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    Summary
    EudraCT Number:2019-002034-36
    Sponsor's Protocol Code Number:V937-011
    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:2019-11-11
    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 number2019-002034-36
    A.3Full title of the trial
    A Phase 2, Randomized Clinical Study of Intravenous or Intratumoral Administration of V937 in Combination with Pembrolizumab (MK-3475) Versus Pembrolizumab Alone in Participants with Advanced/Metastatic Melanoma.
    Estudio clínico de fase 2, aleatorizado de la administración intravenosa o intratumoral de V937 en combinación con pembrolizumab (MK-3475) frente a pembrolizumab en monoterapia en pacientes con melanoma avanzado o metastásico.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2, Randomized Clinical Study of Intravenous or Intratumoral Administration of V937 in Combination with Pembro
    Estudio clínico de fase 2, aleatorizado de V937 administrado por vía IV o IT con pembrolizumab frente a pembrolizumab en monoterapia.
    A.4.1Sponsor's protocol code numberV937-011
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co.,Inc
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co.,Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España SA
    B.5.2Functional name of contact pointInvestigación clínica
    B.5.3 Address:
    B.5.3.1Street AddressCalle Josefa valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491321 06 00
    B.5.5Fax number+3491321 05 90
    B.5.6E-mailensayos_clinicos@merck.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePEMBROLIZUMAB
    D.3.2Product code MK-3475
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA (pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP 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 nameCVA21
    D.3.2Product code V937
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCVA21
    D.3.9.2Current sponsor codeV937
    D.3.9.3Other descriptive nameCVA21
    D.3.9.4EV Substance CodeSUB130806
    D.3.10 Strength
    D.3.10.1Concentration unit TCID50/dose tissue culture infective dose 50/dose
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number49500000 to 495000000
    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 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 Yes
    D.3.11.13.1Other medicinal product typeOncolytic virus
    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/metastatic melanoma
    Melanoma avanzado o metastásico
    E.1.1.1Medical condition in easily understood language
    Patients with advanced/metastatic Skin cancer (melanoma) will particiate in this study
    Pacientes con cáncer de piel avanzado / metastásico (melanoma) participarán en este estudio.
    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 10053571
    E.1.2Term Melanoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To evaluate the objective response rate (ORR) of participants treated with intravenous (IV) V937 administered in combination with pembrolizumab (MK-3475), intratumoral (IT) V937 administered in combination with pembrolizumab, or pembrolizumab alone per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by blinded independent central review (BICR)
    1.Evaluar la tasa de respuestas objetivas (TRO) de participantes tratados con V937 intravenoso (IV) en combinación con pembrolizumab, con V937 Intratumoral (IT) en combinación con pembrolizumab o con pembrolizumab en monoterapia conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según una revisión central independiente y enmascarada (RCIE).
    E.2.2Secondary objectives of the trial
    1. To evaluate progression free survival (PFS), and duration of response (DOR) of participants treated with IV V937 in combination with pembrolizumab, IT V937 in combination with pembrolizumab, or pembrolizumab alone per RECIST 1.1 by BICR .
    2. To evaluate ORR, PFS, and DOR of participants treated with IV V937 in combination with pembrolizumab, IT V937 in combination with pembrolizumab, or pembrolizumab alone, per RECIST 1.1 and iRECIST, as assessed by the investigator.
    3. To evaluate overall survival (OS) of participants treated with IV V937 in combination with pembrolizumab, IT V937 in combination with pembrolizumab, or pembrolizumab alone
    4. To assess the safety and tolerability of participants treated with IV V937 in combination with pembrolizumab, IT V937 in combination with pembrolizumab, or pembrolizumab alone.
    1.Evaluar la supervivencia sin progresión (SSP) y la duración de la respuesta (DR) de participantes tratados con V937 IV en combinación con pembrolizumab, con V937 IT en combinación con pembrolizumab o con pembrolizumab en monoterapia conforme a los criterios RECIST 1.1, según una RCIE.
