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    Summary
    EudraCT Number:2018-001527-39
    Sponsor's Protocol Code Number:SGN22E-002
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Restarted
    Date on which this record was first entered in the EudraCT database:2021-06-08
    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 number2018-001527-39
    A.3Full title of the trial
    A study of enfortumab vedotin (ASG-22CE) as monotherapy or in combination with other anticancer therapies for the treatment of urothelial cancer
    Studio di enfortumab vedotin (ASG-22CE) in monoterapia o in combinazione con altre terapie antitumorali per il trattamento del tumore uroteliale
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study of enfortumab vedotin alone or in combination with other anticancer therapies for the treatment of urothelial cancer
    Studio di enfortumab vedotin in monoterapia o in combinazione con altre terapie antitumorali per il trattamento del tumore uroteliale
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    A.4.1Sponsor's protocol code numberSGN22E-002
    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 SponsorSEAGEN INC.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportSeagen Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationSeagen Inc.
    B.5.2Functional name of contact pointSeagen Clinical Trial Information
    B.5.3 Address:
    B.5.3.1Street Address21823 30th Drive SE
    B.5.3.2Town/ cityBothell
    B.5.3.3Post codeWA 98021
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018663337436
    B.5.5Fax number000000
    B.5.6E-mailEU-Regulatory@seagen.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.2.1.1.1Trade name PADCEV
    D.2.1.2Country which granted the Marketing AuthorisationUnited States
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameEnfortumab vedotin
    D.3.2Product code [ASG-22CE]
    D.3.4Pharmaceutical form Powder for 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 INNENFORTUMAB VEDOTIN
    D.3.9.2Current sponsor codeASG-22CE
    D.3.9.4EV Substance CodeSUB185524
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    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 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 Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePembrolizumab
    D.3.2Product code [MK-3475]
    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 INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    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 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 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 Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Urothelial cancer
    Tumore uroteliale
    E.1.1.1Medical condition in easily understood language
    Urothelial cancer
    Tumore uroteliale
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10046714
    E.1.2Term Urothelial carcinoma bladder
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10046714
    E.1.2Term Urothelial carcinoma bladder
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10046723
    E.1.2Term Urothelial carcinoma ureter
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10046723
    E.1.2Term Urothelial carcinoma ureter
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10046728
    E.1.2Term Urothelial carcinoma urethra
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10046728
    E.1.2Term Urothelial carcinoma urethra
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10077840
    E.1.2Term Urothelial cancer of renal pelvis
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10077840
    E.1.2Term Urothelial cancer of renal pelvis
    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 assess the anti-tumor activity of enfortumab vedotin monotherapy or enfortumab vedotin in combination with pembrolizumab as measured by ORR per RECIST Version 1.1 by blinded independent central review (BICR)
    Valutare l’attività antitumorale di enfortumab vedotin in monoterapia o enfortumab vedotin in combinazione con pembrolizumab come misurata in base all’ORR secondo i criteri RECIST Versione 1.1 mediante revisione centrale indipendente in cieco (BICR)
    E.2.2Secondary objectives of the trial
    -To assess the ORR per RECIST Version 1.1 by investigator assessment
    -To assess the DOR per RECIST Version 1.1 by BICR and investigator assessment
    -To assess the DCR per RECIST Version 1.1 by BICR and investigator assessment
    -To assess the PFS on study therapy per RECIST Version 1.1 by BICR and investigator assessment
    -To assess OS
    -To assess the safety and tolerability of EV monotherapy or enfortumab vedotin in combination with pembrolizumab
    Additional/Exploratory:
    -To assess:
    -PK and the incidence of ATA
    - Nectin-4 and PD-L1 expression levels
    - biomarkers of biological activity and disease resistance, and their potential associations with clinical outcome measures
    - the PFS on subsequent therapy (PFS2) by investigator assessment
    - the impact on quality of life (QoL) and symptoms, including pain, from the patient perspective
    - the ORR, DOR, DCR, and PFS on study therapy per iRECIST for EV in combination with pembrolizumab (EV+Pembro arm) by investigator assessment
    • Valutare l’ORR in base ai criteri RECIST Versione 1.1 secondo la valutazione dello sperimentatore
    • Valutare la DOR in base ai criteri RECIST Versione 1.1 secondo la valutazione dello sperimentatore
    • Valutare il DCR in base ai criteri RECIST Versione 1.1 secondo la valutazione dello sperimentatore
    • Valutare la PFS durante la terapia dello studio in base ai criteri RECIST Versione 1.1 secondo la valutazione dello sperimentatore
    • Valutare l’OS
    • Valutare la sicurezza e la tollerabilità di enfortumab vedotin in monoterapia o enfortumab vedotin in combinazione con pembrolizumab
    Aggiuntivi/Esplorativi:
    • Valutare:
    - la PK e l’incidenza di ATA
    - i livelli di espressione di nectina 4 e PD-L1
    - i biomarcatori di attività biologica e resistenza della malattia e le loro potenziali associazioni con le misure di esito clinico
    - la PFS durante la terapia successiva (PFS2) in base alla valutazione dello sperimentatore
    Per ulteriori dettagli fare riferimento al protocollo.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Patients must have histologically documented locally advanced or metastatic urothelial (previously known as transitional cell) cancer (ie,
    cancer of the bladder, renal pelvis, ureter, or urethra). Patients with squamous differentiation or mixed cell types are eligible. Patients with
    locally advanced disease that is resectable with curative intent are ineligible.
