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    Summary
    EudraCT Number:2019-000854-69
    Sponsor's Protocol Code Number:IPI-549-02
    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:2021-01-22
    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 number2019-000854-69
    A.3Full title of the trial
    A Phase 2, Multicenter, Randomized, Double-Blind, Active-Control Study to Evaluate the Efficacy and Safety of Nivolumab Administered in Combination with IPI 549 Compared to Nivolumab Monotherapy in the Treatment of Patients with Immune Therapy-Naïve, Advanced Urothelial Carcinoma
    Studio di Fase 2, multicentrico, randomizzato, in doppio-cieco, con controllo attivo per valutare l'efficacia e la sicurezza di nivolumab somministrato in combinazione con IPI-549 rispetto a nivolumab in monoterapia nel trattamento di pazienti affetti da carcinoma uroteliale avanzato, naïve all’immunoterapia
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to asses safety and effectiveness of Nivolumab in combination with the study drug (IPI-549) compared to Nivolumab as single therapy to treat patients with advanced urothelial cancer.
    Studio per valutare la sicurezza e l'efficacia di Nivolumab in combinazione con il farmaco in studio (IPI-549) rispetto a Nivolumab in monoterapia nel trattamento di pazienti affetti da carcinoma uroteliale avanzato.
    A.3.2Name or abbreviated title of the trial where available
    Mario-275
    Mario-275
    A.4.1Sponsor's protocol code numberIPI-549-02
    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 SponsorINFINITY PHARMACEUTICALS, INC.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportInfinity Pharmaceuticals, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationInfinity Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointHalle Huihong Zhang, PhD
    B.5.3 Address:
    B.5.3.1Street Address1100 Massachusetts Avenue, 4th Floor MA
    B.5.3.2Town/ cityCambridge, MA
    B.5.3.3Post code02138
    B.5.3.4CountryUnited States
    B.5.4Telephone number6174531245
    B.5.5Fax number6174531245
    B.5.6E-mailhalle.zhang@infi.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 nameNA
    D.3.2Product code [IPI-549]
    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 INNTBC
    D.3.9.1CAS number 1693758-51-8
    D.3.9.2Current sponsor codeIPI-549
    D.3.10 Strength
    D.3.10.1Concentration unit mg/g milligram(s)/gram
    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.IMP: 2
    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 OPDIVO
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    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 No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameOPDIVO 10 mg/mL concentrate for solution for infusion.
    D.3.2Product code [NA]
    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 INNNIVOLUMAB
    D.3.9.2Current sponsor codeNIVOLUMAB
    D.3.9.4EV Substance CodeSUB122750
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    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) 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 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 nameIPI-549
    D.3.2Product code [IPI-549]
    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 INNTBC
    D.3.9.1CAS number 1693758-51-8
    D.3.9.2Current sponsor codeIPI-549
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    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 placeboCapsule, hard
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboCapsule, hard
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Advanced Urothelial Carcinoma
    Carcinoma uroteliale avanzato
    E.1.1.1Medical condition in easily understood language
    Advanced Bladder Cancer
    carcinoma della vescica avanzato
    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 10064467
    E.1.2Term Urothelial carcinoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare the objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1(3) in patients with baseline
    mMDSC levels =22.3% following combination treatment with nivolumab plus IPI-549 with that of nivolumab monotherapy.
    Confrontare il tasso di risposta obiettiva (ORR) mediante i Criteri di valutazione della risposta nei tumori solidi (RECIST) versione 1.1(3) in pazienti che presentano livelli di mMDSC alla baseline =22.3% dopo il trattamento combinato di nivolumab più IPI-549 rispetto a nivolumab in monoterapia.
    E.2.2Secondary objectives of the trial
    •To compare ORR per RECIST v1.1 in patients with baseline mMDSC levels <22.3% and in all patients regardless of baseline mMDSC level
    following combination treatment with nivolumab plus IPI-549 with that of nivolumab monotherapy.
    •To evaluate time to response (TTR), duration of response (DOR), and progression-free survival (PFS) following combination treatment with
    nivolumab plus IPI-549 relative to nivolumab monotherapy.
