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    Summary
    EudraCT Number:2019-001538-33
    Sponsor's Protocol Code Number:MS200095-0031
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Trial now transitioned
    Date on which this record was first entered in the EudraCT database:2021-06-15
    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 number2019-001538-33
    A.3Full title of the trial
    A Phase II, two arm study to investigate tepotinib combined with osimertinib in MET amplified, advanced or metastatic non-small cell lung cancer (NSCLC) harboring activating EGFR mutations and having acquired resistance to prior osimertinib therapy (INSIGHT 2 Study)
    Studio di fase II a due bracci per la valutazione di tepotinib in combinazione con osimertinib nel carcinoma polmonare non a piccole cellule (non-small cell lung cancer, NSCLC) con amplificazione del gene MET, avanzato o metastatico, che presenta mutazioni attivanti del gene dell’EGFR e che ha acquisito resistenza alla terapia precedente con osimertinib (Studio INSIGHT 2).
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    This study will look at whether the study drug Tepotinib works to stop the regrowth of your lung cancer. The study drug will be used in combination with an approved lung cancer medication called osimertinib, which is an EGFR inhibitor.
    Questo studio valuterà se il farmaco dello studio tepotinib agisce nel fermare la ricrescita del carcinoma polmonare. Il farmaco dello studio sarà utilizzato in combinazione con un farmaco per il carcinoma polmonare approvato chiamato osimertinib, un inibitore del recettore del fattore di crescita dell’epidermide (EGFR).
    A.3.2Name or abbreviated title of the trial where available
    Tepotinib plus osimertinib in osimertinib-relapsed MET amplified NSCLC
    Tepotinib più osimertinib nel carcinoma polmonare non a piccole cellule (NSCLC) recidivante con ampl
    A.4.1Sponsor's protocol code numberMS200095-0031
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03940703
    A.5.4Other Identifiers
    Name:IND NumberNumber:128073
    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 HEALTHCARE KGaA
    B.1.3.4CountryGermany
    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 Healthcare KGaA
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck KGaA
    B.5.2Functional name of contact pointCommunication Center
    B.5.3 Address:
    B.5.3.1Street AddressFrankfurter Str. 250
    B.5.3.2Town/ cityDarmstadt
    B.5.3.3Post code64293
    B.5.3.4CountryGermany
    B.5.4Telephone number+496151725200
    B.5.5Fax number+496151722000
    B.5.6E-mailservice@merckgroup.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 nametepotinib
    D.3.2Product code [MSC2156119J]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNtepotinib
    D.3.9.1CAS number 1100598-30-8
    D.3.9.2Current sponsor codeMSC2156119J
    D.3.9.4EV Substance CodeSUB177092
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number250
    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 TAGRISSO EU/1/16/1086/002-004
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca AB
    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 Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNosimertinib
    D.3.9.1CAS number 1421373-65-0
    D.3.9.2Current sponsor code.
    D.3.9.4EV Substance CodeSUB176340
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number80
    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 TAGRISSO
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca AB - EU/1/16/1086/001-003
    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 Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNOSIMERTINIB
    D.3.9.1CAS number 1421373-65-0
    D.3.9.2Current sponsor code.
    D.3.9.4EV Substance CodeSUB176340
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    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
    Locally advanced or metastatic NSCLC histology (confirmed by either histology or cytology) with documented activating mutation of the EGFR receptor including T790M status Resistance on previous first line osimertinib
    Istologia di NSCLC localmente avanzato o metastatico (confermato da istologia o citologia) con mutazione attivante nel recettore di EGFR documentata, inclusa la resistenza allo stato T790M alla terapia di prima linea con osimertinib
    E.1.1.1Medical condition in easily understood language
    Lung Cancer
    Cancro ai polmoni
    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 PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To assess the efficacy of tepotinib combined with osimertinib in participants with advanced or metastatic EGFRm+ NSCLC and MET amplification, determined centrally by FISH.
    Valutare l’efficacia di tepotinib in combinazione con osimertinib in partecipanti con NSCLC EGFRm+ in stadio avanzato o metastatico e amplificazione di MET, determinata a livello centrale mediante FISH.
    E.2.2Secondary objectives of the trial
    To assess the efficacy of tepotinib combined with osimertinib in participants with advanced or metastatic EGFRm+ NSCLC and MET amplification determined centrally by blood-based next generation sequencing.
