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    Summary
    EudraCT Number:2018-002990-24
    Sponsor's Protocol Code Number:RAD1901-308
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-06-26
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2018-002990-24
    A.3Full title of the trial
    Elacestrant Monotherapy vs. Standard of Care for the Treatment of Patients with ER+/HER2- Advanced Breast Cancer Following CDK4/6 Inhibitor Therapy: A Phase 3 Randomized, Open-Label, Active-Controlled, Multicenter Trial (EMERALD)
    Elacestrant en monoterapia, en comparación con el tratamiento habitual, en pacientes con cáncer de mama avanzado ER+/HER2- que han recibido previamente un inhibidor de CDK4/6: Ensayo de fase 3, aleatorizado, abierto, controlado con principio activo y multicéntrico (EMERALD)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Elacestrant Monotherapy for the Treatment of ER+/HER2- Advanced Breast Cancer Following CDK4/6 Inhibitor Therapy: A Phase 3 Randomized, Open-Label, Active-Controlled, Multicenter Trial
    Elacestrant en monoterapia para el tratamiento habitual, en pacientes con cáncer de mama avanzado ER+/HER2- que han recibido previamente un inhibidor de CDK4/6: Ensayo fase 3, aleatorizado, abierto, controlado con principio activo y multicéntrico
    A.3.2Name or abbreviated title of the trial where available
    EMERALD
    A.4.1Sponsor's protocol code numberRAD1901-308
    A.5.4Other Identifiers
    Name:IND No.Number:124748
    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 SponsorRadius Pharmaceuticals 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 supportRadius Pharmaceuticals Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationRadius Pharmaceuticals Inc.
    B.5.2Functional name of contact pointClinical Operations
    B.5.3 Address:
    B.5.3.1Street Address950 Winter Street
    B.5.3.2Town/ cityWaltham
    B.5.3.3Post codeMA 02451
    B.5.3.4CountryUnited States
    B.5.4Telephone number+16175514000
    B.5.5Fax number+16175514701
    B.5.6E-mailRAD1901-308@radiuspharm.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 No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameElacestrant
    D.3.2Product code RAD1901 2HCl
    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 INNELACESTRANT
    D.3.9.1CAS number 1349723-93-8
    D.3.9.2Current sponsor codeRAD1901 Dihydrochloride
    D.3.9.3Other descriptive nameElacestrant Dihydrochloride
    D.3.9.4EV Substance CodeSUB184531
    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 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 No
    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 nameElacestrant
    D.3.2Product code RAD1901 2HCl
    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 INNELACESTRANT
    D.3.9.1CAS number 1349723-93-8
    D.3.9.2Current sponsor codeRAD1901 Dihydrochloride
    D.3.9.3Other descriptive nameElacestrant Dihydrochloride
    D.3.9.4EV Substance CodeSUB184531
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number400
    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 RoleComparator
    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 Faslodex 250 mg solution for injection.
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca AB, SE-151 85 Södertälje, Sweden
    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 Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntramuscular use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFulvestrant
    D.3.9.1CAS number 129453-61-8
    D.3.9.3Other descriptive nameFULVESTRANT
    D.3.9.4EV Substance CodeSUB13933MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleComparator
    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 ARIMIDEX 1 mg filmom obložene tablete
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca d.o.o., Radnička cesta 80, 10000 Zagreb
    D.2.1.2Country which granted the Marketing AuthorisationCroatia
    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 INNAnastrozole
    D.3.9.1CAS number 120511-73-1
    D.3.9.3Other descriptive nameANASTROZOLE
    D.3.9.4EV Substance CodeSUB05502MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleComparator
    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 Femara 2,5 mg filmom obloţene tablete
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Hrvatska d.o.o., Radnička cesta 37b, 10 000 Zagreb
    D.2.1.2Country which granted the Marketing AuthorisationCroatia
