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    Summary
    EudraCT Number:2019-003152-37
    Sponsor's Protocol Code Number:MK3475-A18/ENGOT-cx11
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    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 number2019-003152-37
    A.3Full title of the trial
    A Randomized, Phase 3, Double-Blind Study of Chemoradiotherapy With or Without Pembrolizumab for the Treatment of High-risk, Locally Advanced Cervical Cancer (KEYNOTE-A18 / ENGOT-cx11)
    Studio clinico randomizzato di fase III, in doppio cieco, volto a confrontare la chemioradioterapia più Pembrolizumab (MK-3475) versus la chemioradioterapia in soggetti con tumore alla cervice uterina localmente avanzato ad alto rischio (KEYNOTE-A18 / ENGOT-cx11)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Chemoradiotherapy With or Without Pembrolizumab for the Treatment of High-risk, Locally Advanced Cervical Cancer
    Chemioradioterapia più o senza Pembrolizumab per il trattamento del tumore alla cervice uterina localmente avanzato ad alto rischio
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    A.4.1Sponsor's protocol code numberMK3475-A18/ENGOT-cx11
    A.5.4Other Identifiers
    Name:KEYNOTE / ENGOTNumber:KEYNOTE-A18 / ENGOT-cx11
    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 number0039090636191371
    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. - Num. AIC: 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 Yes
    D.2.1.1.1Trade name Cisplatino
    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 nameCisplatino
    D.3.2Product code [-]
    D.3.4Pharmaceutical form Concentrate for solution for injection
    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 INNCISPLATINO
    D.3.9.1CAS number 15663-27-1
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit µg/ml microgram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    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 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 No
    D.IMP: 4
    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 Cisplatino
    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 nameCisplatino
    D.3.2Product code [-]
    D.3.4Pharmaceutical form Concentrate for solution for injection
    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 INNCISPLATINO
    D.3.9.1CAS number 15663-27-1
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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 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 No
    D.IMP: 5
    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 Cisplatin TEVA
    D.2.1.1.2Name of the Marketing Authorisation holderTEVA gmBH - n. AIC: 71983.00.00
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 Concentrate for solution for injection
    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 INNCISPLATINO
    D.3.9.1CAS number 15663-27-1
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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 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 No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    High-risk locally advanced cervical cancer
    Tumore della cervice ad alto rischio localmente avanzato
    E.1.1.1Medical condition in easily understood language
    Locally Advanced Cervical Cancer
    Tumore della cervice localmente avanzato
    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 10008229
    E.1.2Term Cervical cancer
    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 compare concurrent chemoradiotherapy plus pembrolizumab with concurrent chemoradiotherapy plus placebo with respect to progression free survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by blinded independent central review or by histopathologic confirmation of suspected local disease
    progression (in the absence of radiographic disease progression per RECIST 1.1)
    2. To compare concurrent chemoradiotherapy plus pembrolizumab with concurrent chemoradiotherapy plus placebo with respect to overall survival (OS)
    1. Confrontare la chemioradioterapia concomitante più pembrolizumab con la chemioradioterapia concomitante più il placebo in relazione alla sopravvivenza libera da progressione (PFS) secondo i criteri RECIST 1.1 valutati da un comitato di revisione centrale indipendente e in cieco o tramite conferma istopatologica di sospetta progressione della malattia locale (in assenza di progressione della malattia radiografica secondo RECIST 1.1)
    2. Confrontare la chemioradioterapia concomitante più pembrolizumab con la chemioradioterapia concomitante più il placebo in relazione alla sopravvivenza globale (OS)
    E.2.2Secondary objectives of the trial
    1. To compare concurrent chemoradiotherapy plus pembrolizumab with concurrent chemoradiotherapy plus placebo with respect to:
    - PFS at 2 years per RECIST 1.1
    - OS at 3 years
    - Complete response rate at 12 weeks per RECIST 1.1
    - Objective response rate per RECIST 1.1
    - OS and PFS per RECIST 1.1 by programmed cell death 1 ligand 1 (PDL1) status
    - PFS after next-line treatment (PFS 2) following discontinuation of study treatment administration
    - Change from baseline score in global quality of life and physical function using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
    - Change from baseline score in cervical cancer symptom experience using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Symptom Score for Cervical Cancer (EORTC CX24)
    2. To evaluate the safety and tolerability of pembrolizumab in combination with concurrent chemoradiotherapy
    1. Confrontare la chemioradioterapia concomitante più pembrolizumab con la chemioradioterapia concomitante più il placebo in relazione a:
    - PFS a 2 anni secondo i criteri RECIST 1.1