    To assess the efficacy of tepotinib monotherapy in participants with advanced or metastatic EGFRm+ NSCLC and MET amplification determined centrally by FISH.
    To assess tolerability and safety in participants with advanced or metastatic EGFRm+ NSCLC and MET amplification treated with the combination of tepotinib plus osimertinib.
    To assess tolerability and safety in participants with advanced or metastatic EGFRm+ NSCLC and MET amplification treated with tepotinib monotherapy.
    Please refer to protocol for further details
    Valutare l’efficacia di tepotinib in combinazione con osimertinib in partecipanti con NSCLC EGFRm+ in stadio avanzato o metastatico e amplificazione di MET, determinata a livello centrale mediante sequenziamento di nuova generazione basato sul sangue.
    Valutare l’efficacia di tepotinib in monoterapia in partecipanti con NSCLC EGFRm+ in stadio avanzato o metastatico e amplificazione di MET, determinata a livello centrale mediante FISH.
    Valutare la tollerabilità e la sicurezza in partecipanti con NSCLC EGFRm+ in stadio avanzato o metastatico e amplificazione di MET, trattati con la combinazione di tepotinib più osimertinib.
    Valutare la tollerabilità e la sicurezza in partecipanti con NSCLC EGFRm+ in stadio avanzato o metastatico e amplificazione di MET, trattati con tepotinib in monoterapia.
    Fare riferimento al protocollo per maggiori dettagli
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Are = 18 years of age (or having reached the age of majority according to local laws and regulations, if the age of majority is > 18 years of age [ie, = 20 years of age in Japan]), at the time of signing the
    informed consent.
    2. Are participants with the following:
    a) Locally advanced or metastatic NSCLC histology (confirmed by either histology or cytology) with
    documented activating EGFR mutation.
    b) Presence of at least 1 independently verified Presence of at least 1 independently verified
    measurable lesion in accordance with RECIST Version 1.1, that can be accurately assessed at
    Baseline with = 10 mm in the longest diameter (except lymph nodes which must have short axis =
    15 mm) with computed tomography (CT) or magnetic resonance imaging (MRI), which is suitable for
    accurate repeated measurements and that preferably was not previously irradiated or biopsied.
    c) Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and a minimum life
    expectancy of 12 weeks
    d) Acquired resistance on previous first-line-osimertinib. Participants must meet both of the following 2
    criteria:
    -Radiological documentation of disease progression on first-lineosimertinib.
    -Objective clinical benefit documented during previous osimertinib therapy, defined by either partial or
    complete radiological response, or durable stable disease (SD) (SD should last > 6 months) after
    initiation of osimertinib
    e) Have received only first line osimertinib as a prior line of therapy in the noncurative advanced or
    metastatic NSCLC setting
    f) MET amplification as determined by either FISH testing (central or local) on tumor tissue (TBx) or
    central blood-based next generation sequencing (LBx). Tumor and blood samples must be collected
    following progression on prior first-line osimertinib at Prescreening.
    -Submission of tumor tissue and blood sample obtained after progression on first line osimertinib, is
    mandatory for all patients for MET amplification testing.
    -Submission of tumor tissue during Prescreening or Screening is mandatory for patients with tumor
    tissue tested by local FISH, to confirm MET amplification status. Central confirmation is not
    mandated prior to the start of study treatment.
    3.Woman no WOBCP, or, use a highly effective contraception. Man: Contraception or no intercourse
    with a WOBCP1.
    1. Avere un’età =18 anni (o avere raggiunto la maggiore età in base alle leggi e normative locali, qualora la maggiore età fosse >18 anni [ovvero, =20 anni in Giappone]), al momento della firma del consenso informato.