    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 INNLETROZOLE
    D.3.9.1CAS number 112809-51-5
    D.3.9.4EV Substance CodeSUB08444MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2.5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 6
    D.1.2 and D.1.3IMP RoleComparator
    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 Aromasin 25 mg tablete
    D.2.1.1.2Name of the Marketing Authorisation holderPFIZER Croatia d.o.o., Slavonska avenija 6, 10000 Zagreb
    D.2.1.2Country which granted the Marketing AuthorisationCroatia
    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 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 INNExemestane
    D.3.9.1CAS number 107868-30-4
    D.3.9.3Other descriptive nameEXEMESTANE
    D.3.9.4EV Substance CodeSUB07492MIG
    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 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
    Advanced breast cancer
    Cáncer de mama avanzado
    E.1.1.1Medical condition in easily understood language
    Advanced breast cancer
    Cáncer de mama avanzado
    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 10072737
    E.1.2Term Advanced breast cancer
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To demonstrate that elacestrant, compared with the Standard of Care (SoC options of either fulvestrant or an aromatase inhibitor (AI), is superior in prolonging progression-free survival (PFS) based on blinded central Imaging Review Committee (IRC) assessment in postmenopausal women and in men with advanced/metastatic estrogen receptor positive/ human epidermal growth factor receptor 2 negative (ER+/HER2-) breast cancer, either in subjects with tumors that harbor mutations in the ligand binding domain (LBD) of the estrogen receptor 1 (ESR1) gene (ESR1-mut subjects) or in all (ESR1-mut and ESR1 wild type [ESR1-WT]) subjects. Subjects must have received at least one and no more than two prior lines of endocrine therapy (with documented progression), which must have included prior CDK4/6 inhibitor therapy in combination with fulvestrant or an aromatase inhibitor (AI) and hormonal monotherapy must be an appropriate treatment option.
    Demostrar que elacestrant, comparado con las opciones del tratamiento habitual (Standard of Care, SoC) de fulvestrant o un inhibidor de la aromatasa (aromatase inhibitor, AI), es superior en cuanto a prolongar la supervivencia sin progresión (progression-free survival, PFS) según la evaluación central por un Imaging Review Committee (IRC) desconocedor del tratamiento, en mujeres posmenopáusicas y hombres con cáncer de mama positivo para el receptor estrogénico y negativo para el receptor del factor de crecimiento epidérmico humano 2 (ER+/HER2-), avanzado o metastásico, en sujetos portadores de mutaciones del gen del receptor estrogénico 1 (estrogen receptor 1, ESR1) en el dominio de unión al ligando (ligand binding domain, LBD) (sujetos ESR1-mut) o en todos los sujetos (ESR1-mut y ESR1 de tipo natural [ESR1-WT]). Los sujetos deberán haber recibido un mínimo de una y un máximo de dos líneas previas de tratamiento hormonal (con progresión documentada). Siga leyendose en el protocolo.
    E.2.2Secondary objectives of the trial
    -To compare overall survival (OS) between treatment arms in ESR1-mut subjects,
    -To compare OS between treatment arms in all (ESR1-mut and ESR1-WT) subjects,
    -To compare PFS based on blinded IRC assessment,
    -To compare objective response rate (ORR) based on blinded IRC assessment,
    - To compare duration of response (DoR) based on blinded IRC assessment,
    - To compare clinical benefit rate (CBR) based on blinded IRC assessment,
    -To compare ORR based on local Investigator assessment,
    -To compare DoR based on local Investigator assessment,
    -To compare CBR based on local Investigator assessment,
    -To compare the safety and tolerability between treatment arms
    -To assess the pharmacokinetics (PK) of elacestrant
    -To describe the changes of Patient Reported Outcomes (PROs) and Health-Related Quality of Life (HRQOL) within the study population and the differences in the changes of PROs/HRQOL between treatment arms
    -Comparar la supervivencia global (overall survival, OS) entre los grupos de tratamiento en sujetos ESR1-mut
    -Comparar la OS entre los grupos de tratamiento en todos los sujetos (ESR1-mut y ESR1-WT).
