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    Summary
    EudraCT Number:2019-003096-20
    Sponsor's Protocol Code Number:MedOPP234
    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:2020-05-31
    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 number2019-003096-20
    A.3Full title of the trial
    A randomized phase II trial to evaluate the antitumor activity of Enzalutamide and Talazoparib (PF-06944076) for the treatment of metastatic hormone-naïve prostate cancer
    Ensayo de fase II randomizado para evaluar la actividad antitumoral del
    tratamiento con Enzalutamida y Talazoparib (PF-06944076) en
    pacientes con cáncer de próstata metastásico sin terapia hormonal
    previa
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Enzalutamide plus Talazoparib for the Treatment of Hormone Sensitive Prostate Cancer
    Enzalutamida más talazoparib para el tratamiento del cáncer de
    próstata hormonosensible
    A.3.2Name or abbreviated title of the trial where available
    The ZZ-First Study
    Estudio ZZ-First
    A.4.1Sponsor's protocol code numberMedOPP234
    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 SponsorMedica Scientia Innovation Research S.L. (MEDSIR)
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportPfizer S.L.U
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMedica Scientia Innovation Research S.L. (MEDSIR)
    B.5.2Functional name of contact pointClinical Trial Unit
    B.5.3 Address:
    B.5.3.1Street AddressTorre Glòries. Av. Diagonal, 211, planta 27
    B.5.3.2Town/ cityBarcelona
    B.5.3.3Post code08018
    B.5.3.4CountrySpain
    B.5.4Telephone number34932214135
    B.5.6E-mailmarta.martinezdefalcon@medsir.org
    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 nameTalazoparib
    D.3.2Product code PF-06944076
    D.3.4Pharmaceutical form Capsule, hard
    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 INNTalazoparib
    D.3.9.2Current sponsor codePF-06944076
    D.3.9.3Other descriptive nameTalazoparib tosilate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.5
    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 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 Xtandi
    D.2.1.1.2Name of the Marketing Authorisation holderAstellas Pharma Europe B.V
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    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 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 INNENZALUTAMIDE
    D.3.9.1CAS number 915087-33-1
    D.3.9.4EV Substance CodeSUB77412
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number160
    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
    Metastatic hormone–naïve prostate cancer (mHNPC)
    Cáncer de próstata metastásico (CPMSTHP) sin terapia hormonal previa.
    E.1.1.1Medical condition in easily understood language
    Prostate cancer that cannot be treated with radiotherapy or surgery with curative intent (named "advanced or metastatic prostate cancer")
    cáncer de próstata que no se puede operar ni tratar con radioterapia con intención curativa (llamado «cáncer de próstata avanzado o metastásico»)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10036909
    E.1.2Term Prostate cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10036920
    E.1.2Term Prostate cancer stage IV
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the antitumor activity of talazoparib (PF-06944076) in combination with enzalutamide and ADT –as determined by the confirmed
    prostate-specific antigen-complete response (PSA-CR)– in patients with
    mHNPC
    Evaluar la actividad antitumoral de talazoparib (PF-06944076) en
    combinación con enzalutamida y ADT - según determine la respuesta
    completa confirmada del antígeno prostático específico (RC-PSA) - en
    pacientes con CPMSTHP
    E.2.2Secondary objectives of the trial
    • To analyze PSA response and time to development of castrationresistance (TTCR) when ADT and enzalutamide are administered with talazoparib (PF-06944076) in this population.
    • To assess the correlation between molecular and transcriptomic
    signatures of DNA damage repair (DDR) function and antitumor activity in this population.
    • To assess the impact of ADT and enzalutamide treatment in DNA repair function in this population.
    • To evaluate the safety and tolerability of talazoparib (PF-06944076) in
    combination with enzalutamide and ADT in this population.
    • Analizar la respuesta del PSA y el tiempo hasta el desarrollo de
    resistencia a la castración (TRC) si se administra ADT y
    enzalutamida con talazoparib (PF-06944076) en esta población.
    • Evaluar la correlación entre las características moleculares y
    transcriptómicas de la función de reparación del daño en el ADN
    (RDA) y de la actividad antitumoral en esta población.
    • Evaluar el impacto del tratamiento con ADT y enzalutamida en la
    función de reparación del ADN en esta población.
    • Evaluar la seguridad y la tolerabilidad de talazoparib (PF06944076) en combinación con enzalutamida y ADT en esta
    población.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Versión 3.0 13-Mar-2020
    Optional radiological study of Diffusion-Weighted Imaging (DWI) Magnetic Resonance Imaging (MRI, WB-DWI MRI).

