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    Summary
    EudraCT Number:2019-002034-36
    Sponsor's Protocol Code Number:V937-011
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-01-22
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2019-002034-36
    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
    Studio Clinico di fase 2, randomizzato, per valutare la combinazione di V937 somministrato per via endovenosa o intratumorale con Pembrolizumab Versus Pembrolizumab da solo nel trattamento di pazienti con Melanoma metastatico in stadio avanzato
    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
    Studio Clinico di fase 2, randomizzato, per valutare la combinazione di V937 somministrato per via endovenosa o intratumorale con Pembro
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    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. UNA SUSSIDIARIA DI 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 organisationMSD Italia Srl
    B.5.2Functional name of contact pointDivisione Ricerca Clinica
    B.5.3 Address:
    B.5.3.1Street AddressVia Vitorchiano, 151
    B.5.3.2Town/ cityRoma
    B.5.3.3Post code00189
    B.5.3.4CountryItaly
    B.5.4Telephone number00390636191371
    B.5.5Fax number00390636380371
    B.5.6E-mailgcto.italy@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 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) 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. - EU/1/15/1024/002
    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 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 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) 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.3.9.4EV 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 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 Yes
    D.3.11.13.1Other medicinal product typevirus oncolitico
    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 avanzato/metastatico
    E.1.1.1Medical condition in easily understood language
    Patients with advanced/metastatic Skin cancer (melanoma) will particiate in this study
    I pazienti con carcinoma della pelle avanzato/metastatico (melanoma) parteciperanno a questo studio
    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)
    Valutare il tasso di risposta obiettiva (ORR) dei partecipanti trattati con V937 somministrato per via endovenosa (IV) in associazione a pembrolizumab, con V937 somministrato per via intratumorale (IT) in associazione a pembrolizumab o con pembrolizumab in monoterapia in base ai criteri RECIST 1.1 (Response Evaluation Criteria in Solid Tumors, versione 1.1) mediante revisione centrale indipendente in cieco (BICR)
    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 RECIST 1.1 for immune-based therapeutics (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. Valutare la soprav libera da progressione (PFS) e la durata della risposta (DOR) dei partecipanti trattati con V937 somministrato per via IV in associaz a pembrolizumab, con V937 som per via IT in associaz a pembrolizumab o con pembrolizumab in monoterapia in base ai criteri RECIST 1.1 mediante revisione centrale indipendente in cieco (BICR)
    2. Valutare ORR, PFS e DOR dei partecip trattati con V937 som per via IV in associaz a pembrolizumab, con V937 som per via IT in associaz a pembrolizumab o con pembrolizumab in monoterapia in base ai criteri RECIST 1.1 e iRECIST, secondo la valutazione dello sperimentatore
    3. Valutare OS dei partecip trattati con V937 som per via IV in associaz a pembrolizumab, con V937 som per via IT in associazione a pembrolizumab o con pembrolizumab in monoterapia.
    4. Valut la sicurezza e la tollerabilità dei partecip trattati con V937 som per via IV in associaz a pembrolizumab, con V937 som per via IT in associaz a pembrolizumab o con pembrolizumab in monot
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: 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.

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: Merck condurrà una Ricerca Biomedica Futura su campioni di DNA (sangue) raccolti nel corso di questo studio clinico. Tale ricerca ha lo scopo di esaminare vari biomarcatori per rispondere a domande che stanno emergendo e che non sono descritte in altre parti del protocollo (nell’ambito dello studio principale), e verrà condotta solo su campioni di soggetti che abbiano rilasciato apposito consenso. L'obiettivo della raccolta dei campioni per la Ricerca Biomedica Futura è quello di esplorare e identificare biomarcatori che contribuiscano scientificamente alla comprensione delle malattie e/o della relative terapie. L'obiettivo ultimo è quello di utilizzare tali informazioni per sviluppare farmaci più sicuri e più efficaci, e/o per garantire che i soggetti ricevano la dose giusta del giusto farmaco al momento giusto.
    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.

