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    Summary
    EudraCT Number:2019-002449-39
    Sponsor's Protocol Code Number:42756493BLC2003
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2019-12-20
    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 number2019-002449-39
    A.3Full title of the trial
    A Randomized Phase 2 Study of Erdafitinib Versus Investigator Choice of Intravesical Chemotherapy in Subjects Who Received Bacillus Calmette-Guérin (BCG) and Recurred With High Risk Non-Muscle-Invasive Bladder Cancer (NMIBC) and FGFR Mutations or Fusions.
    Estudio fase II aleatorizado de Erdafitinib frente a la selección del investigador de quimioterapia intravesical en sujetos que recibieron el bacilo de Calmette y Guérin (BCG) y presentaron recidiva de cáncer de vejiga no músculo-invasivo (NMIBC) de alto riesgo y mutaciones o fusiones del FGFR.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Randomized Phase 2 Study of Erdafitinib Versus Investigator Choice of Intravesical Chemotherapy in Subjects Who Received Bacillus Calmette-Guérin (BCG) and Recurred With High Risk Non-Muscle-Invasive Bladder Cancer (NMIBC) and FGFR Mutations or Fusions.
    Estudio fase II aleatorizado de Erdafitinib frente a la selección del investigador de quimioterapia intravesical en sujetos que recibieron el bacilo de Calmette y Guérin (BCG) y presentaron recidiva de cáncer de vejiga no músculo-invasivo (NMIBC) de alto riesgo y mutaciones o fusiones del FGFR.
    A.4.1Sponsor's protocol code number42756493BLC2003
    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 SponsorJanssen-Cilag International NV
    B.1.3.4CountryBelgium
    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 supportJanssen Research & Development LLC
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationJanssen-Cilag International NV
    B.5.2Functional name of contact pointGlobal Clinical Operations Spain
    B.5.3 Address:
    B.5.3.1Street AddressPaseo de las Doce Estrellas, 5-7
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28042
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491722 86 30
    B.5.5Fax number+3491722 86 28
    B.5.6E-mailmsanchez@its.jnj.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 nameErdafitinib
    D.3.2Product code JNJ-42756493
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNErdafitinib
    D.3.9.1CAS number 1346242-81-6
    D.3.9.2Current sponsor codeJNJ-42756493
    D.3.9.3Other descriptive nameERDAFITINIB
    D.3.9.4EV Substance CodeSUB167731
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number3
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 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 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 nameErdafitinib
    D.3.2Product code JNJ-42756493
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNErdafitinib
    D.3.9.1CAS number 1346242-81-6
    D.3.9.2Current sponsor codeJNJ-42756493
    D.3.9.3Other descriptive nameERDAFITINIB
    D.3.9.4EV Substance CodeSUB167731
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 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 nameErdafitinib
    D.3.2Product code JNJ-42756493
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNErdafitinib
    D.3.9.1CAS number 1346242-81-6
    D.3.9.2Current sponsor codeJNJ-42756493
    D.3.9.3Other descriptive nameERDAFITINIB
    D.3.9.4EV Substance CodeSUB167731
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Gemcitabine Accord
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare B.V.
