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    Summary
    EudraCT Number:2019-000221-45
    Sponsor's Protocol Code Number:GIM24-PALBO-BP
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-06-17
    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 number2019-000221-45
    A.3Full title of the trial
    Palbociclib plus fulvestrant in women with hormone receptor positive and human epidermal growth factor receptor type 2 negative locally advanced or metastatic breast cancer previously treated with a CDK4/6 inhibitor in combination with hormonal therapy: a multicenter, phase II trial
    Palbociclib in associazione a fulvestrant in donne affette da carcinoma mammario localmente avanzato (Local Advanced Breast Cancer, LABC) o metastatico (Metastatic Breast Cancer, MBC), recettori ormonali positivo (Hormonal Receptors, HR) e recettore del fattore di crescita epidermico umano 2 negativo (Human Epidermal growth factor Receptor 2, HER2), precedentemente trattate con un inibitore CDK4/6 in combinazione con terapia ormonale: uno studio multicentrico di fase II
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Palbociclib plus the drug fulvestrant in women with hormone receptor positive and human epidermal growth factor receptor type 2 negative locally advanced or with metastases breast cancer previously treated with a CDK4/6 inhibitor in combination with hormonal therapy: a multicenter, phase II trial
    Palbociclib assunto in associazione al farmaco fulvestrant in donne affette da carcinoma mammario localmente avanzato o con metastasi, recettori ormonali positivo e recettore del fattore di crescita epidermico umano 2 negativo, precedentemente trattate con un inibitore CDK4/6 in combinazione con la terapia ormonale: uno studio multicentrico di fase II
    A.3.2Name or abbreviated title of the trial where available
    Palbociclib plus the drug fulvestrant in women with hormone receptor positive and human epidermal gr
    Palbociclib in associazione a fulvestrant in donne affette da carcinoma mammario localmente avanzato
    A.4.1Sponsor's protocol code numberGIM24-PALBO-BP
    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 SponsorCONSORZIO ONCOTECH
    B.1.3.4CountryItaly
    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 supportPfizer
    B.4.2CountryItaly
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationClinical Research Technology
    B.5.2Functional name of contact pointInformazione sulla Sperimentazione
    B.5.3 Address:
    B.5.3.1Street AddressVia San Leonardo trav Migliaro
    B.5.3.2Town/ citySalerno
    B.5.3.3Post code84131
    B.5.3.4CountryItaly
    B.5.4Telephone number089301545
    B.5.5Fax number0897724155
    B.5.6E-mailhelpdesk.gim24@oncotech.org
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name IBRANCE - 75 MG - CAPSULA RIGIDA - USO ORALE - BLISTER (PVC/PCTFE/PVC/AL) - 21 CAPSULE
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Europe MA EEIG
    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 nameNon applicabile da istruzioni AIFA essendo stato indicato un nome commerciale (IBRANCE) che identifi
    D.3.2Product code [Non applicabile da istruzioni AIFA essendo stato
    D.3.4Pharmaceutical form Capsule, hard
    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 INNPALBOCICLIB
    D.3.9.2Current sponsor codePD-0332991-00
    D.3.9.4EV Substance CodePRD6503929
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number75
    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: 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 IBRANCE - 100 MG - CAPSULA RIGIDA - USO ORALE - BLISTER (PVC/PCTFE/PVC/AL) - 21 CAPSULE
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Europe MA EEIG
    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 nameNon applicabile da istruzioni AIFA essendo stato indicato un nome commerciale (IBRANCE) che identifi
    D.3.2Product code [Non applicabile da istruzioni AIFA essendo stato
    D.3.4Pharmaceutical form Capsule, hard
    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 INNPALBOCICLIB
    D.3.9.2Current sponsor codePD-0332991-00
    D.3.9.4EV Substance CodePRD6503927
    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 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: 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 IBRANCE - 125 MG - CAPSULA RIGIDA - USO ORALE - BLISTER (PVC/PCTFE/PVC/AL) - 21 CAPSULE