    •To evaluate the safety of combination treatment with nivolumab plus IPI-549.
    •To evaluate the pharmacokinetics (PK) of IPI-549 administered in combination with nivolumab.
    • Confrontare l’ORR mediante i criteri RECIST v1.1 in pazienti con livelli di mMDSC alla baseline <22.3% e in tutti i pazienti indipendentemente dal livello di mMDSC alla baseline dopo il trattamento combinato di nivolumab più IPI-549 rispetto a nivolumab in monoterapia.
    • Valutare il tempo alla risposta (TTR), la durata della risposta (DOR) e la sopravvivenza libera da progressione (PFS) dopo il trattamento combinato di nivolumab più IPI-549 rispetto a nivolumab in monoterapia.
    • Valutare la sicurezza del trattamento combinato di nivolumab più IPI-549.
    • Valutare la farmacocinetica (PK) di IPI-549 somministrato in combinazione con nivolumab.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.=18 years of age.2.Have signed and dated an independent review board IRB/IEC approved ICF in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol-related
    procedures that are not part of normal patient care. 3.Willing and able to comply with scheduled visits, treatment schedule,laboratory tests, fresh tumor biopsies, and all other protocol requirements. 4.Patients with histologically or cytologically confirmed urothelial carcinoma (including mixed histologies of urothelial carcinoma with elements of other subtypes) of the renal pelvis, ureter, bladder, or urethra, who meet one of the following:
    a.Have progression or refractory disease. Patients must have had at least 1 platinum-based chemotherapy regimen for the treatment of
    metastatic (Stage IV) or locally advanced unresectable disease; or b.Have disease recurrence within 1 year of completing a platinum-based neoadjuvant or adjuvant therapy; or 5.At least 1 measurable disease lesion by computed tomography (CT) or magnetic resonance imaging (MRI) as defined by RECIST v1.1 performed within 1 month prior to first dose. 6.Willing to undergo one pre-treatment core biopsy (unless archival tumor tissue is available within 3 months of first dose) and one ontreatment tumor biopsy with an additional (optional) post-treatment tumor biopsy for an exploratory analysis of mechanisms of resistance.Biopsies performed during the study may be omitted under certain circumstances; for example, if considered medically unfeasible after a discussion between the Investigator and Medical Monitor. Baseline tumor biopsies should preferably be performed from a tumor site that is NOT the only site of measurable disease. For patients with only one site of measurable disease, tumor biopsies are allowed if at
    least one of the following criteria is met: a.CT imaging performed after biopsy and there is still measurable disease, or b.The type of biopsy is not expected to impact the measurability (eg, core needle biopsy) regardless of when imaging occurred, prior to or after biopsy.Tumor material from core biopsies done before the screening period is acceptable if the biopsy was performed within 3 months prior to the planned treatment start and no new systemic cancer therapy was administered after the biopsy and before study entry. 7.Tumor tissue (archived [without time constraints] or new biopsy) should be provided for biomarker analysis, including PD-L1 expression level per central laboratory (Dako PD-L1 immunohistochemical 28-8 pharmDx kit). 8.Blood sample must be provided to the central laboratory for evaluation of mMDSC levels, as measured by Clinical Laboratory Improvement
    Amendments (CLIA)-certified Serametrix flow cytometry assay. Patients must have a confirmed result of mMDSC level for randomization into the
    study. 9.Eastern Cooperative Oncology Group (ECOG) performance status <=1. 10.Baseline laboratory values must meet the following criteria within 14
    days of the first dose:a.Adequate hematologic function, defined as white blood cell (WBC) count >=2.0 × 109/L, absolute neutrophil count >=1.5 × 10^9/L,
    hemoglobin >=9.0 g/dL, and platelet count >=100 × 10^9/L.b.Creatinine clearance >=30 mL/min, as determined by either of the following:Estimation as calculated by Cockcroft-Gault equation;Direct measurement by 24-hour urine collection. c.Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <3 × upper limit of normal (ULN) (<5 × ULN if liver metastasis).d.Total bilirubin <=1.5 × ULN (unless elevated due to Gilbert's syndrome who can have total bilirubin <3.0 mg/dL).e.Albumin >=3 g/dL.11.Patients who have received more than 2 prior lines of chemotherapy must not have liver metastases. Sequential chemotherapy given as a planned sequence to optimize response will count as 1 regimen. 12.Prior focal radiotherapy to an isolated bony or soft tissue metastasis should be completed at least 2 weeks before study drug administration.