    D.2.1.2Country which granted the Marketing AuthorisationNetherlands
    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 nameGemcitabine
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravesical use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNGemcitabine
    D.3.9.3Other descriptive nameGEMCITABINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB02324MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2000
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Mitomycin Medac
    D.2.1.1.2Name of the Marketing Authorisation holderMedac Gesellschaft für klinische Spezialpräparate mbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameMitomycin/ Hyperthermic Mitomycin
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravesical use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMITOMYCIN
    D.3.9.1CAS number 50-07-7
    D.3.9.4EV Substance CodeSUB09006MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 No
    D.IMP: 6
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Midazolam Ratiopharm
    D.2.1.1.2Name of the Marketing Authorisation holderRatiopharm GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameMidazolam
    D.3.4Pharmaceutical form Suspension for oral suspension
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMIDAZOLAM
    D.3.9.1CAS number 59467-70-8
    D.3.9.4EV Substance CodeSUB08950MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 No
    D.IMP: 7
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Metformin Hexal
    D.2.1.1.2Name of the Marketing Authorisation holderHexal AG
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameMetformin
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMETFORMIN
    D.3.9.1CAS number 657-24-9
    D.3.9.4EV Substance CodeSUB08831MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1000
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 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
    Cohorte 1 and 2: High Risk Non-Muscle-Invasive Bladder Cancer (NMIBC) with FGFR Mutations or Fusions
    Cohorte 3 Intermediate Risk Non-Muscle-Invasive Bladder Cancer (NMIBC) with FGFR Mutations or Fusions
    Cohorte 1 y 2: Cáncer de vejiga no invasivo de alto riesgo (NMIBC) con mutaciones o fusiones FGFR
    Cohorte 3 Cáncer de Vejiga No Invasivo de Riesgo Intermedio (NMIBC) con Mutaciones o Fusiones FGFR
    E.1.1.1Medical condition in easily understood language
    Bladder Cancer
    Cáncer de Vejiga
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10005003
    E.1.2Term Bladder cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Cohort 1 only:
    -To evaluate RFS in subjects treated with erdafitinib vs Investigator’s Choice, for subjects with high-risk NMIBC who harbor FGFR mutations or fusions, and who recurred after BCG therapy
    Sólo Cohorte 1:
    -Para evaluar el SSR en sujetos tratados con erdafitinib versus Elección del Investigator, para sujetos con NMIBC de alto riesgo que albergan mutaciones o fusiones de FGFR, y que reaparecieron después de la terapia con BCG.
    E.2.2Secondary objectives of the trial
    Cohort 1 only:
    -To evaluate other measures of efficacy

    All cohorts:
    -To evaluate erdafitinib PK
    -To evaluate safety and tolerability of erdafitinib
    -To evaluate HRQoL
    -To evaluate the potential DDI of repeated dosing of erdafitinib on the single-dose pharmacokinetics of other drugs affected by CYP3A metabolism and OCT2 transport in a substudy performed at select study sites. In addition, local erdafitinib concentration in the bladder may be determined for a subset of subjects from study sites participating in the DDI substudy as an exploratory endpoint.
    Sólo Cohorte 1:
    -Evaluar otras medidas de eficacia

    Todas las cohortes:
    -Para evaluar erdafitinib PK
    -Para evaluar la seguridad y tolerabilidad del erdafitinib
    -Para evaluar HRQoL
    - Evaluar la posible interraccion Farmacológica de la dosificación repetida de erdafitinib en la farmacocinética de dosis única de otros fármacos afectados por el metabolismo de CYP3A y el transporte de OCT2 en un subestudio realizado en centros de estudio seleccionados. Además, se puede determinar la concentración local de erdafitinib en la vejiga para un subconjunto de sujetos de los centros de estudio que participan en el subestudio Si interacción Farmacológica como criterio de valoración exploratorio.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Protocol title: Drug-drug interaction substudy to assess the effect of repeated doses of erdafitinib on the single-dose pharmacokinetics of midazolam and metformin in FGFR-positive subjects with high-risk non-muscle-invasive bladder cancer at selected sites.

    Protocol date: 06 November 2019

    Objectives:
    The objective of this DDI substudy is to evaluate the effects of repeated dosing of erdafitinib on the single-dose pharmacokinetics (PK) of midazolam and metformin in FGFR-positive subjects with high-risk NMIBC. In addition, local erdafitinib concentration in the bladder may be determined.
    Título del protocolo: Subestudio de interacción Farmacológica para evaluar el efecto de las dosis repetidas de erdafitinib sobre la farmacocinética de dosis única de midazolam y metformina en sujetos con FGFR positivos con cáncer de vejiga no músculo invasivo de alto riesgo en centros seleccionados.