    - OS a 3 anni
    - tasso di risposta completa a 12 settimane secondo i criteri RECIST 1.1
    - tasso di risposta oggettiva secondo i criteri RECIST 1.1
    - OS e PFS secondo i criteri RECIST 1.1 per stato PD-L1
    - PFS dopo il trattamento di prima linea (sopravvivenza libera da progressione 2) dopo l’interruzione del trattamento sperimentale
    - variazione dal basale del punteggio di qualità della vita e funzionalità fisica di EORTC QLQ-C30, scala stato salute globale/qualità vita e sottoscala funzionalità fisica
    - variazione dal basale del punteggio relativo alla sperimentazione dei sintomi tramite lo EORTC-QLQ specifico ai sintomi per il carcinoma cervicale, scala specifica per i sintomi EORTC CX24
    2. Valutare la sicurezza e la tollerabilità di pembrolizumab in associazione alla chemioradioterapia concomitante
    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 and Tissue) 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 e tessuto) 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 high-risk LACC (a or b below):
    a. FIGO 2014 Stage IB2-IIB (with node-positive disease) – must meet criteria below for positive pelvic lymph node OR para-aortic lymph node involvement
    Pelvic lymph node involvement as assessed by one of the following criteria:
    - Histopathologic, biopsy-proven pelvic node involvement, or
    - 2 or more positive pelvic nodes by MRI or CT (>=1.5 cm shortest dimension), or
    - 2 or more positive pelvic nodes by PET / CT with SUV >=2.5 Para-aortic lymph node involvement as assessed by one of the following criteria:
    - Histopathologic, biopsy-proven para-aortic node involvement, or
    - 1 or more positive para-aortic nodes by MRI or CT (>=1.5 cm shortest dimension), or
    - 1 or more positive para-aortic nodes by PET / CT with SUV >=2.5
    b. FIGO 2014 Stages III-IVA (either node-positive or node-negative disease)
    2. Has histologically-confirmed squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix.
    3. Has not previously received any definitive surgical, radiation, or systemic therapy for cervical cancer and is immunotherapy-naïve.
    4. Has an ECOG performance status of 0 or 1 within 7 days prior to the first dose of study intervention
    5. Is female, at least 18 years of age at the time of signing the informed consent.
    6. 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 WOCBP
    OR
    - Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, 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
    pembrolizumab or placebo and 180 days following the end of chemoradiotherapy. 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 24 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
    7. The participant (or legally acceptable representative if applicable) provides written informed consent for the study. The participant may also provide consent for future biomedical research. However, the participant may participate in the main study without participating in future biomedical research.
    8. Has radiographically evaluable disease, either measurable or nonmeasurable per RECIST 1.1, as assessed by the local site investigator/radiology
    9. Has provided a tissue sample from a core or excisional biopsy of a tumor lesion for confirmation of adequacy by the central vendor prior to randomization. Formalin-fixed, paraffin embedded tissue blocks are preferred to slides
    10. Has adequate organ function. Specimens must be collected within 7 days prior to the start of study intervention
    1. Presenza di tumore della cervice uterina localmente avanzato (LACC) (a o b sotto):
    a. IB2-IIB secondo la classificazione FIGO 2014 (con malattia linfonodo-positiva) – deve soddisfare i criteri sottostanti per positività ai linfonodi pelvici OPPURE interessamento linfonodale para-aortico
    Interessamento dei linfonodi pelvici in base a uno dei seguenti criteri:
    - Interessamento dei linfonodi pelvici confermato da biopsia ed esame istopatologico, oppure
    - 2 o più linfonodi pelvici positivi alla RM o alla TC (=1,5 cm minimo), oppure
    - 2 o più linfonodi pelvici positivi alla PET / TC con SUV =2,5
    Interessamento dei linfonodi para-aortici in base a uno dei seguenti criteri:
    - Interessamento dei linfonodi para-aortici confermato da biopsia ed esame istopatologico, oppure
    - 1 o più linfonodi para-aortici positivi alla RM o alla TC (=1,5 cm minimo), oppure
    - 1 o più linfonodi para-aortici positivi alla PET / TC con SUV =2,5
    b. III-IVA secondo la classificazione FIGO 2014 (con malattia linfonodo-positiva o linfonodo-negativa)
    2. Presenza di carcinoma a cellule squamose confermato dall’esame istologico, adenocarcinoma o carcinoma adenosquamoso della cervice
    3. Assenza di precedente intervento chirurgico definitivo, radioterapia o terapia sistemica per il carcinoma cervicale e soggetto naïve all’immunoterapia. Nota: è ammessa una precedente procedura chirurgica per il tumore cervicale localizzato
    4. Performance status ECOG pari a 0 o 1 valutato nei 7 giorni precedenti la prima dose del trattamento sperimentale previsto dallo studio
    5. Soggetti di sesso femminile di età pari o superiore a 18 anni al momento della firma del consenso informato
    6. 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
    OPPURE
    • Essere una donna in età fertile e utilizzare un metodo contraccettivo altamente efficace (con un tasso di fallimento <1% all’anno), con scarsa dipendenza dell’utilizzatore, 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 pembrolizumab o placebo e 180 giorni dopo la conclusione della chemioradioterapia. Lo sperimentatore deve valutare la possibilità di fallimento del metodo contraccettivo (mancata compliance, iniziato di recente) in relazione alla prima dose del trattamento sperimentale.