    2. I partecipanti presentano quanto segue:
    a) Istologia di NSCLC localmente avanzato o metastatico (confermato da istologia o citologia) con mutazione attivante nel recettore di EGFR documentata.
    b) Presenza di almeno 1 lesione misurabile secondo i criteri di valutazione della risposta nei tumori solidi (RECIST) Versione 1.1 e verificata in maniera indipendente, che possa essere accuratamente valutata al basale con =10 mm nel diametro più lungo (ad eccezione dei linfonodi, il cui asse corto deve essere =15 mm) mediante tomografia computerizzata (TAC) o risonanza magnetica per immagini (RMI), che sia adatta ad accurate misurazioni ripetute e possibilmente che in precedenza non sia stata irradiata o sottoposta a biopsia.
    c) Stato di validità del Gruppo oncologico cooperativo orientale (ECOG) pari a 0 o 1 e un’aspettativa di vita minima di 12 settimane.
    d) Resistenza acquisita alla precedente terapia di prima linea con osimertinib. I partecipanti devono soddisfare entrambi i 2 criteri che seguono:
    - Documentazione radiologica di progressione della malattia durante la terapia di prima linea con osimertinib.
    - Beneficio clinico oggettivo documentato durante la precedente terapia con osimertinib, definito mediante risposta radiologica parziale o completa, oppure mediante malattia stabile (SD) duratura (la SD deve avere una durata >6 mesi) dopo l’avvio di osimertinib.
    e) Aver ricevuto solo la prima linea di osimertinib come linea di terapia pregressa nell’ambito del NSCLC non curativo avanzato o metastatico.
    f) Amplificazione di MET come determinata mediante test FISH (centrale o locale) sul tessuto tumorale (TBx) o sequenziamento centrale di nuova generazione (LBx) basato sul sangue. I campioni di tumore ed ematici devono essere raccolti al pre-screening dopo la progressione durante la terapia di prima linea con osimertinib.
    - L’invio del tessuto tumorale e del campione ematico ottenuti dopo la progressione durante la terapia di prima linea con osimertinib è obbligatorio per tutti i pazienti ai fini del test di amplificazione di MET.
    - L’invio del tessuto tumorale durante il pre-screening o lo screening è obbligatorio per i pazienti con tessuto tumorale analizzato mediante FISH locale, in modo da confermare lo stato di amplificazione di MET. La conferma centrale non è obbligatoria prima dell’inizio del trattamento dello studio.
    3. Donna non in età potenzialmente fertile (WOBCP), o utilizzo di un metodo contraccettivo altamente efficace. Uomo: contraccezione o nessun rapporto sessuale con una WOBCP1.
    E.4Principal exclusion criteria
    1. Spinal cord compression or brain metastasis unless asymptomatic, stable or not requiring steroids
    for at least 2 weeks prior to start of study intervention. Prior radiotherapy or surgery for brain
    metastases such as stereotactic radiosurgery/gammaknife must have been completed = 2 weeks, all
    others = 4 weeks prior to start of therapy.Participants with leptomeningeal disease are ineligible.
    2. Any unresolved toxicity Grade 2 or more according to NCI-CTCAE version 5, from previous
    anticancer therapy with the exception of alopecia.
    3. Need for transfusion within 14 days prior to the first dose of study intervention.
    4. Participants who have brain metastasis as the only measurable lesion
    5. Inadequate hematological function:
    ¿ Hemoglobin < 8.5 g/dL
    ¿ Neutrophils < 1.5 × 109/L
    ¿ Platelets < 100 × 109/L.
    6. Inadequate liver function:
    ¿ Total bilirubin > 1.5 × ULN
    ¿ AST/ALT/ALP > 3 × ULN
    ¿ For participants with liver metastases:
    i. Total bilirubin > 1.5 × ULN
    ii. AST/ALT/ALP > 5 × ULN
    iii. For participants with bone metastases: ALP > 5 × ULN.
    7. Inadequate renal function:
    ¿ Renal impairment as evidenced by serum creatinine ¿ 1.5 × ULN, or
    creatinine clearance (CrCl) < 30 mL/min calculated by the Cockcroft-
    Gault formula (24-hour CrCl might be requested by the Investigator for
    confirmation, if calculated CrCl is < 50 mL/min. In such case,
    participants with 24-hour CrCl < 30 mL/min should be excluded).
    CrCl (mL/min) = [(140 – age(year)) × weight(kg)] 72 × serum
    creatinine (mg/dL) {× 0.85 for females}
    8. History of ILD or interstitial pneumonitis including radiation
    pneumonitis that required steroid treatment.
    9. Impaired cardiac function:
    ¿ Left ventricular ejection fraction < 45% defined by echocardiography
    ¿ Grade 4 arrhythmia (NCI-CTCAE v5.0)
    ¿ Unstable angina pectoris
    ¿ Congestive Heart Failure New York Heart Association III and IV
    ¿ Myocardial infarction, stroke, or transient ischemic attack within the last 6 months prior to study entry.
