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    Summary
    EudraCT Number:2018-004116-22
    Sponsor's Protocol Code Number:MK-3475-921
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-01-22
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2018-004116-22
    A.3Full title of the trial
    A Phase 3, Randomized, Double-blind Study of Pembrolizumab (MK-3475) Plus Docetaxel Plus Prednisone versus Placebo Plus Docetaxel Plus Prednisone in Participants with Chemotherapy-naïve Metastatic Castration-Resistant Prostate Cancer (mCRPC) who have Progressed on a Next Generation Hormonal Agent (NHA) (KEYNOTE-921)
    Studio di fase III, randomizzato, in doppio cieco, con Pembrolizumab (MK-3475) più Docetaxel e Prednisone versus Placebo più Docetaxel e Prednisone in soggetti affetti da Carcinoma Prostatico metastatico Resistente alla Castrazione e naïve alla Chemioterapia (mCRPC) e che hanno manifestato progressione dopo trattamento con Terapie Ormonali di Nuova Generazione (NHA) (KEYNOTE-921)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 3 Study of Pembrolizumab plus Docetaxel plus Prednisone in mCRPC
    Studio di fase 3 con Pembrolizumab più Docetaxel più prednisone nel Carcinoma Prostatico metastatico Resistente alla Castrazione e naïve alla Chemioterapia
    A.3.2Name or abbreviated title of the trial where available
    Phase 3 Study of Pembrolizumab plus Docetaxel in mCRPC
    Studio di fase 3 con Pembrolizumab più Docetaxel nel Carcinoma Prostatico metastatico Resistente all
    A.4.1Sponsor's protocol code numberMK-3475-921
    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 SponsorMERCK SHARP & DOHME CORP. UNA SUSSIDIARIA DI MERCK & CO. 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 supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMSD Italia Srl
    B.5.2Functional name of contact pointDivisione Ricerca Clinica
    B.5.3 Address:
    B.5.3.1Street AddressVia Vitorchiano, 151
    B.5.3.2Town/ cityRoma
    B.5.3.3Post code00189
    B.5.3.4CountryItaly
    B.5.4Telephone number00390636191371
    B.5.5Fax number00390636380371
    B.5.6E-mailgcto.italy@merck.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 namePEMBROLIZUMAB
    D.3.2Product code [MK-3475]
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA (pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product name-
    D.3.2Product code [-]
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    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: 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 Docetaxel
    D.2.1.1.2Name of the Marketing Authorisation holderAmneal Pharma Europe Limited
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameDocetaxel
    D.3.2Product code [-]
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDocetaxel
    D.3.9.1CAS number 114977-28-5
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB22289
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 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 Deltacortene
    D.2.1.1.2Name of the Marketing Authorisation holderBRUNO FARMACEUTICI S.p.A.
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 namePrednisone
    D.3.2Product code [-]
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INN-
    D.3.9.1CAS number 53-03-2
    D.3.9.2Current sponsor code-
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Metastatic Castration-Resistant Prostate Cancer
    Carcinoma Prostatico metastatico Resistente alla Castrazione
    E.1.1.1Medical condition in easily understood language
    Metastatic Castration-Resistant Prostate Cancer
    Carcinoma Prostatico metastatico Resistente alla Castrazione
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10076506
    E.1.2Term Castration-resistant prostate 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
    1. To compare pembrolizumab plus docetaxel plus prednisone to placebo plus docetaxel plus prednisone with respect to overall survival (OS).
    2. To compare pembrolizumab plus docetaxel plus prednisone to placebo plus docetaxel plus prednisone with respect to radiographic progressionfree survival (rPFS) per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by blinded independent central review (BICR).
    1. Confrontare pembrolizumab più docetaxel più prednisone rispetto al placebo più docetaxel più prednisone in relazione alla sopravvivenza complessiva (Overall Survival, OS).
    2. Confrontare pembrolizumab più docetaxel più prednisone rispetto al placebo più docetaxel più prednisone in relazione alla sopravvivenza libera da progressione radiografica (radiographic Progression-Free Survival, rPFS) in base ai Criteri di valutazione della risposta nei tumori solidi Versione 1.1 (Response Evaluation Criteria in Solid Tumors, RECIST 1.1) modificati del Gruppo di lavoro sul carcinoma della prostata (Prostate Cancer Working Group, PCWG) [Scher, H. I., et al 2016], come valutato mediante revisione centrale indipendente in cieco (Blinded Independent Central Review, BICR).