    Fecha de Protocolo: 06 November 2019

    Objetivos:
    El objetivo de este subestudio de IF es evaluar los efectos de la dosificación repetida de erdafitinib sobre la farmacocinética de dosis única (PK) de midazolam y metformina en sujetos positivos para FGFR con NMIBC de alto riesgo. Además, se puede determinar la concentración local de erdafitinib en la vejiga.
    E.3Principal inclusion criteria
    1. ≥18 yrs of age (or the legal age of consent in the jurisdiction in which the study is taking place).
    2. Histologically confirmed, recurrent, non-muscle-invasive urothelial carcinoma of the bladder.
    a. Histopathology: any urothelial cell carcinoma (UCC) variant (ie, UCC with squamous and/or glandular differentiation, micropapillary, nested, plasmacytoid, neuroendocrine, sarcomatoid) are allowed. Presence of any lymphovascular invasion (LVI) will be considered as evidence of high risk.
    b.Papillary disease (Cohort 1) must be high-risk disease, defined high-grade disease Ta/T1 lesion. Additionally, subjects must have all visible tumor resected completely prior to randomization and documented at baseline cystoscopy. Negative cytology for high-grade urothelial carcinoma is required before randomization.
    c.CIS (Cohort 2) is not expected to be completely excised, but concurrent papillary disease must be completely excised before enrollment and documented at baseline cystoscopy. Urine cytology is not expected to be negative for malignant cells.
    d.Marker Lesion (Cohort 3) must have recurrent intermediate-risk disease with all previous tumors being low grade (G1-G2), Ta or T1, and no previous CIS. Additionally, subjects must have a risk of progression less than 5% in the next 2 yrs and a risk of recurrence greater than 50%, calculated using the EORTC risk calculator. All tumors must be removed except for a single untouched 5 to 10 mm lesion (Marker Lesion).
    3. At least 1 of the following tumor FGFR mutations or fusions as determined by local or central testing at the time of recurrence after BCG therapy: see table in protocol
    4. Criterion modified per Amendment 1.
    4.1.
    4a. BCG-unresponsive.
    BCG-unresponsive subjects must meet at least one of the following:
    i. Persistent or recurrent CIS alone or with recurrent Ta/T1 (noninvasive papillary disease/tumor invades the subepithelial connective tissue) disease within 12m of completion of adequate BCG therapy (Cohort 2 only)
    ii. Recurrent high-grade Ta/T1 disease within 6m of completion of adequate BCG therapy
    iii. T1 high-grade at the first disease assessment following an induction BCG course
    Adequate BCG (Minimum Treatment Requirements)
    1) At least 5 of 6 full doses of an initial induction course plus at least 1
    maintenance (2 of 3 full weekly full doses) in a 6m period
    OR
    2) At least 5 of 6 full doses of an initial induction course plus at least 2 of 6 full doses of a second induction course.

    4b BCG Experienced.
    BCG experienced subjects must meet the following:
    i. Recurrent high-grade Ta/T1 disease within 12m of completion of BCG
    therapy
    Prior BCG (Minimum Treatment Requirements)
    1)At least 5 of 6 full doses of an initial induction course
    2) OR
    3)At least 5 of 6 full doses of an initial induction course plus at least 1 maintenance (2 of 3 weekly doses) in a 6m period. One-half dose or one-third dose is allowed during maintenance
    5. Refuses or is not eligible for cystectomy (Cohort 1 and Cohort 2 only)
    6. Eastern Cooperative Oncology Group (ECOG) performance status Grade 0 or 1
    7. Adequate bone marrow, liver, and renal function:
    a. Bone marrow function (without the support of cytokines or erythropoiesis-stimulating agent in preceding 2wks):
    i. Absolute neutrophil count (ANC) ≥1,000/mm3
    ii. Platelet count ≥75,000/mm3
    iii. Hemoglobin ≥8.0 g/dL
    b. Liver function:
    i. Total bilirubin ≤1.5 x institutional ULN OR direct bilirubin ≤ULN for subjects with total bilirubin levels >1.5xULN
    ii. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5x institutional ULN
    c. Renal function:
    Creatinine clearance >30 mL/min either directly measured via 24-hour urine collection, calculation using the Cockcroft-Gault formula, or calculation for the Modification of Diet in Renal Disease for adult subjects.
