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    Summary
    EudraCT Number:2019-003593-17
    Sponsor's Protocol Code Number:BNT411-01
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2020-01-10
    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 number2019-003593-17
    A.3Full title of the trial
    Phase 1/2a, first-in-human, open-label, dose-escalation trial with expansion cohorts to evaluate safety, pharmacokinetics, pharmacodynamics, and preliminary efficacy of BNT411 as a monotherapy in patients with solid tumors and in combination with atezolizumab, carboplatin and etoposide in patients with chemotherapy-naïve extensive-stage small cell lung cancer (ES-SCLC)
    Estudio de fase I/IIa sin enmascaramiento, de aumento de la dosis y realizado por primera vez con pacientes humanos, con cohortes de prolongación para evaluar la seguridad, la farmacocinética, la farmacodinámica y la eficacia preliminar de BNT411 como monoterapia en pacientes con tumores sólidos y en combinación con atezolizumab, carboplatino y etopósido en pacientes con carcinoma microcítico de pulmón en estadio extendido (CMP-EE) que no hayan recibido nunca quimioterapia
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to investigate the safety and efficacy of BNT411 in cancer patients with solid tumor types. The study will also assess the safety and efficacy of BNT411 when taken on its own and in combination with standard chemotherapy treatments in patients with late stage small cell lung cancer who have not taken chemotherapy before.
    Estudio para investigar la seguridad y la eficacia de BNT411 en pacientes oncológicos con tipos de tumores sólidos. En el estudio también se evaluarán la seguridad y la eficacia de BNT411 cuando se toma en monoterapia y en combinación con los tratamientos quimioterápicos habituales en pacientes con carcinoma de pulmón microcítico en estadio tardío que no hayan recibido quimioterapia con anterioridad.
    A.4.1Sponsor's protocol code numberBNT411-01
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04101357
    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 SponsorBioNTech Small Molecules GmbH
    B.1.3.4CountryGermany
    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 supportBioNTech Small Molecules GmbH
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationBioNTech Small Molecules GmbH
    B.5.2Functional name of contact pointClinical Trials Information
    B.5.3 Address:
    B.5.3.1Street AddressAn der Goldgrube 12
    B.5.3.2Town/ cityMainz
    B.5.3.3Post code55131
    B.5.3.4CountryGermany
    B.5.4Telephone number+349327460004916
    B.5.5Fax number+49 6131 – 9084 – 390
    B.5.6E-mailsecretariuitm@vhio.net
    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 nameBNT411
    D.3.4Pharmaceutical form Concentrate for 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 INNNot applicable
    D.3.9.1CAS number 2296821-50-4
    D.3.9.2Current sponsor codeBNT411
    D.3.9.3Other descriptive nameBNT411
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.25
    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 Yes
    D.2.1.1.1Trade name Tecentriq
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Concentrate for 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 INNATEZOLIZUMAB
    D.3.9.1CAS number 1380723-44-3
    D.3.9.4EV Substance CodeSUB178312
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number3.2 to 16.8
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product 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 Yes
    D.3.11.13.1Other medicinal product typeAtezolizumab is an Fc-engineered, humanised IgG1 anti-programed death-ligand 1 (PD-L1) monoclonal antibody produced in Chinese hamster ovary cells by recombinant DNA technology
    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 Carboplatin
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 Concentrate for 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 INNCarboplatin
    D.3.9.1CAS number 41575-94-4
    D.3.9.3Other descriptive nameCARBOPLATIN
    D.3.9.4EV Substance CodeSUB06614MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    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 Yes
    D.3.11.13.1Other medicinal product typeCarboplatin is a small molecule antineoplastic alkylating agent
    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 Etoposide
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 Concentrate for 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 INNEtoposide
    D.3.9.1CAS number 33419-42-0
    D.3.9.3Other descriptive nameETOPOSIDE
    D.3.9.4EV Substance CodeSUB07337MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 Yes
    D.3.11.13.1Other medicinal product typeEtoposide is a small molecule semisynthetic derivative of podophyllotoxin.
    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
    Chemotherapy-naïve extensive-stage small cell lung cancer
    Carcinoma de pulmón microcítico en estadio extendido sin quimioterapia previa
    E.1.1.1Medical condition in easily understood language
    Patients with late stage advanced lung cancer of the small cell type who have not taken chemotherapy treatment before.
    Pacientes con carcinoma de pulmón avanzado en estadio tardío de tipo microcítico que no han recibido tratamiento quimioterápico con anterioridad.
    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 10041068
    E.1.2Term Small cell lung cancer extensive stage
    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 LLT
    E.1.2Classification code 10049280
    E.1.2Term Solid tumour
    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 assess the safety profile and determine the maximum tolerated dose (MTD) and/or recommended phase 2 dose (RP2D) of BNT411 in a mixed population of patients with solid tumors.
