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    Summary
    EudraCT Number:2018-003535-30
    Sponsor's Protocol Code Number:2018_16
    National Competent Authority:Belgium - FPS Health-DGM
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2020-05-26
    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 ConcernedBelgium - FPS Health-DGM
    A.2EudraCT number2018-003535-30
    A.3Full title of the trial
    A Phase 3 Study Comparing Lenalidomide and Daratumumab Subcutaneous Injection (R-Dara SC) vs Lenalidomide and Dexamethasone (Rd) in Frail Subjects with Previously Untreated Multiple Myeloma who are Ineligible for High Dose Therapy
    Etude de phase III comparant le Lénalidomide et le Daratumumab en injection sous cutanée versus le Lénalidomide et la Dexaméthasone chez des sujets fragiles atteints de myélome multiple en traitement de première ligne et non éligible à une chimiothérapie à forte dose
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    IFM 2017-03
    IFM 2017-03
    A.4.1Sponsor's protocol code number2018_16
    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 SponsorCHU de Lille
    B.1.3.4CountryFrance
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportJanssen Pharmaceutica NV
    B.4.2CountryBelgium
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCHU de Lille
    B.5.2Functional name of contact pointKEMKEM Aomar
    B.5.3 Address:
    B.5.3.1Street Address6 rue du Pr. LAGUESSE
    B.5.3.2Town/ cityLILLE
    B.5.3.3Post code59037
    B.5.3.4CountryFrance
    B.5.4Telephone number0033320444145
    B.5.5Fax number0033320445711
    B.5.6E-maildrs.promotion@chru-lille.fr
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/13/1153
    D.3 Description of the IMP
    D.3.1Product nameDaratumumab co-formulated with recombinant human hyaluronidase (rHuPH20)
    D.3.2Product code JnJ-54767414
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDARATUMUMAB
    D.3.9.1CAS number 945721-28-8
    D.3.9.2Current sponsor codeJnJ-54767414
    D.3.9.3Other descriptive nameHUMAX-CD38
    D.3.9.4EV Substance CodeSUB175772
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number120
    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 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 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 REVLIMID 25 mg gélules
    D.2.1.1.2Name of the Marketing Authorisation holderCELGENE EUROPE LIMITED
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/03/177
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Capsule
    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 INNLENALIDOMIDE
    D.3.9.1CAS number 191732-72-6
    D.3.9.4EV Substance CodeSUB25389
    D.3.10 Strength
    D.3.10.1Concentration unit mg/g milligram(s)/gram
    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.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 NEOFORDEX 40mg comprimés
    D.2.1.1.2Name of the Marketing Authorisation holderLABORATOIRE CTRS
    D.2.1.2Country which granted the Marketing AuthorisationFrance
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/03/177
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Pillules
    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 INNDEXAMETHASONE
    D.3.9.2Current sponsor codeDEXAMETHASONE
    D.3.9.4EV Substance CodeSUB07017MIG
    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.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
    A Phase III Study Comparing Lenalidomide and Daratumumab (R-Dara) vs Lenalidomide and Dexamethasone (Rd) in Frail Subjects with Previously Untreated Multiple Myeloma who are Ineligible for High Dose Therapy.
    Etude de phase III comparant le Lénalidomide et le Daratumumab en injection sous cutanée versus le Lénalidomide et la Dexaméthasone chez des sujets fragiles atteints de myélome multiple en traitement de première ligne et non éligibles à une chimiothérapie à forte dose.
    E.1.1.1Medical condition in easily understood language
    Multiple Myeloma
    Myélome multiple
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10028228
    E.1.2Term Multiple myeloma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective is to compare the efficacy of daratumumab SC injection when combined with lenalidomide (R-Dara SC) to that of lenalidomide and dexamethasone (Rd), in terms of PFS in frail subjects with newly diagnosed myeloma who are not candidates for high dose chemotherapy and autologous stem cell transplant.