    -Comparar la PFS entre los grupos de tratamiento, según la evaluación por el IRC desconocedor del tratamiento
    -Comparar la tasa de respuesta objetiva (objective response rate, ORR) entre los grupos de tratamiento, según la evaluación por el IRC desconocedor del tratamiento
    -Comparar la CBR entre los grupos de tratamiento, según la evaluación por el Investigador local
    -Comparar la seguridad y tolerabilidad entre los grupos de tratamiento
    -Estudiar la farmacocinética (pharmacokinetics, PK) de elacestrant
    Véase el protocolo para el resto de objetivos secundarios
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    - Subjects with histologically or cytologically proven diagnosis of adenocarcinoma of the breast with evidence of either locally advanced disease not amenable to resection or radiation therapy with curative intent or metastatic disease not amenable to curative therapy
    -Subjects must be appropriate candidates for endocrine monotherapy
    -Subjects must have one of the terms as defined by RECIST v1.1 and confirmed by central radiology review prior to randomization:
    a. Measurable disease
    b. Nonmeasurable (evaluable) bone-only disease. Evaluable bone-only disease must include at least one lytic bone lesion or a mixed lytic-blastic bone lesion; blasticonly metastases are not allowed. Subjects who have had prior radiation to bone must have at least one evaluable lesion in a non-irradiated area
    -Female or male subjects age >= 18 years
    -Female subjects must be postmenopausal, defined as:
    a. Documented bilateral surgical oophorectomy
    b. Age >= 60 years with amenorrhea >= 1 year since last menses
    c. Age < 60 years with amenorrhea >= 1 year since last menses with no alternative pathological or physiological cause (including chemotherapy, treatment with tamoxifen or toremifene, or a GnRH agonist), and serum estradiol and FSH level within the laboratory reference range for postmenopausal women
    d. Age < 60 years with tamoxifen or toremifene therapy within the last 12 months, with documentation of 12 months of amenorrhea prior to tamoxifen or toremifene therapy, and serum estradiol and FSH levels within the laboratory reference range for postmenopausal women
    -Male subjects:
    a. Must have suppression of testicular hormone production through chemical ablation with an approved GnRH agonist, starting at least six weeks prior to study entry and continuing without interruption for the duration of protocol treatment (unless they have undergone prior orchiectomy). Note: GnRH agonists should be administered as per local standard of care and should be documented as concomitant medication
    b. Must, even if surgically sterilized (ie, status post-vasectomy):
    i. Agree to practice highly effective barrier contraception (use condoms) during the entire study treatment period and through 120 days after the last dose of study drug. For subjects (who have not undergone vasectomy) with female
    partners of childbearing potential, the subject and his partner must in addition to condoms, use highly effective contraceptive measures when engaging in sexual intercourse throughout the study, and for at least 120 days after the last dose of study drug (eg, oral contraceptive and condoms, intrauterine device (IUD) and condoms, diaphragm with spermicide and condoms, other forms of contraception must be approved by the medical monitor) OR Agree to practice true abstinence during the entire study treatment period and through 120 days after the last dose of study drug
    ii. Agree not to donate sperm during the course of this study or within 120 days after receiving their last dose of the study drugs
    -Subjects must have ER-positive, HER2-negative tumor status confirmed per local laboratory testing on their most recent biopsy from a metastatic lesion (if metastatic disease), or recurrent disease lesion (if locally advanced), or for subjects with bone only disease, from the most recent results from a biopsy from any site
    -Subjects must have previously received at least one and no more than two lines of endocrine therapy for advanced/metastatic breast cancer
    -Subjects must have received prior treatment with a CDK4/6 inhibitor in combination with either fulvestrant or an AI
    - Subjects may have received no more than one line of chemotherapy in the advanced/metastatic setting. Chemotherapy administered for less than one cycle will not be counted as a prior line of chemotherapy. For subjects who progress within 12 months of (neo)adjuvant chemotherapy, this will count as one prior line of therapy for
    advanced/metastatic disease
    - Subjects must have ctDNA ESR1-mut or ESR1-WT status as determined by central testing before subject is randomized