    2.Evaluar la TRO, SSP y DR de participantes tratados con V937 IV en combinación con pembrolizumab, con V937 IT en combinación con pembrolizumab o con pembrolizumab en monoterapia, conforme a los criterios RECIST 1.1 e iRECIST, según la evaluación del investigador.
    3.Evaluar la Supervivencia Global (SG) de participantes tratados con V937 IV en combinación con pembrolizumab, con V937 IT en combinación con pembrolizumab o con pembrolizumab en monoterapia.
    4.Evaluar la seguridad y la tolerabilidad de participantes tratados con V937 IV en combinación con pembrolizumab, con V937 IT en combinación con pembrolizumab o con pembrolizumab en monoterapia
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Merck will conduct Future Biomedical Research on DNA (Blood) specimens collected during this clinical trial. Such research is for biomarker testing to address emergent questions not described elsewhere in the protocol (as part of the main trial) and will only be conducted on specimens from appropriately consented subjects. The objective of collecting specimens for Future Biomedical Research is to explore and identify biomarkers that inform the scientific understanding diseases and/or their therapeutic treatments. The overarching goal is to use such information to develop safer, more effective drugs, and/or to ensure that subjects receive the correct dose of the correct drug at the correct time.
    Merck realizará investigaciones biomédicas futuras con las muestras
    obtenidas (sangre) para tal finalidad durante este ensayo clínico. Estas investigaciones tendrán por objeto el análisis de biomarcadores con el fin de abordar aspectos nuevos que no se describen en otras partes del protocolo (como parte del ensayo principal) y solo se llevarán a cabo en muestras de los pacientes que hayan otorgado el consentimiento correspondiente. El objetivo de la obtención de muestras para investigaciones biomédicas futuras es estudiar e identificar biomarcadores que proporcionen información a los científicos sobre las enfermedades y sus tratamientos. El objetivo último es utilizar tal información para desarrollar fármacos más seguros y eficaces o para garantizar que los sujetos reciban la dosis correcta del fármaco en el momento preciso.
    E.3Principal inclusion criteria
    1. Has histologically or cytologically confirmed diagnosis of advanced/metastatic melanoma
    2. Has Stage III (unresectable) or Stage IV melanoma
    3. Participants must be naive to anti-PD-(L)1 treatment, TVEC and other oncolytic viruses
    4. Has 2 lesions as defined below:
    Lesion 1: Has at least 1 cutaneous or subcutaneous lesion amenable to IT injection and biopsy. The injectable lesion must be measurable and meet 1 of the following criteria (per RECIST 1.1 for solid tumors):
    - A cutaneous or subcutaneous lesion ≥ 1 cm in longest diameter for solid tumors, or ≥ 1.5 cm in short axis for a nodal lesion in participants with solid tumor. The longest diameter for an injectable lesion must be ≤ 10 cm for both solid tumors and nodal lesions in participants with solid tumor
    - Multiple coalescing, superficial lesions that in aggregate have a longest diameter of ≥ 1 cm and ≤ 10 cm
    Lesion 2: Have at least 1 measurable, distant and/or discrete noninjected lesion that is amenable to biopsy via visual inspection or amenable to biopsy via image guidance, such as ultrasound or computed tomography (CT)/magnetic resonance imaging (MRI). The lesion must be measurable and meet 1 of the above mentioned criteria per RECIST 1.1
    5. Has a a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale
    6. Demonstrates adequate organ function
    7. Is male or female, from ≥18 years of age, at the time of signing the informed consent
    8. Male participants are eligible to participate if they agree to the following during the intervention period and for at least 120 days:
    - Refrain from donating sperm
    PLUS either:
    - Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent
    OR
    - Must agree to use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause) as detailed below:
    Agree to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a WOCBP who is not currently pregnant
    9. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    - Is not a woman of childbearing potential (WOCBP)
    OR
    - Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis), during the intervention period and for at least 120 days after the last dose of study intervention. The investigator should evaluate the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention
    - A WOCBP must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 72 hours before the first dose of study intervention
    - If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive
    - The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy
    10. The participant (or legally acceptable representative if applicable) provides written informed consent for the study. The participant must consent to screening and on-treatment biopsies. The participant may also provide consent for future biomedical research (FBR). However, the participant may participate in the main study without participating in FBR
    11. Has measurable disease per RECIST 1.1 as assessed by the local site investigator/radiology. Lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions
    12. Is able to provide newly obtained core or excisional biopsy of a tumor lesion not previously irradiated. Formalin-fixed, paraffin embedded (FFPE) tissue blocks are preferred to slides