    L’objectif principal est de comparer l’efficacité du Daratumumab (R-Dara SC) en combinaison avec le Lenalidomide versus le Lenalidomide en combinaison avec la Dexamethasone (Rd), en terme de survie sans progression chez des sujets fragiles atteints de myélome multiple non antérieurement traité et non éligibles à une chimiothérapie à forte dose avec greffe de cellules souches autologues.
    E.2.2Secondary objectives of the trial
    1.Time-to-treatment failure.
    2.Time-to-next treatment.
    3.PFS2 time.
    4.Overall survival.
    5.Complete remission (CR).
    6.Very good partial response (VGPR) or better.
    7.Overall response (CR + VGPR + partial response [PR]).
    8.Occurrence of grade 3 or more side effects.
    9.Safety and tolerability of Daratumumab SC when administered in combination with R.
    10.Treatment effects on patient reported outcomes and heath economic/resource utilization.
    11.Minimal residual disease (MRD) negative rate at 12 months.
    12. Event Free Survival
    1.Déterminer le temps jusqu’à échec du traitement
    2.Déterminer le temps jusqu’à la ligne de traitement suivante
    3.Déterminer la survie sans progression après la ligne de traitement suivante (PFS2)
    4.Evaluer la survie globale (OS)
    5.Déterminer le taux de réponse complète (CR)
    6.Déterminer le taux de très bonne réponse partielle (VGPR) ou mieux
    7.Evaluer le taux de réponse global (Réponse complète CR, très bonne réponse partielle VGPR et réponse Partielle PR)
    8.Evaluer le taux d’effets indésirables de grade 3 ou plus
    9.Evaluer la tolérance du Daratumumab SC en combinaison avec le Revlimid
    10.Evaluer la qualité de vie
    11.Taux de maladie résiduelle minimale (MRD) négative
    12. Evaluer la survie sans évènement
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Subject must be at least 65 years of age.
    2.Subject must have documented multiple myeloma satisfying the CRAB criteria and measurable disease defined as:
    •Monoclonal plasma cells in the bone marrow ≥10% or presence of a biopsy proven plasmacytoma
    •Measurable disease as defined by any of the following:
    -IgG myeloma: Serum monoclonal paraprotein (M-protein) level ≥1.0 g/dL ; or
    -IgA, IgM, IgD, or IgE multiple myeloma: serum M-protein level ≥0.5 g/dL ; or
    -Light chain multiple myeloma: Serum immunoglobulin free light chain ≥10 mg/dL and abnormal serum immunoglobulin kappa lambda free light chain ratio (only measurable with freelite® by Binding site) or
    -Urine M-protein level ≥ 200 mg/24 hours
    3.Newly diagnosed and not considered candidate for high-dose chemotherapy with SCT.
    4.Subject must have a Frailty Score ≥ 2
    5.Subject must have within 5 days prior to first drug intake (C1D1) pretreatment clinical laboratory values meeting the following criteria during the Screening Phase:
    a) hemoglobin ≥7.5 g/dL (≥4.65 mmol/L; prior red blood cell [RBC] transfusion or recombinant human erythropoietin use is permitted);
    b) absolute neutrophil count ≥1.0 x 109/L (granulocyte colony stimulating factor [GCSF] use is permitted);
    c) platelet count ≥70 x 109/L for subjects in whom <50% of bone marrow nucleated cells are plasma cells; otherwise platelet count >50 × 109/L (transfusions are not permitted to achieve this minimum platelet count).
    d) aspartate aminotransferase (AST) ≤2.5 x upper limit of normal (ULN);
    e) alanine aminotransferase (ALT) ≤2.5 x ULN;
    f) total bilirubin ≤2.0 x ULN, except in subjects with congenital bilirubinemia, such as Gilbert syndrome (direct bilirubin ≤2.0 x ULN);
    g) creatinine clearance≥30mL/min(for lenalidomide dose adjustment for subjects with creatinine clearance 30-60 mL/min). Creatinine clearance may be calculated using the Cockcroft-Gault formula
    h) corrected serum calcium ≤14 mg/dL (≤3.5 mmol/L);
    6. Measurable ISS with β2-microglobulin and albumin values for randomization
    7.A man who is sexually active with a woman of childbearing potential must agree to use a latex or synthetic condom, even if they had a successful vasectomy. All men must also not donate sperm during the study, for 4 weeks after the last dose of lenalidomide, and for 4 months after the last dose of daratumumab. Women participating in this study must be postmenopausal.