    This sub-study aims to evaluate the changes in whole-body by diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) and the correlation with the patient outcome.

    Patients who meet all the selection criteria and have documented bone metastases and consent to participate are eligible for this sub-study. Radiological evaluations will be done at the following time points: baseline, C3D1, C5D1, C13D1 and the time of progression.
    Versión 3.0 13-Mar-2020
    Estudio radiológico opcional de imagen potenciada en difusión (WD-DWI) en resonancia magnética (RM, WD-DWI RM).

    El objetivo del sub-estudio es evaluar los cambios en el cuerpo entero mediante pruebas de imagen potenciada en difusión (WD-DWI) en resonancia magnética (RM) y correlacionarlos con la evolución del paciente.

    Son candidatos para participar aquellos pacientes que cumplan todos los criterios de selección, presenten de forma documentada metástasis óseas y den su consentimiento para participar en el sub-estudio.

    Las evaluaciones radiológicas serán realizadas en los siguientes tiempos: al inicio del estudio, C3D1, C5D1, C13D1 y al tiempo de progresión.
    E.3Principal inclusion criteria
    1. Adult patients (>18 y.o.) who signed informed consent form (ICF) prior to participation in any study-related activities.
    2. Willing and able to comply with scheduled visits, treatment plan,
    laboratory tests, and other study procedures.
    3. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0
    or 1.
    4. High-volume metastatic disease documented on bone scan or computed tomography (CT)/magnetic resonance imaging (MRI) scan, defined as the presence of either visceral disease and/or at least four bone metastases on bone scan, with at least one of them beyond spine/pelvis.
    5. Life expectancy of ≥ 12 months.6. Histologically confirmed adenocarcinoma of the prostate without predominance of small-cell or neuroendocrine features according to American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines based on local testing on the most recent analyzed biopsy.
    Note: Central confirmation of adenocarcinoma is not required for study
    entry. However, tissue blocks, or slides, must be submitted to confirm the diagnoses by a Sponsor-designated central laboratory retrospectively and/or exploratory biomarker analyses.
    7. Willingness and ability to provide tumor paired biopsies during the study participation in order to perform exploratory studies. At the study entry, the most recent tumor biopsy since last progression from either metastatic or primary tissues will be provided. If not feasible, patient eligibility should be evaluated by a Sponsor’s qualified designee.
    8. Adequate hematologic and organ function within 28 days before the first study treatment on Cycle 1 Day 1, defined by the following:
    a. Hematological:
    i. White blood cell (WBC) count > 3.0 x 109/L;
    ii. Absolute neutrophil count (ANC) > 1.5 x 109/L;
    iii. Platelet count > 100.0 x109/L;
    iv. Hemoglobin (Hb) > 9.0 g/dL.
    Note: Patients receiving growth factors or blood transfusions within 14 days before obtaining the hematology values at screening will be excluded.
    b. Hepatic:
    i. Total bilirubin ≤ 1.5 times the upper limit of normal (× ULN) (≤ 3 x ULN in the case of Gilbert’s disease);
    ii. Aspartate transaminase (AST) and alanine transaminase
    (ALT) ≤ 2.5 × ULN (in the case of liver metastases ≤ 5 × ULN);
    iii. Alkaline phosphatase (ALP) ≤ 2.5 × ULN (≤ 5 × ULN in the case of liver and/or bone metastases).
    c. Renal:
    i. Serum creatinine < 1.5 × ULN or creatinine clearance ≥ 30 mL/min based on Cockcroft−Gault glomerular filtration rate estimation.
    d. Coagulation:
    i. International normalized ratio (INR) and activated partial thromboplastin time (aPTT) ≤ 1.5 x ULN unless on medication known to alter INR and/or aPTT.
    e. Nutritional status:
    i. Serum Albumin ≥ 2.8 g/dL.
    9. Bisphosphonates or denosumab dosage must have been stable for at
    least 4 weeks before Day 1 for patients receiving these therapies.
    10. Patients must agree to use a condom when is engaged in sexual activity with a pregnant woman during the treatment period and for at least 90 days after last dose of enzalutamide or at least 120 days after last dose of talazoparib (PF-06944076), whichever occurs later. Patients must also agree to use an additional highly effective form of contraception or two effective contraceptive methods, when is engaged in sexual intercourse with a woman of childbearing potential during the treatment period and for at least 90 days after last dose of enzalutamide or at least 120 days after last dose of talazoparib (PF-06944076), whichever occurs later.
