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    Summary
    EudraCT Number:2019-001998-90
    Sponsor's Protocol Code Number:ALK4230-A101
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-11-06
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2019-001998-90
    A.3Full title of the trial
    A Phase 1/2 Study of ALKS 4230 Administered Intravenously as Monotherapy and in Combination with Pembrolizumab in Subjects with Advanced Solid Tumors- ARTISTRY-1
    Ensayo de fase 1/2 de ALKS 4230 administrado por vía intravenosa como monoterapia y en combinación con pembrolizumab en sujetos con tumores sólidos avanzados – ARTISTRY-1
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 1/2 Study of ALKS 4230 Administered Intravenously as Monotherapy and in Combination with Pembrolizumab in Subjects with Advanced Solid Tumors- ARTISTRY-1
    Ensayo de fase 1/2 de ALKS 4230 administrado por vía intravenosa como monoterapia y en combinación con pembrolizumab en sujetos con tumores sólidos avanzados – ARTISTRY-1
    A.3.2Name or abbreviated title of the trial where available
    ARTISTRY-1
    A.4.1Sponsor's protocol code numberALK4230-A101
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT02799095
    A.5.4Other Identifiers
    Name:INDNumber:128,159
    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 SponsorAlkermes, 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 supportAlkermes, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationSyneos Health
    B.5.2Functional name of contact pointMelanie Owen
    B.5.3 Address:
    B.5.3.1Street Address4277 Cider Mill Dr.
    B.5.3.2Town/ cityCincinnati
    B.5.3.3Post codeOhio 45245
    B.5.3.4CountryUnited States
    B.5.4Telephone number1513763 1937
    B.5.6E-mailmelanie.owen@syneoshealth.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.3.2Product code ALKS 4230
    D.3.4Pharmaceutical form Lyophilisate 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 INNALKS 4230
    D.3.9.2Current sponsor codeALKS 4230
    D.3.9.3Other descriptive nameALKS 4230
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Keytruda
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namepembrolizumab
    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 INNPEMBROLIZUMAB
    D.3.9.3Other descriptive nameKeytruda
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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
    Advanced Solid Tumors
    Tumores sólidos avanzados
    E.1.1.1Medical condition in easily understood language
    Advanced Solid Tumors
    Tumores sólidos avanzados
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10065147
    E.1.2Term Malignant solid tumor
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027150
    E.1.2Term Melanoma malignant
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10067946
    E.1.2Term Renal cell carcinoma
    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 investigate the safety and tolerability of ALKS 4230 and to determine the maximum tolerated dose and the recommended Phase 2 dose (RP2D) of ALKS 4230 in subjects with advanced solid tumors who are refractory or intolerant to therapies known to provide clinical benefit (Part A)
    - To further characterize the safety profile of ALKS 4230 at the RP2D in subjects with melanoma or renal cell carcinoma (RCC) who have received prior therapies known to provide clinical benefit (Part B)
    - To characterize the safety profile and antitumor activity of ALKS 4230 administered intravenously (IV) in combination with pembrolizumab in subjects with advanced solid tumors (Part C)
    - To describe the dose-limiting toxicity (DLT) of ALKS 4230 (Part A)
    - To describe the adverse event (AE) profile of ALKS 4230 (Part A and Part B)
    - investigar la seguridad y la tolerabilidad de ALKS 4230 y determinar la dosis maxima tolerable (DMT) y la dosis de fase 2 recomendada (DF2R) de ALKS 4230 en sujetos con tumores sólidos avanzados que son refractarios o intolerantes a las terapias que aportan un beneficio clínico demostrado (parte A);
    - caracterizar más el perfil de seguridad de ALKS 4230 en la DF2R en sujetos con melanoma o carcinoma de células renales (CCR) que han recibido terapias previas especificadas que aportan un beneficio clínico demostrado (parte B);
    - caracterizar el perfil de seguridad y la actividad antineoplásica de ALKS 4230 administrado por vía intravenosa (i.v.) en combinación con pembrolizumab en sujetos con tumores sólidos
    avanzados (parte C);
    - describir la toxicidad limitante de la dosis (TLD) de ALKS 4230 (parte A);
    - describir el perfil de acontecimientos adversos (AA) de ALKS 4230 (parte A y parte B).