    8.Each subject must sign an informed consent form (ICF) indicating that he or she understands the purpose of and procedures required for the study and are willing to participate in the study. Subject must be willing and able to adhere to the prohibitions and restrictions specified in this protocol, as referenced in the ICF.
    9. Subjects affiliated with an appropriate social security system.

    1.Patient âgé de 65 ans ou plus.
    2.Patient ayant un myélome multiple documenté selon les critères CRAB et des signes mesurables de la maladie définis par:
    •Présence de plasmocytes monoclonaux dans la moelle osseuse ≥10% ou présence d’un plasmocytome prouvé à la biopsie
    •Signes mesurables de la maladie définis par:
    oMyélome multiple de type IgG: taux de protéine monoclonale sérique (protéine M) ≥1,0 g/dl ; ou
    oMyélome multiple de type IgA, IgE, IgD, ou IgM: taux de protéine M sérique ≥0.5 g/dl or
    oMyélome multiple à chaînes légères sans signes mesurables de la maladie au niveau sérique ou urinaire: chaînes légères libres d'immunoglobulines dans le sérum. ≥10 mg/dl et rapport anormal kappa/lambda des chaines libres d’immunoglobulines (mesurable avec freelite® de Binding site uniquement)
    oTaux de protéine M urinaire ≥ 200 mg/24 heures
    3.Patient nouvellement diagnostiqué et non éligible pour un traitement à forte dose avec une greffe autologue de cellules souches.
    4.Score de fragilité ≥2
    5.Patients dont les paramètres biologiques avant traitement satisfont aux critères suivants dans les 5 jours avant le 1er jour de traitement (C1J1):
    a)taux d’hémoglobine ≥ 7.5 g/dl (≥4.65 mmol/l; une transfusion préalable de GR ou l’utilisation d’érythropoïétine humaine recombinante est autorisée);
    b)nombre absolu de polynucléaires neutrophiles (NAN) ≥ 1.0 x 109/L (l’utilisation de cytokine GCSF est autorisée);
    c)numération plaquettaire ≥ 70 x 109/l chez les patients dont <50% des cellules nucléées de la moelle osseuse sont des plasmocytes; autrement numération plaquettaire >50x109/l (des transfusions destinées à atteindre ce nombre minimum de plaquettes ne sont pas autorisées).
    d)ASAT ≤ 2,5 fois la limite supérieure de la normale (LSN);
    e)ALAT ≤2,5 fois la limite supérieure de la normale (LSN);
    f)bilirubine totale ≤2 fois la limite supérieure de la normale (LSN); (excepté chez les patients atteints de bilirubinémie congénitale, comme la maladie de Gilbert, bilirubine directe ≤2 fois la limite supérieure de la normale);
    g)clairance de la créatinine calculée ≥ 30 ml/min
    h)calcémie corrigée ≤14 mg/dl (<3,5 mmol/l);
    6.ISS mesurable avec valeurs de beta2-microglobuline et albumine à la randomisation
    7.Les hommes participants à cette étude qui ont des relations sexuelles avec leurs partenaires en âge de procréer doivent utiliser une méthode de contraception de type barrière (préservatif synthétique ou en latex), même si ils ont eu une vasectomie. Tous les hommes doivent également s’engager à ne pas donner leur sperme au cours de l’étude et durant 4 semaines après leur dernière prise de Lenalidomide et 4 mois après leur dernière administration de Daratumumab. Les femmes participant à cette étude doivent être ménopausées.