    Refer to protocol for the rest of inclusion criteria.
    1. Ha una diagnosi confermata istologicamente o citologicamente di melanoma avanzato/metastatico.
    2. Ha un melanoma di stadio III (non resecabile) o IV.
    3. Deve essere naïve al trattamento anti-PD-(L)1, a TVEC e ad altri virus oncolitici.
    4. Presenta 2 lesioni con le seguenti caratteristiche:
    Lesione 1: ha almeno 1 lesione cutanea o sottocutanea idonea all’iniezione IT e alla biopsia. La lesione in cui è possibile eseguire l’iniezione deve essere misurabile e soddisfare 1 dei seguenti criteri (in base ai criteri RECIST 1.1 per i tumori solidi):
    - Una lesione cutanea o sottocutanea con diametro maggiore >=1 cm per i tumori solidi o asse corto >=1,5 cm per una lesione linfonodale nei soggetti con tumore solido. Il diametro maggiore per una lesione in cui è possibile eseguire l’iniezione deve essere <=10 cm sia per i tumori solidi sia per le lesioni linfonodali nei soggetti con tumore solido.
    - Molteplici lesioni superficiali coalescenti che complessivamente hanno un diametro maggiore >=1 cm e <=10 cm.
    Lesione 2: ha almeno 1 lesione misurabile, distante e/o separata non soggetta a iniezione che è idonea a biopsia tramite ispezione visiva o è idonea a biopsia guidata ad esempio da tomografia computerizzata (TC) o a ultrasuoni/risonanza magnetica (RM). La lesione deve essere misurabile e soddisfare 1 dei criteri menzionati in precedenza in base ai criteri RECIST 1.1.
    5. Ha un performance status pari a 0 o 1 secondo la scala ECOG (Eastern Cooperative Oncology Group).
    6. Presenta una funzionalità d’organo adeguata.
    7. È un soggetto di sesso maschile o femminile di età pari o superiore a 18 anni al momento della firma del consenso informato.
    8. I pazienti di sesso maschile sono idonei a partecipare se acconsentono a quanto segue durante il periodo di trattamento sperimentale e per almeno 120 giorni:
    - Astenersi dal donare sperma
    PIÙ:
    - Non avere rapporti eterosessuali come stile di vita preferito e abituale (astinenza a lungo termine e persistente) e accettare di astenersi da tali rapporti
    OPPURE
    - Acconsentire a utilizzare un metodo contraccettivo, a meno che non sia confermata l’azoospermia (in seguito a vasectomia o secondaria a cause mediche come specificato di seguito:
    - Acconsentire a utilizzare un preservativo maschile più utilizzo da parte della partner di un metodo contraccettivo aggiuntivo in caso di rapporti sessuali penetrativi vaginali con una donna in età fertile che non è al momento incinta. Nota: gli uomini con una partner incinta o che allatta al seno devono acconsentire ad astenersi dai rapporti sessuali penetrativi vaginali o a utilizzare un profilattico maschile durante ogni rapporto di questo tipo.
    9. Le pazienti di sesso femminile sono idonee alla partecipazione se non sono in gravidanza o in allattamento, e se almeno una delle condizioni indicate di seguito risulta applicabile:
    - Non essere una donna in età fertile (WOCBP)
    OPPURE
    - Essere una donna in età fertile e utilizzare un metodo contraccettivo altamente efficace (con un tasso di fallimento <1% all’anno) o non avere rapporti eterosessuali come stile di vita preferito e abituale (astinenza a lungo termine e persistente), durante il periodo di trattamento sperimentale e per almeno 120 giorni dopo l’ultima dose di trattamento. Lo sperimentatore deve valutare la possibilità di fallimento del metodo contraccettivo (mancata compliance, iniziato di recente) in relazione alla prima dose del trattamento sperimentale.
    - Nelle donne in età fertile il test di gravidanza estremamente sensibile deve risultare negativo (eseguito su urine o siero secondo quanto stabilito dai regolamenti locali) nelle 72 ore che precedono la prima dose del trattamento sperimentale.

    Per i restanti criteri di inclusione fare riferimento al Protocollo.
    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 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 PDL2 agent or with an agent directed to another stimulatory or coinhibitory 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