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer Europe MA EEIG
    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 nameNon applicabile da istruzioni AIFA essendo stato indicato un nome commerciale (IBRANCE) che identifi
    D.3.2Product code [Non applicabile da istruzioni AIFA essendo stato
    D.3.4Pharmaceutical form Capsule, hard
    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 INNPALBOCICLIB
    D.3.9.2Current sponsor codePD-0332991-00
    D.3.9.4EV Substance CodePRD6503996
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number125
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Pre- and post-menopausal women with HR+/HER2- LABC or MBC whose disease has progressed to CDK4/6 inhibitor in combination with a hormonal therapy in the adjuvant or metastatic setting
    Donne in pre- e post-menopausa con HR+/HER2- LABC o MBC la cui malattia è progredita ad un trattamento con un inibitore di CDK4/6 in combinazione con la terapia ormonale nel setting adiuvante o metastatico
    E.1.1.1Medical condition in easily understood language
    Women with hormone receptor positive and human who are previously treated with a CDK4/6 inhibitor in combination with hormonal therapy
    Donne con carcinoma mammario localmente avanzato o metastatico che sono state precedentemente trattate con un inibitore CDK4/6 in combinazione con terapia ormonale
    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 10027475
    E.1.2Term Metastatic breast cancer
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10072740
    E.1.2Term Locally 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
    The aim of the present study is to evaluate the efficacy and safety of palbociclib plus fulvestrant after failure of a combined treatment of hormonal therapy (aromatase inhibitor or tamoxifen ± LHRHa) plus a CDK4/6 inhibitor, in women with HR+ and HER2- LABC or MBC
    Lo scopo del presente studio è quello di valutare l’efficacia e la sicurezza di palbociclib + fulvestrant dopo il fallimento di un trattamento combinato di terapia ormonale (inibitore dell’aromatasi o tamoxifene ± LHRHa) + un inibitore CDK4/6, in donne con HR+ e HER2- LABC o MBC
    E.2.2Secondary objectives of the trial
    To assess predictive biomarkers of response/resistance to fulvestrant plus palbociclib using metastatic tumor tissue samples and liquid biopsies
    Valutare biomarcatori predittivi di risposta/resistenza a fulvestrant + palbociclib utilizzando campioni di tessuto tumorale metastatico e biopsie liquide
    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: Version 1.0, 25 November 2018
    The objectives of the substudy are reported below:
    For each patient enrolled in the present study a blood sample (mandatory) at study enrollment and at disease progression (mandatory) will be provided. Additionally, a tissue sample from the most accessible metastatic site will be collected at study enrollment and at disease progression (optional). Blood and tumor samples will be used to investigate the mechanisms of response and resistance to therapy with palbociclib in combination with fulvestrant.
    In detail, biological samples will be employed:
    - to evaluate copy-number aberrations, mutations, gene-expression and protein expression levels,
    - to perform analysis of circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs).

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: Versione 1.0, 25 Novembre 2018
    Gli obiettivi del sottostudio sono riportati a seguire:
    Per ogni paziente arruolato nel presente trial, verrà prelevato un campione di sangue (mandatorio) all’arruolamento nello studio e alla progressione della malattia (mandatorio). Inoltre, sarà raccolto un campione di tessuto dal sito metastatico più accessibile all’arruolamento e alla progressione di malattia (opzionale). Campioni di sangue e di tumore verranno utilizzati per studiare i meccanismi di risposta e resistenza alla terapia con palbociclib in combinazione con fulvestrant.
    Nel dettaglio i campioni biologici saranno impiegati per:
    - Valutare le amplificazioni, le delezioni e le mutazioni geniche, i livelli di espressione genica e di espressione proteica.
    - Eseguire analisi del DNA tumorale circolante (ctDNA) e cellule tumorali circolanti (CTCs).
