sexual intercourse or employ highly effective contraception during the
    study drug administration period and for at least 30 days after the last dose of study
    drug. Men who are unwilling, if not surgically sterile, to abstain from sexual
    intercourse or employ highly effective contraception during the study drug
    administration period and for at least 90 days after the last dose of study drug.
    1. Al paziente è stata diagnosticata una delle seguenti sottoclassifiche WHO della SM:
    solo CM, SM-AHN, ASM, MCL, sarcoma MC.
    2. Al paziente è stata diagnosticata un'altra malattia mieloproliferativa.
    3. Il paziente presenta uno qualsiasi dei seguenti danni agli organi C-risultati
    attribuibili a SM: citopenia, epatomegalia con ascite e alterata funzionalità epatica,
    splenomegalia palpabile con ipersplenismo, malassorbimento con ipoalbuminemia e
    significativa perdita di peso, lesioni scheletriche: grandi lesioni osteolitiche con
    fratture patologiche, danno d'organo potenzialmente letale in altri sistemi organici
    causato da infiltrazione di MC nei tessuti.
    4. Il paziente soddisfa uno dei seguenti criteri di laboratorio: aspartato
    aminotransferasi o alanina aminotransferasi >3,0×ULN, bilirubina totale >1,5×ULN;
    >3,0×ULN se dovuta a malattia di Gilbert, albumina <1×LLN, eGFR <30 ml/min/1,73 m^2 o
    clearance della creatinina calcolata dall'equazione di Cockcroft-Gault <40 ml/min, conta
    assoluta dei neutrofili <1,5×10^9/L, emoglobina <10g/dl, conta piastrinica <100 ×10^9/l.
    5. Il paziente ha ricevuto uno dei seguenti farmaci, terapie o procedure nei tempi
    indicati: qualsiasi precedente trattamento con avapritinib, qualsiasi TKI, incluso ma
    non limitato a masitinib e midostaurina, o agente sperimentale <14 giorni prima di
    iniziare l'ISM-SAF per la determinazione di ammissibilità, qualsiasi terapia
    farmacologica antineoplastica <28 giorni prima dell'inizio dell'ISM-SAF per la
    determinazione dell'idoneità, radioterapia o psoraleni e terapia con ultravioletto A
    (PUVA) <14 giorni prima dell'inizio dell'ISM-SAF per la determinazione dell'idoneità,
    qualsiasi fattore di crescita ematopoietico <14 giorni prima di iniziare l'ISM-SAF per
    la determinazione dell'ammissibilità, Qualsiasi procedura chirurgica maggiore <14 giorni
    prima di iniziare l'ISM-SAF per la determinazione dell'idoneità.
    6. Il paziente richiede una terapia con un farmaco concom. che sia un forte inibitore,
    forte induttore o moderato induttore del citocromo P450 3A4 (CYP3A4).
    7. Il paziente ha una storia di neoplasia che è stata diagnosticata o ha richiesto la
    terapia entro 3 anni prima della prima dose del farmaco in studio. I seguenti sono
    esenti dal limite di 3 anni: carcinoma cutaneo a cellule basali e cellule squamose
    completamente resecato, carcinoma prostatico localizzato curativamente trattato e
    carcinoma completamente resecato in situ di qualsiasi sito.
    8. Il paziente ha QTcF >450 msec.
    9. Il paziente ha una storia di disturbi convulsivi o necessita di farmaci
    anticonvulsivi.
    10. Il paziente ha una storia di accidente cerebrovascolare o di attacchi ischemici
    transitori entro 12 mesi prima della prima dose di farmaco in studio.
    11. Il paziente ha un rischio noto o storia recente (12 mesi prima della prima dose del
    farmaco in studio) di emorragia intracranica (ad es. aneurisma cerebrale).
    12. Il paziente ha una malignità cerebrale primaria o metastasi al cervello.
    13. Il paziente ha una malattia cardiovascolare clinicamente significativa e
    incontrollata, inclusa insufficienza cardiaca congestizia di grado III o IV secondo la
    classificazione della New York Heart Association; infarto del miocardio o angina
    instabile entro i 6 mesi precedenti; aritmie clinicamente significative, incontrollate o
    ipertensione incontrollata.
    14. Il paziente non è disposto o non è in grado di rispettare le visite programmate, il
    piano di somministrazione del farmaco, i test di laboratorio o altre procedure di
    studio.
    E.5 End points
    E.5.1Primary end point(s)
    Part 1 - RP2D in patients with ISM.
    Part 2 - mean change in ISM-SAF TSS.
    Part 3 - long-term safety and efficacy of avapritinib.
    Parte 1 - la RP2D nei pazienti con ISM.
    Parte 2 - la variazione media nel TSS dello ISM-SAF.