    E.2.2Secondary objectives of the trial
    1. Compare pembrolizumab plus docetaxel plus prednisone to placebo plus docetaxel plus prednisone with respect to time to initiation of the first subsequent anti-cancer therapy or death
    2. Evaluate pembrolizumab plus docetaxel plus prednisone versus placebo plus docetaxel plus prednisone with respect to:PSA response rate;and ORR and DOR per PCWG-modified RECIST 1.1 as assessed by BICR
    3. Compare pembrolizumab plus docetaxel plus prednisone versus placebo plus docetaxel plus prednisone with respect to:TTPP based on BPI-SF item 3 "worst pain in 24 hours" and opiate analgesic use;time to first SSRE;and time to PSA progression
    4. Compare pembrolizumab plus docetaxel plus prednisone versus placebo plus docetaxel plus prednisone with respect to the time to radiographic soft tissue progression per soft tissue rules of PCWGmodified RECIST 1.1,as assessed by BICR
    5. Evaluate the safety and tolerability of pembrolizumab plus docetaxel plus prednisone versus placebo plus docetaxel plus prednisone
    1.Confrontare pembro più docetaxel più prednisone rispetto al placebo più docetaxel più prednisone in relazione al TFST o al decesso
    2.Confrontare pembro più docetaxel più PL rispetto al placebo più docetaxel più prednisone in relazione al: Tasso di risposta del PSA; ORR e DOR in base ai criteri RECIST 1.1 modificati del PCWG, come valutato BICR
    3.Confrontare pembro più docetaxel più prednisone rispetto al PL più docetaxel più prednisone in relazione al: TTPP in base alla voce 3 “dolore più intenso nelle 24ore” del BPI-SF e AQA; SSRE; tempo alla progress PSA; t alla progress radio nei tessuti molli in base al RECIST 1.1 modificati del PCWB, come valutato mediante BICR
    4.Confrontare pembro più docetaxel più prednisone rispetto al PL più docetaxel più prednisone in relazione al tempo alla progress radio nei tessuti molli in base alle regole dei tessuti molli
    5.Valutare la sicurezza e la tollerabilità di pembro più docetaxel più prednisone rispetto al PL più docetaxel più prednisone
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: Exploratory Biomarker Research, Genetic (DNA) analysis from tumor, Tumor and blood RNA analyses, Proteomics and immunohistochemistry (IHC) using blood or tumor, Other biomarkers, Future Biomedical Research

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: Ricerca esplorativa sui biomarcatori, analisi genetica (DNA) da campioni tumorali, analisi RNA da campioni tumorali e da sangue, proteomica e immunoistochimica (IHC) utilizzando sangue o campioni tumorali, altri biomarker, ricerca biomedica futura
    E.3Principal inclusion criteria
    1. Have histologically- or cytologically-confirmed (if acceptable according to local health authority regulations) adenocarcinoma of the prostate without small cell histology. Diagnosis must be stated in a pathology report and confirmed by the investigator
    2. Have prostate cancer progression while on androgen deprivation therapy (or post bilateral orchiectomy) within 6 months prior to screening, as determined by the investigator, by means of one of the following:
    a. PSA progression using local laboratory values as defined by a minimum of 2 consecutive rising PSA levels with an interval of >=1 week between each assessment where the PSA value at screening should be >=1 ng/ml
    b. Radiographic disease progression in soft tissue based on RECIST 1.1 criteria with or without PSA progression
    c. Radiographic disease progression in bone based on PCWG, defined as the appearance of 2 or more new bone lesions on bone scan with or without PSA progression
    3. Have progression under the following conditions if the participant received antiandrogen therapy prior to enrollment:
    a. Evidence of progression >4 weeks since last flutamide treatment
    b. Evidence of progression >6 weeks since last bicalutamide or nilutamide treatment
    4. Have current evidence of metastatic disease documented by either bone lesions on bone scan and/or soft tissue disease by CT/MRI. Participants whose disease spread is limited to regional pelvic lymph nodes are not eligible
    5. Have received prior treatment with with one (but not more than one) NHA (eg, abiraterone acetate, enzalutamide, apalutamide, or darolutamide) for mHSPC or CRPC and either:
    a) progressed through treatment after a minimum of 8 weeks treatment (minimum 14 weeks for those with bone progression) OR b) have become intolerant of the drug (minimum 4 weeks treatment)
