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    Summary
    EudraCT Number:2018-002820-18
    Sponsor's Protocol Code Number:F-FR-60000-023
    National Competent Authority:France - ANSM
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-06-03
    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 ConcernedFrance - ANSM
    A.2EudraCT number2018-002820-18
    A.3Full title of the trial
    A PHASE II, MULTICENTRE, OPEN-LABEL STUDY OF CABOZANTINIB AS 2ND LINE TREATMENT IN SUBJECTS WITH UNRESECTABLE, LOCALLY ADVANCED OR METASTATIC RENAL CELL CARCINOMA WITH A CLEAR-CELL COMPONENT WHO PROGRESSED AFTER 1ST LINE TREATMENT WITH CHECKPOINT INHIBITORS
    Étude de phase II, multicentrique, en ouvert, évaluant le cabozantinib en traitement de 2ème ligne chez des patients atteints d’un carcinome rénal avec composante à cellules claires, inopérable, localement avancé ou métastatique, ayant progressé après un traitement de 1ère ligne par inhibiteurs de point de contrôle immunitaire
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Open-Label Study of Cabozantinib as 2nd Line Treatment in Subjects with Unresectable, Locally Advanced or Metastatic Renal Cell Carcinoma with a Clear-Cell Component Who Progressed After 1st Line Treatment.
    Étude en ouvert, évaluant le cabozantinib en traitement de 2ème ligne chez des patients atteints d’un carcinome rénal avec composante à cellules claires, inopérable, localement avancé ou métastatique, ayant progressé après un traitement de 1ère ligne de traitement
    A.3.2Name or abbreviated title of the trial where available
    CABOPOINT
    A.4.1Sponsor's protocol code numberF-FR-60000-023
    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 SponsorIpsen Pharma
    B.1.3.4CountryFrance
    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 supportIpsen Pharma
    B.4.2CountryFrance
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationIpsen Pharma
    B.5.2Functional name of contact pointGlobal Medical Affairs Director.
    B.5.3 Address:
    B.5.3.1Street Address65 Quai Georges Gorse
    B.5.3.2Town/ cityBoulogne-Billancourt Cedex
    B.5.3.3Post code92650
    B.5.3.4CountryFrance
    B.5.4Telephone number+33058335000
    B.5.6E-mailnaila.taguieva.pioger@ipsen.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 Yes
    D.2.1.1.1Trade name CABOMETYX 20 mg film-coated tablets
    D.2.1.1.2Name of the Marketing Authorisation holderIpsen Pharma
    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.3.4Pharmaceutical 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.3.8INN - Proposed INNCABOZANTINIB
    D.3.9.1CAS number 849217-68-1
    D.3.9.2Current sponsor codeXL184
    D.3.9.4EV Substance CodeSUB93452
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 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 CABOMETYX 40 mg film-coated tablets
    D.2.1.1.2Name of the Marketing Authorisation holderIpsen Pharma
    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.3.4Pharmaceutical 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.3.8INN - Proposed INNCABOZANTINIB
    D.3.9.1CAS number 849217-68-1
    D.3.9.2Current sponsor codeXL184
    D.3.9.4EV Substance CodeSUB93452
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name CABOMETYX 60 mg film-coated tablets
    D.2.1.1.2Name of the Marketing Authorisation holderIpsen Pharma
    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.3.4Pharmaceutical 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.3.8INN - Proposed INNCABOZANTINIB
    D.3.9.1CAS number 849217-68-1
    D.3.9.2Current sponsor codeXL184
    D.3.9.4EV Substance CodeSUB93452
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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
    Unresectable, Locally Advanced or Metastatic Renal Cell Carcinoma with a Clear-Cell Component Who Progressed After 1st Line Treatment with Checkpoint Inhibitors
    carcinome rénal avec composante à cellules claires, inopérable, localement avancé ou métastatique, ayant progressé après un traitement de 1ère ligne par inhibiteurs de point de contrôle immunitaire
    E.1.1.1Medical condition in easily understood language
    Renal Cell Carcinoma
    carcinome rénal
    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 PT
    E.1.2Classification code 10067946
    E.1.2Term Renal cell carcinoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The overall objective of this study is to evaluate the efficacy and safety of cabozantinib as 2nd line treatment in subjects with unresectable, locally advanced or metastatic RCC with a clear-cell component, who progressed after prior CPI therapy with ipilimumab and nivolumab in combination or CPI combined with VEGF-targeted therapy.