    E.2.2Secondary objectives of the trial
    - To characterize the clinical pharmacokinetic (PK) profile and immunogenicity of ALKS 4230 alone (Part A and Part B) and in combination with pembrolizumab (Part C)
    - To investigate the clinical pharmacodynamic effects of ALKS 4230 alone (Part A and Part B) and in combination with pembrolizumab (Part C)
    - To describe any antitumor activity and responses observed with ALKS 4230 (Part A)
    - To evaluate the overall response rate (ORR), duration of response (DOR), and time to response for subjects treated with ALKS 4230 in each of the expansion cohorts (Part B) and in combination with pembrolizumab (Part C)
    - caracterizar el perfil de farmacocinética (FC) clínica y la inmunogenia de ALKS 4230 cuando se administra solo (parte A y parte B) y en combinación con pembrolizumab (parte C);
    - investigar los efectos farmacodinámicos clínicos de ALKS 4230 cuando se administra solo (parte A y parte B) y en combinación con pembrolizumab (parte C);
    - describir la actividad antineoplásica y las respuestas observadas con ALKS 4230 (parte A);
    - evaluar la tasa de respuesta global (TRG), la duración de la respuesta (DR) y el tiempo de respuesta en los sujetos tratados con ALKS 4230 en cada una de las cohortes de aumento (parte B) y en combinación con pembrolizumab (parte C).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. The subject or the subject’s legal representative is willing and able to provide written informed consent.
    2. The subject is aged ≥18 years.
    3. For the dose-escalation portion of the study, the subject has a diagnosis of an advanced solid tumor; for the dose-expansion portion of the study (Part B), the subject has a diagnosis of melanoma or RCC.
    4. All subjects must have an advanced solid tumor (including lymphomas) that is refractory or, in the judgment of their physician, intolerant to established therapies known to provide clinical benefit for the malignancy in question. Treatment with prior immunotherapy is permitted, with the exception of subjects enrolling in the PD-1/L1 approved tumor types (PD-1/L1 treatment naive) cohort in Part C who are not permitted to have received prior treatment with an anti-PD-1/L1 therapy or prior IL-2 or IL-15 cytokine therapy.
    5. Subjects enrolled in the dose-expansion monotherapy part (Part B) or combination therapy part (Part C) of the study must have at least 1 lesion that qualifies as a target lesion based on RECIST.
    6. Subjects enrolled in the dose-expansion monotherapy part (Part B) or combination therapy part (Part C) of the study must specifically indicate on the informed consent that he or she agrees to provide archival tumor tissue biopsy sample(s). The archival tumor tissue sample does not have to be obtained prior to enrollment into the study, however every effort should be made to obtained before the subject completes study participation.
    7. Subjects enrolled in the combination therapy part (Part C) of the study must have completed the last dose of any broad spectrum antibiotic at least 30 days prior to first dose (Cycle 1, Day 1).
    8. Subject is ambulatory with an Eastern Cooperative Oncology Group (ECOG)
    performance status of 0 or 1 and an estimated life expectancy of at least 3 months.
    9. Subjects must have adequate hematologic reserve as evidenced by:
    • Absolute neutrophil count (ANC) of ≥1000/μL,
    • Absolute lymphocyte count of ≥500/μL,
    • Platelet count of ≥75,000/μL, and
    • Hemoglobin of ≥9 g/dL (subjects may be transfused to this level if necessary).
    10. Subjects must have adequate hepatic function as evidenced by aspartate transaminase and alanine transaminase values ≤3 × the upper limit of normal (ULN) (≤5 × the ULN if the liver is known to be involved by metastatic disease) and serum total bilirubin values of ≤1.5 × ULN (≤2 × ULN for subjects with known Gilbert’s syndrome) for the reference laboratory.