    For the DDI substudy, creatinine clearance ≥60 mL/min.
    d. Phosphate: <ULN within 14 days before the first dose of study drug on Cycle 1 Day 1 (medical management allowed)
    8. Must sign an informed consent form (ICF) (or their legally acceptable representative must sign) indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study.
    9. A woman of childbearing potential must have a negative pregnancy test (β-hCG) (urine or serum) within 7 days before randomization (Cohort 1) or the first dose of study drug (Cohort 2 and Cohort 3).
    10. Contraceptive use by men or women should be consistent with local regulations regarding the use of contraceptive methods for subjects participating in clinical studies.
    a. For women of childbearing potential (defined as: fertile, following menarche and until becoming postmenopausal unless permanently sterile) -> see protocol
    b. For men who are sexually active with women of childbearing potential: -> see protocol
    1.≥18 años
    2.Carcinoma urotelial de vejiga no músculo-invasivo, recurrente y confirmado histológicamente.
    a.Histopatología:se permite cualquier variante de carcinoma de céls. uroteliales (es decir, CCU con diferenciación escamosa o glandular, micropapilar, anidada, plasmacitoide, neuroendocrina, sarcomatoide).Presencia de cualquier invasión linfovascular (ILV) se considerará como indicio de alto riesgo.
    b. Enf. papilar (cohorte 1) debe ser una Enf. de alto riesgo,definida como lesión Ta/T1 de alto grado. Además, Sujs. deben presentar todos los Tum. visibles extirpados por completo antes de la aleatorización y documentados en cistoscopia inicial.Se requiere una citología negativa para el carcinoma urotelial de alto grado antes de aleatorización.
    c.No se espera que el CIS (cohorte 2) haya sido extirpado por completo,pero la Enf. papilar concomitante debe extirparse en su totalidad antes reclutamiento y documentarse en la cistoscopia inicial.No se espera que citología de orina dé negativo para céls malignas.
    d.Lesión marcadora (cohorte 3) debe presentar una Enf. recurrente de riesgo intermedio con todos los Tum. anteriores de bajo grd (G1-G2), Ta o T1, y sin CIS previo.Además, Sujs. deben tener un riesgo de progresión infr al 5% en los próximos 2años y un riesgo de recurrencia supr al 50%,calculado mediante calculadora de riesgo de EORTC. Todos los Tum. deben extirparse,excepto 1 sola lesión intacta de 5 a 10mm (lesión marcadora)
    3.Al menos 1 de las sigs mutaciones tumorales o fusiones del FGFR según lo determinado por las pruebas locales o centrales en el momento de la recidiva después del Tto. con BCG. ver tabla en Protocolo
    4.Criterio modificado por Enmda 1
    4.1
    4a. Ausencia de respuesta a BCG.
    Sujs. sin respuesta a BCG deben cumplir al menos uno de los parámetros sigs:
    i.CIS persistente o recurrente solo o con Enf. Ta/T1 recurrente (Enf. papilar no invasiva/el Tum. invade tejd conjuntivo subepitelial) en 12m posteriores a finalización del Tto. adecuado con BCG (solo cohorte 2).
    ii.Enf. Ta/T1 recurrente de alto grd en los 6m posteriores a la finalización del Tto. adecuado con BCG.
    iii.T1 de alto grd en la 1ª evaluación de la Enf. después de un ciclo de inducción con BCG.