    2.Patients in Cohort K must be eligible for CPI therapy.
    3. Cohort-specific eligibility:
    Randomized Cohort K (EV Mono arm and EV+Pembro arm): Patients must be ineligible for cisplatin-based chemotherapy at the time of
    enrollment due to at least 1 of the following criteria:
    i. Glomerular filtration rate (GFR) <60 mL/min but =30 mL/min (measured by the Cockcroft-Gault formula, modification of diet in renal
    disease [MDRD] or 24-hour urine)
    ii. ECOG performance status of <= 2 (refer to inclusion criterion #6 for additional criteria for subjects with ECOG 2)
    iii. NCI CTCAE Version 4.03 Grade > = 2 hearing loss
    iv. NYHA Class III heart failure
    Patients must not have received prior systemic treatment for locally advanced or metastatic disease. Patients may not have previously
    received adjuvant/neoadjuvant platinum-based therapy within 12 months prior to randomization.
    4. Minimum age of 18 years
    5. Patients must have measurable disease according to RECIST Version 1.1 (Eisenhauer 2009). Lesions in a prior irradiated field must have
    progressed to be considered measurable.
    6. An ECOG performance status of 0, 1, or 2 .
    • Subjects with ECOG performance status of 2 must additionally meet the following criteria:
    i. Hemoglobin > = 10 g/dL
    ii. GFR > = 50 mL/min
    iii. May not have NYHA Class III heart failure
    7. Anticipated life expectancy of > = 3 months as assessed by the investigator.
    8. Have adequate organ function as defined in the following table.
    Specimens must be collected within 7 days prior to the start of study treatment.
    9. A female subject of childbearing potential is anyone born female who has experienced menarche and who has not undergone surgical
    sterilization (eg, hysterectomy, bilateral salpingectomy, bilateral oophorectomy) or has not completed menopause. Menopause is defined clinically as 12 months of amenorrhea in a person over age 45 in the absence of other biological, physiological, or pharmacological causes. Female subjects of childbearing potential must meet the following conditions:
    • Agree not to try to become pregnant during the study and for at least 6 months after the final dose of study drug.
    • Must have a negative urine or serum pregnancy test (minimum sensitivity of 25 mIU/mL or equivalent units of beta human chorionic
    gonadotropin [ß-hCG]) within 3 days prior to Day 1. Female subjects with false positive results and documented verification of negative
    pregnancy status are eligible for participation.
    • If heterosexually active, must consistently use highly effective methods of birth control, with a failure rate of less than 1% starting at
    screening, throughout the study period, and for at least 6 months after the final dose of study drug.
    • Female subjects must agree not to breastfeed or donate ova starting at screening and throughout the study period, and for at least 6 months
    after the final dose of study drug.
    10. A male subject who can father children is anyone born male who has testes and who has not undergone surgical sterilization (eg, vasectomy followed by a clinical test proving that the procedure was effective). Male subjects who can father children, must meet the following conditions:
    • Must not donate sperm starting at screening and throughout the study period, and for at least 6 months after the final dose of study drug. Male
    subjects will be informed about the negative risk to reproductive function and fertility from the study treatment. Prior to treatment male subjects should be advised to seek information on fertility preservation and sperm cryoconservation.