    13. HIV-infected participants must have well controlled HIV on antiretroviral therapy (ART)
    1. Diagnóstico de melanoma avanzado o metastásico confirmado histológica o citológicamente.
    2. Melanoma en estadio III (irresecable) o IV.
    3. Ausencia de tratamiento previo con anticuerpos anti-PD-(L)1, TVEC u otros virus oncolíticos.
    4. Presencia de dos lesiones tal como se define a continuación:
    Lesión 1: presencia de al menos una lesión cutánea o subcutánea susceptible de inyección IT y biopsia. La lesión inyectable debe ser mensurable y cumplir uno de los criterios siguientes (conforme a los criterios RECIST 1.1 para tumores sólidos):
    -Lesión cutánea o subcutánea ≥ 1 cm de diámetro mayor en el caso de tumores sólidos o ≥ 1,5 cm de eje menor en el caso de lesión ganglionar en participantes con tumores sólidos. El diámetro mayor de una lesión inyectable debe ser ≤ 10 cm en el caso de tumores sólidos y lesiones ganglionares en participantes con tumores sólidos.
    - Múltiples lesiones superficiales coalescentes que, en conjunto, tienen un diámetro mayor ≥ 1 y ≤ 10 cm.
    Lesión 2: Presencia de al menos una lesión no inyectada mensurable, a distancia y/o aislada, susceptible de biopsia mediante inspección visual o susceptible de biopsia con control por técnicas de imagen, como ecografía o tomografía computarizada (TC)/resonancia magnética (RM). La lesión debe ser mensurable y cumplir uno de los criterios mencionados anteriormente conforme a los criterios RECIST 1.1.
    5. Estado funcional según la escala del Eastern Cooperative Oncology Group (ECOG) de 0 o 1.
    6. Presencia de una función orgánica adecuada
    7. Participante de cualquier sexo con una edad mínima de 18 años en el momento de firmar el consentimiento informado.
    8. Podrán participar en el estudio los varones que se comprometan a todo lo siguiente durante el período de intervención y hasta, como mínimo, 120 días después:
    -Abstenerse de donar semen.
    MÁS:
    -Abstenerse de mantener relaciones heterosexuales como modo de vida habitual y preferido (abstinencia a largo plazo y constante) y compromiso de mantener la abstinencia.
    O
    -Comprometerse a utilizar métodos anticonceptivos a menos que se confirme la presencia de azoospermia (por vasectomía o secundaria a una causa médica) tal como se detalla a continuación:
    Comprometerse a utilizar preservativo masculino más uso por parte de la pareja de un método anticonceptivo adicional cuando mantengan relaciones sexuales con penetración vaginal con mujeres en edad fértil que no estén embarazadas.
    9. Una mujer podrá participar si no está embarazada ni en período de lactancia y se cumple al menos una de las condiciones siguientes:
    -No es una mujer en edad fértil (MEF).
    O
    -Es una MEF y utiliza un método anticonceptivo muy eficaz (con un índice de fallos < 1 % anual) o practica la abstinencia de relaciones heterosexuales como modo de vida preferido y habitual (abstinencia a largo plazo y persistente), durante el período de intervención y hasta, como mínimo, 120 días después de recibir la última dosis de la intervención del estudio. El investigador deberá evaluar la posibilidad de fracaso del método anticonceptivo (es decir, incumplimiento, inicio reciente) antes de la primera dosis de la intervención del estudio.
    -Las MEF deberán dar negativo en una prueba de embarazo de alta sensibilidad (en orina o suero, según exija la normativa local) en las 72 horas previas a la primera dosis de la intervención del estudio.