    BCG adecuado (requisitos míns. Tto)
    1)Al menos 5 de 6 dosis completas de un ciclo de inducción inicial más al menos 1 ciclo de mantenimiento (2 de 3 dosis semanales completas) en periodo de 6m
    O BIEN
    2)Al menos 5 de 6 dosis completas de un ciclo de inducción inicial más al menos 2 de 6 dosis completas de un 2º ciclo de inducción.
    4b. Sensibles a BCG.
    Sujs. sensibles a BCG deben cumplir el parámetro sig:
    i.Enf. Ta/T1 recurrente de alto grd en 12m posteriores a la finalización del Tto. con BCG
    BCG previo (requisitos míns. Tto.)
    1)Al menos 5 de 6 dosis completas de ciclo de inducción inicial.
    2)OR
    3)Al menos 5 de 6 dosis completas de un ciclo de inducción inicial más al menos 1 ciclo de mantenimiento (2 de 3 dosis semanales) en periodo de 6m.Se permite mitad de dosis o un tercio de dosis durante mantenimiento
    5.Rechaza o no es elegible para cistectomía (solo cohorte 1 y cohorte 2)
    6.Situación funcional en escala del Eastern Cooperative Oncology Group de grd. 0 o 1
    7.Función renal, hepática y de médula ósea adecuadas:
    a.Función de médula ósea (sin apoyo de citocinas o de fármaco estimulador de eritropoyesis en las 2semanas anteriores)
    i.Recuento absoluto neutrófilos (RAN) ≥1000/mm3
    ii.Recuento plaquetario ≥75 000/mm3
    iii.Hemoglobina ≥8,0 g/dl
    b.Función hepática:
    i.Bilirrubina total ≤1,5 veces el LNS institucional O bilirrubina directa ≤LNS en Sujs. con concentraciones totales bilirrubina >1,5 veces el LNS
    ii. ALT y AST ≤2,5 veces el LNS institucional
    c.Función renal:
    Aclaramiento de creatinina >30 ml/min, medido directamente mediante recogida de orina de 24h,calculado usando fórmula de Cockcroft-Gault o calculado para modificación de dieta en la Enf. renal para Sujs. adultos
    Para el subest. de IF, aclaramiento de creatinina ≥60 ml/min
    d.Fosfato:<LNS en los 14d anteriores a admón. de la 1ª dosis del fármaco del estudio el día 1 del ciclo 1 (se permite Tto. médico)
    8. Debe firmar un CI (o debe hacerlo su representante legal) en el que se indique que comprende el propósito del estudio y procedimientos necesarios para él y que está dispuesto a participar en el estudio.
    9. Si es una mujer en edad fértil, debe presentar una prueba de embarazo negativa (β-hCG) (orina o suero) en 7d previos a la aleatorización (cohorte 1) o admón. de la 1ª dosis del fármaco del estudio (cohorte 2 y cohorte 3).
    10.Uso de anticonceptivos por parte de varones o mujeres debe ajustarse a normativa local respecto al uso métodos anticonceptivos en Sujs. que participan en EECC
    a.Mujeres en edad fértil (definidas como:fértiles, después de la menarquia y hasta llegar a ser posmenopáusicas, a menos que sean permanentemente estériles) deben:ver Protocolo
    b.Varones sexualmente activos con mujeres en edad fértil deben:ver Protocolo
    E.4Principal exclusion criteria
    1. Histologically confirmed, muscle-invasive (T2 or higher stage) urothelial carcinoma of the bladder
    2. Histopathology demonstrating any small cell component, pure adenocarcinoma, pure squamous cell carcinoma, or pure squamous CIS of the bladder
    3. Prior treatment with an FGFR inhibitor
    4. Active malignancies (ie, progressing or requiring treatment change in the last 24 months) other than the disease being treated under study. The only allowed exceptions are:
    a. skin cancer treated within the last 24 months that is considered completely cured
    b. adequately treated lobular carcinoma in situ (LCIS) and ductal CIS
    c. history of localized breast cancer and receiving antihormonal agents, or history of localized prostate cancer (N0M0) and receiving androgen deprivation therapy
    5. Current central serous retinopathy or retinal pigment epithelial detachment of any grade
    6. History of uncontrolled cardiovascular disease including:
    a. any of the following in the preceding 3 months: unstable angina, myocardial infarction, ventricular fibrillation, Torsades de Pointes, cardiac arrest, or known congestive New York Heart Association Class III-IV heart failure, cerebrovascular accident, or transient ischemic attack.