    To assess the efficacy of cabozantinib by the objective response rate (ORR) per Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 evaluated by independent central review
    L'objectif global de cette étude est d’évaluer l’efficacité et la tolérance du cabozantinib en traitement de 2ème ligne chez des patients atteints d’un carcinome à cellules rénales (CCR) avec composante à cellules claires inopérable, localement avancé ou métastatique ayant progressé, après un traitement antérieur par inhibiteur de point de contrôle (IPC - ipilimumab et nivolumab en association) seuls ou IPC associés à un traitement ciblant le VEGF.

    Évaluer l’efficacité du cabozantinib par le taux de réponse objective (TRO) d’après les critères RECIST (Response Evaluation Criteria in Solid Tumours, critères d’évaluation de la réponse dans les tumeurs solides) 1.1 évalués par un examen central.
    E.2.2Secondary objectives of the trial
    •To assess other efficacy criteria of cabozantinib such as best overall response (BOR)
    • To determine Time to response (TTR)
    •To determine duration of response (DOR)
    •To determine disease control rate (DCR)
    •To determine progression-free survival (PFS)
    •To assess overall survival (OS);
    •To assess the change in disease-related symptoms as assessed by the Functional Assessment of Cancer Therapy-Kidney Cancer Symptom Index (FKSI-DRS) questionnaire;
    •To assess the safety and tolerability of cabozantinib
    • Évaluer d’autres critères d’efficacité du cabozantinib tels que la meilleure réponse globale (MRG),
    • Évaluer le délai avant la réponse (DAR),
    • Évaluer la durée de la réponse (DdR),
    • Évaluer le taux de contrôle de la maladie (TCM),
    • Évaluer la survie sans progression (SSP)
    • Évaluer la modification des symptômes liés à la maladie d’après l’évaluation reposant sur le questionnaire FKSI-DRS (Functional Assessment of Cancer Therapy-Kidney Cancer Symptom Index, évaluation fonctionnelle du traitement anticancéreux–Indice des symptômes rénaux).
    • Évaluer la tolérance et la sécurité d’emploi du cabozantinib.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    At selected sites, tumour tissue (archived before 1st line treatment) may be obtained at any time (archived biopsy) for a biomarker sub-study (exploratory analysis) of MET and PD-L1 expression (status) associated with RCC prognosis or the mechanism(s) of action of study treatment. Details regarding the preparation, processing, and shipping of samples can be found in the biomarkers manual.
    E.3Principal inclusion criteria
    (1) Subjects must provide a signed informed consent prior to any study-related procedures;
    (2) Male or female subjects must be aged ≥18 years on the day the informed consent is signed;
    (3)Subjects must have histologically confirmed unresectable, locally advanced (defined as disease not eligible for curative surgery or radiation therapy) or metastatic RCC with a clear-cell carcinoma component;
    (4) Subjects must have radiographic disease progression, according to Investigator’s judgement, following 1st line treatment with CPI (ipilimumab plus nivolumab) (Cohort A) or CPI in combination with VEGF-targeted therapy (Cohort B);
    (5) Subjects present ≥1 target lesion according to RECIST 1.1 per investigator;
    (6)Subjects should have Eastern Cooperative Oncology Group (ECOG) status 0-1;
    (7) Subjects with treated brain metastases are eligible if metastases have been shown to be stable as per Investigator’s judgement;
    (8) Subjects must have adequate organ and marrow function, based upon meeting all of the following laboratory criteria within 10 days before study entry:
    (a)Absolute neutrophil count (ANC) ≥ 1500/mm3 (≥ 1.5 GI/L).
    (b) Platelets ≥ 100,000/mm3 (≥ 100 GI/L).
    (c) Hemoglobin ≥ 9 g/dL (≥ 90 g/L).
    (d) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) < 3.0 × upper limit of normal.