    E.3Principal inclusion criteria
    1. Adult (>=18 years of age) pre or post-menopausal women with LABC or MBC not amenable to curative treatment by surgery or radiotherapy, progressing to a CDK4/6 inhibitor in combination with aromatase inhibitor or tamoxifen in the adjuvant or metastatic setting. To be enrolled in the present trial patients must have relapsed at least after 12 months from the last CDK4/6 dosage in the adjuvant setting or at progression from a first line combined hormonal treatment for metastatic disease with a CDK4/6 inhibitor plus AI or Tam with duration of, at least, 6 months. For metastatic disease, patients must have achieved, at least a stable disease while the first line hormonal treatment with a CDK4/6 inhibitor plus AI or Tam to be enrolled in the trial.
    2. Patients receiving up to one line of chemotherapy before the first line hormonal treatment with a CDK4/6 inhibitor for metastatic disease may be enrolled in the study.
    3. Histological confirmation of ER and/or PgR >= 1% and HER2 negative breast cancer (IHC status 0, 1+, 2+ and FISH not amplified).
    4. Premenopausal women: in order to be eligible must have achieved surgical menopause with bilateral oophorectomy or ovarian radiation or medical menopause by treatment with a luteinizing hormone-releasing hormone (LHRH) agonist (LHRHa) for induction of ovarian suppression.
    5. Radiological or objective evidence of recurrence or progression on or after the last systemic therapy prior to enrollment.
    6. Patients who received <= 28 days of fulvestrant for second line advanced breast cancer treatment prior to study enrollment are eligible.
    7. Patients must have:
    - At least one lesion that can be accurately measured in at least one dimension >= 20 mm with conventional imaging techniques or >= 10 mm with spiral CT or MRI
    - Bone lesions: lytic or mixed (lytic + sclerotic) in the absence of measurable disease as defined above.
    8. Adequate bone marrow and coagulation and adequate organ function defined as follows:
    - ANC > 1,000/mm3 (1.0 x 109/L);
    - Platelets > 75,000/mm3 (75 x 109/L);
    - Hemoglobin >= 9 g/dL (90 g/L);
    - Serum creatinine <= 1.5 x ULN or estimated creatinine clearance >= 60 ml/min as calculated using the method standard for the institution;
    - Total serum bilirubin <= 1.5 x ULN (<2.5 ULN if Gilbert’s disease);
    - AST and/or ALT <= 3 x ULN (<= 5 x ULN if liver metastases present);
    - Alkaline phosphatase <= 2.5 x ULN (<= 5 x ULN if bone or liver metastases present);
    - ECOG Performance Status <= 2;
    - Resolution of all acute toxic effects of prior therapy or surgical procedures to National Cancer Institute (NCI) CTCAE Grade <=1 (except alopecia).
    9. Estimated life expectancy > of 12 weeks.
    10. Patients must perform liquid biopsy at study entry and at disease progression. Tissue biopsy of the most accessible metastatic site at study entry and at disease progression are required but not mandatory.
    11. Written informed consent obtained before any screening procedure and according to local guidelines.
    1. Donne adulte (>= 18 anni) in pre- o post-menopausa con LABC o MBC non sottoposte a trattamento curativo mediante chirurgia o radioterapia, progredite ad un inibitore di CDK4/6 in combinazione con un inibitore dell’aromatasi o tamoxifene nel setting adiuvante o metastatico. Per essere arruolate nel presente studio la recidiva di malattia deve essere avvenuta dopo almeno 12 mesi dall’ultima dose di CDK4/6 nel setting adiuvante o a progressione al trattamento combinato di prima linea per malattia metastatica con l’inibitore CDK4/6 + inibitori dell’aromatasi o tamoxifene che deve essere avvenuta dopo un trattamento di almeno 6 mesi. Per la malattia metastatica, le pazienti per essere reclutate nello studio devono aver raggiunto almeno la stabilità di malattia durante il trattamento ormonale di prima linea con un inibitore CDK4/6 + inibitori dell’aromatasi o tamoxifene.