    b. QTc prolongation as confirmed by ECG assessment at screening (Fridericia; QTc >480 milliseconds).
    c. Pulmonary embolism or other venous thromboembolism within the preceding 2 months.
    7. Criterion modified per Amendment 1.
    7.1. Known human immunodeficiency virus (HIV) infection, unless the subject has been on a stable anti-retroviral therapy regimen for the last 6 months or more and has had no opportunistic infections and a CD4 count >350 in the last 6 months.
    8. Criterion modified per Amendment 1.
    8.1. Evidence of active hepatitis B or C infection (for example, subjects with history of hepatitis C infection but normal hepatitis C virus polymerase chain reaction test and subjects with hepatitis B with positive HBsAg antibody are allowed).
    9. Not recovered from toxicity of prior anticancer therapy (except toxicities which are not clinically significant such as alopecia, skin discoloration, neuropathy, hearing loss)
    10. Impaired wound healing capacity defined as skin/decubitus ulcers, chronic leg ulcers, known gastric ulcers, or unhealed incisions
    11. Major surgery within 4 weeks before Cycle 1 Day 1 (TURBT is not considered major surgery)
    12. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subjects (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments. Examples include ongoing active infection requiring systemic therapy and uncontrolled ongoing medical conditions.
    13. Use of strong CYP3A4 inhibitors or inducers or moderate CYP3A4 inducers(Section 10.9) within 14 days or 5 half-lives (whichever is longer) before the first dose of study drug
    1.Carcinoma urotelial de vejiga músculo-invasivo (T2 o etapa más avanzada) confirmado histológicamente
    2.Histopatología que muestre cualquier componente de células pequeñas, adenocarcinoma puro, carcinoma de células escamosas puro o CIS escamoso puro de la vejiga
    3.Tto. previo con un inhibidor del FGFR
    4.Neoplasias malignas activas (es decir, que hayan progresado o requerido un cambio de tratamiento en los últimos 24 meses) distintas a la Enf. que se está tratando en el estudio. Únicas excepciones permitidas son:
    a.Cáncer de piel tratado en los últimos 24m que se considere completamente curado
    b.carcinoma lobular in situ (CLIS) tratado adecuadamente y CIS ductal
    c.antecedentes de cáncer de mama localizado y recepción de agentes antihormonales, o antecedentes de cáncer de próstata localizado (N0M0) y recepción de terapia de privación de andrógenos
    5.Retinopatía serosa central actual o desprendimiento epitelial de pigmento de retina cualquier grado
    6.Antecedentes de enfermedades cardiovasculares no controladas, entre las que se incluyen:
    a.cualquiera de los siguientes en los 3m anteriores:angina inestable, infarto de miocardio, fibrilación ventricular, taquicardia ventricular polimorfa en entorchado, paro cardíaco o insuficiencia cardíaca congestiva conocida de clase III-IV de la New York Heart Association ,accidente cerebrovascular o ataque isquémico transitorio.
    b.Prolongación del QTc confirmada mediante evaluación del ECG en el momento de la selección (Fridericia; QTc >480 milisegundos).
    c.Embolia pulmonar u otra tromboembolia venosa en los 2m anteriores
    7.Criterio modificado por la enmienda 1:
    7.1 Infección por VIH conocida, a menos que el Suj.haya recibido una pauta de terapia antirretroviral estable durante los últimos 6m o más; y no haya tenido infecciones oportunistas y tenga una cifra de CD4 >350 en los últimos 6m.