    -Cuando no pueda confirmarse que el resultado de una prueba en orina es negativo (por ejemplo, resultado ambiguo), será necesario hacer una prueba de embarazo en suero. En tal caso, la participante será excluida si el resultado de la prueba de embarazo en suero es positivo.
    -El investigador es responsable de revisar los antecedentes médicos, los antecedentes menstruales y la actividad sexual reciente para reducir el riesgo de incluir a una mujer con un embarazo de poco tiempo no detectado.
    10. El participante (o su representante legal cuando proceda) otorga su consentimiento informado por escrito para el estudio. El participante debe otorgar su consentimiento para las biopsias de selección y durante el tratamiento. El participante también podrá otorgar su consentimiento para las investigaciones biomédicas futuras. No obstante, podrá participar en el estudio principal sin necesidad de hacerlo en las investigaciones biomédicas futuras
    11. Presencia de enfermedad mensurable conforme a los criterios RECIST 1.1, según la evaluación del investigador o radiólogo del centro. Las lesiones ubicadas en una zona previamente irradiada se considerarán mensurables siempre que se haya constatado progresión en dichas lesiones.
    12. Capacidad de proporcionar una biopsia reciente, con aguja gruesa o por escisión, de una lesión tumoral no irradiada previamente. Se prefieren los bloques de tejido fijados en formol e incluidos en parafina (FFIP) a los cortes para microscopio.
    13. Los participantes infectados por el VIH deben estar bien controlados con el tratamiento antirretroviral (TAR).
    E.4Principal exclusion criteria
    1.Has had chemotherapy, definitive radiation, or biological cancer therapy or an investigational agent or investigational device within 4 weeks (2 weeks for palliative radiation) prior to the first dose of study intervention or has not recovered to Common Terminology Criteria for Adverse Events Grade 1 or better (except alopecia) from any AEs that were due to cancer therapeutics administered more than 4 weeks earlier. If participant received major surgery or radiation therapy of>30 Gy, they must have recovered from the toxicity and/or complications from the intervention. Participants receiving ongoing replacement hormone therapy for endocrine immune-related AEs will not be excluded from participation in this study
    2.Has ocular melanoma
    3.Has radiographic evidence of major blood vessel invasion/infiltration. The degree of tumor invasion/infiltration of major blood vessels should be considered because of the potential risk of severe hemorrhage associated with tumor shrinkage/necrosis
    4.Has clinically significant hemoptysis or tumor bleeding within 2 weeks prior to the first dose of study drug
    5.Has an active autoimmune disease that has required systemic treatment in the past 2 years except vitiligo or resolved childhood asthma/atopy. Replacement therapy, such as thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, is not considered a form of systemic treatment and is allowed
    6.HIV-infected participants with a history of Kaposi’s sarcoma and/or Multicentric Castleman’s Disease
    7.Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study
    8.Has undergone prior allogeneic hematopoietic stem cell transplantation within the last 5 years
    9. Has not fully recovered from any effects of major surgery without significant detectable infection. Surgeries that required general anesthesia must be completed at least 2 weeks before first study intervention administration. Surgery requiring regional/epidural anesthesia must be completed at least 72 hours before first study intervention administration and participants should be recovered
    10.Clinically significant cardiovascular disease:cerebral vascular accident/stroke (<6 months prior to enrollment), myocardial infarction (<6 months prior to enrollment), unstable angina, congestive heart failure, or serious cardiac arrhythmia requiring medication
    11.A woman of childbearing potential who has a positive urine pregnancy test within 72 hours prior to randomization or treatment allocation. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
    12.Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor
    13.Has received a live vaccine within 30 days prior to the first dose of study drug. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines are live attenuated vaccines and are not allowed
    14.Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study intervention
    15.Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy in excess of replacement doses or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug. Use of nonsystemic steroids is permitted
    16.Has a known additional malignancy that is progressing or has required active treatment within the past 2 years
    17.Has known active CNS metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable, for at least 4 weeks by repeat imaging, clinically stable and without requirement of steroid treatment for at least 14 days prior to first dose of study intervention
    18.Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients
    1. Recepción de quimioterapia, radioterapia definitiva o tratamiento biológico contra el cáncer o de un fármaco o dispositivo experimental en las 4 semanas (2 semanas en caso de radioterapia paliativa) previas a la primera dosis de la intervención del estudio o ausencia de recuperación a un grado 1 o mejor según los Criterios terminológicos comunes para acontecimientos adversos (excepto alopecia) de cualquier AA debido a tratamientos antineoplásicos administrados más de 4 semanas antes. Cuando el paciente se haya sometido a una intervención de cirugía mayor o haya recibido > 30 Gy de radioterapia, tendrá que haberse recuperado de la toxicidad y/o las complicaciones de la intervención. No se excluirá de este estudio a los posibles participantes que estén recibiendo tratamiento hormonal sustitutivo por AA relacionados con la inmunidad.