    11. Subjects must have adequate renal function as evidenced by a serum creatinine ≤1.5 × the ULN for the reference laboratory or a calculated creatinine clearance of ≥60 mL/min by the Cockroft-Gault equation.
    12. Subjects must be recovered from the effects of any previous chemotherapy,
    immunotherapy, other prior systemic anticancer therapy, radiotherapy, or surgery (ie, toxicity no worse than Grade 1 [Grade 2 alopecia and treatment-associated peripheral neuropathy are acceptable]).
    13. Subjects who have received standard or investigational agents must wait at least 5 half-lives or 4 weeks (whichever is shorter) following prior therapy before enrollment into the study, or 4 weeks if the half-life of the investigational agent is not known.
    14. Women of childbearing potential (WOCBP) must have a negative pregnancy test (serum or urine) within 7 days of the start of treatment, and on Day 1 before the first dose is administered. A woman is considered as a WOCBP (fertile) following menarche and until becoming postmenopausal unless permanently sterile. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause.
    15. Meets contraceptive requirements defined in protocol Section 8.4.2. Women of childbearing potential and men (if their sexual partners are WOCBP) must use at least 1 highly effective form of birth control throughout the study. Highly effective methods of birth control include true sexual abstinence (defined as refraining from heterosexual intercourse during the entire period of risk, in line with the preferred and usual lifestyle of the patient), surgery (bilateral tubal ligation or occlusion, vasectomized partner), progestogen-only or estrogen/progestogen hormonal contraceptive associated with inhibition of ovulation (oral, patch, injectable, implantable, or intravaginal), intrauterine device, or intrauterine hormone-releasing system. See Section 8.4.2 for a definition of WOCBP and a complete description of contraceptive requirements.

    In addition to the criteria listed above, to participate in Part C of the study, subjects must meet additional Part C tumor type specific inclusion criteria to enroll into the applicable cohorts.
    1. Los sujetos aptos deben ser mayores de 18 años
    2. Estar dispuestos y ser capaces de proporcionar su consentimiento informado (o su representante legal debe estar dispuesto y ser capaz de hacerlo).
    3. Para la parte A del estudio el sujeto debe contar con un diagnóstico de un tumor sólido avanzado. Para la parte B del estudio, el sujeto debe contar con un diagnóstico de un melanoma o CCR
    4. Todos los sujetos deben tener un tumor sólido avanzado (incluidos linfomas) que sea refractario o intolerante a las terapias establecidas que aportan beneficios clínicos demostrados para la neoplasia maligna en cuestión, o, a criterio de su médico, deben ser intolerantes a las terapias establecidas. Se permite el tratamiento con inmunoterapia previa, a excepción de los sujetos que se inscriban en la cohorte de tipos de tumor aprobados con PD-1/L1 (sin tratamiento previo con PD-1/L1) en la parte C a los que no se haya permitido recibir tratamiento previo con una terapia anti-PD-1/L1 ni una terapia previa con interleuquina-2 o citocina interleuquina-15..
    5. Los sujetos en la parte de aumento de dosis del estudio (parte B) y en la parte de politerapia del estudio (parte C) deben tener al menos 1 lesión que califique como lesión objetivo según las directrices RECIST.
    6. Para la inscripción en las partes B y C, los sujetos deben indicar en el formulario de consentimiento informado que aceptan que el centro obtenga una o más muestras de biopsia de tejido tumoral de archivo. No es necesario obtener la muestra de tejido tumoral de archivo antes de la inscripción en el estudio; no obstante, deben realizarse todos los esfuerzos posibles por obtenerla antes de que el sujeto finalice su participación en el estudio
    7. Los sujetos inscritos en la parte de politerapia (parte C) del estudio deben haber completado la última dosis de cualquier antibiótico de espectro amplio al menos 30 días antes de la primera dosis (ciclo 1, día 1).