    8. Criterio modificado por la enmienda 1:
    8.1.Evidencia de hepatitis B o C activa, (por ejemplo, están permitidos los Sujs. con historial de infección de hepatitis C pero cuya prueba de reacción en cadena de la polimerasa sea normal y Sujs. con hepatitis B con anticuerpos HBsAg positivos).
    9.No haberse recuperado de la toxicidad de Ttos anteriores contra el cáncer (excepto las toxicidades que no son clínicamente significativas como la alopecia, la decoloración de la piel, la neuropatía y la pérdida de audición)
    10.Deterioro de la capacidad de cicatrización de heridas definida como úlceras de piel/decúbito, úlceras crónicas en las piernas, úlceras gástricas conocidas o incisiones no cicatrizadas
    11.Cirugía mayor en las 4semanas anteriores al día 1 del ciclo 1 (TURBT no se considera cirugía mayor)
    12.Cualquier Enf. para la cual, en opinión del investigador, la participación no redunde en el mejor interés de los Sujs. (por ejemplo, que ponga en peligro su bienestar) o que pudiera evitar, limitar o confundir las evaluaciones especificadas en el protocolo. Ejemplos incluyen infección activa en curso que requiera Tto. sistémico y afecciones médicas en curso no controladas.
    13. Uso de inhibidores o inductores potentes de CYP3A4 o inductores moderados de CYP3A4 (apartado 10.9) en los 14d o 5 semividas (el periodo que sea más largo) anteriores a la admón. de la primera dosis del fármaco del estudio
    E.5 End points
    E.5.1Primary end point(s)
    Recurrence-free survival (RFS)
    Supervivencia sin recidiva (RFS)
    E.5.1.1Timepoint(s) of evaluation of this end point
    At study analysis
    En el análisis del estudio
    E.5.2Secondary end point(s)
    1. Time to progression
    2. Time to disease worsening
    3. Disease-specific survival (invasive bladder cancer)
    4. OS
    5. RFS rate at 6, 12, and 24 months
    6. RFS2
    7. RFS by central histopathologic review
    1. Tiempo para progresar
    2. Tiempo para que la enfermedad empeore
    3. Supervivencia específica de la enfermedad (cáncer invasivo de vejiga)
    4. Supervivencia Global
    5. Supervivencia sin progresion a los 6, 12 y 24 meses
    6. Supervivencia por recaída
    7. Supervivencia por recaída por revisión histopatológica central
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Throughout the study
    2. Throughout the study
    3. Throughout the study
    4. Throughout the study
    5. At 6, 12 and 14 months
    6. Throughout the study
    7. Throughout the study
    1. A lo largo del estudio
    2. A lo largo del estudio
    3. A lo largo del estudio
    4. A lo largo del estudio
    5. A los 6, 12 y 14 meses
    6. A lo largo del estudio
    7. A lo largo del estudio
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarkers
    Biomarcadores
    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 No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo 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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA56
    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
    Brazil
    China
    France
    Germany
    Italy
    Japan
    Korea, Republic of
    Poland
    Spain
    Taiwan
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The study is considered completed with the last follow-up survival assessment for the last subject participating in the study, or 4 years after the last subject is enrolled.
    El estudio se considera completado con la última evaluación de supervivencia de seguimiento para el último sujeto que participó en el estudio, o 4 años después de que se inscribió el último sujeto.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years6
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days15
    E.8.9.2In all countries concerned by the trial years6
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days15
    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: 28
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 252
    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 state14
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 156
    F.4.2.2In the whole clinical trial 280
    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)
    The sponsor will ensure that subjects benefiting from treatment with erdafitinib continue to receive treatment after the end of the study. Subsequent anticancer therapy is left to the investigator's discretion.
    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 Decision2020-03-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-03-04
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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