    1.>=18anni.2.Aver firmato e datato ICF approvato dal IRB/CEI conforme a linee guida regolatorie e istituzionali.Tale consenso deve essere ottenuto prima di eseguire qualsiasi procedura correlata al protocollo che non faccia parte della normale terapia del paziente.3.Volontà e capacità di attenersi a: visite programmate,programma di trattamento,test laboratorio,biopsie tumorali nuove,tutti altri requisiti del protocollo.4.Pazienti affetti da carcinoma uroteliale confermato da esame istologico o citologico di pelvi renale,uretere,vescica,uretra,che soddisfano uno dei seguenti criteri:Mostrano progressione della malattia o malattia refrattaria.I pazienti devono aver ricevuto almeno 1 regime chemioterapico a base di platino per il trattamento della malattia metastatica o localmente avanzata non operabile;o Presentare recidiva della malattia entro 1anno dal completamento di una terapia neoadiuvante o adiuvante a base di platino.5.Almeno 1lesione della malattia misurabile mediante TAC o RMI come definita dai criteri RECIST v1.1,eseguita entro 1mese prima della prima dose.6.Volontà di sottoporsi a agobiopsia prima del trattamento e a una biopsia tumorale durante il trattamento con una biopsia tumorale aggiuntiva post-trattamento per un'analisi esplorativa dei meccanismi di resistenza.Le biopsie eseguite durante lo studio possono essere omesse in determinate circostanze;per esempio,se considerato clinicamente non fattibile dopo discussione tra Sperimentatore e Medical Monitor.Le biopsie tumorali a baseline dovranno preferibilmente essere eseguite su una sede tumorale che NON sia la sola sede della malattia misurabile.Per i pazienti con una sola sede di malattia misurabile,le biopsie tumorali sono consentite se viene soddisfatto almeno uno dei seguenti criteri:La scansione TAC viene eseguita dopo la biopsia e la malattia è ancora misurabile, o Non si prevede che il tipo di biopsia abbia un impatto sulla misurabilità,indipendentemente che la scansione sia stata eseguita prima o dopo la biopsia.Il materiale tumorale ottenuto da agobiopsie eseguite prima del periodo di screening è accettabile,se la biopsia è stata eseguita entro 3mesi prima dell'inizio del trattamento programmato e non è stata somministrata alcuna nuova terapia antitumorale sistemica dopo la biopsia e prima dell'ingresso nello studio.7.Il tessuto tumorale dovrebbe essere fornito per l'analisi dei biomarcatori,compreso il livello di espressione di PD-L1 secondo il laboratorio centrale. 8.Il campione di sangue deve essere fornito al laboratorio centrale per la valutazione dei livelli di mMDSC,come misurato dal saggio di citometria a flusso di Serametrix con certificazione Clinical Laboratory Improvement Amendments.I pazienti devono presentare un risultato confermato del livello di mMDSC per la randomizzazione nello studio.9.Stato di performance ECOG<=1. 10.I valori di laboratorio alla baseline devono soddisfare i seguenti criteri entro 14 giorni dalla prima dose:a.Adeguata funzionalità ematologica,definita come conta dei globuli bianchi>=2,0 × 10^9/L,conta assoluta dei neutrofili>=1,5×10^9/L,emoglobina>=9,0 g/dL e conta delle piastrine>=100×10^9/L.Clearance della creatinina>=30 mL/min,come definito da una delle seguenti condizioni:Stima calcolata tramite equazione di Cockcroft-Gault;Misurazioni mirate mediante raccolta di urine nelle 24ore.Aspartato aminotransferasi e alanina aminotransferasi<3 ×ULN.d.Bilirubina totale <= 1,5 x ULN.e.Albumina >=3 g/dL. 11.I pazienti che hanno ricevuto più di 2 linee precedenti di chemioterapia non devono presentare metastasi epatiche.La chemioterapia sequenziale somministrata come sequenza pianificata per ottimizzare la risposta sarà considerata come 1 regime. 12.La precedente radioterapia focale per una metastasi ossea o dei tessuti molli isolata dovrà essere completata almeno 2 settimane prima della somministrazione del farmaco in studio.