    Parte 3 - la sicurezza ed efficacia a lungo termine di avapritinib.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Part 1 - weekly for the first 4 weeks, then every 4 weeks
    Part 2 - from Baseline to Week 12
    Part 3 - weekly for 4 weeks, then every 4 weeks for 5 months, and then every 3
    months, for a total of 2 years from C1D1; patients still on study after 2 years
    will have visits every 6 months (24 weeks) for a total study duration of 5 years,
    inclusive of Part 1 and Part 2
    Part 1 - settimanalmente per le prime 4 settimane, dopo ogni 4 settimane;
    Part 2 - dal basale alla Settimana 12;
    Part 3 - settimanalmente per 4 settimane, dopo ogni 4 settimane per 5 mesi, e in
    seguito ogni 3 mesi, per un totale di 2 anni dalla C1D1; i pazienti ancora in
    studio dopo 2 anni saranno visitati ogni 6 mesi (24 settimane) per una durata
    totale di 5 anni, inclusiva della Parte 1 e Parte 2.
    E.5.2Secondary end point(s)
    Part 1 and Part 2
    • Change in measures of MC burden:
    o Serum tryptase.
    o KIT D816V allele burden in blood.
    o BM MCs.
    o Skin MCs in patients with baseline CM.
    • Change in percent body surface area (BSA) involved by CM and change in pigmentation
    of cutaneous lesions in patients with baseline CM.
    • Change in BSC concomitant medication usage.
    • Change in "lead symptom" score of ISM-SAF from Baseline to Week 12.
    • Proportion of patients with at least 5-point, 10-point, and 15-point reductions in
    TSS and domain scores of ISM-SAF from Baseline to Week 12.
    • Time to achieve 5-point, 10-point, 15-point, and maximum reductions in TSS and
    domain scores of ISM-SAF.
    • Change in domain scores and individual symptom scores of ISM-SAF from Baseline to
    Week 12.
    • Change in MC-QoL, PGIS, SF-12, PGIC, and EQ-5D-5L.
    • Change in number of episodes of anaphylaxis, based on epinephrine use.
    • Safety and tolerability of avapritinib, as assessed by AEs, vital signs, ECGs, and
    laboratory tests.
    • Pharmacokinetics of avapritinib.
    • Correlations between avapritinib exposure and safety and efficacy endpoints.
    Part 3
    • Change in the following measures of MC burden:
    o Serum tryptase.
    o KIT D816V allele burden in blood.
    o BM MCs (optional).
    o Skin MCs in patients with baseline CM (optional).
    • Change in BSA involved by CM and change in pigmentation of cutaneous lesions in
    patients with baseline CM.
    • Change in BSC concomitant medication usage.
    • Change in "lead symptom" score of ISM-SAF.
    • Change in TSS, domain scores, and individual symptom scores of ISM-SAF from Part 3
    baseline (and from Part 1 and Part 2 baseline for patients receiving same dose of
    avapritinib in both study parts) to Weeks 12, 24, 36, and 52.
    • Time to achieve 5-point, 10-point, and 15-point, and maximum reductions in TSS and
    domain scores of ISM-SAF from Part 3 baseline (and from Part 1 and Part 2 baseline for
    patients receiving same dose of avapritinib in both study parts).
    • Changes in MC-QoL, PGIS, SF-12, PGIC, and EQ-5D-5L.
    • Change in number of episodes of anaphylaxis, based on epinephrine use.
    • Safety and tolerability of avapritinib, as assessed by AEs, vital signs, ECGs, and
    laboratory tests.
    Parte 1 e Parte 2
    • Variazioni dei parametri relativi al carico di MC: Triptasi sierica; Carico di
    alleli KIT D816V nel sangue; MC nel BM; MC cutanei nei pazienti con CM al Basale.
    • Variazione della percentuale di superfice corporea (BSA) coinvolta dalla CM e
    variazione della pigmentazione delle lesioni cutanee nei pazienti con CM al Basale.
    • Variazioni nell’utilizzo dei farmaci BSC concomitanti.
    • Variazioni del punteggio del “sintomo cardine” dello ISM-SAF dal Basale alla
    Settimana 12.
    • Percentuale di pazienti con riduzioni di almeno 5 punti, 10 punti e 15 punti nei
    punteggi TSS e dei domini dello ISM-SAF, dal Basale alla Settimana 12.
    • Tempo necessario al raggiungimento delle riduzioni di 5 punti, 10 punti, 15 punti e
    massime riduzioni dei punteggi TSS e dei domini dello ISM-SAF.
    • Variazioni dei punteggi dei domini e dei punteggi dei singoli sintomi dello ISM-SAF
    dal Basale alla Settimana 12.
    • Variazioni nei MC-QoL, PGIS, SF-12, PGIC ed EQ-5D-5L.
    • Variazioni del numero di episodi di anafilassi, sulla base dell’uso di epinefrina.