    8.Signature du formulaire de consentement éclairé avant l’inclusion dans l’étude.
    9.Patient bénéficiant d’un régime de protection sociale.
    E.4Principal exclusion criteria
    1.Subject has a diagnosis of primary amyloidosis, monoclonal gammopathy of undetermined significance, or smoldering multiple myeloma.
    2.Subject has a diagnosis of Waldenström’s disease, or other conditions in which IgM M-protein is present in the absence of a clonal plasma cell infiltration with lytic bone lesions.
    3.Subject has prior or current systemic therapy or SCT for multiple myeloma, with the exception of an emergency use of a short course of corticosteroids before treatment.
    4.Subject has a history of malignancy within 5 years before the date of randomization (exceptions are squamous and basal cell carcinomas of the skin and carcinoma in situ of the cervix, or malignancy that in the opinion of the investigator, with concurrence with the sponsor's medical monitor, is considered cured with minimal risk of recurrence within 5 years).
    5.Subject has had radiation therapy within 14 days of randomization.
    6.Subject has had plasmapheresis within 28 days of randomization.
    7.Subject is exhibiting clinical signs of meningeal involvement of multiple myeloma.
    8.Subject has known chronic obstructive pulmonary disease (COPD) (defined as a forced expiratory volume [FEV] in 1 second <60% of predicted normal), persistent asthma, or a history of asthma within the last 2 years (intermittent asthma is allowed). Subjects with known or suspected COPD or asthma must have a FEV1 test during screening.
    9.Subject is known to be seropositive for history of human immunodeficiency virus (HIV)
    10. Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HBsAg]). Subjects with resolved infection (ie, subjects who are HBsAg negative but positive for antibodies to hepatitis B core antigen [anti-HBc] and/or antibodies to hepatitis B surface antigen [anti-HBs]) must be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) DNA levels. Those who are PCR positive will be excluded. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR.
    11.(Known to be) seropositive for hepatitis C.
    12.Subject has any concurrent medical or psychiatric condition or disease (eg, active systemic infection, uncontrolled diabetes, acute diffuse infiltrative pulmonary disease) that is likely to interfere with the study procedures or results, or that in the opinion of the investigator, would constitute a hazard for participating in this study.
    13.Subject has clinically significant cardiac disease, including:
    •myocardial infarction within 1 year before randomization, or an unstable or uncontrolled disease/condition related to or affecting cardiac function (eg, unstable angina, congestive heart failure, New York Heart Association Class III-IV
    •uncontrolled cardiac arrhythmia (National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] Version 4 Grade ≥2) or clinically significant ECG abnormalities
    •screening 12-lead ECG showing a baseline QT interval as corrected by Fridericia’s formula (QTcF) >470 msec
    14.Subject has known allergies, hypersensitivity, or intolerance to corticosteroids, monoclonal antibodies or human proteins, or their excipients (refer to respective package inserts or Investigator's Brochure).
    15.Subject has plasma cell leukemia (according to World Health Organization [WHO] criterion: ≥20% of cells in the peripheral blood with an absolute plasma cell count of more than 2 × 109/L) or POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).
    16.Subject is known or suspected of not being able to comply with the study protocol (eg, because of alcoholism, drug dependency, or psychological disorder). Subject has any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments. Subject is taking any prohibited medications as per Section 8.3.
    17.Subject has had major surgery within 2 weeks before randomization or has not fully recovered from surgery.
    18.Subject has received an investigational drug (including investigational vaccines) or used an invasive investigational medical device within 4 weeks before randomization or is currently enrolled in an interventional investigational study.
    19. Refusal to consent or protected by legal regime ( guardianship, trusteeship)
    20. Subject has contraindications to required prophylaxis for deep vein thrombosis and pulmonary embolism
    21. Incidence of gastrointestinal disease that may significantly alter the absorption of oral drugs.


    1.Patient ayant fait l’objet d’un diagnostic d’amyloïdose primaire, de gammapathie monoclonale de signification indéterminée, ou de myélome multiple peu évolutif.