    2. Melanoma ocular.
    3. Signos radiológicos de invasión o infiltración de vasos sanguíneos importantes. El grado de invasión o infiltración tumoral de vasos sanguíneos importantes ha de tenerse en cuenta debido al posible riesgo de hemorragia grave asociada a una reducción del tamaño o necrosis del tumor.
    4. Hemoptisis o hemorragia tumoral clínicamente significativa en las dos semanas previas a la primera dosis del fármaco del estudio.
    5. Presencia de una enfermedad autoinmunitaria activa que ha precisado tratamiento sistémico en los dos últimos años, excepto vitíligo o atopia/asma infantil resuelta. El tratamiento de reposición, por ejemplo, tiroxina, insulina o corticoides en dosis fisiológicas por insuficiencia suprarrenal o hipofisaria, no se considera una forma de tratamiento sistémico y se permitirá su uso.
    6. Infección por el VIH con antecedentes de sarcoma de Kaposi y/o enfermedad de Castleman multicéntrica.
    7. Presencia de un trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante para colaborar en el cumplimiento de los requisitos del estudio.
    8. Recepción de un alotrasplante de células madre hematopoyéticas en los cinco años precedentes
    9. Ausencia de recuperación plena de los efectos de una intervención de cirugía mayor sin una infección detectable significativa. Las intervenciones quirúrgicas que precisen anestesia general deberán practicarse al menos dos semanas antes de la primera administración de la intervención del estudio. Las intervenciones quirúrgicas que precisen anestesia regional o epidural deberán practicarse al menos 72 horas antes de la primera administración de la intervención del estudio y los participantes deberán haberse recuperado.
    10. Enfermedad cardiovascular clínicamente importante: accidente cerebrovascular/ictus (< 6 meses antes de la inclusión), infarto de miocardio (< 6 meses antes de la inclusión), angina inestable, insuficiencia cardíaca o arritmia cardíaca grave con necesidad de medicación.
    11. Mujer en edad fértil que dé positivo en una prueba de embarazo en orina realizada en las 72 horas previas a la aleatorización o asignación del tratamiento. Si el resultado de la prueba en orina es positivo o si no puede confirmarse que sea negativo, será necesario hacer una prueba de embarazo en suero.
    12. Tratamiento previo con un fármaco anti-PD-1, anti-PD-L1 o anti-PD-L2 o con un fármaco dirigido contra otro receptor de los linfocitos T estimulador o coinhibidor
    13. Recepción de una vacuna de microorganismos vivos en los 30 días previos a la administración de la primera dosis del fármaco del estudio. Las vacunas inyectables contra la gripe estacional contienen, por lo general, virus muertos y están permitidas; en cambio, las vacunas antigripales intranasales son vacunas de virus vivos atenuados y no están permitidas.
    14. Participación activa o pasada en un estudio de un fármaco en investigación o uso de un dispositivo en investigación en las cuatro semanas previas a la administración de la primera dosis de la intervención del estudio.
    15. Diagnóstico de inmunodeficiencia o recepción de tratamiento sistémico crónico con esteroides que supere las dosis de reposición o cualquier otra forma de tratamiento inmunodepresor en los siete días previos a la primera dosis del fármaco del estudio. Se permite el uso de esteroides no sistémicos.
    16. Presencia de otra neoplasia maligna conocida que está en progresión o que ha necesitado tratamiento activo en los últimos dos años.