    (e) Total bilirubin ≤ 1.5 × the upper limit of normal. For subjects with Gilbert’s disease ≤ 3 mg/dL (≤ 51.3 μmol/L).
    (f) Fasting serum triglycerides ≤ 2.5 × upper limit of normal AND total cholesterol ≤ 300 mg/dL (≤ 7.75 mmol/L). Lipid-lowering medication is allowed.
    (g) Serum creatinine ≤ 2.0 × upper limit of normal or calculated creatinine clearance ≥ 30 mL/min (≥ 0.5 mL/sec) using the Cockroft-Gault equation
    (h) Urine protein-to-creatinine ratio (UPCR) ≤ 1 mg/mg (≤ 113.2 mg/mmol) creatinine or 24-hour urine protein < 1 g.
    (9) Subject must have recovered to baseline or ≤ Grade 1 per Common Terminology Criteria for Adverse Events (CTCAE) v5 from toxicities related to any prior treatments, unless AE(s) are clinically nonsignificant and/or stable on supportive therapy as determined by the investigator;
    (10) Subjects must have completed a steroid taper, if he/she must have had an immune-related adverse event associated with immune CPI;
    (11) Female subjects of childbearing potential (i.e. less than or equal to 2 years post-menopause and not surgically sterile) must provide a negative pregnancy test within 7 days prior to the start of study treatment. If a urine test cannot be confirmed as negative, a negative serum pregnancy test is required;
    (12) Female subjects of childbearing potential (i.e. less than or equal to 2 years post-menopause and not surgically sterile) must agree to use medically accepted methods of contraception (e.g. barrier methods, including male condom, female condom, or diaphragm with spermicidal gel) during the course of the study and for 4 months after the last dose of study treatment;
    (13) All male participants must agree to refrain from donating sperm and unprotected sexual intercourse with female partners during the study and for 120 days after the last dose of study treatment;
    (14)Subjects must be willing and able to comply with study requirements, remain at the investigational site for the required duration of each study visit and be willing to return to the investigational site for the follow up evaluation, as specified in the protocol.
    1. Fourniture d’un consentement éclairé signé avant toute activité liée à l’étude ;
    2. Homme ou femme âgé(e) de ≥ 18 ans le jour de la signature du consentement éclairé ;
    3. Présence d’un CCR histologiquement confirmé avec composante à cellules claires, inopérable, localement avancé (défini comme une atteinte non éligible à une intervention chirurgicale ou une radiothérapie curative) ou métastatique ;
    4. Progression radiographique de la maladie d’après le jugement de l’investigateur, après le traitement de 1ère ligne par IPC (ipilimumab plus nivolumab) (Cohorte A) ou IPC en association à un traitement ciblant le VEGF (Cohorte B) ;
    5. Présence de ≥ 1 lésion cible d’après les critères RECIST 1.1 d’après l’investigateur ;
    6. Score de performances ECOG (Eastern Cooperative Oncology Group) de 0 à 1;
    7. Les patients ayant des métastases cérébrales traitées sont éligibles si l’investigateur juge que les métastases sont stables ;
    8. Fonction satisfaisante des organes et de la moelle osseuse, basée sur la réunion de tous les critères biologiques suivants dans les 10 jours précédant l’entrée dans l’étude :
    a) Numération absolue des neutrophiles (NAN) ≥ 1 500/mm3 (≥ 1,5 G/l).
    b) Plaquettes ≥ 100 000/mm3 (≥ 100 G/l).
    c) Hémoglobine ≥ 9 g/dl (≥ 90 g/l).
    d) Alanine aminotransférase (ALAT) et aspartate aminotransférase (ASAT) < 3,0 × limite supérieure de la normale.
    e) Bilirubine totale ≤ 1,5 × limite supérieure de la normale. Pour les patients présentant un syndrome de Gilbert ≤ 3 mg/dl (≤ 51,3 μmol/l).
    f) Triglycéridémie à jeun ≤ 2,5 × limite supérieure de la normale ET cholestérol total ≤ 300 mg/dl (≤ 7,75 mmol/l). L’administration de médicaments antilipémiants est autorisée.