    2.Patient ayant fait l’objet d’un diagnostic de macroglobulinémie de Waldenström ou d’autres affections dans lesquelles la protéine M de type IgM est présente en l’absence d’infiltration de plasmocytes clonaux avec lésions ostéolytiques.
    3.Patient recevant ou ayant reçu antérieurement un traitement par voie systémique ou une greffe de cellules souches pour des dyscrasies plasmocytaires.
    4.Patient ayant ou ayant eu une affection maligne invasive concomitante au cours des 5 années précédant le début de l’étude.
    5.Patient ayant subi une radiothérapie au cours des 14 jours précédant la randomisation.
    6.Patient ayant subi une plasmaphérèse au cours des 28 jours précédant la randomisation.
    7.Patient présentant des signes cliniques d’atteinte méningée du myélome multiple.
    8.Patient ayant souffert de maladie respiratoire obstructive chronique avec un volume expiratoire maximum par seconde < 60% des valeurs normales prévues. Patient ayant souffert d’asthme persistant modéré ou sévère au cours des 2 dernières années ou souffrant actuellement d’asthme persistant (asthme intermittent autorisé). Noter qu’un test VEM1 au screening est exigé pour les patients suspectés de BPCO ou ayant de l’asthme : les patients devront être exclus si le VEM1 est <60% des valeurs normales prévues.
    9.Patient connu pour sa séropositivité au VIH
    10.Patient connu pour présenter une infection à l’hépatite B (HBsAg positif). Les sujets dont l’infection est résolue (c.-à-d. les sujets qui sont HBsAg négatifs, mais positifs pour anti-HBc et/ou anti-HBs) doivent être soumis à un dépistage par PCR du virus de l’hépatite B (HBV). Ceux qui sont positifs à la PCR seront exclus.
    EXCEPTION : Les sujets dont les résultats sérologiques suggèrent une vaccination contre le VHB ET un historique connu de vaccination antérieure contre le VHB n’ont pas besoin d’être testés pour l’ADN du VHB par PCR.
    11. Patient connu pour présenter une infection à l’hépatite C active.
    12.Patient ayant une affection médicale ou psychiatrique concomitante (par ex. infection systémique active, diabète non contrôlé, maladie pulmonaire diffuse aiguë) susceptible d’interférer avec les procédures de l’étude ou pouvant constituer un danger en cas de participation à l’étude.
    13.Patient présentant une maladie cardiaque cliniquement significative y compris:
    •un infarctus du myocarde au cours de l’année précédant la randomisation, ou une pathologie/affection instable ou non contrôlée en rapport avec la fonction cardiaque ou affectant cette dernière
    •troubles du rythme cardiaque (Grade ≥2 d’après les critères communs de terminologie du National Cancer Institute (NCI) pour les événements indésirables (CTCAE) Version 4) ou anomalies à l’ECG cliniquement significatives
    •ECG à 12 dérivations de dépistage montrant un intervalle QTcF initial >470 msec.
    14.Patient ayant une allergie connue, une hypersensibilité ou une intolérance aux corticoïdes, aux anticorps monoclonaux ou aux protéines humaines ou à leurs excipients (voir la brochure Investigateur).
    15.Patient souffrant d’une leucémie à plasmocytes (selon le critère OMS: ≥20% des cellules dans le sang périphérique avec un nombre absolu de plasmocytes supérieur à 2 × 109/l) ou un syndrome POEMS.
    16.Patient connu pour ou suspecté de ne pas être en mesure de se conformer aux procédures de l’étude (ex en raison d’un alcoolisme, d’une dépendance à des substances illicites ou d’un trouble psychologique). Patient ayant une affection quelconque en raison de laquelle, de l’avis de l’investigateur, une participation à l’étude de ce dernier ne serait pas dans son meilleur intérêt (ex, compromettrait son bien-être) ou serait susceptible d’empêcher, limiter ou confondre les évaluations décrites dans le protocole.