    2. Possono essere arruolate nello studio le pazienti che hanno ricevuto fino ad una linea di chemioterapia prima del trattamento ormonale di prima linea con un inibitore di CDK4/6 per malattia metastatica.
    3. Conferma istologica di ER e/o PgR >= 1% e carcinoma mammario HER2 negativo (IHC status 0, 1+, 2+ e FISH non amplificato).
    4. Donne in premenopausa: per essere eleggibili devono aver raggiunto la menopausa tramite trattamento chirurgico (ovariectomia bilaterale), radioterapico o farmacologico con un agonista dell’ormone-rilasciante l’ormone luteinizzante (LHRH) per l’induzione della soppressione ovarica.
    5. Evidenza radiologica o obiettiva di recidiva o progressione di malattia dopo l’ultima terapia sistemica prima dell’arruolamento.
    6. Sono eleggibili pazienti che hanno ricevuto <= 28 giorni di fulvestrant per il trattamento del carcinoma mammario avanzato di seconda linea prima dell’arruolamento nello studio.
    7. Le pazienti devono avere:
    - Almeno una lesione misurabile con tecniche di imaging convenzionali di dimensione >= 20 mm o con CT spirale o MRI >= 10 mm.
    - Lesioni ossee: litiche o miste (litiche + sclerotiche) in assenza di malattia misurabile come sopra definita.
    8. Adeguate funzionalità d’organo, definite come di seguito:
    - Neutrofili > 1,000/mm3 (1.0 x 109/L);
    - Piastrine > 75,000/mm3 (75 x 109/L);
    - Emoglobina >= 9 g/dL (90 g/L);
    - Creatinina sierica <= 1.5 volte il limite superiore dei valori normali (ULN) o clearance stimata della creatinina >= 60 ml/min calcolata utilizzando il metodo standard del centro;
    - Bilirubina sierica totale <= 1.5 x ULN (<2.5 ULN in caso di malattia di Gilbert);
    - AST e/o ALT <= 3 x ULN (<= 5 x ULN se sono presenti metastasi epatiche)
    - Fosfatasi alcalina <= 2.5 x ULN (<= 5 x ULN se sono presenti metastasi ossee o epatiche);
    - ECOG Performance Status <= 2;
    - Risoluzione di tutti gli effetti tossici acuti di terapie primarie o procedure chirurgiche in accordo al National Cancer Institute (NCI) CTCAE Grado <= 1 (ad eccezione dell’alopecia).
    9. Aspettativa di vita stimata > di 12 settimane.
    10. Le pazienti devono eseguire un prelievo di sangue per biopsia liquida all’ingresso nello studio e alla progressione della malattia. È suggerita ma non obbligatoria una biopsia tissutale del sito metastatico più accessibile all’ingresso nello studio e alla progressione della malattia.
    11. Consenso informato scritto raccolto prima di ogni procedura di screening e secondo le linee guida locali.
    E.4Principal exclusion criteria
    1. HER2-overexpressing patients by local laboratory testing (IHC3+ staining or in situ hybridization positive).
    2. Patients who received > 1 line of chemotherapy as treatment for MBC.
    3. Patients who received > 1 line of a CDK4/6 inhibitor in combination with hormonal treatment for LABC or MBC or who have relapsed at less than 12 months from the end of adjuvant treatment with a CDK4/6 inhibitor. For metastatic disease, patients with a progressive disease within the first 6 months of treatment while on first line therapy with a CDK4/6 inhibitor, will be excluded.
    4. Patients receiving chemotherapy or any type of hormonal therapy after treatment with a CDK4/6 inhibitor for metastatic disease.
    5. Patients interrupting the previous treatment with CDK4/6 inhibitor for cardiac and/or hepatic toxicity and not for disease progression.
    6. Pregnant, lactating women.
    7. Known hypersensitivity to CDK4/6 inhibitors, fulvestrant, or to any of the excipients.
    8. Radiotherapy within four weeks prior to enrollment (baseline/treatment start) except in case of localized radiotherapy for analgesic purpose or for lytic lesions at risk of fracture which can then be completed within two weeks prior to enrollment (baseline/treatment start). Patients must have recovered from radiotherapy toxicities prior to enrollment.