    Please refer to protocol to see complete inclusion criteria.
    1.I pazienti devono avere un tumore uroteliale localmente avanzato o metastatico (noto in precedenza come a cellule transizionali) (vale a dire tumore della vescica, della pelvi renale, dell’uretere o dell’uretra) documentato istologicamente. I pazienti con differenziazione squamosa o con tipi cellulari misti sono idonei. I pazienti con malattia localmente avanzata che è resecabile con intento curativo non sono idonei.
    2. I pazienti nella Coorte K devono essere idonei alla terapia con CPI.
    3. Idoneità specifica per la coorte:
    Coorte K randomizzata (braccio EV Mono e braccio EV+Pembro): i pazienti devono essere non idonei a chemioterapia a base di cisplatino al momento dell’arruolamento a causa di almeno 1 dei seguenti criteri:
    i. Velocità di filtrazione glomerulare (GFR) <60 ml/min. ma =30 ml/min. (misurata mediante la formula di Cockcroft-Gault, modifica della dieta nella malattia renale [MDRD] o urine delle 24 ore)
    ii. Stato di validità ECOG < =2 (fare riferimento al criterio di inclusione n. 6 per ulteriori criteri per i soggetti con ECOG 2)
    iii. Perdita dell’udito di grado > = 2 secondo NCI CTCAE Versione 4.03
    iv. Insufficienza cardiaca di classe NYHA III
    I pazienti non devono aver ricevuto alcun trattamento sistemico precedente per malattia localmente avanzata o metastatica. I pazienti possono non aver ricevuto in precedenza una terapia a base di platino adiuvante/neoadiuvante nei 12 mesi precedenti la randomizzazione.
    4. Almeno 18 anni di età
    5. I pazienti devono presentare una malattia misurabile in base ai criteri RECIST Versione 1.1 (Eisenhauer 2009). Le lesioni in un campo precedentemente irradiato devono aver manifestato una progressione per essere considerate misurabili.
    6. Stato di validità ECOG di 0, 1 o 2.
    • I soggetti con stato di validità ECOG pari a 2 devono inoltre soddisfare i seguenti criteri:
    i. Emoglobina > = 10 g/dl
    ii. GFR > = 50 ml/min.
    iii. Non possono avere insufficienza cardiaca di classe NYHA III
    7. Aspettativa di vita prevista =3 mesi, come valutato dallo sperimentatore.
    8. Funzione d’organo adeguata come definito nella tabella seguente. I campioni devono essere prelevati entro 7 giorni prima dell’inizio del trattamento dello studio.
    9. Un soggetto di sesso femminile in età fertile è una persona nata di sesso femminile che ha avuto il menarca e che non è stata sottoposta a sterilizzazione chirurgica (ad es. isterectomia, salpingectomia bilaterale, ovariectomia bilaterale) o non ha completato la menopausa. La menopausa è definita clinicamente come 12 mesi di amenorrea in una persona di età superiore a 45 anni in assenza di altre cause biologiche, fisiologiche o farmacologiche. I soggetti di sesso femminile in età fertile devono soddisfare le seguenti condizioni:
    • Acconsentire a non avviare una gravidanza durante lo studio e per almeno 6 mesi dopo la dose finale del farmaco dello studio.
    • Devono risultare negative al test di gravidanza sul siero o sulle urine (sensibilità minima di 25 mUI/ml o unità equivalenti di beta-gonadotropina corionica umana [ß-hCG]) entro 3 giorni prima del Giorno 1. I soggetti di sesso femminile con risultati falsi positivi e verifica documentata della negatività dello stato di gravidanza sono idonei alla partecipazione.
    • Se eterosessualmente attivi, devono acconsentire a utilizzare in modo costante metodi contraccettivi altamente efficaci con un tasso di insuccesso inferiore all’1%, a partire dallo screening, per tutta la durata del periodo di studio e per almeno 6 mesi dopo la dose finale del farmaco dello studio.
    • I soggetti di sesso femminile devono acconsentire a non allattare al seno o a non donare ovuli a partire dallo screening, per l’intera durata del periodo dello studio e per almeno 6 mesi dopo la dose finale del farmaco dello studio.