    10. Corrected QT interval by Fredericia (QTcF) > 470 ms for women and > 450 ms for men at screening. Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such
    as hypokalemia, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years of age in first degree relatives, or any concomitant medication
    known to prolong the QT interval and cause Torsade de Pointes.
    11. Hypertension uncontrolled by standard therapies (not stabilized to < 150/90 mmHg).
    12. Contraindication to the administration of osimertinib.
    13. Medical history of liver fibrosis/cirrhosis.
    14. Past or current history of neoplasm other than NSCLC, except for curatively treated non-melanoma skin cancer, in situ carcinoma of the cervix, benign prostate neoplasm/hypertropia, or
    other cancer curatively treated and with no evidence of disease for at least 5 years.
    15. Medical history of difficulty swallowing, malabsorption, or other chronic gastrointestinal disease, or conditions that may hamper compliance and/or absorption of the tested product.
    16. Major surgery within 28 days prior to Day 1 of study intervention.
    17. Known human immunodeficiency virus positivity.
    18. Known hypersensitivity to any of the study intervention ingredients.
    For further details please refer to the protocol
    1. Compressione del midollo spinale o metastasi cerebrali a meno che non siano asintomatici, stabili o non richiedenti steroidi per almeno 2 settimane prima dell’inizio del trattamento dello studio. Qualsiasi precedente radioterapia o intervento chirurgico per metastasi cerebrali, quali radiochirurgia stereotassica/Gammaknife, deve essere completata/o =2 settimane, tutte le altre procedure =4 settimane prima dell’inizio della terapia. I partecipanti con malattia leptomeningea non sono idonei.
    2. Qualsiasi tossicità non risolta, derivante dalla precedente terapia antitumorale, di Grado 2 o superiore secondo i Criteri terminologici comuni per gli eventi avversi [CTCAE] dell’Istituto nazionale dei tumori [NCI], versione 5, ad eccezione dell’alopecia.
    3. Necessità di trasfusione nei 14 giorni precedenti la prima dose di trattamento dello studio.
    4. Partecipanti che presentano metastasi cerebrali come unica lesione misurabile.
    5. Funzionalità ematologica inadeguata:
    • Emoglobina <8,5 g/dl
    • Neutrofili <1,5 × 109/l
    • Piastrine <100 × 109/l
    6. Funzionalità epatica inadeguata:
    • Bilirubina totale >1,5 x ULN
    • AST/ALT/ALP >3 × ULN
    • Per partecipanti con metastasi epatiche:
    i. Bilirubina totale >1,5 x ULN
    ii. AST/ALT/ALP >5 × ULN
    iii. Per partecipanti con metastasi ossee: ALP >5 × ULN.
    7. Funzionalità renale inadeguata:
    • Insufficienza renale come evidenziato da creatinina sierica ¿1,5 × ULN, o clearance della creatinina (CrCl) <30 ml/min calcolata mediante la formula di Cockcroft-Gault (se la CrCl calcolata è <50 ml/min, lo sperimentatore potrebbe richiedere la CrCl delle 24 ore per conferma. In tal caso, i partecipanti con CrCl 24 ore <30 ml/min dovranno essere esclusi). CrCl (ml/min) = [(140 - età (anno)) × peso (kg)] 72 × creatinina sierica (mg/dl) {× 0,85 per le femmine}.
    8. Anamnesi di malattia polmonare interstiziale (ILD), compresa la polmonite da radiazioni che ha richiesto un trattamento steroideo.
    9. Funzionalità cardiaca compromessa:
    • Frazione di eiezione ventricolare sinistra <45%, definita mediante ecocardiografia.
    • Aritmia di grado 4 (NCI-CTCAE v5.0).
    • Angina pectoris instabile.
    • Scompenso cardiaco congestizio di classe III e IV in base alla classificazione della New York Heart Association.
    • Infarto del miocardio, ictus o attacco ischemico transitorio negli ultimi 6 mesi prima dell’ingresso nello studio.
    10. Intervallo QT corretto (QTc) mediante la formula di Fredericia (QTCf) >470 ms per le donne e >450 ms per gli uomini allo screening.