    g) Créatininémie ≤ 2,0 × limite supérieure de la normale ou clairance calculée de la créatinine ≥ 30 ml/min (≥ 0,5 ml/sec) par l’équation de Cockroft-Gault.
    h) Rapport protéines/créatinine urinaires (RPCU) ≤ 1 mg/mg (≤ 113,2 mg/mmol) créatinine ou protéinurie des 24 heures
    9. Retour aux valeurs initiales ou ≤ Grade 1 selon les critères communs de terminologie des événements indésirables, établis par l’Institut national du cancer v5 après la survenue de toxicités liées à d’éventuels traitements antérieurs, sauf si le ou les évènements indésirables (EI) sont cliniquement non significatifs et/ou stables sous traitement de soutien, d’après l’évaluation de l’investigateur ;
    10. Achèvement d’une diminution progressive de corticothérapie instaurée en raison d’un événement indésirable lié au système immunitaire, associé au traitement par IPC ;
    11. Les femmes en âge de procréer (c’est-à-dire au maximum 2 ans après la ménopause et non stérilisées chirurgicalement) devront avoir un test de grossesse négatif dans les 7 jours précédant le début du traitement à l’étude. S’il n’est pas possible de confirmer qu’un test urinaire de grossesse est négatif, un test sanguin de grossesse est exigé ;
    12. Les femmes en âge de procréer (c’est-à-dire au maximum 2 ans après la ménopause et non stérilisées chirurgicalement) devront accepter d’utiliser des moyens de contraception médicalement acceptés (par exemple, méthodes mécaniques (« barrières »), y compris préservatif masculin, préservatif féminin ou diaphragme avec gel spermicide) pendant le déroulement de l’étude et pendant 4 mois après la dernière dose de traitement à l’étude ;
    13. Les hommes participant à l’étude doivent accepter de s’abstenir de faire des dons de sperme et d’avoir des rapports sexuels sans protection avec des partenaires féminines pendant l’étude et les 120 jours après leur dernière dose de traitement à l’étude ;
    14. Volonté et capacité de respecter les exigences de l’étude, rester dans le centre d’étude pendant la durée exigée à chaque visite d’étude et volonté de se rendre à nouveau dans le centre d’étude pour l’évaluation de suivi, conformément à ce qui est spécifié dans le protocole.
    E.4Principal exclusion criteria
    (1) diagnosis of predominant non clear cell RCC;
    (2)Inability to swallow tablets or capsules;
    (3)treated with any other investigational medicinal product (IMP) within the last 30 days before study entry;
    (4) previously treated with cabozantinib;
    (5)Presents untreated brain or leptomeningeal metastases, or current clinical or radiological progression of known brain metastases;
    (6)diagnosis of a serious cardiovascular disorder:
    (a)Congestive heart failure New York Heart Association class 3 or 4, unstable angina pectoris, or serious cardiac arrhythmias;
    (b)Uncontrolled hypertension, defined as sustained blood pressure (BP) (>140 mm Hg systolic or >90 mm Hg diastolic pressure) despite optimal antihypertensive treatment;
    (c)Stroke (including transient ischaemic attack (TIA)), myocardial infarction (MI) or other ischaemic event, or thromboembolic event (e.g. deep venous thrombosis, pulmonary embolism) within 6 months before study entry;
    (d)History of risk factors for torsades de pointes (eg, long QT syndrome);
    (7) receiving a concomitant anticoagulation with oral anticoagulants (e.g. warfarin, direct thrombin and Factor Xa inhibitors) or platelet inhibitors
    Note: Low dose aspirin for cardioprotection, low dose warfarin (<1 mg/day), and low dose, (LMWH) are permitted.
    (8)gastrointestinal (GI) disorder including those associated with a high risk of perforation or fistula formation:
    (a)Tumours invading the GI tract, active peptic ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute pancreatitis or acute obstruction of the pancreatic or biliary duct, or gastric outlet obstruction;
    (b)Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess within 6 months before study entry;
    Note: Complete healing of an intra-abdominal abscess must have been confirmed before study entry.