    • Le donne in età fertile devono avere esito negativo al test di gravidanza ad alta sensibilità (eseguito su urine o siero secondo quanto stabilito dai regolam loc) nelle 24hr che precedono la 1a ds del trattam sperim.
    • Se non può essere confermata la negatività del test su urine (es.risultato ambiguo), è necessario eseguire test di gravid su siero. In tali casi, la pz deve essere escl da partecip se test di grav su siero positivo
    • Lo sperim è resp dell’analisi dell’anamnesi medica, di quella mestruale e dell’att sess recente per ridurre il rischio di incl nello stu di 1 donna in grav allo stadio iniz non rilevata
    7. Il partecip (o il rappr legalm riconosc, ove appl) fornisce il cons inform scritto per lo stu. Il partecip deve inoltre fornire il cons a partecip a future ricerche biomediche. Tuttavia, il sogg può partecipare allo stu princip senza partecipare a future ricerche biomediche
    8. Presenza di 1 malattia radiograficam valutab, misurab o non misurab tramite i crit RECIST v.1.1, valutata dal ricercatore/radiologo del centro
    9. Avere fornito 1 camp tissut ottenuto tramite biopsia con ago tranciante o escission di 1 lesione tumor per conferma dell’idoneità da parte del serv centr prima di randomizz. Preferibile 1 blocco di tess tum fissato in formalina e incl in paraffina rispetto al vetrino
    10. Avere una funzionalità d’organo adeguata. Si dovrà procedere al prel dei camp nei 7 gg precedenti l’inizio del trattam sperim
    E.4Principal exclusion criteria
    1. Has histological subtypes other than those allowed per inclusion criterion 2 (eg, sarcoma, small cell carcinoma with neuroendocrine differentiation, non-epithelial cancer).
    2. Has FIGO 2014 Stage IVB disease.
    3. Has undergone a previous hysterectomy defined as removal of the entire uterus or will have a hysterectomy as part of their initial cervical cancer therapy.
    4. Has bilateral hydronephrosis, unless at least one side has been stented or resolved by positioning of nephrostomy
    5. Has anatomy or tumor geometry or any other reason or contraindication that cannot be treated with intracavitary brachytherapy or a combination of intracavitary and interstitial brachytherapy
    6. Has received a live vaccine within 30 days prior to the first dose of study intervention. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, BCG, and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (eg, FluMist®) are live attenuated vaccines and are not allowed.
    7. Has received treatment with systemic immunostimulatory agents such as bacterial or viral vaccines, colony stimulating factors, interferons, interleukins and vaccine combinations within 6 weeks or 5 half-lives of the drug, whichever is shorter, prior to Cycle 1, Day 1.
    8. 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 recepto (eg, CTLA-4, OX-40, CD137).
    9. Has received prior systemic anticancer therapy including investigational agents within 4 weeks prior to randomization.
    10. 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 randomization
    11. Has any contraindication to the use of cisplatin.
    12. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study medication.
    13. Has a known additional malignancy that is progressing or has required active treatment within the past 3 years.
    14. Has severe hypersensitivity (=Grade 3) to pembrolizumab and/or any of its excipients.
    15. Has an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic
    treatment and is allowed.
    16. Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
    17. Has an active infection requiring systemic therapy.
    18. Has a known history of HIV infection.
    19. Has a known history of Hepatitis B (defined as HBsAg reactive) or known active Hepatitis C virus (defined as HCV RNA [qualitative] is detected) infection.
    20. Has a known history of active tuberculosis (TB; Bacillus tuberculosis).
    For remaining criteria refer to protocol
    1. Avere sottotipi istologici diversi da quelli consentiti in base al criterio di inclusione 2 (ad es. sarcoma, carcinoma a piccole cellule con differenziamento neuroendocrino, cancro non epiteliale).