    6. Have ongoing androgen deprivation with serum testosterone <50 ng/dL (<2.0 nM). If the participant is currently being treated with luteinizing hormone-releasing hormone agonists or antagonists (participants who have not undergone an orchiectomy) this therapy must have been initiated at least 4 weeks prior to randomization and treatment must be continued throughout the study
    7. Participants receiving bone resorptive therapy (including, but not limited to, bisphosphonate or denosumab) must have been on stable doses for >=4 weeks prior to randomization
    8. Demonstrate adequate organ function; all screening labs should be performed in the central laboratory within 10 days of the first dose of study intervention
    9. Participant is male
    10. Participant is >=18 years of age on day of signing informed consent
    11. Male participants are eligible to participate if they agree to the following during the intervention period and for at least 120 days after the last dose of pembrolizumab or 180 days after the last dose of
    docetaxel, whichever is longer:
    a) Refrain from donating sperm PLUS either: b) Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent OR a) Must agree to use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause as detailed below: Agree to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a woman of childbearing potential (WOCBP) who is not currently pregnant
    12. Male participants must agree to use male condom when engaging in any activity that allows for passage of ejaculate to another person of any sex
    13. The participant (or legally acceptable representative if applicable) provides written informed consent/assent for the study. The participant may also provide consent/assent for future biomedical research. However, the participant may participate in the main study without participating in future biomedical research
    For inclusion criteria #14 and 15 refer to the protocol
    1.Presentare una diagnosi confermata istologicam o citologicam (se consentito dalle normative delle autorità sanitarie locali) di adenocarcinoma prostatico senza istologia a piccole cellule. La diagnosi deve essere dichiarata in un referto istopatologico e confermata dallo speriment
    2.Presentare progressione del carcinoma prostatico durante la terap di deprivazione androgenica (o post-orchiectomia bilaterale) entro i 6 mesi precedenti allo screening, come determinato dallo speriment, mediante uno dei seguenti parametri:
    a. Progressione del PSA utilizzando valori del lab locale definiti come un minimo di 2 gg consecutivi di aumento dei livelli di PSA con un intervallo di >=1 settimana tra ciascuna valutazione, in cui il valore del PSA allo screening deve essere >=1 ng/ml
    b. Progressione radiografica della malattia nei tessuti molli in base ai criteri RECIST 1.1 con o senza progressione del PSA
    c. Progressione radiografica della malattia nel tessuto osseo basata su PCWG, definita come comparsa di 2 o più nuove lesioni ossee alla scintigrafia ossea con o senza progres del PSA
    3.Presentare progressione secondo le condiz seguenti se il partecipante ha ricevuto terap anti-androgenica prima dell’arruolamento:
    a. Evidenza di progressione >4 settim dall’ultimo trattam con flutamide
    b. Evidenza di progressione >6 settim dall’ultimo trattam con bicalutamide o nilutamide
    4.Evidenza attuale di malattia metastatica documentata da lesioni ossee alla scintigrafia ossea e/o malattia dei tessuti molli alla TC/RM. I partecipanti la cui diffusione della malattia è limitata ai linfonodi pelvici regionali non sono idonei
    5.Somministrazione di un precedente trattamento con uno (ma non più di uno) di NHA (ad es. eg, abiraterone acetate, enzalutamide, apalutamide, o darolutamide) per mHSPC o CRPC e per entrambi:
    a) progressione durante il trattam dopo un minimo di 8 sett di trattam (minimo 14 sett per i partecipanti con progressione ossea) OPPURE b) sviluppo di intolleranza al farmaco (minimo 4 sett di trattam)
    6. Deprivazione androgenica in corso con testosterone sierico <50 ng/dL (<2,0 nM). Se il partecipante è attualmente in trattam con agonisti o antagonisti dell’ormone di rilascio dell’ormone luteinizzante (partecipanti che non si sono sottoposti a orchiectomia), questa terapia deve essere iniziata almeno 4 sett prima della randomiz e il trattamento deve essere proseguito per tutta la durata dello studio
    7. I partecipanti che ricevono una terapia ossea riassorbitiva (inclusi, a titolo esemplificativo, gli inibitori con bifosfonati o denosumab) devono essersi mantenuti a dosi stabili per >=4 settimane prima della randomizzazione