    (9)Presents a corrected QT (QTc) interval calculated by the Fridericia formula (QTcF) > 500 msec within 1 month prior to study entry;
    Note: If a single ECG shows a QTcF with an absolute value > 500 ms, two additional ECGs at intervals of approximately 3 min must be performed within 30 min after the initial ECG, and the average of these three consecutive results for QTcF will be used to determine eligibility
    (10) clinically significant haematuria, hematemesis, or haemoptysis of >0.5 teaspoon (2.5 mL) of red blood, or other history of significant bleeding within 3 months before study entry;
    (11) cavitating pulmonary lesion(s) or known endobronchial disease manifestation;
    (12) lesions invading major pulmonary blood vessels;
    (13) diagnosed with other clinically significant disorders such as:
    (a)Serious nonhealing wound/ulcer/bone fracture;
    (b)Malabsorption syndrome;
    (c)Free thyroxine (FT4) outside the laboratory normal reference range;
    (d)Uncompensated/symptomatic hypothyroidism;
    (e)Moderate to severe hepatic impairment
    (f)Requirement for haemodialysis or peritoneal dialysis
    (g)History of solid organ transplantation;
    (14)predicted life expectancy of less than 3 months;
    (15)prior surgery within 4 weeks prior to study entry. Note: If the subject has undergone major surgery, complete wound healing must have occurred 1 month prior to study entry.
    (16) palliative radiation therapy for bone within 2 weeks or for radiation fields including viscera within 4 weeks prior to study entry. Note: Resolution/healing of side effects must be complete within 4 weeks prior to study entry;
    (17) history of another active malignancy within 3 years from study entry except for locally curable cancers that have been apparently cured, such as low-grade thyroid carcinoma, prostate cancer not requiring treatment , basal or squamous cell skin cancer, superficial bladder cancer, in situ melanoma, in situ prostate, cervix or breast carcinoma or other treated malignancies with <5% chance of relapse according to the Investigator;
    (18) history of allergy to study treatment components or agents with a similar chemical structure or any excipient used in the formulation as listed in the SmPC document;
    (19) rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption;
    (20) serious medical or psychiatric condition that render the subject unable to understand the nature, scope and possible consequences of the study, and/or presents an uncooperative attitude;
    (21) pregnant or breastfeeding. A β-human chorionic gonadotrophin (HCG) serum pregnancy test will be performed up to 7 days prior to study entry for all female subjects of childbearing potential (i.e. less than or equal to 2 years post-menopause and not surgically sterile);
    (22) likely to require treatment during the study with drugs that are not permitted by the study protocol;
    (23)abnormal baseline findings, any other medical condition(s) or laboratory findings that, in the opinion of the Investigator, might jeopardise the subject’s safety.
    1. Diagnostic d’un CCR à prédominance non à cellules claires ;
    2. Incapacité à avaler des comprimés ou des gélules ;
    3. Traitement par un autre médicament à l’étude (ME) dans les 30 derniers jours avant l’entrée dans l’étude ;
    4. Traitement antérieur par cabozantinib ;
    5. Présence de métastases cérébrales ou leptoméningées non traitées ou progression clinique ou radiologique en cours de métastases cérébrales connues
    6. Diagnostic de trouble cardiovasculaire grave :
    a) Insuffisance cardiaque congestive de classe NYHA (New York Heart Association) 3 ou 4, angor instable ou arythmies cardiaques graves
    b) Hypertension artérielle non contrôlée, définie comme une pression artérielle (PA) élevée (pression systolique > 140 mm Hg ou pression diastolique > 90 mm Hg) persistant malgré un traitement antihypertenseur optimal
    c) Accident vasculaire cérébral (y compris accident ischémique transitoire (AIT), infarctus du myocarde (IDM) ou autre événement ischémique, ou événement thrombo-embolique (par exemple, thrombose veineuse profonde, embolie pulmonaire) dans les 6 mois avant l’entrée dans l’étude
    d) Antécédents de facteurs de risque de torsades de pointes (par exemple, syndrome du QT long) ;
    7. Traitement anticoagulant concomitant par anticoagulants oraux (par exemple, warfarine, inhibiteur direct de la thrombine et inhibiteurs du facteur Xa) ou antiplaquettaires (par exemple, clopidogrel)
    Remarque : L’aspirine à faibles doses à des fins de cardioprotection (conformément aux directives locales applicables), la warfarine à faible dose (< 1 mg/jour), et l’héparine de bas poids moléculaire (HBPM) à faible dose sont autorisées ;
    8. Présence d’un trouble gastro-intestinal (GI) incluant ceux associés à un risque élevé de perforation ou de formation de fistules :
    a) Tumeurs envahissant le tube digestif, ulcère gastro-duodénal actif, maladie intestinale inflammatoire, diverticulite, cholécystite, cholangite symptomatique ou appendicite, pancréatite aiguë ou obstruction aiguë des conduits pancréatiques ou biliaires ou obstruction de la sortie gastrique
    b) Fistule abdominale, perforation GI, obstruction intestinale ou abcès intra-abdominal dans les 6 mois précédant l’entrée dans l’étude
    Remarque : La cicatrisation complète d’un abcès intra-abdominal doit avoir été confirmée avant l’entrée dans l’étude.