    -Except where prohibited by local regulations, subjects must agree to provide a tissue sample taken from a metastatic disease lesion (if metastatic) or recurrent disease lesion (if locally advanced). A fresh biopsy is requested; however, an archival sample taken from the most recent available surgical biopsy (from a metastatic disease lesion or recurrent disease lesion) is acceptable. For subjects with bone only disease, archival tissue from the most recent biopsy of any kind is acceptable
    - Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
    -Resolution of all toxic effects of prior therapies or surgical procedures to Grade ≤ 1 (except alopecia and peripheral neuropathy)
    -Adequate organ function as defined below:
    a. Hematologic function
    b. Renal function
    c. Hepatic function
    d. Serum chemistry
    e. Coagulation
    -Ability to understand the protocol and provide informed consent
    1.Sujetos con diagnóstico de adenocarcinoma de mama, demostrado histológica o citológicamente, con evidencia de enfermedad localmente avanzada no susceptible de resección o de radioterapia con intención curativa o con evidencia de enfermedad metastásica no susceptible de tratamiento con intención curativa
    2.Sujetos que sean candidatos adecuados para monoterapia hormonal
    3.Sujetos con una de las situaciones siguientes según RECIST v1.1 y con confirmación en la revisión radiológica central antes de la aleatorización:
    a.Enfermedad medible
    b.Enfermedad solamente ósea no medible (evaluable). La enfermedad evaluable solamente ósea debe incluir como mínimo una lesión ósea lítica o una lesión ósea mixta lítica-blástica; no se permiten las metástasis solamente blásticas. Si el sujeto ha recibido previamente radioterapia ósea, deberá presentar como mínimo una lesión evaluable en una zona no irradiada
    4.Mujeres u hombres de edad >= 18 años
    5.Las mujeres deben encontrarse en posmenopausia, lo que se define como:
    a.Ovariectomía quirúrgica bilateral documentada
    b.Edad >= 60 años con amenorrea >= 1 año desde la última menstruación
    c.Edad < 60 años con amenorrea >= 1 año desde la última menstruación sin causa patológica o fisiológica alternativa (tal como quimioterapia, tratamiento con tamoxifeno o toremifeno o un agonista de GnRH), y niveles séricos de estradiol y FSH dentro del valor de referencia del laboratorio para las mujeres posmenopáusicas
    d.Edad < 60 años con tratamiento con tamoxifeno o toremifeno en los últimos 12 meses, con documentación de 12 meses de amenorrea antes del tratamiento con tamoxifeno o toremifeno y niveles séricos de estradiol y FSH dentro del valor de referencia del laboratorio para las mujeres posmenopáusicas.
    6.Los varones:
    a.Deberán haber sido sometidos a supresión de la producción de hormonas testiculares mediante ablación química con un agonista de GnRH aprobado, iniciado como mínimo seis semanas antes de la entrada en el estudio y continuado sin interrupción durante todo el tratamiento del protocolo (salvo si hubieran sido sometidos a orquiectomía). Nota: Los agonistas de GnRH deben administrarse de acuerdo a la práctica local y documentarse como medicación concomitante
    b.Deberán, incluso aunque hayan sido esterilizados quirúrgicamente (es decir, encontrarse en posvasectomía):
    i.Estar de acuerdo en utilizar una anticoncepción de barrera altamente efectiva (preservativo) durante todo el periodo de tratamiento del estudio y hasta 120 días después de la última dosis del fármaco del estudio. En el caso de sujetos (no sometidos a vasectomía) con parejas femeninas potencialmente fértiles, el sujeto y su pareja deberán utilizar, además de preservativos, otras medidas anticonceptivas altamente efectivas en sus relaciones sexuales durante el estudio y hasta transcurridos como mínimo 120 días desde la última dosis del fármaco del estudio (por ejemplo, anticonceptivos orales y preservativos, dispositivo intrauterino y preservativos, diafragma con espermicida y preservativos; otros métodos anticonceptivos deberán ser aprobados por el monitor médico)
    O BIEN
    Acordar practicar una abstinencia real durante todo el periodo de tratamiento del estudio y hasta transcurridos 120 días desde la última dosis del fármaco del estudio
    ii.Estar de acuerdo no donar semen durante el curso del estudio y hasta transcurridos 120 días desde la última dosis del fármaco del estudio
    7.Sujetos con tumor ER-positivo y HER2-negativo, confirmado por el laboratorio local en la biopsia más reciente de una lesión metastásica (en caso de enfermedad metastásica) o de una lesión recidivante (en caso de enfermedad localmente avanzada) o, en los sujetos con enfermedad solamente ósea, en la biopsia más reciente de cualquier zona.