    8. El sujeto debe ser ambulatorio con un valor de 0 o 1 en la escala de valoración del Grupo Oncológico Cooperativo del Este y una esperanza de vida estimada de al menos 3 meses.
    9. Los sujetos deben tener una reserva hematológica adecuada como lo demuestra:
    - Recuento absoluto de neutrófilos (ANC) de ≥1000 / μL,
    - Recuento absoluto de linfocitos de ≥500 / μL,
    - Recuento de plaquetas de ≥75,000 / μL, y
    - Hemoglobina de ≥9 g / dL (se pueden hacer transfusiones a los pacientes a este nivel si es necesario).
    10. Los sujetos deben tener una función hepática adecuada como lo demuestran los valores de aspartato transaminasa y alanina transaminasa ≤3 × el límite superior de la normalidad (ULN) (≤5 × el ULN si se sabe que el hígado está afectado por una enfermedad metastásica) y la bilirrubina total en suero valores de ≤1.5 × ULN (≤2 × ULN para sujetos con síndrome de Gilbert conocido) para el laboratorio de referencia.
    11. Los sujetos deben tener una función renal adecuada como lo demuestra una creatinina sérica ≤1.5 × el ULN para el laboratorio de referencia o un aclaramiento de creatinina calculado de ≥60 ml / min por la ecuación de Cockroft-Gault.
    12. Todos los sujetos deben haberse recuperado de los efectos de cualquier quimioterapia, inmunoterapia, radioterapia, cirugía u otros tratamientos sistémicos anteriores contra el cáncer (es decir, deben presentar una toxicidad no inferior al grado 1 [se aceptan la alopecia de grado 2 y la neuropatía periférica asociada con el tratamiento]).
    13. Los sujetos deben esperar al menos 5 semividas o 4 semanas (el periodo que sea más corto) después de una terapia anterior para inscribirse en el estudio.
    14. Las mujeres en edad fértil deben obtener un resultado negativo en una prueba de embarazo en orina o suero dentro de los 7 días anteriores al inicio del tratamiento, y el día 1 antes de la administración de la primera dosis.
    15. Los sujetos deben estar dispuestos y en condiciones de cumplir con los requisitos anticonceptivos enumerados en la sección 8.4.2 Las mujeres en edad fértil y los hombres (si sus parejas sexuales son WOCBP) deben usar al menos 1 método anticonceptivo altamente efectivo durante todo el estudio. Métodos anticonceptivos altamente efectivos incluyen la verdadera abstinencia sexual y cirugía (ligadura u oclusión tubárica bilateral, pareja vasectomizada), progestágeno - solo anticonceptivos hormonales con estrógenos / progestágenos asociados con la inhibición de la ovulación (oral, parche, inyectable, implantable o intravaginal), dispositivo intrauterino o sistema de liberación hormonal intrauterino. Consulte la Sección 8.4.2 para obtener una definición de WOCBP y una descripción completa de los requisitos anticonceptivos.

    Además de los criterios enumerados anteriormente, para participar en la Parte C del estudio, los sujetos deben cumplir con los criterios adicionales de inclusión específicos del tipo de tumor de la Parte C para inscribirse en las cohortes aplicables.
    E.4Principal exclusion criteria
    1. Subject is currently pregnant or breastfeeding or is planning to become pregnant during the study period
    2. Subjects with an active infection or with a fever ≥38.5°C (≥101.3°F) within 3 days of the first scheduled day of dosing
    3. Subjects with active or symptomatic central nervous system metastases unless the metastases have been treated by surgery and/or radiation therapy, the subject has been tapered to a dose of 10 mg or less of corticosteroids for at least 2 weeks before the first dose, and the subject is neurologically stable
    4. Subjects with known hypersensitivity to any components of ALKS 4230
    5. Subjects who require pharmacologic doses of corticosteroids (greater than 10 mg of prednisone daily, or equivalent); however, replacement doses, topical, ophthalmologic, and inhalational steroids are permitted. Use of glucocorticoids for the purpose of treating immune-mediated AEs is permitted (see Section 9.8) but may result in discontinuation from study based on consultation between the Investigator and the Medical Monitor. A brief course of corticosteroids for prophylaxis (eg, contrast dye allergy) or for treatment of non-autoimmune conditions (eg, delayed-type hypersensitivity reaction caused by a contact allergen) is permitted.