    8.Dimostrare una funzionalità organica adeguata come definita nella Tabella 1; tutti gli esami di laboratorio di screening devono essere eseguiti nel laboratorio centrale entro 10 giorni prima della prima dose di trattamento dello studio
    9.Il partecipante è di sesso maschile
    10.Il partecipante ha >=18 anni di età il giorno della firma del consenso informato
    11.I partecipanti di sesso maschile sono idonei a partecipare se acconsentono a quanto segue durante il periodo di trattamento e per almeno 120 giorni dopo l’ultima dose di pembrolizumab o 180 gg dopo l’ultima dose di docetaxel, indipendentemente dal periodo più lungo: a)Astenersi dalla donazione di sperma PIÙ: b)Essere in astinenza da rapporti eterosessuali come stile di vita preferito e abituale (astinenti a lungo termine e in modo persistente) e acconsentire a continuare a osservare l’astinenza OPPURE a)accettare di usare un metodo contraccettivo a meno che non abbia azoospermia confermata (da vasectomia o secondaria a causa medica) come descritto di seguito: Acconsentire a utilizzare un preservativo maschile unito all’uso da parte della partner di un metodo contraccettivo supplementare durante rapporti sessuali penili-vaginali con una donna in età fertile (WOCBP) che attualmente non è incinta
    Per i criteri di inclusione dal #12 al #15 fare riferimento al protocollo
    E.4Principal exclusion criteria
    1. Has a known additional malignancy that is progressing or has required active treatment in the last 3 years. Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ that have undergone potentially curative therapy are not excluded
    2. Has an active autoimmune disease that has required systemic treatment in past 2 years. Replacement therapy is not considered a form of systemic treatment
    3. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of study intervention
    4. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the participant's participation for the full duration of the
    trial, or is not in the best interest of the participant, in the opinion of the treating investigator
    5. Has undergone major surgery including local prostate intervention (excluding prostate biopsy) within 28 days prior to randomization and not recovered adequately from the toxicities and/or complications
    6. Has a gastrointestinal disorder affecting absorption
    7. Is unable to swallow tablets/capsules
    8. Has an active infection requiring systemic therapy
    9. Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis
    10. Has a known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the trial
    11. Has known active human immunodeficiency virus, hepatitis B virus or hepatitis C virus. Testing at screening is not required unless mandated by local regulations
    12. Has known active central nervous system metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are stable, have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to randomization
    13. Has severe hypersensitivity (>=Grade 3) to pembrolizumab and/or any of its excipients
    14. Has CTCAE Grade >=2 peripheral neuropathy, except when due to trauma
    15. Has ascites and/or clinically significant pleural effusion
    16. Has symptomatic congestive heart failure (New York Heart Association Class III or IV heart disease)
    17. Has received a whole blood transfusion in the last 120 days prior to entry into the study. Packed red blood cells and platelet transfusions are acceptable if not given within 28 days of the first dose of study intervention
    18. Has received colony-stimulating factors within 28 days prior to the first dose of study intervention
    19. Has had a prior anticancer mAb within 4 weeks prior to randomization or who has not recovered from AEs due to mAbs administered more than 4 weeks prior to randomization
    20. Has used herbal products that may have hormonal anti prostate cancer activity and/or are known to decrease PSA levels within 4 weeks prior to treatment randomization
    21. Has received prior treatment with radium or other therapeutic radiopharmaceuticals for prostate cancer
    22. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PDL2 agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor
    23. Has received prior treatment with docetaxel or another chemotherapy agent for mCRPC
    24. Has hypersensitivity to docetaxel or polysorbate 80
    25. Participant is currently receiving either strong or moderate inhibitors of cytochrome P450 (CYP)3A4 that cannot be discontinued for the duration of the study