    9. Présence d’un intervalle QT corrigé (QTc) calculé à partir de la formule de Fridericia (QTcF) > 500 msec dans le mois précédant l’entrée dans l’étude
    Remarque : si un ECG montre un intervalle QTcF ayant une valeur absolue > 500 ms, deux autres ECG devront être effectués dans les 30 minutes suivant l’ECG initial à environ 3 min d’intervalle, et la moyenne de ces trois résultats consécutifs de QTcF sera utilisée pour déterminer l’éligibilité ;
    10. Présence d’une hématurie cliniquement significative, d’une hématémèse ou d’une hémoptysie d’un volume > 0,5 cuillère à café (2,5 ml) de sang rouge ou tout antécédent de saignement significatif (par exemple, hémorragie pulmonaire) dans les 3 mois précédant l’entrée dans l’étude ;
    11. Présence de lésion(s) pulmonaire(s) cavitaire(s) ou de manifestations endobronchiques connues ;
    12. Présence de lésions envahissant les gros vaisseaux sanguins pulmonaires ;
    13. Diagnostic d’autres pathologies cliniquement significatives telles que :
    a) Plaie/ulcération/fracture osseuse grave ne cicatrisant pas
    b) Syndrome de malabsorption
    c) Taux de thyroxine libre (FT4) en dehors de la plage de référence de valeurs normales pour le laboratoire
    d) Hypothyroïdie non compensée/symptomatique
    e) Insuffisance hépatique modérée à sévère (Child-Pugh B ou C) ;
    f) Nécessité d’une hémodialyse ou d’une dialyse péritonéale
    g) Antécédents de greffe d’organe solide ;
    14. Espérance de vie prédite inférieur à 3 mois ;
    15. Antécédents d’intervention chirurgicale dans les 4 semaines précédant l’entrée dans l’étude. Remarque : Si le patient a eu une intervention chirurgicale majeure, la plaie doit avoir cicatrisé complètement 1 mois avant l’entrée dans l’étude ;
    16. Radiothérapie palliative pour une atteinte osseuse dans les 2 semaines avant l’entrée dans l’étude ou pour des champs d’irradiation incluant les viscères dans les 4 semaines précédant l’entrée dans l’étude. Remarque : La résolution/cicatrisation des effets indésirables doit être terminée dans les 4 semaines précédant l’entrée dans l’étude ;
    17. Antécédents d’un autre cancer actif dans les 3 ans précédant l’entrée dans l’étude, hormis des cancers localement curables apparemment guéris, comme un carcinome de la thyroïde de bas grade, un cancer de la prostate ne nécessitant pas de traitement (grade Gleason ≤ 6), un épithélioma malpighien spinocellulaire ou carcinome basocellulaire de la peau, un cancer superficiel de la vessie ou un mélanome in situ , un cancer de la prostate, du col ou du sein in situ ou d’autres cancers traités avec < 5 % probabilité de récidive d’après l’investigateur ;

    cf le protocole pour l'item 18-23


    E.5 End points
    E.5.1Primary end point(s)
    Objective response rate (ORR) per RECIST 1.1 evaluated by independent central review.