    11. Must agree to refrain to donate sperm during the treatment period and for at least 90 days after last dose of enzalutamide or at least 120 days after last dose of talazoparib (PF-06944076), whichever occurs later.
    12. PSA ≥ 4 ng/mL at diagnosis or before starting ADT therapy.
    1. Pacientes adultos (>18 años) que hayan firmado el formulario de
    consentimiento informado (FCI) antes de participar en cualquier
    actividad relacionada con el estudio.
    2. Voluntad y capacidad para cumplir con las visitas programadas, el
    plan de tratamiento, las pruebas analíticas y demás procedimientos del estudio.
    3. Estado funcional del Grupo Cooperativo Oncológico del Este
    (ECOG) de 0 o 1.
    4. Enfermedad metastásica de gran volumen documentada mediante gammagrafía ósea o tomografía computarizada (TC)/resonancia magnética (RM), definida como la presencia de enfermedad visceral o al menos cuatro metástasis óseas en la gammagrafía ósea, de las cuales al menos una debe estar fuera de la columna/pelvis.
    5. Esperanza de vida ≥12 meses.
    6. Adenocarcinoma en la próstata, confirmado histológicamente, sin
    predominancia de células pequeñas ni características neuroendocrinas según las guías de American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) basadas en las pruebas locales de la biopsia más reciente analizada.
    Nota: no es necesaria la confirmación central de adenocarcinoma
    para entrar en el estudio. No obstante, se deben enviar los bloques o cortes de tejido para que un laboratorio central designado por el promotor confirme los diagnósticos de manera retrospectiva o analice los biomarcadores de manera exploratoria.
    7. Voluntad y capacidad de proporcionar biopsias emparejadas
    durante la participación en el estudio para realizar estudios
    exploratorios. Cuando se entre en el estudio, se proporcionará la
    biopsia tumoral más reciente desde la última progresión bien de
    tejido primario o bien de tejido metastásico. Si no es posible, una
    persona cualificada designada por el promotor deberá evaluar la
    elegibilidad de la paciente.
    8. Función hematológica y orgánica adecuada durante los 28 días
    anteriores al primer tratamiento del estudio el día 1 del ciclo 1,
    definida del siguiente modo:
    a. Valores hematológicos:
    • Recuento de leucocitos (WBC) >3 x 109/l.
    • Recuento absoluto de neutrófilos (RAN) >1,5 x
    109/l.
    • Recuento de plaquetas >100,0 x109/l.
    • Hemoglobina (Hb) >9,0 g/dl.
    Nota: se excluirá a los pacientes que hayan recibido factores de
    crecimiento o transfusiones de sangre durante los 14 días
    anteriores a la obtención de los valores hematológicos en la
    selección.
    b. Valores hepáticos:
    • Bilirrubina total ≤1,5 veces el límite superior de
    normalidad (× LSN) (≤3 × LSN en caso de
    enfermedad de Gilbert).
    • Aspartato transaminasa (AST) y alanino
    transaminasa (ALT) ≤2,5 × LSN (en caso de
    metástasis hepáticas, ≤5 × LSN).
    • Fosfatasa alcalina (FA) ≤2,5 × LSN (≤5 × LNS en
    caso de metástasis hepáticas u óseas).
    c. Valores renales:
    • Creatinina sérica <1,5 x LSN o aclaramiento de
    creatinina ≥30 ml/min según la estimación de la
    tasa de filtración glomerular de Cockroft-Gault.
    d. Coagulación:
    • Índice internacional normalizado (INR) y tiempo
    de tromboplastina parcial activado (TTPa)
    ≤1,5 x LSN salvo que tome medicamentos que se
    sepa que alteran el INR o el TTPa.
    e. Estado nutricional:
    • Albúmina sérica ≥2,8 g/dl.
    9. La dosis de bisfosfonatos o desonumab debe haber sido estable
    durante al menos 4 semanas antes del día 1 para que los pacientes reciban el tratamiento.