    26. Has received prior targeted small molecule therapy or abiraterone acetate, enzalutamide, apalutamide or darolutamide within 4 weeks
    prior to the first dose of study intervention, or has not recovered from AEs due to a previously administered agent
    For exclusion criteria # 27, 28, 29, 30, 31, 32, 33 and 34 refer to the protocol
    1.Ha un’ulteriore malignità nota che è progredita o ha richiesto un trattamento attivo negli ultimi 3 anni. I partecipanti con carcinoma cutaneo basocellulare, carcinoma cutaneo squamocellulare o carcinoma in situ sottoposti a terapia potenzialmente curativa non saranno esclusi
    2.Presenta una malattia autoimmune in fase attiva che ha richiesto un trattamento per via sistemica negli ultimi 2 anni (ossia con impiego di agenti modificanti il decorso della malattia, corticosteroidi o farmaci immunosoppressori). La terapia di sostituzione (ad es., terapia di sostituzione con tiroxina, insulina o corticosteroidi fisiologici in caso di insufficienza surrenalica o ipofisaria, ecc.) non è considerata una forma di trattamento sistemico
    3.Diagnosi di immunodeficienza o trattamento in corso con terapia steroidea sistemica cronica (a dosi superiori a 10 mg al giorno di prednisone o equivalente) o qualsiasi altra forma di terapia immunosoppressiva nei 7 giorni precedenti alla prima dose di trattamento dello studio
    4.Anamnesi con o attuale evidenza di qualsiasi condizione, terapia o anomalia di laboratorio che potrebbe precludere la chiarezza dei risultati della sperimentazione, interferire con la partecipazione del soggetto per tutta la durata della sperimentazione oppure non essere nel miglior interesse del soggetto, secondo l’opinione dello sperimentatore responsabile del trattamento
    5. Ha subito un intervento chirurgico maggiore tra cui un intervento locale alla prostata (ad esclusione della biopsia della prostata) entro i 28 giorni precedenti alla randomizzazione e non si è ripreso adeguatamente dalla tossicità e/o dalle complicanze
    6.Presenta un disturbo gastrointestinale che influenza l’assorbimento (ad es., gastrectomia, ulcera peptica in fase attiva entro gli ultimi 3 mesi)
    7. È incapace di inghiottire le compresse/capsule
    8. Presenta un’infezione attiva con necessità di terapia sistemica.
    9. Ha un’anamnesi di polmonite (non infettiva) che ha richiesto l’uso di steroidi o presenta una polmonite corrente
    10. Presenta un disturbo psichiatrico noto o abuso di sostanze che interferirebbe con la collaborazione con i requisiti della sperimentazione
    11.Presenta virus dell’immunodeficienza umana (HIV), virus dell’epatite B (ad es., antigene reattivo di superficie dell’epatite B) o virus dell’epatite C (HCV) (ad es., determinazione [qualitativa] dell’HVC-RNA) attivo noto. Il test allo screening non è richiesto, tranne quando imposto dalle normative locali
    12.Presenta metastasi attive note al sistema nervoso centrale (SNC) e/o meningite carcinomatosa. I partecipanti con metastasi cerebrali già trattate in precedenza possono partecipare purché siano stabili (senza evidenza di progressione all’imaging per almeno 4 settimane prima della randomizzazione e purché qualsiasi sintomo neurologico sia tornato al valore basale), non abbiano evidenze di metastasi cerebrali nuove o ingrossate e non assumano steroidi da almeno 7 giorni prima della randomizzazione
    13.Ha ipersensibilità grave (grado >=3) a pembrolizumab e/o a uno qualsiasi degli eccipienti
    14.Presenta neuropatia periferica di grado >=2 secondo i criteri CTCAE, eccetto quando dovuta a trauma
    15.Presenta ascite e/o versamento pleurico clinicamente significativo
    16.Presenta insufficienza cardiaca congestizia sintomatica (cardiopatia di Classe III o IV secondo la New York Heart Association)
    17.Ha ricevuto una trasfusione di sangue intero negli ultimi 120 giorni prima dell’ingresso nello studio. Le trasfusioni di globuli rossi concentrati e di piastrine sono accettabili se non sono state somministrate entro 28 giorni dalla prima dose di trattamento dello studio
    18.Ha ricevuto fattori stimolanti le colonie entro 28 giorni prima della prima dose di trattamento dello studio
    Per i criteri di esclusione dal #19 al #34 fare riferimento al protocollo
    E.5 End points
    E.5.1Primary end point(s)
    1. Overall Survival (OS)
    2. Radiographic Progression-free Survival (rPFS) Per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    1. Sopravvivenza complessiva (OS)