    8.Los sujetos que hayan recibido previamente un mínimo de una y un máximo de dos líneas de hormonoterapia por cáncer de mama avanzado/metastásico
    9.Los sujetos deberán haber recibido tratamiento previo con un inhibidor de CDK4/6 en combinación con fulvestrant o con un AI
    10. Los sujetos no podrán haber recibido más de una línea de quimioterapia por enfermedad avanzada/metastásica. La quimioterapia administrada durante menos de un ciclo no se contará como una línea previa de quimioterapia. En los sujetos con progresión de la enfermedad en el plazo de los 12 meses siguientes a la quimioterapia (neo)adyuvante, esta contará como una línea previa de tratamiento por enfermedad avanzada/metastásica
    11.Antes de su aleatorización, los sujetos deberán presentar ESR1-mut o ESR1-WT en ctDNA según el laboratorio central
    Para el resto de criterios de inclusión vease el protocolo
    E.4Principal exclusion criteria
    -Prior treatment with elacestrant, GDC-0810, GDC-0927, GDC-9545, LSZ102, AZD9496, bazedoxifene, or other investigational selective estrogen receptor degrader (SERD) or investigational ER antagonist
    - Prior anticancer or investigational drug treatment
    - Presence of symptomatic metastatic visceral disease, defined as extensive hepatic involvement, untreated or progressive central nervous system (CNS) metastases, or symptomatic pulmonary lymphangitic spread. Subjects with discrete pulmonary parenchymal metastases are eligible, provided their respiratory function is not significantly compromised as a result of disease in the opinion of the Investigator. Subjects with previously treated CNS metastases are eligible provided that that all known lesions were previously treated, they have completed radiotherapy at least 28 days prior to first dose of study drug, are clinically stable, and require no steroid medication. If anti-convulsant medication is required, subjects must be stable on a non-enzyme inducing anticonvulsant regimen
    -Subjects with an intact uterus with a history of endometrial intraepithelial neoplasia (atypical endometrial hyperplasia or higher-grade lesion)
    -Diagnosis of any other malignancy within five years before enrollment, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ of the cervix
    - Any of the following within six months before enrollment: myocardial infarction, severe/unstable angina, ongoing cardiac dysrhythmias ≥ Grade 2, prolonged QTcF ≥ Grade 2, uncontrolled atrial fibrillation of any grade, coronary/peripheral artery bypass graft, heart failure > Class II as defined by the New York Heart Association (NYHA) guidelines (Appendix 5), or cerebrovascular accident including transient ischemic attack
    - Subjects with abnormal coagulation profiles, or any history of coagulopathy within the past six months, including history of deep vein thrombosis (DVT) or pulmonary embolism. However, subjects with the following conditions will be allowed to participate: a.Subjects with adequately treated catheter-related venous thrombosis occurring more than one month prior to the first dose of study drug b.Subjects being treated with an anticoagulant, eg, warfarin or heparin, for a thrombotic event occurring more than six months before enrollment, or for an otherwise stable and allowed medical condition (eg, well controlled atrial fibrillation), provided dose and coagulation parameters (as defined by local standard of care) are stable for at least one month prior to the first dose of study drug, and provided that an AI would be an appropriate therapy for the subject
    -Subjects with known difficulty in tolerating oral medications or conditions which would impair absorption of oral medications such as: uncontrolled nausea or vomiting, gastrointestinal obstruction/motility disorder, malabsorption syndrome, or prior gastric bypass
    -Subjects unable or unwilling to avoid prescription medications, over the counter medications, dietary/herbal supplements, and/or foods (eg, pomelos, star fruit, Seville oranges, and their juices) that are strong inhibitors or inducers of CYP3A4 activity, or cholestyramine or other anion exchange resins. Participation will be allowed if the medication, supplements and/or foods are discontinued for at least five half-lives or 14 days (whichever is longer) prior to study entry and for the duration of the study
    -Major surgery within 28 days before the first dose of study drug
    -Radiation therapy within 14 days (28 days for brain lesions per Exclusion Criterion 3) before the first dose of study drug. Note: tumor lesions previously subjected to radiation therapy or other locoregional therapy will be considered measurable only if disease progression after completion of locoregional therapy is clearly documented
    -Any concurrent severe, acute, or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the subject inappropriate for entry into this study
    -Known hypersensitivity reaction to drugs chemically related to elacestrant or their excipients