    Fare riferimento al protocollo per visionare i criteri di inclusione completi.
    E.4Principal exclusion criteria
    1. Received any prior treatment with a CPI. A CPI is defined as a PD-1 inhibitor, PD-L1 inhibitor, or PD-L2 inhibitor (including, but not limited
    to, atezolizumab, pembrolizumab, nivolumab, durvalumab, or avelumab). Patients in Expansion Cohort F may have previously received treatment with a CPI.
    2. Received any prior treatment with an agent directed to another stimulatory or co-inhibitory T-cell receptor (including but not limited to
    CD137 agonists, CTLA-4 inhibitors, or OX-40 agonists).
    3. Ongoing sensory or motor neuropathy Grade 2 or higher.
    4. Active central nervous system [CNS] metastases. Patients with treated CNS metastases are permitted on study if all the following are
    true:
    a. CNS metastases have been clinically stable for at least 6 weeks prior to screening and baseline scans show no evidence of new or enlarged
    metastasis.
    b. If requiring steroid treatment for CNS metastases, the patient is on a stable dose <10 mg/day of prednisone or equivalent for at least 2
    weeks.
    c. Patient does not have leptomeningeal disease.
    5. Ongoing clinically significant toxicity (Grade 2 or greater) associated with prior treatment (including radiotherapy or surgery).
    6. Patients with conditions requiring high doses of steroids (>10 mg/day of prednisone or equivalent) or other immunosuppressive medications
    are excluded. Inhaled or topical steroids are permitted in the absence of active autoimmune disease.
    7. Prior treatment with enfortumab vedotin or other MMAE-based ADCs for urothelial cancer.
    8. History of another malignancy within 3 years before the first dose of study drug, or any evidence of residual disease from a previously
    diagnosed malignancy. Patients with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ (eg, breast carcinoma,
    cervical cancer) who have undergone potentially curative therapy are not excluded. Patients with low-risk prostate cancer (T1-T2a, Gleason
    score =6, and prostate specific antigen [PSA] <10 ng/mL) either treated with definite intent any time prior to screening or untreated in active
    surveillance are not excluded.
    9. Currently receiving systemic antimicrobial treatment for active infection (viral, bacterial, or fungal) at the time of first dose of
    enfortumab vedotin. Routine antimicrobial prophylaxis is permitted.
    10. Patients with a positive hepatitis B surface antigen and/or antihepatitis B core antibody; patients with a negative polymerase chain
    reaction (PCR) assay are permitted with either universal prophylaxis or the use of a pre-emptive approach. The approach will be selected in accordance with regional or national guidelines for patients who receive anticancer therapies.
    11. Active hepatitis C infection or known human immunodeficiency virus (HIV) infection. Patients who have been curatively treated for hepatitis C
    infection are permitted if they have documented sustained virologic response of 12 weeks. No HIV testing is required unless mandated by local health authority.
    12. Patients with active tuberculosis.
    13. Documented history of a cerebral vascular event (stroke or transient ischemic attack), unstable angina, myocardial infarction, or cardiac
    symptoms (including congestive heart failure) consistent with NYHA Class III–IV (see Appendix E) within 6 months prior to the first dose of
    enfortumab vedotin. Patients with NYHA Class III are permitted in Cohort K.
    14. Radiotherapy or major surgery within 2 weeks prior to first dose of study drug. Patient must have recovered adequately from the toxicity
    and/or complications from the intervention prior to starting study treatment.
    15. Treatment with chemotherapy, biologics, or investigational agents not otherwise prohibited by exclusion criterion No. 2 that is not
    completed 4 weeks prior to first dose of study drug.
    Please refer to protocol to see complete exclusion criteria.
    1. Aver ricevuto qualsiasi trattamento precedente con un CPI. Un CPI è definito come un inibitore di PD-1, un inibitore di PD-L1 o un inibitore di PD-L2 (tra cui, senza pretesa di esaustività, atezolizumab, pembrolizumab, nivolumab, durvalumab o avelumab). I pazienti della Coorte di espansione F possono avere precedentemente ricevuto un trattamento con un CPI.
    2. Aver ricevuto qualsiasi trattamento precedente con un agente diretto contro un altro recettore co-inibitorio o stimolante delle cellule T (tra cui, senza pretesa di esaustività, agonisti di CD137, inibitori di CTLA-4 o agonisti di OX-40).