    2. Sopravvivenza libera da progressione radiografica (rPFS) in base ai Criteri di valutazione della risposta nei tumori solidi Versione 1.1 modificati del Gruppo di lavoro sul carcinoma della prostata (PCWG)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 28 months
    2. Up to approximately 28 months
    1. Fino a circa 28 mesi
    2. Fino a circa 28 mesi
    E.5.2Secondary end point(s)
    1. Time to Initiation of the First Subsequent Anti-Cancer Therapy or Death (TFST)
    2. Prostate-specific Antigen (PSA) Response Rate
    3. Objective Response Rate (ORR) Per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    4. Duration of Response (DOR) Per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    5. Time to Pain Progression (TTPP) as Assessed by Brief Pain Inventory-Short Form (BPI-SF) Item 3 ("Worst Pain in 24 Hours") and Opiate Analgesic Use (Analgesic Quantification Algorithm [AQA] Score)
    6. Time to First Symptomatic Skeletal-related Event (SSRE)
    7. Time to Prostate-specific Antigen (PSA) Progression
    8. Time to Radiographic Soft Tissue Progression Per Soft Tissue Rules of Per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    9. Number of Participants Who Experience an Adverse Event (AE)
    10. Number of Participants Who Discontinue Study Treatment Due to an Adverse Event (AE)
    1. Tempo all’inizio della prima terapia antitumorale successiva (TFST) o decesso
    2. Tasso di risposta dell’antigene prostatico specifico (PSA)
    3. Tasso di risposta obiettiva (ORR) in base ai criteri RECIST 1.1 modificati del PCWG, come valutato mediante BICR
    4. Durata della risposta (DOR) in base ai criteri RECIST 1.1 modificati del PCWG, come valutato mediante BICR
    5. Tempo alla progressione del dolore (TTPP) in base alla voce 3 “dolore più intenso nelle 24 ore” del Questionario breve per la valutazione del dolore (Brief Pain Inventory-Short Form, BPI-SF) e all’uso di analgesici oppiacei (punteggio dell’algoritmo di quantificazione di analgesici [Analgesic Quantification Algorithm, AQA])
    6. Tempo al primo evento scheletrico sintomatico (SSRE)
    7. Tempo alla progressione del PSA
    8. Tempo alla progressione radiografica nei tessuti molli in base ai i criteri RECIST 1.1 modificati del PCWB, come valutato mediante BICR
    9. Numero di partecipanti che manifestano un evento avverso (AE)
    10. Numero di partecipanti che interrompono il trattamento dello studio a causa di un evento avverso (AE)
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 28 months
    2. Up to approximately 28 months
    3. Up to approximately 28 months
    4. Up to approximately 28 months
    5. Up to approximately 28 months
    6. Up to approximately 28 months
    7. Up to approximately 28 months
    8. Up to approximately 28 months
    9. Up to approximately 28 months
    10. Up to approximately 28 months
    1. Fino a circa 28 mesi
    2. Fino a circa 28 mesi
    3. Fino a circa 28 mesi
    4. Fino a circa 28 mesi
    5. Fino a circa 28 mesi
    6. Fino a circa 28 mesi
    7. Fino a circa 28 mesi
    8. Fino a circa 28 mesi
    9. Fino a circa 28 mesi
    10. Fino a circa 28 mesi
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis Yes
    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 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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the 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 concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA86
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Australia
    Brazil
    Canada
    Chile
    Colombia
    Israel
    Japan
    Korea, Republic of
    New Zealand
    Russian Federation
    Taiwan
    United States
    Austria
    France
    Germany
    Italy
    Netherlands
    Poland
    Spain
    United Kingdom
    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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months4
    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: 250
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 750
    F.2 Gender
    F.2.1Female No
    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 state43
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 494
    F.4.2.2In the whole clinical trial 1000
    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)
    None
    Nessuno
    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 Decision2019-04-18
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-02-14
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2023-07-18
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