    9. Currently receiving hormone replacement therapy, unless discontinued prior to enrollment.
    10. Patients receiving concomitant immunosuppressive agents or chronic corticosteroids use, at the time of study entry except in cases outlined below:
    a. short duration (<2 weeks) of systemic corticosteroids is allowed (e.g., chronic obstructive pulmonary disease, anti-emetic);
    b. low doses of corticosteroids for brain metastasis treatment is allowed.
    11. Patients with symptomatic visceral disease in need of urgent disease control (e.g., significant dyspnea related to pulmonary lymphangitic carcinomatosis and lung metastases or clinically meaningful symptomatic liver metastasis at the judgement of treating investigator).
    12. Symptomatic brain metastases.
    13. Patients with a known history of HIV seropositivity.
    14. Active, bleeding diathesis, or on oral anti-vitamin K medication (except low dose warfarin, low-molecular-weight heparin (LMWH) and acetylsalicylic acid or equivalent, as long as the INR is <= 2.0).
    15. Any severe and/or uncontrolled medical conditions such as: unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction <= 6 months prior to enrollment, serious uncontrolled cardiac arrhythmia.
    16. Acute and chronic, active infectious disorders.
    17. Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of the study treatments (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome).
    18. Inability to swallow oral medications.
    19. Significant symptomatic deterioration of lung function.
    20. Patients being treated with drugs recognized as being strong inhibitors or inducers of the isoenzyme CYP3A (Rifabutin, Rifampicin, Clarithromycin, Ketoconazole, Itroconazole, Voriconazole, Ritinavir, Telithromycin) within the last 5 days prior to enrollment.
    21. History of non-compliance to medical regimens.
    22. Patients refusing to perform liquid biopsy at study entry and disease progression.
    23. Patients unwilling to or unable to comply with the protocol.
    1. Pazienti con over-espressione di HER2 definita da test di laboratorio locale (colorazione IHC3+ o ibridazione in situ positiva).
    2. Pazienti che hanno ricevuto > 1 linea di chemioterapia come trattamento per MBC.
    3. Pazienti che hanno ricevuto > 1 linea con inibitore CDK4/6 in combinazione con un trattamento ormonale per LABC o MBC o che hanno avuto una recidiva a meno di 12 mesi dalla fine del trattamento adiuvante con un inibitore CDK4/6. Per la malattia metastatica, saranno escluse le pazienti con una malattia progredita entro i primi 6 mesi di trattamento durante la terapia di prima linea con un inibitore di CDK4/6.
    4. Pazienti sottoposte a chemioterapia o qualsiasi tipo di terapia ormonale dopo trattamento con un inibitore di CDK4/6 per la malattia metastatica.
    5. Pazienti che interrompono il precedente trattamento con l’inibitore di CDK4/6 per tossicità cardiaca e/o epatica e non per progressione di malattia.
    6. Donne in gravidanza e in allattamento.
    7. Ipersensibilità nota agli inibitori di CDK4/6, al fulvestrant, o ad uno qualsiasi degli eccipienti.
    8. Radioterapia entro quattro settimane prima dell’arruolamento (basale/inizio del trattamento) eccetto in caso di radioterapia localizzata per uso analgesico o per lesioni litiche a rischio di frattura che può essere completata entro due settimane prima dell’arruolamento (basale/inizio del trattamento). Le pazienti devono aver recuperato dalla tossicità radioterapica prima dell’arruolamento.
    9. Pazienti attualmente sottoposte a terapia ormonale sostitutiva, a meno che la stessa non venga sospesa prima dell’arruolamento.
    10. Pazienti che assumono agenti immunosoppressivi concomitanti o che fanno un uso cronico di corticosteroidi al momento dell’ingresso nello studio ad eccezione dei casi descritti di seguito:
    a. È consentita una breve durata (<2 settimane) di terapia sistemica con corticosteroidi (es. Malattia polmonare ostruttiva cronica, anti-emetico);
    b. Sono consentite basse dosi di corticosteroidi per il trattamento delle metastasi cerebrali.