    2. Malattia allo stadio IVB secondo la classificazione FIGO 2014.
    3. Essere stati sottoposti a precedente isterectomia definita come la rimozione dell’intero utero o avere un’isterectomia programmata all’interno della terapia iniziale per il carcinoma. NOTA: le donne che hanno subito un’isterectomia parziale/subtotale per motivi diversi dal carcinoma cervicale possono partecipare allo studio.
    4. Presenza di idronefrosi bilaterale, salvo in caso di posizionamento di stent da almeno un lato o di risoluzione con nefrostomia.
    5. Avere un’anatomia o geometria del tumore o qualsiasi altra ragione di controindicazione che non può essere trattata con brachiterapia intracavitaria o una combinazione di brachiterapia intracavitaria e interstiziale
    6. Essere stati vaccinati con vaccino vivo nei 30 giorni precedenti la prima dose del trattamento in studio. Alcuni esempi di vaccini vivi comprendono, in via esemplificativa, i vaccini per morbillo, parotite, rosolia, varicella, febbre gialla, rabbia, tubercolosi (BCG) e tifo. I vaccini antinfluenzali stagionali per via iniettiva sono solitamente vaccini inattivati e sono consentiti; i vaccini antinfluenzali intranasali (ad es. FluMist®) sono invece vaccini vivi attenuati e non sono consentiti.
    7. Avere ricevuto un trattamento con agenti immunostimolanti sistemici come i vaccini batterici o virali, fattori stimolanti le colonie, interferoni, interleuchine e associazioni di vaccini nelle 6 settimane o 5 emivite del farmaco, a seconda di quale sia il più breve, prima del Ciclo 1, Giorno 1
    8. Pregressa terapia a base di un agente anti-PD-1, anti-PD-L1 o anti-PD-L2 o di un agente diretto contro un altro recettore delle cellule T co-inibitorio o stimolatorio (ad es. CTLA-4, OX-40, CD137).
    9. Precedente terapia antitumorale sistemica tra cui gli agenti sperimentali nelle 4 settimane precedenti la randomizzazione.
    10. Partecipazione attuale o pregressa a uno studio su un farmaco sperimentale o utilizzo di un dispositivo sperimentale nelle 4 settimane precedenti la randomizzazione
    11. Presentare qualsiasi controindicazione all’uso di cisplatino.
    12. Avere una diagnosi di immunodeficienza o trattamento cronico con steroidi sistemici (in dosi superiori a 10 mg/die di un equivalente del prednisolone) o qualsiasi altra forma di terapia immunosoppressiva nei 7 giorni precedenti la prima dose del trattamento sperimentale.
    13. Avere un ulteriore tumore maligno noto in progressione o che ha richiesto un trattamento attivo negli ultimi 3 anni.
    Nota: i partecipanti con carcinoma basocellulare della cute, carcinoma squamocellulare della cute o carcinoma in situ (ad es. carcinoma mammario, cancro cervicale in situ) trattato con una terapia potenzialmente curativa non sono esclusi.
    14. Avere una grave ipersensibilità (= grado 3) a pembrolizumab e/o a uno qualsiasi dei suoi eccipienti.
    15. Malattia autoimmune attiva che ha richiesto il trattamento sistemico negli ultimi 2 anni (uso di agenti modificanti la malattia, corticosteroidi o farmaci immunosoppressori). La terapia di sostituzione (ad es. terapia di sostituzione con tiroxina, insulina o corticosteroidi fisiologici in caso di insufficienza ipofisaria o surrenalica) non è considerata una forma di trattamento sistemico.
    16. Anamnesi di polmonite (non infettiva) che ha richiesto il trattamento con steroidi, o polmonite in corso.
    17. Infezione attiva che richiede una terapia sistemica.
    18. Anamnesi nota positiva per infezione da HIV.
    19. Anamnesi nota di epatite B (HBsAg reattivo) o epatite C nota in atto (determinazione [qualitativa] dell’RNA del virus dell’epatite C [HCV RNA]).