    • Sicurezza e tollerabilità di avapritinib, valutate in termini di EA, segni vitali,
    ECG e test di laboratorio.
    • Farmacocinetica di avapritinib.
    • Correlazioni tra l’esposizione ad avapritinib e gli endpoint di sicurezza ed
    efficacia.
    Parte 3
    • Variazioni dei parametri relativi al carico di MC: Triptasi sierica; Carico di
    alleli KIT D816V nel sangue; MC nel BM (opzionale); MC cutanei nei pazienti con CM
    al Basale
    (opzionale).
    • Variazione della BSA interessata dalla CM e variazione della pigmentazione nelle
    lesioni cutanee nei pazienti con CM al Basale.
    • Variazioni nell’utilizzo dei farmaci BSC concomitanti.
    • Variazioni del punteggio del “sintomo cardine” dello ISM-SAF.
    • Variazioni di TSS, punteggi dei domini e punteggi dei singoli sintomi dello ISM-SAF,
    dal Basale della Parte 3 (e Basale della Parte 1 o Parte 2 per i pazienti trattati con
    la stessa dose di avapritinib in entrambe le parti dello studio) alle Settimane 12,
    24, 36 e 52.
    • Tempo necessario al raggiungimento delle riduzioni di 5 punti, 10 punti, 15 punti e
    massime riduzioni dei punteggi TSS e dei domini dello ISM-SAF dal Basale della Parte 3
    (e Basale della Parte 1 e della Parte 2 per i pazienti trattati con la stessa dose di
    avapritinib in entrambe le parti dello studio).
    • Variazioni nei MC-QoL, PGIS, SF-12, PGIC ed EQ-5D-5L.
    • Variazioni del numero di episodi di anafilassi, sulla base dell’uso di adrenalina.
    • Sicurezza e tollerabilità di avapritinib, valutate in termini di EA, segni vitali,
    ECG e test di laboratorio.
    E.5.2.1Timepoint(s) of evaluation of this end point
    •Tryptase: Screening, every visit through C3D8 (P1-2); every visit (P3)
    •KIT D816V allele burden: Screening, C1D1/D15, C2D1, C3D8 (P1-2), every 4W until P3
    (P1); C1D1, C3D1, every 12W during C6-25, every 24W during C26 through end of study
    (P3)
    •BM & skin biopsy: Screening, between C3D8 & D15 (P1-2); optional at W52 (P3)
    •Skin photo: Screening, between C3D8 & D15, every 12W until W52 in P3
    •ISM-SAF: daily from baseline to W12 (P1-2); from P3 baseline to W12/24/36/52
    •QoL: each visit through P3 W52
    •Anaphylaxis episode: Screening, throughout study
    •AE & BSC: throughout study
    •Vital signs, hematology & chemistry: every visit until EOT
    •ECG: Screening, C1D1, C2D1, C3D8 (P1-2), between C3D8 & D15, D1 of every C (P1);
    D1 of every P3 visit
    •PK: before & after study drug dosing (P1-2)
    Tryptase: Screening, ogni visita per tutto C3D8 (P1-2); ogni visita (P3)
    •KIT D816V allele burden: Screening, C1D1/D15, C2D1, C3D8 (P1-2), ogni 4S sino a P3
    (P1); C1D1, C3D1, ogni 12S durante C6-25, ogni 24S durante during C26 per tutto
    il termine dello studio (P3)
    •BM & biopsia cutanea: Screening, tra C3D8 e D15 (P1-2); opzionale a W52 (P3)
    •Foto della Pelle: Screening, tra C3D8 & D15, ogni 12S sino a W52 in P3
    •ISM-SAF: quotidianamente dal basale alla S12 (P1-2); dal basale P3 alle
    S12/24/36/52
    •QoL: ogni visita per tutto P3 S52
    • Episoadi di Anafilassi : Screening, per tutta la durata dello studio
    •Segni Vitali, ematologia e chimica: ad ogni visita sino al termine dello studio
    •ECG: Screening, C1D1, C2D1, C3D8 (P1-2), tra C3D8 e D15, D1 di ogni C (P1); D1 di
    ogni visita P3
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    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) 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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA14
    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 Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Belgium
    Canada
    Denmark
    Germany
    Italy
    Netherlands
    Spain
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study is defined as the time that the last patient completes his/her last visit (LPLV), including assessments performed as part of safety follow-up.
    Il termine dello studio è definito come il tempo in cui l'ultimo paziente effettua
    l'ultima visita (LPLV), includendo le valutazioni effettuate per la sicurezza al
    follow up.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    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 years5
    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: 100
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 12
    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 state6
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 30
    F.4.2.2In the whole clinical trial 60
    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)
    Normal standard of care.
    Normale cura standard
    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 Decision2019-03-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-01-11
    P. End of Trial
    P.End of Trial StatusOngoing
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