    6. Subjects with mean QT interval corrected by the Fridericia Correction Formula values of >470 msec (in females) or >450 msec (in males) following 3 standard 12-lead electrocardiograms (ECGs) conducted approximately 5 minutes apart; subjects who are known to have congenital prolonged QT syndromes; or subjects who are on medications known to cause prolonged QT interval on ECG.
    7. Subjects who developed autoimmune disorders while on prior immunotherapy, including pneumonitis, nephritis, and neuropathy. (Subjects who have immune-mediated endocrinopathies and are stable on hormone replacement therapy are not excluded.) Subjects who developed other autoimmune disorders of Grade ≤3 may enroll if the disorder has resolved and the subject is off steroids for 2 weeks. Subjects who experienced autoimmune colitis as a toxicity of prior immunotherapy must undergo screening colonoscopy to rule out ongoing inflammation.
    8. Subjects with any other concurrent uncontrolled illness, including mental illness or substance abuse, which may interfere with the ability of the subject to cooperate and participate in the study; other examples of such conditions would include unstable or poorly controlled hypertension; unstable angina; myocardial infarction, or cardiovascular accident within 6 months of study entry; New York Heart Association Grade 3 or 4 congestive heart failure; chronic obstructive pulmonary disease or diabetes mellitus that has required 2 or more hospitalizations in the last year; severe peripheral vascular disease; or recent serious trauma.
    9. Subjects known to be positive for human immunodeficiency virus, hepatitis B or hepatitis C, or active tuberculosis or has a known history of tuberculosis.
    10. Subjects who are employed by Alkermes, Syneos Health, the Investigator, the study center (included permanent or temporary contract workers and designees responsible for the conduct of the study), or other affiliate of this study or is immediate family of an employee of Alkermes, Syneos Health, the Investigator, the study center, or other biological or legally adopted.
    11. Subjects with known hypersensitivity to any components of pembrolizumab (Part C subjects only)
    12. Subjects who have had a second malignancy within the previous 3 years. This criterion does not apply to subjects with an adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, prostate cancer Gleason score <6 with undetectable prostate-specific antigen over the previous 12 months, ductal breast carcinoma in situ with full surgical resection, or treated medullary or papillary thyroid cancer.
    1. los sujetos de sexo femenino que estén actualmente embarazadas o en lactancia, o que tengan planeado quedar embarazadas durante el periodo del estudio;
    2. los sujetos que tengan una infección activa o fiebre ≥38,5 °C dentro de los 3 días anteriores al primer día programado para la administración de la dosis;
    3. los sujetos con metástasis del sistema nervioso central activa o sintomática a menos que dicha metástasis se haya tratado con cirugía o radioterapia, que se haya reducido la dosis del sujeto a 10 mg o menos de corticosteroides durante al menos 2 semanas antes de la primera dosis y que el sujeto sea neurológicamente estable;
    4. los sujetos con hipersensibilidad conocida a cualquier componente de ALKS 4230;
    5. los sujetos que requieran dosis farmacológicas de corticosteroides (más de 10 mg de prednisona a diario, o equivalente); no obstante, se permiten las dosis de sustitución, así como los corticosteroides tópicos, oftalmológicos e inhalados. Se permite el uso de glucocorticoides para el tratamiento de AA mediados por el sistema inmunitario (consulte la sección 9.8), pero dicho uso podrá determinar la interrupción del estudio según lo determine el investigador en consulta con el monitor médico. Se permite un breve curso de corticosteroides para profilaxis (p. ej., alergia al medio de contraste) o para el tratamiento de trastornos no autoinmunitarios (p. ej., reacción de hipersensibilidad retardada causada por un alérgeno de contacto).