    11. Pazienti con malattia viscerale sintomatica che necessitano un controllo urgente della malattia (es. dispnea significativa correlata a carcinomatosi polmonare linfagitica e metastasi polmonari o metastasi epatiche sintomatiche clinicamente significative a giudizio dello sperimentatore).
    12. Metastasi cerebrali sintomatiche.
    13. Pazienti con una storia nota di sieropositività da HIV.
    14. Diatesi attiva, emorragica o trattamento anti-vitamina K (eccetto warfarin a basso dosaggio, eparina a basso peso molecolare (LMWH) e acido acetilsalicilico o equivalente purché l’INR sia <= 2.0).
    15. Qualsiasi condizione grave e/o incontrollata come: angina pectoris instabile, insufficienza cardiaca congestizia sintomatica, infarto miocardico <= 6 mesi prima dell’arruolamento, grave aritmia cardiaca incontrollata.
    16. Disordini acuti e cronici, infezioni attive.
    17. Compromissione della funzione gastrointestinale o malattia gastrointestinale che può alterare in modo significativo l’assorbimento dei farmaco in studio (es. malattia ulcerosa, nausea incontrollata, vomito, diarrea, sindrome da malassorbimento).
    18. Incapacità di deglutire farmaci orali.
    19. Significativo deterioramento sintomatico della funzionalità polmonare.
    20. Pazienti trattate con farmaci riconosciuti come forti inibitori o induttori dell’isoenzima CYP3A (Rifabutina, Rifampicina, Claritromicina, Ketoconazolo, Itroconazolo, Voriconazolo, Ritinavir, Telitromicina) entro gli ultimi 5 giorni prima dell’arruolamento.
    21. Storia di non-compliance ai regimi terapeutici.
    22. Pazienti che si rifiutano di eseguire una biopsia liquida all’ingresso nello studio e a progressione di malattia.
    23. Pazienti riluttanti o incapaci di seguire il protocollo
    E.5 End points
    E.5.1Primary end point(s)
    1. To assess the clinical benefit rate (CBR) of the combination treatment palbociclib plus fulvestrant at progression of a combined treatment of hormonal therapy (aromatase inhibitor or tamoxifen ± LHRHa) and a CDK4/6 inhibitor.
    Clinical benefit rate for primary efficacy endpoints derivation will be based on the local (treating center’s) radiologist’s/investigator’s tumor assessment.
    - For patients with measurable disease at baseline, progression will be determined according to the RECIST criteria v1.1.
    - In the absence of measurable disease at baseline, patients with bone only lesions, lytic or mixed (lytic + sclerotic), will be allowed to enter the study and the following will be considered disease progression among these patients:
    - The appearance of one or more new lytic lesions in bone,
    - The appearance of one or more new lesions outside of bone,
    - Unequivocal progression of existing bone lesions.
    Note: Pathologic fracture, new compression fracture, or complications of bone metastases will not be considered as evidence of disease progression, unless one of the above-mentioned criteria is fulfilled.
    2. To assess the Quality of Life (QoL) of patients receiving the combination treatment palbociclib plus fulvestrant at progression of a combined treatment of hormonal therapy (aromatase inhibitor or tamoxifen ± LHRHa) and a CDK4/6 inhibitor.
    Endpoint primario:
    1. Valutare il tasso di beneficio clinico (Clinical Benefit Rate, CBR) del trattamento combinato con palbociclib + fulvestrant a progressione da un trattamento combinato di terapia ormonale (inibitore dell’aromatasi o tamoxifen ± LHRHa) e di un inibitore CDK4/6.
    La risposta al trattamento per il calcolo degli endpoints primari di efficacia si baserà sulla valutazione locale (centro di cura) del tumore da parte degli investigatori.