    3. Neuropatia sensoriale o motoria in corso di grado 2 o superiore.
    4. Metastasi attive nel sistema nervoso centrale [SNC]. I pazienti con metastasi del SNC trattate possono partecipare allo studio se tutte le seguenti condizioni sono vere:
    a. Le metastasi al SNC sono state clinicamente stabili da almeno 6 settimane prima dello screening e le scansioni al basale non mostrano evidenza di metastasi nuove o ingrandite.
    b. Se le metastasi del SNC necessitano di trattamento a base di steroidi, il paziente riceve una dose stabile <10 mg/giorno di prednisone o equivalente da almeno 2 settimane.
    c. Il paziente non presenta malattia leptomeningea.
    5. Tossicità clinicamente significativa (Grado 2 o superiore) in corso associata a precedente trattamento (tra cui radioterapia o interventi chirurgici).
    6. I pazienti con condizioni che richiedono alte dosi di steroidi (>10 mg/giorno di prednisone o equivalente) o altri farmaci immunosoppressori sono esclusi. L’uso di steroidi topici o inalatori è consentito in assenza di malattia autoimmune attiva.
    7. Precedente trattamento con enfortumab vedotin o altri ADC a base di MMAE per il tumore uroteliale.
    8. Anamnesi di altra neoplasia maligna nei 3 anni precedenti la prima dose del farmaco in studio o qualsiasi evidenza di malattia residua da una neoplasia maligna precedentemente diagnosticata. I pazienti con carcinoma a cellule basali della cute, carcinoma a cellule squamose della pelle, oppure carcinoma in situ (ad es. carcinoma della mammella, tumore della cervice) che sono stati sottoposti a terapia potenzialmente curativa non sono esclusi. I pazienti con tumore alla prostata a basso rischio (T1-T2a, punteggio di Gleason < = 6 e antigene prostatico specifico [PSA] <10 ng/ml) trattati con intento definito in qualsiasi momento prima dello screening o non trattati in sorveglianza attiva non sono esclusi.
    9. Attuale trattamento antimicrobico sistemico per infezione in fase attiva (virale, batterica o fungina) al momento della prima dose di enfortumab vedotin. È consentita la profilassi antimicrobica di routine.
    10. I pazienti con risultato positivo dell’antigene di superficie dell’epatite B e/o anticorpo del nucleo B anti epatite; i pazienti con un risultato negativo alla reazione a catena della polimerasi (PCR) sono consentiti o con una profilassi universale o con l’adozione di un approccio preventivo. L’approccio sarà selezionato in conformità alle linee guida nazionali o regionali per i pazienti che ricevono terapie antitumorali.
    11. Infezione nota da epatite C oppure infezione da virus dell’immunodeficienza umana (HIV) in fase attiva. I pazienti che sono stati trattati a scopo curativo per l’infezione da epatite C sono consentiti se hanno risposta virologica sostenuta di 12 settimane documentata. Il test HIV non è obbligatorio salvo se richiesto dalle autorità sanitarie locali.
    12. Pazienti con tubercolosi attiva.
    13. Anamnesi documentata di un evento vascolare cerebrale (ictus o attacco ischemico transitorio), angina instabile, infarto miocardico o sintomi cardiaci (inclusa insufficienza cardiaca congestizia) di classe III-IV NYHA (vedere Appendice E) nei 6 mesi precedenti la prima dose di enfortumab vedotin. I pazienti con classe NYHA III sono consentiti nella Coorte K.
    Fare riferimento al protocollo per visionare i criteri di esclusione completi.