    -Known hypersensitivity to fulvestrant, anastrozole, letrozole, or exemestane (or to any of their excipients), unless treatment with one of the other three of these four treatment options would be appropriate therapy
    1.Tratamiento previo con elacestrant, GDC-0810, GDC-0927, GDC-9545, LSZ102, AZD9496, bazedoxifeno u otro reductor selectivo del receptor de estrógenos (selective estrogen receptor degrader, SERD) en fase de investigación o con un antagonista de ER en fase de investigación
    2.Tratamiento previo antitumoral o con un fármaco en investigación
    3.Presencia de enfermedad metastásica visceral sintomática, definida como afectación hepática amplia, metástasis en sistema nervioso central no tratadas o en progresión o diseminación linfangítica pulmonar sintomática. Serán elegibles los sujetos con metástasis aisladas en parénquima pulmonar, siempre que, en opinión del Investigador, no tengan afectada significativamente la función respiratoria como consecuencia de la enfermedad. Podrán ser elegibles los sujetos con metástasis en sistema nervioso central tratadas previamente si dicho tratamiento abarcó todas las lesiones conocidas, han finalizado la radioterapia como mínimo 28 días antes de la primera dosis del fármaco del estudio, se encuentran clínicamente estables y no precisan corticosteroides. Si precisan medicación anticonvulsivante, los sujetos deberán encontrarse estables con un régimen anticonvulsivante sin acción de inducción enzimática
    4. Sujetos con útero intacto e historia de neoplasia intraepitelial de endometrio (hiperplasia endometrial atípica o lesión de grado superior)
    5. Diagnóstico de cualquier otro proceso maligno en los cinco años anteriores a la entrada en el estudio, excepto el carcinoma cutáneo de células basales o escamosas o el carcinoma in situ de cuello uterino tratados adecuadamente
    6.Cualquiera de los siguientes procesos en el plazo de los seis meses anteriores a la entrada en el estudio: infarto de miocardio, angina severa/inestable, arritmia cardíaca actual de Grado >= 2, prolongación del QTcF de Grado >= 2, fibrilación auricular no controlada de cualquier grado, cirugía de bypass coronario/arterial periférica, insuficiencia cardíaca de Clase > II de la New York Heart Association (NYHA) (Appendix 5) o accidente cerebrovascular, incluido el ataque isquémico transitorio.
    7.Sujetos con perfil de coagulación anormal, o con cualquier antecedente de coagulopatía en los 6 últimos meses, incluida historia de trombosis venosa profunda (deep vein trombosis, DVT) o de embolismo pulmonar. No obstante, podrán participar: a.Sujetos con trombosis venosa por catéter tratada adecuadamente producida más de un mes antes de la primera dosis del fármaco del estudio
    b.Sujetos en tratamiento anticoagulante, por ejemplo, con cumarínico o heparina, por un fenómeno trombótico producido más de 6 meses antes de la entrada en el estudio, o por otro tipo de proceso médico estable y permitido (por ejemplo, fibrilación auricular bien controlada), a condición de que la dosis y los parámetros de la coagulación (según la práctica local) se encuentren estables desde como mínimo un mes antes de la primera dosis del fármaco del estudio y de que un AI constituya un tratamiento adecuado del sujeto
    8.Sujetos con problemas conocidos de intolerancia de medicación oral o procesos que puedan dificultar la absorción de la medicación oral, como náuseas o vómitos no controlados, obstrucción/trastorno de la motilidad gastrointestinal, síndrome de malabsorción o bypass gástrico previo
    9. Sujetos que no pueden o no desean dejar de tomar ciertos medicamentos (a obtener con receta o de venta libre en farmacia), suplementos dietéticos/de herbolario y/o alimentos (a saber, pomelos, fruta estrella o carambola, naranjas amargas y sus zumos) que son potentes inhibidores o inductores de la actividad de CYP3A4, o colestiramina u otras resinas de intercambio aniónico. Podrán participar en el estudio si suspenden la medicación, suplementos y/o alimentos como mínimo cinco semividas o 14 días (eligiéndose el mayor de estos plazos) antes de la entrada en el estudio y durante todo el estudio
    10. Cirugía mayor en el plazo de 28 días antes de la primera dosis del fármaco del estudio
    11. Radioterapia en el plazo de 14 días (28 días en las lesiones cerebrales, según el Criterio de Exclusión 3) antes de la primera dosis del fármaco del estudio. Nota: Las lesiones tumorales sometidas previamente a radioterapia u otro tratamiento locorregional solamente se considerarán medibles si se ha documentado claramente la progresión de la enfermedad después del tratamiento locorregional
    12.Todo trastorno médico o psiquiátrico o anomalía de laboratorio de carácter severo, agudo o crónico, que pueda aumentar el riesgo derivado de la participación en el estudio o de la administración del medicamento en investigación o que pueda interferir con la interpretación de los resultados del estudio y que, en opinión del Investigador, contraindique la participación del sujeto en el estudio