    17. Presencia de metástasis activas en el SNC y/o de meningitis carcinomatosa. Los participantes con metástasis cerebrales tratadas anteriormente podrán participar siempre que se encuentren radiológicamente estables, es decir, sin signos de progresión durante al menos cuatro semanas en estudios de imagen repetidos clínicamente estables y sin necesidad de tratamiento con esteroides durante al menos 14 días antes de la primera dosis de la intervención del estudio.
    18. Presencia de hipersensibilidad grave (grado ≥ 3) a pembrolizumab y/o a cualquiera de sus excipientes.
    E.5 End points
    E.5.1Primary end point(s)
    1. Objective Response Rate (ORR) per Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR)
    1.Tasa de respuesta objetiva (ORR) por criterios de evaluación de respuesta en tumores sólidos versión 1.1 (RECIST 1.1) evaluado por Blinded Independent Central Review (BICR)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to 3 years
    1.Hasta 3 años
    E.5.2Secondary end point(s)
    1. Progression-free Survival (PFS) per RECIST 1.1 as Assessed by BICR
    2. Duration of Response (DOR) per RECIST 1.1 as Assessed by BICR
    3. ORR per RECIST 1.1 as Assessed by the Investigator
    4. ORR per RECIST 1.1 for Immune-based Therapeutics (iRECIST) as Assessed by the Investigator
    5. PFS per RECIST 1.1 as Assessed by the Investigator
    6. PFS per iRECIST as Assessed by the Investigator
    7. DOR per RECIST 1.1 as Assessed by the Investigator
    8. DOR per iRECIST as Assessed by the Investigator
    9. Overall Survival (OS)
    10. Number of Participants with One or More Adverse Events (AEs)
    11.Number of Participants who Discontinue Study Drug Due to an AE
    1. Supervivencia libre de progresión (PFS) por RECIST 1.1 evaluado por BICR
    2. Duración de la respuesta (DOR) por RECIST 1.1 evaluado por BICR
    3. ORR según RECIST 1.1 evaluado por el Investigador
    4. ORR según RECIST 1.1 para Terapia Inmune (iRECIST) como
    Evaluado por el Investigador
    5. SLP según RECIST 1.1 evaluado por el Investigador
    6. PfS por iRECIST evaluado por el Investigador
    7. DOR según RECIST 1.1 evaluado por el Investigador
    8. DOR per iRECIST evaluado por el Investigador
    9. Supervivencia global (OS)
    10. Número de participantes con uno o más eventos adversos (AE)
    11.Número de participantes que interrumpen el estudio de drogas debido a un AE
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to 3 years
    2. Up to 3 years
    3. Up to 3 years
    4. Up to 3 years
    5. Up to 3 years
    6. Up to 3 years
    7. Up to 3 years
    8. Up to 3 years
    9. Up to 3 years
    10. Up to 30 days after last dose (up to 3 years)
    11. Up to 2 years
    1.hasta 3 años
    2.hasta 3 años
    3.hasta 3 años
    4.hasta 3 años
    5.hasta 3 años
    6.hasta 3 años
    7.hasta 3 años
    8.hasta 3 años
    9.hasta 3 años
    10.hasta 30 días después de la última dosis (hasta 3 años)
    11.hasta dos años
    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 Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) 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 Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA21
    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
    France
    Germany
    Israel
    Italy
    Korea, Republic of
    New Zealand
    Norway
    South Africa
    Spain
    United Kingdom
    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
    The overall study ends when the last participant completes the last study-related telephone-call or visit, withdraws from the study, or is lost to follow-up (ie, the participant is unable to be contacted by the investigator).
    El estudio general finaliza cuando el último participante completa la última llamada telefónica o visita relacionada con el estudio, se retira del estudio o se pierde en el seguimiento (es decir, el participante no puede ser contactado por el investigador).
    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 months6
    E.8.9.1In the Member State concerned days6
    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: 60
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 75
    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 state12
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 50
    F.4.2.2In the whole clinical trial 135
    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
    Ninguno
    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 Decision2019-12-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-11-11
    P. End of Trial
    P.End of Trial StatusOngoing
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