    Qualsiasi fattore che aumenti il rischio di prolungamento del QTc o il rischio di eventi aritmici come ipocaliemia, sindrome congenita del QT lungo, anamnesi familiare di sindrome del QT lungo o decesso improvviso inspiegabile sotto i 40 anni in parenti di primo grado, o qualsiasi farmaco concomitante che è noto causi il prolungamento dell’intervallo QT e torsioni di punta.
    11. Ipertensione non controllata da terapie standard (non stabilizzata a <150/90 mmHg).
    12. Controindicazione alla somministrazione di osimertinib.
    13. Anamnesi medica di fibrosi epatica/cirrosi.
    14. Anamnesi pregressa o attuale di neoplasia diversa da NSCLC, fatta eccezione per il tumore cutaneo non melanoma trattato a scopo curativo, carcinoma in situ della cervice, neoplasia/ipertropia benigna della prostata o altro tumore trattato a scopo curativo e senza evidenza di malattia da almeno 5 anni.
    15. Anamnesi di difficoltà a deglutire, malassorbimento o altre malattie gastrointestinali croniche o condizioni che possono intralciare la conformità e/o l’assorbimento del prodotto testato.
    16. Intervento chirurgico maggiore nei 28 giorni precedenti il Giorno 1 del trattamento dello studio.
    17. Positività nota al virus dell’immunodeficienza umana.
    18. Ipersensibilità nota a uno qualsiasi dei componenti del trattamento dello studio.
    Per ulteriori dettagli si faccia riferimento al protocollo
    E.5 End points
    E.5.1Primary end point(s)
    Objective response (confirmed complete response [CR] or partial response [PR]) determined according to Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 as per Independent Review Committee (IRC).
    Risposta obiettiva (risposta completa [CR] o risposta parziale [PR]) confermata, determinata dal Comitato di revisione indipendente (IRC) secondo i Criteri di valutazione della risposta nei tumori solidi (RECIST) Versione 1.1.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Cycles of 21 days until disease progression (according to RECIST Version 1.1), death, adverse event leading to discontinuation, study withdrawal or consent withdrawal.
    Cicli di 21 giorni fino a progressione della malattia (secondo i criteri RECIST Versione 1.1), decesso, evento avverso che porta all’interruzione del trattamento dello studio, al ritiro dallo studio o al ritiro del consenso.
    E.5.2Secondary end point(s)
    Objective response (CR or PR) determined according to RECIST Version 1.1 as per IRC.
    Occurrence of Adverse Events (AEs) and treatment related AEs.
    Occurrence of abnormalities (Grade = 3) in laboratory test values (hematology and coagulation, biochemistry) and urinalysis. Occurrence of markedly abnormal vital sign measurements, change in body weight, and Eastern Cooperative Oncology Group (ECOG) performance status.
    Occurrence of clinically significantly abnormal electrocardiograms (ECGs).
    Objective response according to RECIST Version 1.1 assessed by Investigator.
    Confirmed CR assessed by IRC and by Investigator.
    Duration of response assessed from CR or PR until progressive disease (PD), death, or last tumor assessment assessed by IRC and by Investigator.
    Disease control (confirmed CR + PR or stable disease [SD] lasting at least 12 weeks) as assessed by IRC and by Investigator.
    Progression free survival according to RECIST Version 1.1 by IRC and by Investigator.
    Overall survival Patient reported outcomes/health related quality of life as reported using the following:
    EuroQol Five Dimension Five Level Scale
    European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 Non–small Cell Lung Cancer Symptom Assessment Questionnaire Single and multiple dose PK profile of osimertinib, tepotinib, and their metabolites including but not limited to AUC0-t, Cmax, and tmax after first dose (Day 1) and after multiple study intervention dose administrations (Day 15) (safety run-in).
    Population PK profile of osimertinib, tepotinib, and their metabolites, including, but not limited to, CL/f and VZ/f based on sparse PK sampling on Day 1, Cycle 1 and 2. (all study participants). Mutation status in EGFR and other pathways assessed in circulating tumor deoxyribonucleic acid (ctDNA) at Baseline and progression.; Risposta obiettiva (CR o PR) determinata dall’IRC secondo i criteri RECIST Versione 1.1.
    Insorgenza di eventi avversi (EA) e di EA correlati al trattamento.
    Insorgenza di anomalie (di grado =3) nei valori degli esami di laboratorio (ematologia e coagulazione, biochimica) e nelle analisi delle urine.