    20. Anamnesi nota di tubercolosi attiva (TB; Bacillus tuberculosis).
    Per i restanti criteri fare riferimento al Protocollo
    E.5 End points
    E.5.1Primary end point(s)
    1. Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    2. Overall Survival (OS)
    1. Sopravvivenza libera da progressione (PFS) secondo i criteri di valutazione di risposta nei tumori solidi Versione 1.1 (RECIST 1.1)
    2. Sopravvivenza globale (OS)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 38 months
    2. Up to approximately 46 months
    1. Fino a circa 38 mesi
    2. Fino a circa 46 mesi
    E.5.2Secondary end point(s)
    1. Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) at Month 24
    2. Overall Survival (OS) at Month 36
    3. Complete Response (CR) Rate Per Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST 1.1) at Week 12
    4. Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    5. Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) in Programmed Cell Death 1 Ligand 1 (PD-L1) Positive Participants
    6. Overall Survival (OS) in Programmed Cell Death 1 Ligand 1 (PD-L1) Positive Participants
    7. Progression-Free Survival (PFS) After Next-Line Treatment (PFS 2) Following Discontinuation of Study Treatment
    8. Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQC30) Global Health Status Score
    9. Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQC30) Physical Function Score
    10. Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Symptom Specific Scale for Cervical Cancer (EORTC QLQ-CX24) Score
    11. Number of Participants Who Experience One or More Adverse Events (AEs)
    12. Number of Participants Who Discontinue Study Treatment Due to an Adverse Event (AE)
    1. Sopravvivenza libera da progressione (PFS) a 2 anni secondo i criteri di valutazione di risposta nei tumori solidi Versione 1.1 (RECIST 1.1)
    2. Sopravvivenza globale (OS) a 3 anni
    3. Tasso di Risposta Completa (CR) a 12 settimane secondo i criteri di valutazione di risposta nei tumori solidi Versione 1.1 (RECIST 1.1)
    4. Tasso di Risposta Obiettiva (ORR) secondo i criteri di valutazione di risposta nei tumori solidi Versione 1.1 (RECIST 1.1)
    5. Sopravvivenza libera da progressione (PFS) secondo i criteri di valutazione di risposta nei tumori solidi Versione 1.1 (RECIST 1.1) in partecipanti positivi al PD-L1
    6. Sopravvivenza globale (OS) in partecipanti positivi al PD-L1
    7. Sopravvivenza libera da progressione (PFS) dopo linea successiva di trattamento (PFS 2) seguita da interruzione del trattamento di studio
    8. variazione dal basale del punteggio di qualità della vita dello European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30),
    9. variazione dal basale del punteggio di funzionalità fisica dello European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
    10. variazione dal basale del punteggio relativo alla sperimentazione dei sintomi per il carcinoma cervicale tramite lo European Organization for Research and Treatment of Cancer Quality of Life Questionnaire su scala specifica per i sintomi EORTC CX24
    11. Numero di Partecipanti che manifestano uno o più eventi avversi (AEs)
    12. Numero di Partecipanti che hanno interrotto il trattamento di studio a causa di un evento avverso (AE)
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 38 months
    2. Up to approximately 46 months
    3. Up to approximately 38 months
    4. Up to approximately 46 months
    5. Up to approximately 38 months
    6. Up to approximately 46 months
    7. Up to approximately 46 months
    8. Baseline and up to approximately 46 months
    9. Baseline and up to approximately 46 months
    10. Baseline and up to approximately 46 months
    11. Up to approximately 46 months
    12. Up to approximately 46 months
    1. Fino a circa 38 mesi
    2. Fino a circa 46 mesi
    3. Fino a circa 38 mesi
    4. Fino a circa 46 mesi
    5. Fino a circa 38 mesi
    6. Fino a circa 46 mesi
    7. Fino a circa 46 mesi
    8. Basale e fino a circa 46 mesi
    9. Basale e fino a circa 46 mesi
    10. Basale e fino a circa 46 mesi
    11. Fino a circa 46 mesi
    12. Fino a circa 46 mesi
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) 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) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    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) No
    E.8.2.2Placebo Yes
    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 concerned10
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA63
    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
    Brazil
    Canada
    Chile
    China
    Colombia
    Guatemala
    Israel
    Japan
    Korea, Republic of
    Peru
    Russian Federation
    Taiwan
    Thailand
    Turkey
    Ukraine
    United States
    Austria
    Belgium
    Czechia
    Denmark
    France
    Germany
    Greece
    Hungary
    Ireland
    Italy
    Norway
    Spain
    Sweden
    United Kingdom
    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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years0
    E.8.9.1In the Member State concerned months63
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years0
    E.8.9.2In all countries concerned by the trial months63
    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: 833
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 147
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    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 state58
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 342
    F.4.2.2In the whole clinical trial 980
    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
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation European Network of Gynaecological Oncological Trial groups (ENGOT)
    G.4.3.4Network Country Italy
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-04-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-03-19
    P. End of Trial
    P.End of Trial StatusOngoing
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