    - Per pazienti con malattia misurabile al basale, la progressione sarà determinata in accordo ai criteri RECIST v1.1.
    - In assenza di malattia misurabile al basale, saranno autorizzati a entrare nello studio le pazienti con sole lesioni ossee litiche o miste (litico + scleorotico) e per queste pazienti la progressione sarà valutata sulla base di quanto riportato di seguito:
    - La comparsa di una o più nuove lesioni litiche nell’osso.
    - La comparsa di una o più nuove lesioni al di fuori dell’osso.
    - Progressione inequivocabile delle lesioni ossee esistenti.
    Note: la frattura patologica, una nuova frattura da compressione o complicanze delle metastasi ossee non saranno considerate come evidenza di una progressione di malattia, a meno che non venga soddisfatto uno dei criteri sopra menzionati.
    2. Valutare la qualità della vita (Quality of Life, QoL) delle pazienti che ricevono il trattamento in associazione con palbociclib + fulvestrant a progressione di un trattamento combinato di terapia ormonale (inibitore dell’aromatasi o tamoxifen ± analogo LHRH) e di un inibitore CDK4/6.
    E.5.1.1Timepoint(s) of evaluation of this end point
    About 48 months
    Circa 48 mesi
    E.5.2Secondary end point(s)
    1. To evaluate the efficacy of the combination of fulvestrant plus palbociclib at the progression of a combined treatment of hormonal therapy (aromatase inhibitor or tamoxifen ± LHRHa) and CDK4/6 inhibitors with respect to:
    - Overall response rate (ORR)
    - Progression Free Survival (PFS)
    - Overall Survival (OS)
    - Safety and tolerability; To assess predictive biomarkers of response/resistance to fulvestrant plus palbociclib using metastatic tumor tissue samples and liquid biopsies
    1. Valutare l’efficacia della combinazione di fulvestrant + palbociclib a progressione di un trattamento combinato di terapia ormonale (inibitore dell’aromatasi o tamoxifen ± analogo LHRH) e di un inibitore CDK4/6 in considerazione di:
    - Tasso di risposta globale (Overall Response Rate, ORR)
    - Sopravvivenza libera da progressione (Progression-free survival, PFS)
    - Sopravvivenza globale (Overall survival, OS)
    - Sicurezza e tollerabilità; Valutare biomarcatori predittivi di risposta/resistenza a fulvestrant + palbociclib utilizzando campioni di tessuto tumorale metastatico e biopsie liquide
    E.5.2.1Timepoint(s) of evaluation of this end point
    About 48 months; About 48 months
    Circa 48 mesi; Circa 48 mesi
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others 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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Studio di fase II, multicentrico, a singolo braccio che segue il disegno ottimale di Simon a due sta
    Phase II, multicentre, single-arm study following a Simon’s two-stage optimal design
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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 concerned19
    E.8.5The trial involves multiple Member States No
    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 Information not present in EudraCT
    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
    Study treatment will continue until one of the following conditions apply - whichever comes first:
    • tumor progression
    • unacceptable toxicity according to investigator’s judgment
    • patient refusal
    • death
    About two years of post-treatment follow-up period will follow after LPLV
    Il trattamento sperimentale sarà continuativo fino a che una delle seguenti condizioni si verifichi:
    • progressione di malattia
    • tossicità inaccettabile a giudizio dello sperimentatore
    • rifiuto del paziente
    • decesso
    Seguiranno due anni circa di follow-up successivi alla LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months48
    E.8.9.1In the Member State concerned days14
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months48
    E.8.9.2In all countries concerned by the trial days14
    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: 100
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 68
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    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 state168
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 168
    F.4.2.2In the whole clinical trial 168
    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)
    Plans for treatment or care after a subject has ended his/her participation in the trial will follow standard clinical practice
    I programmi per il trattamento o l'assistenza per i soggetti al termine della loro partecipazione allo studio seguono la normale pratica clinica
    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 Decision2019-05-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-04-17
    P. End of Trial
    P.End of Trial StatusOngoing
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