    17.Patient ayant subi une intervention chirurgicale majeure au cours des 2 semaines précédant la randomisation ou n’ayant pas complètement récupéré après cette intervention.
    18.Patient ayant reçu un médicament expérimental (y compris des vaccins expérimentaux) ou ayant utilisé un dispositif expérimental médical invasif au cours des 4 semaines précédant la randomisation ou participant actuellement à une étude expérimentale interventionnelle.
    19. Refus de participation à l’étude ou protégée par un régime juridique (tutelle, curatelle).
    20. Patient ayant des contre-indications pour suivre un traitement prophylactique pour thrombose veineuse profonde ou embolie pulmonaire.
    21. Présence d’une maladie gastro-intestinale pouvant modifier de manière significative l’absorption de médicaments administrés par voie orale.


    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is PFS time, which is defined as the duration from the date of randomization to either progressive disease, or death, whichever occurs first. Disease progression will be determined according to the 2016 IMWG criteria.
    Le critère d’évaluation principal est le temps de survie sans progression, qui est défini comme la durée entre la date de la randomisation et la date de progression de la maladie ou de décès. La progression de la maladie sera déterminée selon les critères IMWG de 2016.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the study using the IMWG response criteria.
    Tout au long de l'étude
    E.5.2Secondary end point(s)
    1.Time-to-treatment failure, defined as time from randomization to discontinuation of therapy for any reason including death, progression, toxicity.
    2.Time to next treatment, defined as the time from randomization to the start of the next-line treatment.
    3.PFS2 time, defined as the time from randomization to progression on the next line of treatment or death, whichever comes first. Disease progression will be based on investigator judgment. For those subjects who are still alive and not yet progressed on the next line of treatment, they will be censored on the last date of follow-up.
    4.Overall survival (OS) time, measured from the date of randomization to the date of the subject’s death. If the subject is alive or the vital status is unknown at last contact, then the subject’s data will be censored at the date the subject was last known to be alive.
    5.CR, defined as:
    -Negative immunofixation of serum and urine, and
    -Disappearance of any soft tissue plasmacytomas, and
    -<5% plasma cells (PCs) in bone marrow
    -For those IgG Kappa myeloma subjects with at least ≤2g/l M-protein on 2 consecutive visits, no additional M-proteins detected, urine and FLC normal (suspected daratumumab interference on immunofixation), a reflex assay using anti-idiotype antibody (DIRA test) will be utilized to confirm daratumumab interference and rule out false positive immunofixation (for patients with uncommon kappa light chain myeloma, appearance of a band <or = 2g/l on electrophoresis typed IgG kappa on immunofixation and migrating to the same level as the light chain involved, is required). Patients who have confirmed daratumumab interference, but meet all other clinical criteria for CR, will be considered CR.
    6.VGPR or better, defined as VGPR or CR according to the IMWG criteria during or after the study treatment at the time of data cutoff.
    7.Overall response, defined as CR or VGPR or PR, according to the IMWG criteria, during or after the study treatment.
    8.Collecting all AE (grade 3 or more) since the beginning of treatment until progression.
    9.Evaluation of safety data by type, frequency, severity, relation to study drug, as well as changes in vital signs, physical examinations, incidence of treatment emergent adverse events (TEAEs), serious adverse events, abnormal laboratory test results (according to NCI-CTCAE V4.0).
    10.Evaluation of quality of life based on EORTC C30, MY20 and EQ-5D questionnaires filled every 3 months from the C1J1 during the first year then every 6 months until the end of treatment for progression (then 8 and 16 weeks after the end of treatment).
    11.MRD negativity, as measured at 12 months.
    12. Event Free Survival, defined as time from randomization to discontinuation of therapy for any reason including death, progression or toxicity
    1.Temps jusqu’à échec du traitement est défini comme étant le temps entre la randomisation et la fin de traitement pour progression, toxicité, décès ou autres raisons.