    E.5 End points
    E.5.1Primary end point(s)
    ORR (confirmed) per RECIST Version 1.1 by BICR
    ORR (confermato) secondo RECIST Versione 1.1 mediante BICR
    E.5.1.1Timepoint(s) of evaluation of this end point
    Every 9 weeks starting from Cycle 1 Day 1 through EOT and for up to one year, then every 12 weeks
    Ogni 9 settimane a partire dal ciclo 1, giorno 1, fino a EOT e fino a un anno, poi ogni 12 settimane
    E.5.2Secondary end point(s)
    • ORR (confirmed) per RECIST Version 1.1 by investigator assessment
    • DOR per RECIST Version 1.1 by BICR
    • DOR per RECIST Version 1.1 by investigator assessment
    • DCR per RECIST Version 1.1 by BICR
    • DCR per RECIST Version 1.1 by investigator assessment
    • PFS per RECIST Version 1.1 by BICR
    • PFS per RECIST Version 1.1 by investigator
    • OS
    • Type, incidence, severity, seriousness, and relatedness of AEs
    • Type, incidence, and severity of laboratory abnormalities
    Corresponding Additional/Exploratory Endpoints
    • Selected plasma or serum PK parameters of enfortumab vedotin,
    MMAE, and TAb
    • Incidence of ATA to enfortumab vedotin
    • Exploratory biomarkers of clinical activity, including relationship of Nectin-4 expression and PD-L1 expression status to response
    • PFS2 by investigator assessment
    • Change from baseline in PRO assessments of the EQ-5D-5L, EORTC QLQ-C30, and BPI-SF
    For the EV+Pembro arm:
    • ORR (confirmed) per iRECIST by investigator assessment
    • DOR per iRECIST by investigator assessment
    • DCR per iRECIST by investigator assessment
    • PFS per iRECIST by investigator assessment
    • ORR (confermato) secondoRECIST versione 1.1 dalla valutazione dello sperimentatore
    • DOR secondo RECIST Versione 1.1 mediante BICR
    • DOR secondo RECIST Versione 1.1 dalla valutazione dello sperimentatore
    • DCR secondo RECIST versione 1.1 mediante BICR
    • DCR secondo RECIST Versione 1.1 dalla valutazione dello sperimentatore
    • PFS secondo RECIST versione 1.1 mediante BICR
    • PFS secondo RECIST versione 1.1 mediante lo sperimentatore
    • OS
    • Tipo, incidenza, gravità, gravità e correlazione degli eventi avversi
    • Tipo, incidenza e gravità delle anomalie di laboratorio
    Endpoint aggiuntivi / esplorativi corrispondenti
    • Parametri PK plasmatici o sierici selezionati di enfortumab vedotin,
    MMAE e TAb
    • Incidenza di ATA per enfortumab vedotin
    • Biomarcatori esplorativi dell'attività clinica, inclusa la relazione tra l'espressione di nectina-4 e lo stato di espressione di PD-L1 con la risposta
    • PFS2 dalla valutazione dello sperimentatore
    • Modifica rispetto al basale nelle valutazioni PRO di EQ-5D-5L, EORTC QLQ-C30 e BPI-SF
    Per il braccio EV + Pembro:
    • ORR (confermato) per iRECIST dalla valutazione dello sperimentatore
    • DOR secondo iRECIST in base alla valutazione dello sperimentatore
    • DCR secondo iRECIST in base alla valutazione dello sperimentatore
    • PFS secondo iRECIST in base alla valutazione dello sperimentatore
    E.5.2.1Timepoint(s) of evaluation of this end point
    Following documentation of PFS2, patients will enter the survival followup period and be followed every 12 weeks for survival status until death, study closure, or withdrawal of consent, whichever occurs first.
    Dopo la documentazione della PFS2, i pazienti entreranno nel periodo di follow-up della sopravvivenza e saranno seguiti ogni 12 settimane per lo stato di sopravvivenza fino alla morte, alla chiusura dello studio o al ritiro del consenso, a seconda di quale condizione si verifichi per prima.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarker
    Biomarker
    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
    1b/2 Phase
    Fase 1b/2
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned6
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA18
    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
    Canada
    France
    Italy
    Spain
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The study will be closed 5 years after enrollment of the last patient, or when no patients remain in long-term follow-up, whichever occurs first
    Lo studio verrà chiuso 5 anni dopo l'arruolamento dell'ultimo paziente o quando nessun paziente rimane nel follow-up a lungo termine, a seconda di quale condizione si verifichi per prima
    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 months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years6
    E.8.9.2In all countries concerned by the trial months6
    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: 50
    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 Yes
    F.3.3.2Women of child-bearing potential using contraception No
    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 state13
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 30
    F.4.2.2In the whole clinical trial 150
    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)
    Standard of care
    Standard of care
    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 Decision2021-04-21
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-03-25
    P. End of Trial
    P.End of Trial StatusRestarted
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