    E.4Principal exclusion criteria
    1.Active brain metastases or leptomeningeal metastases.Patients with brain metastases are eligible if these have been treated and there is no MRI evidence of progression for at least 4 weeks after treatment is complete and within 28 days prior to first dose of study drug administration.There must also be no requirement for immunosuppressive doses of systemic corticosteroids for at least 2weeks prior to study drug administration.Patients with incidental findings of asymptomatic brain metastases at screening may start study treatment without prior radiation treatment after discussion between the Infinity Medical Monitor or designee and Investigator.2.Any serious or uncontrolled medical disorder that,in the opinion of the Investigator,may increase the risk associated with study participation or study drug administration,impair the ability of the patient to receive protocol therapy,or interfere with the interpretation of study results.3.Other prior malignancy active within the previous 3years except for local or organ confined early stage cancer that has been definitively treated with curative intent,does not require ongoing treatment,has no evidence of residual active disease,and has a negligible risk of recurrence and is therefore unlikely to interfere with the primary and secondary endpoints of the study,including response rate and safety.4.Active, known, or suspected autoimmune disease. Patients with type I diabetes mellitus, hypothyroidism only requiring hormone replacement,skin disorders not requiring systemic treatment,or conditions not expected to recur in the absence of an external trigger are permitted to enroll.5.Condition requiring systemic treatment with either corticosteroids or other immunosuppressive medications within 14 days of first dose.Inhaled or topical steroids, and adrenal replacement steroid doses are permitted in the absence of active autoimmune disease.6.Prior therapy with experimental anti-tumor vaccines; any T cell costimulation or checkpoint pathways,such as anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-CTLA-4 antibody, including ipilimumab,or other medicines specifically targeting the T cell; or IPI-549.7.Treatment with any chemotherapy, radiation therapy, biologics for cancer, or investigational therapy within 28 days of first administration of study treatment (patients with prior cytotoxic or investigational products <28 days prior to treatment might be eligible after discussion between Investigator and Infinity Medical Monitor or designee, if toxicities from the prior treatment have resolved to CTCAE Grade 1 level).8.Treatment with botanical preparations intended for general health support or to treat the disease under study within 2 weeks prior to randomization.9.Major surgery within 4 weeks prior to Screening.10.Positive test for HBV using HBsAg and HBcAb or positive test for HCV using HCV RNA test indicating acute or chronic infection.11.Known history of testing positive for HIV or known AIDS.12.Dependence on continuous supplemental oxygen use.13.History of allergy to study drug components or severe hypersensitivity reaction to any monoclonal antibody.14.Ongoing systemic bacterial, fungal, or viral infections at Screening.15.Administration of a live or attenuated vaccine within 6 weeks of first dose of study drug.16.Administration of any of the following within 1 week prior to the administration of study drug:a.Strong inhibitors or inducers of cytochrome P450 (CYP) 3A4 and 2C8,including grapefruit, grapefruit juice and herbal supplements b.Warfarin, phenytoin, or other substrates of CYP2C8 or CYP2C9 with a narrow therapeutic range.c.P-gp inhibitors;17.Baseline QT interval corrected with Fridericia's method QTcF>480 ms.18.Prior surgery or gastrointestinal dysfunction that may affect drug absorption (eg gastric bypass surgery, gastrectomy).19.WOCBP who are pregnant or reastfeeding.20.Women with a positive pregnancy test at enrollment or prior to administration of study medication.