    Refer to protocol for the rest of exclusion criteria.
    1. Si è sottoposto a chemioterapia, radioterapia definitiva o terapia antitumorale biologica, a un trattamento con un farmaco sperimentale o un dispositivo sperimentale nelle 4 settimane (2 settimane in caso di terapia palliativa) precedenti la prima dose del trattamento in studio o non si è ripreso secondo i criteri CTCAE (Common Terminology Criteria for Adverse Events) di grado 1 o migliore (ad eccezione dell’alopecia) da eventuali EA causati dalle terapie antitumorali somministrate più di 4 settimane prima (inclusi i partecipanti sottoposti a pregressa terapia immunomodulatoria con EA immuno-correlati residui). Se il partecipante si è sottoposto a un intervento chirurgico maggiore o a radioterapia con >30 Gy, deve essersi ripreso dalle tossicità e/o dalle complicanze correlate all’intervento. Ai partecipanti in trattamento con terapia ormonale sostitutiva per EA endocrini immuno-correlati non sarà preclusa la partecipazione a questo studio.
    2. Ha un melanoma oculare.
    3. Presenta evidenze radiografiche di invasione/infiltrazione dei vasi sanguigni maggiori. L’entità dell’invasione/infiltrazione tumorale dei vasi sanguigni maggiori deve essere presa in considerazione a causa del potenziale rischio di emorragia grave associata a riduzione/necrosi del tumore.
    4. Ha emottisi o emorragia tumorale clinicamente significative nelle 2 settimane precedenti la prima dose del trattamento in studio.
    5. Ha una malattia autoimmune attiva che ha richiesto il trattamento sistemico negli ultimi 2 anni a eccezione della vitiligine o dell’asma/atopia infantile risolta. La terapia di sostituzione, come la terapia di sostituzione con tiroxina, insulina o corticosteroidi fisiologici in caso di insufficienza ipofisaria o surrenalica, non è considerata una forma di trattamento sistemico ed è ammessa.
    6. Partecipanti con infezione da HIV e un’anamnesi di sarcoma di Kaposi e/o malattia di Castleman multicentrica.
    7. È affetto da disturbi noti di natura psichiatrica o correlati all’abuso di sostanze che potrebbero interferire con il rispetto dei requisiti dello studio.
    8. Si è sottoposto a un trapianto allogenico di cellule staminali ematopoietiche negli ultimi 5 anni.
    9. Non si è completamente ristabilito dagli effetti di un intervento chirurgico maggiore senza infezione significativa rilevabile. Gli interventi che richiedono l’anestesia generale devono essere completati almeno 2 settimane prima della prima somministrazione del trattamento in studio. Gli interventi che richiedono l’anestesia regionale/epidurale devono essere completati almeno 72 ore prima della prima somministrazione del trattamento in studio e i partecipanti devono essersi ripresi.
    10. Malattia cardiovascolare clinicamente significativa: ictus cerebrovascolare (<6 mesi prima dell’arruolamento), infarto miocardico (<6 mesi prima dell’arruolamento), angina instabile, insufficienza cardiaca congestizia o aritmia cardiaca seria che necessita di trattamento.
    11. Donna in età fertile con risultato positivo al test di gravidanza sulle urine nelle 72 ore precedenti la randomizzazione o l’assegnazione al trattamento. Se il test sulle urine è positivo o se non può esserne confermata la negatività, sarà necessario un test di gravidanza su siero.
    12. Ha ricevuto in precedenza una terapia con un agente anti-PD-1, anti-PD-L1 o anti-PD-L2 o con un agente diretto contro un altro recettore dei linfociti T stimolatorio o co-inibitorio.

    Per i restanti criteri di esclusione fare riferimento al Protocollo.
    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. Tasso di risposta obiettiva (ORR) valutato mediante revisione centrale indipendente in cieco (BICR) secondo i criteri RECIST 1.1 (Response Evaluation Criteria in Solid Tumors).
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to 3 years
    1. Fino a 3 anni
    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. Sopravvivenza libera da progressione (PFS) secondo i criteri RECIST 1.1 valutata dal BICR
    2. Durata della risposta (DOR) in base i criteri RECIST 1.1 valutata dal BICR
    3. ORR in base ai criteri RECIST 1.1 secondo la valutazione dello sperimentatore
    4. ORR in base ai criteri RECIST 1.1 per terapia a base immunitaria (iRECIST) secondo la valutazione dello sperimentatore
    5. PFS in base ai criteri RECIST 1.1 secondo la valutazione dello sperimentatore
    6. PFS in base ai criteri iRECIST secondo la valutazione dello sperimentatore
    7. DOR in base ai criteri RECIST 1.1 secondo la valutazione dello sperimentatore
    8. DOR n base ai criteri iRECIST secondo la valutazione dello sperimentatore
    9. Sopravvivenza globale (OS)
    10. Numero di partecipanti con uno o più eventi avversi (AEs)
    11. Numero di partecipanti che interrompono il farmaco in studio a causa di 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. Fino a 3 anni
    2. Fino a 3 anni
    3. Fino a 3 anni
    4. Fino a 3 anni
    5. Fino a 3 anni
    6. Fino a 3 anni
    7. Fino a 3 anni
    8. Fino a 3 anni
    9. Fino a 3 anni
    10. Fino a 30 giorni dopo l'ultima dose (fino a 3 anni)
    11. Fino a 2 anni
    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 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
    Australia
    Israel
    Korea, Republic of
    New Zealand
    South Africa
    United States
    France
    Germany
    Italy
    Norway
    Spain
    United Kingdom
    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).
    Lo studio complessivo termina quando l'ultimo partecipante completa l'ultima telefonata o visita relativa allo studio, si ritira dallo studio o è perso al follow-up (ovvero, il partecipante non può essere contattato dallo sperimentatore).
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 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
    Nessuno
    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 Decision2020-02-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-12-11
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2023-07-12
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