    10. Los pacientes deben aceptar el uso de preservativo cuando
    tengan relaciones sexuales con mujeres embarazadas durante el
    periodo de tratamiento y al menos los 90 días posteriores a la
    última dosis de enzalutamida o al menos los 120 días posteriores
    a la última dosis de talazoparib (PF-06944076), aquello que ocurra
    más tarde. Los pacientes también deben aceptar el uso de
    métodos anticonceptivos adicionales altamente eficaces o dos
    métodos anticonceptivos eficaces cuando tengan relaciones
    sexuales con mujeres con posibilidad de quedarse embarazadas
    durante el periodo de tratamiento y al menos los 90 días
    posteriores a la última dosis de enzalutamida o al menos los
    120 días posteriores a la última dosis de talazoparib (PF06944076), aquello que ocurra más tarde.
    11. Deben aceptar abstenerse de donar esperma durante el periodo
    de tratamiento y al menos los 90 días posteriores a la última dosis
    de enzalutamida o al menos los 120 días posteriores a la última
    dosis de talazoparib (PF-06944076), aquello que ocurra más tarde.
    12. PSA ≥ 4 ng/mL en el momento del diagnóstico o antes de iniciar
    la terapia ADT.
    E.4Principal exclusion criteria
    1. Prior treatment with enzalutamide, apalutamide, darolutamide or
    abiraterone acetate.
    2. History of malabsorption syndrome or other condition that would interfere with enteral absorption or results in the inability or unwillingness to swallow pills.
    3. Known hypersensitivity to recombinant proteins, or any excipient contained in the drug formulation for talazoparib (PF-06944076) and enzalutamide.
    4. Prior systemic therapy for metastatic prostate cancer (mPCa).
    Note: Initiation of androgen deprivation therapy (ADT) within 4 weeks prior
    to study entry would be allowed (with or without first-generation
    antiandrogens), providing a tumor biopsy sample was taken prior to
    initiation of ADT is made available for biomarker studies and upon
    approval by the sponsor. If patient was started on first-generation
    antiandrogens, these would be discontinued on prior to randomization.
    Note: Patients relapsing after having received an ADT-based regimen in
    neoadjuvant or adjuvant setting will be suitable for the study if metastatic progression occured while on non-castrate testosterone levels or at least 12 months after discontinuation of ADT.
    5. Treatment with approved or investigational cancer therapy within 28 days (or 5 half-lives of the drug‒ whichever is longer) prior to initiation of study treatment.
    6. Known or suspected brain metastases or active leptomeningeal disease.
    7. Symptomatic or impending spinal cord compression or cauda equina
    syndrome.
    8. Subject has a history of seizure or any condition that may predispose to seizure (i.e. prior significant brain trauma, brain vascular malformations, ...), or subjects that have had unexplained loss of consciousness or transient ischemic attacks within 1 year prior to scheduled Day 1 of treatment.
    9. Therapeutic radiation therapy within 14 days (seven days for limited-field palliative radiotherapy) prior to study enrolment, or patients who have not recovered from radiotherapy-related toxicities to grade ≤ 1 according to National Cancer Insitute ́s Common Terminology Criteria for Adverse Events (NCI-CTCAE) version (v.)5.0.
    10. Major surgery (defined as requiring general anesthesia) or significant traumatic injury within 14 days of start of study drugs, or patients who have not recovered from the side effects of any major surgery.
    11. History of another malignancy within three years of study enrollment with the exception of carcinoma in situ, non-melanoma skin carcinoma, or American Joint Committee on Cancer stage 0 or stage 1 cancer that has a remote probability of recurrence in the opinion of the investigator and the Sponsor’s Medical Monitor is required, or any concurrent malignancy for which the patient is receiving therapy.
    12. Active uncontrolled infection at the time of enrollment.
    13. Congenital long QT syndrome or Electrocardiogram (ECG) at screening with QT interval corrected using Fridericia's formula (QTcF) > 500 milliseconds.
    14. Patients with clinically significant cardiovascular disease including but not limited to any of the following:
    a. Stroke, transient ischemic attack, unstable angina pectoris,
    or documented myocardial infarction within 12 months prior to study entry.
    b. Symptomatic pericarditis or clinically significant pericardial
    effusion or myocarditis.
    c. Documented congestive heart failure (New York Heart
    Association functional classification III- IV).
    d. Uncontrolled, persistent hypertension defined as systolic
    blood pressure > 170 mmHg or diastolic blood pressure > 100
    mmHg.
    15. Patients have any of the following cardiac conduction abnormalities:
    a. Ventricular arrhythmias except for benign premature
    ventricular contractions.
    b. Supraventricular and nodal arrhythmias requiring a
    pacemaker or not controlled with medication.
    c. Conduction abnormality requiring a pacemaker.
    d. Other cardiac arrhythmia not controlled with medication.