    1.Metastasi cerebrali attive o metastasi leptomeningee. I pazienti con metastasi cerebrali sono eleggibili se tali metastasi sono state trattate e non vi è evidenza di progressione rilevata mediante RMI per almeno 4settimane dopo il completamento del trattamento e nei 28gg precedenti la somministrazione della prima dose di farmaco in studio.Inoltre non deve essere necessario l'impiego di dosi immunosoppressive di corticosteroidi sistemici per almeno 2sett prima della somministrazione del farmaco in studio.I pazienti con scoperte accidentali di metastasi cerebrali asintomatiche allo screening potranno iniziare il trattamento in studio senza una precedente radioterapia dopo che il Medical Monitor di Infinity o un incaricato ne avrà discusso con lo Sperimentatore.2.Qualsiasi disturbo medico serio o non controllato che, a giudizio dello Sperimentatore, possa aumentare il rischio associato alla partecipazione allo studio o alla somministrazione del farmaco in studio o possa compromettere la capacità del paziente di ricevere la terapia di protocollo oppure interferire con l’interpretazione dei risultati dello studio.3.Altri precedenti tumori maligni attivi nei 3 anni precedenti, ad eccezione dei tumori in fase iniziale locali o organo-confinati trattati in maniera definitiva con intento curativo, non richiedono un trattamento in corso,non hanno evidenza di malattia attiva residua e hanno un rischio trascurabile di recidiva e pertanto è improbabile che interferiscano con gli endpoint primari e secondari dello studio,compresi il tasso di risposta e la sicurezza.4.Malattia autoimmune attiva,nota o sospetta.5.Patologia che richieda un trattamento sistemico con corticosteroidi o altri farmaci immunosoppressivi entro 14gg dalla prima dose.Sono consentiti steroidi per via inalatoria o topica e dosi di steroidi per terapia sostitutiva surrenalica, in assenza di malattia autoimmune attiva.6.Terapia precedente con vaccini antitumorali sperimentali; qualsiasi costimolazione delle cellule T o delle vie del checkpoint, come anti-PD-1,anti-PD-L1,anti-PD-L2,anti-CD137 o anti-CTLA-4, incluso ipilimumab, o altri farmaci mirati in modo specifico alle cellule T;o IPI-549.7.Trattamento con qualsiasi chemioterapia,radioterapia,agenti biologici per il cancro o terapia sperimentale entro 28 giorni dalla prima somministrazione del trattamento in studio. 8.Trattamento con preparati botanici destinati all'assistenza sanitaria generale o per il trattamento della malattia in studio entro 2 settimane prima della randomizzazione.9.Intervento chirurgico importante nelle 4 settimane precedenti lo screening.10.Test positivo per il HBV utilizzando HBsAg e HBcAb o test positivo per HCV utilizzando il test HCV RNA che indica un'infezione acuta o cronica.11.Anamnesi nota di test positivi per il virus HIV o AIDS nota.12.Dipendenza dall'ossigenoterapia continua supplementare.13.Anamnesi di allergia ai componenti del farmaco in studio o grave reazione di ipersensibilità a qualsiasi anticorpo monoclonale.14.Infezioni batteriche, fungine o virali sistemiche in corso allo screening.15.Somministrazione di vaccino vivo o attenuato nelle 6 settimane dalla prima dose del farmaco in studio.16.Somministrazione di una delle seguenti sostanze entro 1settimana prima della somministrazione del farmaco in studio:a.Forti inibitori o induttori del citocromo P450 3A4 e 2C8, compresi pompelmo,succo di pompelmo e integratori a base di erbe.b.Warfarina, fenitoina o altri substrati di CYP2C8 o CYP2C9 con un indice terapeutico ristretto.c.Inibitori della glicoproteina P .17.Intervallo QT corretto con il metodo Fridericia alla baseline>480 ms.18.Precedente intervento chirurgico o disfunzione gastrointestinale che possa influire sull'assorbimento dei farmaci19.Donne in età fertile in gravidanza o in allattamento.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint for this study is ORR, with objective response defined as best response of complete response or partial
    response as measured by RECIST v1.1
    L'endpoint primario di efficacia per questo studio è ORR, con risposta obiettiva definita come migliore risposta di risposta completa o risposta parziale, in base a quanto stabilito dai criteri RECIST v1.1.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Response to treatment will be determined based on radiographic evaluations and assessments conducted by the Investigators using
    RECIST v1.1 at baseline, every 8 weeks through Week 48 and at least every 12 weeks thereafter until disease progression.