    Taux de réponse objective (TRO) selon les critères RECIST 1.1 évalués par un examen central indépendant
    E.5.1.1Timepoint(s) of evaluation of this end point
    Objective response rate (ORR) defined as the proportion of subjects who achieved a
    partial response (PR) or complete response (CR) at any timepoint as determined by
    independent central review per Response Evaluation Criteria in Solid Tumours (RECIST) 1.1, confirmed by a subsequent visit ≥28 days later.
    Le critère d’évaluation principal (TRO), défini comme la proportion de patients présentant une réponse complète (RC) et une réponse partielle (RP) conformément aux critères RECIST 1.1 évalués par un examen central indépendant et confirmés par une visite effectuée ≥ 28 jours plus tard.
    E.5.2Secondary end point(s)
    • Best overall response (BOR) per RECIST 1.1 evaluated by independent central review;
    • Time to response (TTR) per RECIST 1.1 evaluated by independent central review;
    • Duration of response (DOR) per RECIST 1.1 evaluated by independent central review;
    • Disease control rate (DCR) per RECIST 1.1 by independent central review;
    • Progression-free survival (PFS) per RECIST 1.1 by independent central review;
    • Overall survival (OS);
    • ORR, BOR, TTR, DOR, DCR and PFS per RECIST 1.1 according to local Investigator’s review;
    • Change in disease-related symptoms as assessed by the Functional Assessment of Cancer Therapy-Kidney Cancer Symptom Index (FKSI-DRS) questionnaire.
    • Meilleure réponse globale (MRG) selon les critères RECIST 1.1 évalués par un examen central indépendant
    • Délai avant la réponse (DAR) selon les critères RECIST 1.1 évalués par un examen central indépendant
    • Durée de la réponse (DdR) selon les critères RECIST 1.1 évalués par un examen central indépendant
    • Taux de contrôle de la maladie (TCM) selon les critères RECIST 1.1 évalués par un examen central indépendant
    • Survie sans progression (SSP) selon les critères RECIST 1.1 évalués par un examen central indépendant
    • Survie globale (SG)
    • TRO, MRG, DAR, DdR, TCM et SSP selon les critères RECIST 1.1 évalués par un examen d’investigateur local
    • Modification des symptômes liés à la maladie d’après l’évaluation reposant sur le questionnaire FKSI-DRS (Functional Assessment of Cancer Therapy-Kidney Cancer Symptom Index, évaluation fonctionnelle du traitement anticancéreux–Indice des symptômes rénaux).
    E.5.2.1Timepoint(s) of evaluation of this end point
    Time-to-event endpoints (TTR, DOR, PFS and OS) will be analysed using the Kaplan-Meier method. Median durations and associated 2-sided 95% CIs will be provided. Event rates at timepoints from either first dose of study treatment or first documented response will also be estimated with associated 2-sided 95% CIs.
    Les critères d’évaluation de délai avant l’événement (DAR, DdR, SSP et SG) seront analysés à l’aide de la méthode de Kaplan-Meier. Les durées médianes et IC à 95 % bilatéraux associés seront fournis. Les taux d’événement à des points temporels évalués à partir de la première dose de traitement à l’étude ou de la première réponse documentée seront également estimés avec leurs IC à 95 % bilatéraux associés.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Tolerability
    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 No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    two independent cohorts
    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.8.3 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 Yes
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Austria
    Belgium
    France
    Germany
    Netherlands
    Spain
    Switzerland
    United Kingdom
    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 end 18 months after the last subject included in the study received the first cabozantinib dose.
    18 mois après l’administration de la première dose de cabozantinib au dernier patient inclus dans l’étude
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months6
    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: 150
    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 No
    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 state70
    F.4.2 For a multinational trial
    F.4.2.2In the whole clinical trial 250
    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)
    The study will end 18 months after the last subject included in the study received the first cabozantinib dose.
    Subjects who continue to benefit from the treatment after the end of the study will be supplied with Cabometyx® free of charge from Ipsen, according to local regulations and as long as there is safety and efficacy evidence to support the continuation of this treatment.
    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 Decision2019-07-03
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-08-29
    P. End of Trial
    P.End of Trial StatusOngoing
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