    6. los sujetos con un intervalo QT medio corregido según los valores de la fórmula de corrección de Fridericia superior a 470 ms (en los sujetos de sexo femenino) o superior a 450 ms (en los sujetos de sexo masculino) después de 3 electrocardiografías de 12 derivaciones estándar realizados a un intervalo de aproximadamente 5 minutos. Los sujetos con síndrome de QT prologado congénito confirmado; los sujetos que reciben medicación que causa un intervalo QT prolongado, confirmado mediante una electrocardiografía de 12 derivaciones estándar;
    7. los sujetos que desarrollaron trastornos antoinmunes durante una inmunoterapia anterior, incluida neumonitis, nefritis y neuropatía. (No quedan excluidos los sujetos que tengan endocrinopatías inmunomediadas y que sean estables durante la hormonoterapia restitutiva). Los sujetos que hayan desarrollado otros trastornos autoinmunes de grado ≤3 podrán inscribirse si el trastorno se resolvió y el sujeto no recibe corticosteroides desde hace 2 semanas. Los sujetos que hayan experimentado colitis autoinmune como una toxicidad de una inmunoterapia anterior deben someterse a una colonoscopia de control para descartar una inflamación en curso.
    8. los sujetos con cualquier otra enfermedad no controlada concomitante, incluida enfermedad mental o abuso de sustancias, que pudiera interferir con su capacidad de colaborar y participar en el estudio; otros ejemplos de estos trastornos son hipertensión inestable o mal controlada, angina inestab, infarto del miocardio o accidente cardiovascular dentro de los 6 meses anteriores al ingreso en el estudio, insuficiencia cardiaca congestiva de grado 3 o 4 según la New York Heart Association, enfermedad pulmonar obstructiva crónica o diabetes mellitus que haya requerido dos o más hospitalizaciones durante el año pasado, enfermedad vascular periférica grave o traumatismo grave reciente.
    9. los sujetos que tengan un diagnóstico positivo confirmado de virus de inmunodeficiencia humana, hepatitis B o C o tuberculosis activa, o antecedentes de tuberculosis confirmados;
    10. los sujetos que sean empleados de Alkermes, Syneos Health, el investigador, el centro del estudio (incluidos los trabajadores permanentes o con contratos temporales y las personas designadas responsables de la realización del estudio) o cualquier otra filial de este estudio, así como los familiares inmediatos de un empleado de Alkermes, Syneos Health, el investigador, el centro del estudio o cualquier otra filial. (Familiares inmediatos se define como el cónyuge, el padre, la madre y los hijos o hermanos biológicos o legalmente adoptados).
    11. los sujetos con hipersensibilidad conocida a cualquier componente de pembrolizumab (solo para los sujetos de la parte C);
    12. los sujetos que hayan tenido una segunda neoplasia maligna dentro de los 3 años anteriores. Este criterio no se aplica a los sujetos con cáncer de piel de células basales o escamosas adecuadamente tratado, carcinoma in situ del cuello uterino, cáncer de próstata con una puntuación de Gleason <6 con antígeno específico de la próstata no detectable durante los 12 meses anteriores, carcinoma de mama ductal in situ con resección quirúrgica completa o cáncer de tiroides medular o papilar tratado.