    16. Patients have any other concurrent severe and/or uncontrolled medical condition that would, in the Investigator’s judgment contraindicate patient participation in the clinical study.
    17. Treatment with estrogens, cyprotoerone acetate or glucocorticoids (at a dose greater than the equivalent to 10 mg/day of prednisone) in the 4 weeks prior to scheduled Day 1 of treatment.
    18. Investigator site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the investigator, or patients who are employees of the trial sponsor, including their family members, directly involved in the conduct of the study.
    19. Concurrent participation in other clinical trial, except other translational studies or observational studies (defined as those with no therapeutic intervention).
    1.Tratamiento anterior con enzalutamida, apalutamida, darolutamida o acetato de abiraterona.
    2.Antecedentes de síndrome de mala absorción u otra enfermedad que pudiera interferir en la absorción enteral o que causa incapacidad o falta de voluntad para tragar las pastillas.
    3.Hipersensibilidad conocida a las proteínas recombinantes o a cualquiera de los excipientes contenidos en la formulación de talazoparib(PF-06944076) y enzalutamida.
    4.Tratamiento sistémico anterior para el cáncer de próstata metastásico.
    Nota:Se permite el inicio de la terapia de privación de andrógenos (ADT) (con antiandrógenos de primera generación o sin ellos durante las 4 semanas anteriores al estudio siempre que se facilite una biopsia tumoral tomada antes de iniciar el ADT para estudios de biomarcadores y con la aprobación del promotor. Si el paciente ha iniciado el tratamiento con antiandrógenos de primera generación, se discontinuará este tratamiento antes de la aleatorización.
    Nota:Los pacientes recidivantes tras haber recibido un régimen basado en ADT en situación neoadyuvante o adyuvante serán aptos para el estudio si la progresión metastásica se ha producido con unos niveles de testosterona en rango de no castración o al menos 12 meses después de la discontinuación del ADT.
    5.Tratamiento antineoplásico aprobado o en investigación durante los 28 días anteriores (o 5 vidas medias del fármaco, el periodo que sea más largo) al inicio del tratamiento del estudio.
    6.Metástasis cerebrales o enfermedad leptomeníngea activa o sospecha de ello.
    7.Compresión de la médula espinal sintomática o inminente o síndrome de cauda equina.
    8.El sujeto presenta antecedentes de crisis u otras enfermedades que predispongan a las crisis (es decir, traumatismo cerebral significativo previo, malformaciones vasculares cerebrales,etc) o sujetos que hayan tenido pérdidas de consciencia o accidentes isquémicos transitorios sin causa aparente durante 1 año antes del día 1 de tratamiento planificado.
    9.Radioterapia terapéutica durante los 14 días anteriores al reclutamiento en el estudio (siete días si se trata de radioterapia paliativa de campo limitado) o pacientes que no se hayan recuperado de las toxicidades relacionadas con la radioterapia hasta el grado ≤1 según los CTCAE versión 5.0.
    10.Cirugía mayor o lesión traumática significativa durante los 14 días anteriores al inicio de los fármacos del estudio o pacientes que no se hayan recuperado de los efectos secundarios de alguna cirugía mayor.
    11.Antecedentes de otros tumores malignos durante los tres años anteriores al reclutamiento del estudio, a excepción de carcinoma in situ, cáncer de piel no melanocítico o cáncer de estadio 0 o estadio 1 según el AJCC que presente una probabilidad remota de recidiva a juicio del investigador y del monitor médico del promotor, u otros tumores malignos concurrentes para los que esté recibiendo tratamiento el paciente.
    12.Infección activa no controlada en el momento de la inclusión.
    13.Síndrome del segmento QT largo congénito o electrocardiograma (ECG) en la selección con intervalo QT corregido con la fórmula de Fridericia (QTcF) >500 milisegundos.
    14.Pacientes con enfermedad cardiovascular clínicamente relevante como, entre otras, las siguientes:
    a.Ictus, accidente isquémico transitorio, angina de pecho inestable o infarto de miocardio documentado durante los 12 meses anteriores a su entrada en el estudio.
    b.Pericarditis sintomática, o derrame pericárdico o miocarditis clínicamente significativos.
    c.Insuficiencia cardíaca congestiva documentada (clasificación funcional III-IV de la New York Heart Association).
    d.Hipertensión persistente no controlada definida como presión arterial sistólica >170 mmHg o presión arterial diastólica >100 mmHg.