    Episodi di misurazioni significativamente anomale nei segni vitali, variazioni nel peso corporeo e nello stato di validità secondo il Gruppo cooperativo orientale di oncologia (ECOG).
    Episodi di anomalie clinicamente significative negli elettrocardiogrammi (ECG).
    Risposta obiettiva valutata dallo sperimentatore secondo i criteri RECIST Versione 1.1.
    CR confermata, come da valutazione dell’IRC e dello sperimentatore.
    Durata della risposta valutata a partire dalla CR o PR fino a progressione della malattia (PD), decesso o ultima valutazione del tumore da parte dell’IRC e dello sperimentatore.
    Controllo della malattia (CR + PR confermata o malattia stabile [SD] che dura da almeno 12 settimane) come valutato dall’IRC e dallo sperimentatore.
    Sopravvivenza libera da progressione valutata secondo i criteri RECIST Versione 1.1 dall’IRC e dallo sperimentatore.
    Esiti riferiti dal paziente sulla sopravvivenza complessiva/qualità della vita correlata alla salute segnalati usando quanto segue:
    Questionario per misurare la qualità della vita a 30 voci, 5 dimensioni e 5 livelli della European Organization for Research and Treatment of Cancer [Organizzazione europea per la ricerca e il trattamento dei tumori].
    Questionario sulla valutazione dei sintomi del carcinoma polmonare non a piccole cellule.
    Profilo PK a dosi singole e multiple di osimertinib, tepotinib e rispettivi metaboliti, inclusi, a titolo esemplificativo ma non esaustivo, area sotto la curva (AUC0-t), concentrazione massima (Cmax) e tempo al raggiungimento della Cmax (tmax) dopo la prima dose (Giorno 1) e dopo la somministrazione di più dosi di trattamento dello studio (Giorno 15) (run-in di sicurezza).
    Profilo PK di popolazione di osimertinib, tepotinib e dei rispettivi metaboliti, inclusi, a titolo esemplificativo ma non esaustivo, clearance apparente (CL/f) e volume apparente di distribuzione (VZ/f) in base a un campionamento PK sparso il Giorno 1 dei Cicli 1 e 2 (tutti i partecipanti allo studio).
    Stato mutazionale in EGFR e altri pathway valutato nell’acido desossiribonucleico tumorale circolante (ctDNA) al basale e alla progressione.
    E.5.2.1Timepoint(s) of evaluation of this end point
    continuous
    continuo
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic 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
    In aperto
    Open
    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 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 concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA50
    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
    China
    Hong Kong
    Japan
    Korea, Republic of
    Malaysia
    Philippines
    Russian Federation
    Singapore
    Taiwan
    Thailand
    Turkey
    United States
    Vietnam
    Belgium
    France
    Germany
    Italy
    Netherlands
    Spain
    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
    The end of the study is defined as the date of study intervention discontinuation by all participants (due to either disease progression, undue toxicity, or withdrawal, and, therefore, are not likely to benefit from the study intervention any longer) and two thirds of the participants have died or were followed up for at least 3 years, whatever occurs first. After the end of the study a final analysis, including an analysis of efficacy and safety, will be conducted in all participants.
    La fine dello studio è definita come la data di interruz del trattam da parte di tutti i partecip (dovuta a progressione della malattia, tossicità ingiustificata o ritiro, e pertanto non è probabile che si trarrà beneficio dal trattam), con due terzi dei partecipanti deceduti o che sono stati seguiti per almeno 3 anni, a seconda di quale evento si verifichi per primo. Dopo la fine dello studio sarà condotta un’analisi finale, compresa un’analisi di efficacia e sicurezza, su tutti i partecipanti
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days14
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months5
    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: 70
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 50
    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 Yes
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others Yes
    F.3.3.7.1Details of other specific vulnerable populations
    the elderly, people in emergency situation
    anziani, persone in situazione di emergenza
    F.4 Planned number of subjects to be included
    F.4.1In the member state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 47
    F.4.2.2In the whole clinical trial 120
    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)
    anti-cancer treatments to discuss with the doctor
    trattamenti antitumorali da discutere con il medico
    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 Decision2021-01-12
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-10-21
    P. End of Trial
    P.End of Trial StatusTrial now transitioned
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