    13. Hipersensibilidad conocida a fármacos químicamente relacionados con elacestrant o sus excipientes.
    Para el resto de criterios véase el protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    ● IRC assessed PFS in ESR1-mut subjects
    ● IRC assessed PFS in all (ESR1-mut and ESR1-WT) subjects-,
    where IRC assessed PFS is defined as the length of time from randomization until the date of objective disease progression per RECIST v1.1 as assessed by the blinded IRC, or death from any cause.
    -PFS en los sujetos ESR1-mut, evaluada por el IRC
    -PFS en todos los sujetos (ESR1-mut y ESR1-WT), evaluada por el IRC
    La PFS evaluada por el IRC se define como el plazo de tiempo transcurrido desde la aleatorización hasta la fecha de la progresión objetiva de la enfermedad según RECIST v1.1 en su evaluación por el IRC desconocedor del tratamiento, o de la muerte por cualquier causa.
    E.5.1.1Timepoint(s) of evaluation of this end point
    The date of objective disease progression per RECIST v1.1 or the date of subject's death.
    La fecha de progresión objetiva de la enfermedad según RECIST v1.1 o la fecha de la muerte del sujeto.
    E.5.2Secondary end point(s)
    ● OS in ESR1-mut subjects, where OS is defined as the length of time from randomization until the date of death from any cause
    ● OS in all (ESR1-mut and ESR1-WT) subjects
    -OS en los sujetos ESR1-mut, definiéndose la OS como el periodo de tiempo transcurrido desde la aleatorización hasta la fecha de la muerte por cualquier causa
    -OS en todos los sujetos (ESR1-mut y ESR1-WT)
    E.5.2.1Timepoint(s) of evaluation of this end point
    The date of subject's death.
    La fecha de la muerte del paciente.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned13
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA92
    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
    Argentina
    Australia
    Austria
    Belgium
    Canada
    Denmark
    France
    Germany
    Greece
    Hungary
    Ireland
    Israel
    Italy
    Korea, Republic of
    Portugal
    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
    A survival analysis will be performed at the same time as the final PFS analysis and again when approximately 50% of subjects have died at which time the study will be complete.
    Se efectuará un análisis de la supervivencia, al mismo tiempo que el análisis final de PFS y se repetirá otra vez cuando haya fallecido aproximadamente el 50% de los sujetos, momento en que se considerará que el estudio ha finalizado
    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 months3
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months2
    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: 233
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 233
    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 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 state46
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 304
    F.4.2.2In the whole clinical trial 466
    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)
    Subjects will enter a FU phase during which survival and new anti-cancer therapy information will be collected following the EOT visit for the duration of the study.For subjects who discontinue treatment for reasons other than disease progression,and who do not begin a new course of anti-cancer therapy,tumor assessments will continue per the SOE until disease progression;at that time,they will continue to be monitored for survival and new anti-cancer therapy information.
    Los sujetos continuarán en fase de seguimiento donde se recogerá información de su supervivencia y nuevo tto antitumoral según SOE después de la visita de EOT,a lo largo del estudio.Los que abandonen el tto por razones distintas de progresión de la enfermedad y que no comiencen uno nuevo,continuarán sometidos a evaluaciones del tumor según SOE,hasta la progresión de la enfermedad;a partir de ese momento,seguirán en observación para obtener información de su supervivencia y nuevo tto antitumoral.
    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 Decision2019-06-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-03-28
    P. End of Trial
    P.End of Trial StatusOngoing
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