    La risposta al trattamento sarà determinata dagli Sperimentatori sulla base di valutazioni radiografiche e valutazioni eseguite utilizzando i criteri RECIST v1.1 al baseline, ogni 8 settimane fino alla Settimana 48 e successivamente almeno ogni 12 settimane fino alla progressione confermata della malattia
    E.5.2Secondary end point(s)
    The secondary endpoints for this study are:
    •TTR, defined as the time from the first dose of study treatment to first objective response (CR or PR) in patients with CR or PR.
    •DOR, defined as the time from the first objective response (CR or PR) to documented disease progression in patients with CR or PR.
    •PFS, defined as the time from the first dose of study treatment to documented disease progression or death due to any cause.
    •Incidence of TEAEs, immune-mediated AEs (IMAEs), SAEs, including deaths, AEs leading to treatment discontinuation, changes from baseline
    in safety laboratory parameters, vital signs, and electrocardiograms (ECGs).
    •Population PK estimates, including inter- and intra-subject variability,covariate effects and drug-interaction parameters.
    Gli endpoints secondari pr questo studio sono:
    • TTR, definito come il tempo che intercorre tra la prima dose del trattamento in studio e la prima risposta obiettiva (CR o PR) in pazienti con CR o PR.
    • DOR, definita come il tempo che intercorre tra la prima risposta obiettiva (CR o PR) e la progressione della malattia documentata in pazienti con CR o PR.
    • PFS, definita come il tempo che intercorre tra la prima dose del trattamento in studio e la progressione della malattia documentata o il decesso per qualsiasi causa.
    • Incidenza di eventi avversi emergenti dal trattamento (TEAE), eventi avversi immuno-mediati (IMAE), SAEs, che includono casi di decesso, AE che comportano l’interruzione del trattamento, variazioni rispetto alla baseline dei parametri di laboratorio di sicurezza, funzioni vitali ed elettrocardiogrammi (ECG).
    • Stime della popolazione per i parametri PK, inclusi variabilità inter e intrasoggetto, effetti covariati e parametri di interazione farmacologica.
    E.5.2.1Timepoint(s) of evaluation of this end point
    During the treatment period, patients will be evaluated for safety based on monitoring for adverse events (AEs) and concomitant medications,
    and physical examinations, vital signs, ECGs, clinical laboratory tests (hematology, chemistry, urinalysis), and Eastern Cooperative Oncology
    (ECOG) performance status. Blood samples for population PK assessment will be obtained on Day 1 of Cycles 1 and 2 through 6 hours
    following administration of IPI-549 (or placebo). The date of progression to be used for all relevant time-to-event
    endpoints will be based on first documentation of PD (ie, RECIST v1.1 date of PD), regardless of date of confirmation of PD
    Durante il periodo di trattamento, i pazienti saranno valutati per la sicurezza sulla base del monitoraggio di eventi avversi AE, farmaci concomitanti, esami obiettivi, funzioni vitali, ECG, esami clinici di laboratorio (analisi ematologiche, chimiche e delle urine) e stato di performance ECOG. Il sangue per la valutazione di PK sarà prelevato fino a 6 ore dopo la dose di IPI-549 (o placebo) il Giorno 1 dei Cicli 1 e 2.
    La data di progressione utilizzata nelle analisi per il tempo all'evento sarà basata sulla prima documentazione di PD (es RECIST v1.1 data della PD), indipendentemente dalla data di conferma della PD.
    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 Yes
    E.6.7Pharmacodynamic Yes
    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 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 No
    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 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 concerned6
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA30
    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
    Georgia
    Serbia
    United States
    Czechia
    France
    Germany
    Italy
    Poland
    Spain
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study will occur 2 years after the enrollment of the last patient to account for survival follow-up of all patients.
    La fine dello studio avverrà 2 anni dopo l'arruolamento dell'ultimo paziente per tenere conto del follow up di sopravvivenza di tutti i pazienti.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months0
    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: 80
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 80
    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 Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 113
    F.4.2.2In the whole clinical trial 160
    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
    nessuna
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2019-07-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-07-16
    P. End of Trial
    P.End of Trial StatusOngoing
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