    2.Temps jusqu’à la ligne de traitement suivante défini comme étant le temps entre la randomisation et le début de la ligne de traitement suivante.
    3.Temps de PFS2, défini comme étant le temps entre la randomisation et la progression (ou décès) lors de la deuxième ligne de traitement.
    4.Temps de survie globale mesuré entre la date de randomisation et la date du décès du patient.
    5.Le taux de réponse complète (CR), défini comme répondant aux critères suivants :
    -Immunofixation du sérum et des urines négative, et
    -Disparition de tout plasmocytome des tissus mous, et
    -Moins de 5% d’infiltration plasmocytaire au myélogramme
    -Pour les patients avec un myélome IgG kappa ayant un pic ≤ 2 g/l sur 2 visites consécutives, urine et FLC normal (une interférence suspectée avec le Daratumumab sur l’immunofixation), un test DIRA sera réalisé pour confirmer l’interférence avec le Daratumumab (pour les patients avec myélome à chaîne légère kappa plus rare, apparition nécessaire d’une bande à l’électrophorèse < ou = 2g/l typée IgG kappa en immunofixation et migrant au même niveau que la chaîne légère impliquée). Si ces patients répondent à tous les autres critères de réponses complètes CR, alors ces patients seront considérés comme étant en CR
    6.VGPR ou mieux, définie comme étant le taux de VGPR ou CR selon les critères IMWG de 2016 pendant ou après la fin de traitement.
    7.Taux de réponse global défini comme étant le taux de CR, VGPR ou PR selon les critères IMWG de 2016, pendant ou après la fin de traitement
    8.Recueil de l’ensemble des effets indésirables (grade 3 ou plus) depuis le début du traitement jusqu’à la récidive (selon NCI-CTCAE V4.0).
    9.Evaluation des données de sécurité par type, fréquence, sévérité, relation de causalité au traitement à l’étude, ainsi que des changements dans les signes vitaux, les examens physiques, incidence des évènements indésirables liés au traitement (TEAE), évènements indésirables graves, résultats d’analyses de laboratoires anormales (gradés selon le NCI-CTCAE V4.0)
    10.Evaluer la qualité de vie grâce aux questionnaires EORTC C30, MY20 et EQ-5D remplies tous les 3 mois dès le C1J1 pendant la première année puis tous les 6 mois jusqu’à la fin de traitement pour progression (puis 8 et 16 semaines après la fin de traitement).
    11.Mesure de la MRD à 12 mois
    12. Temps entre la randomisation et l'arrêt du traitement pour une raison quelconque, y compris le décès, la progression ou la toxicité
    E.5.2.1Timepoint(s) of evaluation of this end point
    As specified for each end point
    Comme précisé précédemment dans les End Point
    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 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 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 concerned80
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA80
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    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
    Patients are followed from diagnosis to death.
    The study is considered completed after 160 deaths have occurred or 5 years after the last subject is randomized.
    Les patients sont suivis du diagnostic au décès.
    L’étude est considérée comme étant terminée dès la survenue de 160 décès ou 5 ans après la randomisation du dernier patient.
    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 months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years5
    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) No
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 294
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception 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 Yes
    F.3.3.7.1Details of other specific vulnerable populations
    frail subjects ≥ 65 years with newly diagnosed multiple myeloma
    sujets fragiles ≥ 65ans atteints de myélome multiple en traitement de première ligne
    F.4 Planned number of subjects to be included
    F.4.1In the member state274
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 20
    F.4.2.2In the whole clinical trial 294
    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)
    If patient stop study, he will start another treatment of myeloma
    according to his doctor
    si un patient arrête l’étude, il entamera un autre traitement du myélome
    multiple en concertation avec son médecin
    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 Decision2020-05-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-11-17
    P. End of Trial
    P.End of Trial StatusOngoing
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