    E.5 End points
    E.5.1Primary end point(s)
    - The incidence of DLTs from the first dose through the end of the DLT observation period (Part A)
    - The incidence and severity of treatment-emergent AEs according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 (CTCAE v4.03) (Part A)
    - ORR based on Response Evaluation Criteria in Solid Tumors (RECIST) guidelines version 1.1 (Part B and Part C)
    - la incidencia de las TLD desde la primera dosis hasta el final del periodo de observación
    de la TLD (parte A);
    - la incidencia y la gravedad de los AA emergentes del tratamiento de acuerdo con los criterios
    de terminología común para acontecimientos adversos (Common Terminology Criteria for
    Adverse Events, CTCAE) del National Cancer Institute (NCI), versión 4.03 (CTCAE v4.03)
    (parte A);
    - la TRG de acuerdo con las directrices de evaluación de respuesta en tumores sólidos
    (Response Evaluation Criteria in Solid Tumors, RECIST) versión 1.1 (Eisenhauer
    y col. 2009) (parte B y parte C).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Antitumor activity will be determined by the measurement of extent of known disease at baseline and approximately every 5 to 6 weeks, following each even-numbered treatment cycle.
    La actividad antitumoral se determinará midiendo la extensión de la enfermedad conocida al inicio del estudio y aproximadamente cada 5 a 6 semanas, después de cada ciclo de tratamiento de número par.
    E.5.2Secondary end point(s)
    - The incidence and severity of treatment-emergent AEs according to the National Cancer Institute CTCAE v4.03
    - Serum concentrations of ALKS-4230 and descriptive PK parameters using noncompartmental analysis
    - Serum concentrations of anti-ALKS-4230 antibodies
    - Immune (i-) ORR (iORR) based on Immune RECIST (iRECIST) guidelines
    - Disease control rate (DCR) based on RECIST guidelines and immune DCR (iDCR) based on iRECIST guidelines
    - DOR based on RECIST guidelines and immune DOR (iDOR) based on iRECIST guidelines
    - Progression-free Survival (PFS) for Part B and Part C Cohorts C5, C6, C7 only
    - Numbers of circulating CD8 T cells, regulatory T cells, and natural killer cells in peripheral blood
    - Serum levels of IL-6 and other cytokines
    - la incidencia y la gravedad de los AA emergentes del tratamiento de acuerdo con los criterios
    CTCAE v4.03 del NCI;
    - las concentraciones séricas de ALKS 4230 y los parámetros de FC descriptivos mediante
    análisis no compartimentales;
    - las concentraciones séricas de anticuerpos anti-ALKS 4230;
    - la TRG inmunitaria (i-) (TRGi) de acuerdo con las directrices RECIST de respuesta
    inmunitaria (RECISTi) (Seymour y col. 2017);
    - la tasa de control de la enfermedad (TCE) de acuerdo con las directrices RECIST y la TCE
    inmunitaria (TCEi) de acuerdo con las directrices RECISTi;
    - la DR de acuerdo con las directrices RECIST y la DR inmunitaria (DRi) de acuerdo con las
    directrices RECISTi;
    - la supervivencia sin progresión (SSP) para las cohortes de la parte B y la parte C C5, C6, C7
    únicamente;
    - los números de células T CD8 circulantes, linfocitos T reguladores y linfocitos citolíticos
    naturales en la sangre periférica;
    - las concentraciones séricas de IL-6 y otras citocinas.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Serum samples for evaluation of ALKS 4230 PK and patient immunogenicity will be obtained from each subject at predetermined time points.
    Se obtendrán muestras de suero para la evaluación de ALKS 4230 PK y la inmunogenicidad del paciente de cada sujeto en puntos de tiempo predeterminados.
    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 Yes
    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) Yes
    E.7.1.1First administration to humans Yes
    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 Yes
    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
    grupos secuenciales
    sequential groups
    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 EEA19
    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 No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Belgium
    Canada
    Hungary
    Korea, Republic of
    Poland
    Spain
    United States
    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
    LVLS
    LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months2
    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: 156
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 191
    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 state38
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 293
    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. Once a patient has completed study treatment, their treating physician can discuss standard of care or other alternative options available to them.
    Ninguna. Una vez que un paciente ha completado el tratamiento del estudio, su médico tratante puede analizar el estándar de atención u otras opciones alternativas disponibles para él.
    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 Decision2019-12-16
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-12-12
    P. End of Trial
    P.End of Trial StatusOngoing
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