    15.Pacientes con alguna de las siguientes anomalías de conducción cardíaca:
    e.Arritmias ventriculares excepto contracciones ventriculares prematuras benignas.
    f.Arritmias supraventriculares y nodales que requieran un marcapasos o no están controladas con medicación.
    g.Anomalía de conducción que requiere un marcapasos.
    h.Otra arritmia cardíaca que no está controlada con medicación.
    16.Pacientes con alguna otra patología no controlada o grave concurrente que, según el criterio del investigador, estaría contraindicada para su participación en el estudio clínico.
    17.Tratamiento con estrógenos, acetato de ciproterona o glucocorticoides (en una dosis superior a la equivalente a 10 mg/día de prednisona) durante las 4 semanas anteriores al día 1 de tratamiento planificado.
    18.Los miembros del equipo del centro investigador implicados directamente en la realización del estudio y sus familiares, miembros de la plantilla del centro supervisados de otro modo por el investigador o pacientes que sean empleados del promotor del ensayo, o sus familiares, implicados directamente en la realización del estudio.
    19.Participación concurrente en otro ensayo clínico, excepto en otros estudios traslacionales u observacionales
    E.5 End points
    E.5.1Primary end point(s)
    PSA-CR defined as the percentage of patients with PSA < 0.2 ng/mL at month 12 of therapy.
    RC-PSA definida como el porcentaje de pacientes con PSA <0,2 ng/ml
    en el mes 12 de tratamiento.
    E.5.1.1Timepoint(s) of evaluation of this end point
    at month 12 of therapy.
    en el mes 12 de tratamiento.
    E.5.2Secondary end point(s)
    • Rate of PSA complete response (CR) at any time point and at month 7
    (<0.2 ng/mL), PSA response (< 4ng/ml) at 7 and 12 months, PSAprogression-free survival (PSA-PFS) based on Prostate Cancer Working Group 3 (PCWG3) criteria (PSA ≥ 25% and ≥ 2 ng/mL from nadir confirmed by a second value obtained 3 or more weeks later), radiologic PFS (rPFS) based on Response Evaluation Criteria in Solid Tumors (RECIST) version (v.)1.1, time to castration resistance (TTCR), based on PSA-PFS and RECIST rPFS, and overall survival (OS).
    • Incidence of adverse events (AEs), incidence of prespecified AEs as per National Cancer Insitute’s Common Terminology Criteria for AdverseEvents (CTCAE) v.5.0, change from baseline in targeted vital signs, and change from baseline in targeted clinical laboratory test results.
    • Tasa de respuesta completa (RC) del PSA en cualquier momento
    y en el mes 7 (<0,2 ng/ml); respuesta del PSA (<4 ng/ml) en el
    mes 7 y en el 12; supervivencia libre de progresión PSA (PSAPFS) según los criterios del Prostate Cancer Working Group 3 (PCWG3) (PSA ≥25 % y ≥2 ng/ml desde la concentración mínima con confirmación por un segundo valor obtenido 3 o más semanas después); SLP radiológica (SLPr) basada en los criterios de evaluación de respuesta en tumores sólidos (RECIST) versión (v.) 1.1; tiempo hasta la resistencia a la castración (TRC), basado en PSA-SLP, SLPr según RECIST; y supervivencia global (SG).
    • Incidencia de acontecimientos adversos (AA), incidencia de AA
    predefinidos por los Criterios de terminología común de
    acontecimientos adversos del National Cancer Institute (CTCAE)
    versión 5.0, cambio respecto a la basal en las constantes vitales
    de referencia y cambio respecto a la basal en los resultados de las
    pruebas analíticas de referencia
    E.5.2.1Timepoint(s) of evaluation of this end point
    Time from randomization to disease progression.
    Desde la randomización hasta progresión de la enfermedad.
    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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled 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 concerned9
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    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
    EoS will occur at 12 months after the last patient included in the study, unless premature termination of the study.
    Se producirá 12 meses después del último paciente incluida en el estudio, salvo finalización prematura del estudio.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months5
    E.8.9.1In the Member State concerned days
    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: 20
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 34
    F.2 Gender
    F.2.1Female No
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state54
    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)
    Standard of care
    Práctica clínica habitual
    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 Decision2020-05-29
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-05-26
    P. End of Trial
    P.End of Trial StatusOngoing
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