    Evaluar el perfil de seguridad y determinar la dosis máxima tolerada (DMT) y/o la dosis recomendada para la fase II (DRFII) de BNT411 en una población mixta de pacientes con tumores sólidos.
    E.2.2Secondary objectives of the trial
    To establish the PK profile and evaluate the anti-tumor activity of BNT411 according to RECIST 1.1.
    Establecer el perfil de FC y evaluar la actividad antitumoral de BNT411 de conformidad con los criterios RECIST 1.1.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    For Part 1A:
    1. Histologically confirmed solid tumor (cytology is allowed for non small cell lung cancer (NSCLC), small cell lung cancer (SCLC) and pancreatic cancer) that is metastatic or unresectable and for which there is no available standard therapy likely to confer clinical benefit, or patients who are not candidates for such available therapy.

    For Part 1B:
    2. Histologically or cytologically confirmed extensive stage small cell lung cancer (ES-SCLC)(per the Veterans Administration Lung Study Group [VALG] staging system) who received no prior chemotherapy for extensive stage disease.
    3. Those treated with prior chemo/radiotherapy with curative intent for limited stage small cell lung cancer (LS-SCLC) should be treatment-free for at least 6 months since last chemo/radiotherapy.
    4. No interstitial lung disease or active, non-infectious pneumonitis.

    For Both Part 1A and Part 1B
    5. Male and female ≥ 18 years of age.
    6. Must sign an ICF indicating that he or she understands the purpose of and procedures required for the trial and are willing to participate in the trial prior to any trial related assessments or procedures.
    7. ECOG performance status of 0 to 1.
    8. Measurable disease according to RECIST 1.1.
    9. Albumin level at screening ≥3 mg/dL.
    10. Adequate coagulation function at Screening as determined by:
    a. International normalized ratio (INR) or prothrombin time ≤1.5 x upper limit normal (ULN; unless on therapeutic anticoagulants with values within therapeutic window).
    b. Activated partial thromboplastin time (aPTT) ≤1.5 x ULN (unless on therapeutic anticoagulants with values within therapeutic window).
    11. Adequate hematologic function at Screening as determined by:
    a. White blood count (WBC) ≥3 x 10^9/L,
    b. Absolute neutrophil count (ANC) ≥1.5 x 10^9/L (patient may not use granulocyte-colony stimulating factor (G-CSF) or granulocyte-macrophage colony stimulating factor (GMCSF) to achieve these WBC and ANC levels),
    c. Platelet count ≥100 x 10^9/L,
    d. Hemoglobin (Hgb) ≥9.0 g/dL (may not transfuse or use erythropoietin to obtain this Hgb level).
    12. Adequate hepatic function at Screening as determined by:
    a. Total bilirubin ≤ 1.5 mg/dL (or ≤ 2.0 mg/dL for patients with known Gilbert's syndrome),
    b. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x ULN; or ≤5 x ULN in patients with metastatic liver disease.
    13. Adequate renal function at Screening as determined by:
    a. Glomerular filtration rate (GFR) ≥ 60 mL/min/1.73 m²– e.g. according to the abbreviated Modification of Diet in Renal Disease (MDRD) equation:
    GFR = 186 × (SCr^-1.154) × (age^-0.203)
    (where SCr, the serum creatinine level, is expressed in mg/dL; multiplied by 0.742 if the patient is female; multiplied by 1.212, if the patient is African-American.
    14. Able to attend trial visits as required by the protocol.
    15. Women of childbearing potential (WOCBP) must have a negative serum (beta-human chorionic gonadotropin [beta-hCG]) test/value at Screening. Patients who are postmenopausal or permanently sterilized (See section 10.4 of the protocol) can be considered as not having reproductive potential.
    16. WOCBP must agree not to donate eggs (ova, oocytes) for the purposes of assisted reproduction during the entire trial, until 6 months after last BNT411 treatment.
    17. A man who is sexually active with a woman of childbearing potential and has not had a vasectomy must agree to use a barrier method of birth control, e.g. either condom with spermicidal foam/gel/film/cream/suppository or partner with occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository, and all men must also not donate sperm during the trial and for 6 months after receiving the last dose of BNT411 (refer to Section 10.4 of the protocol for information on effective contraceptive methods).
    18. All patients must provide an FFPE (Formalin Fixed Paraffin Embedded) from the latest available archival tumor tissue. If such tissue cannot be provided, the sponsor’s approval of enrollment is needed.
    Para la parte 1A:
    1. Tumor sólido confirmado histológicamente (se admite citología en CPNM, CMP y cáncer de páncreas) metastásico o inoperable y para el que no haya tratamiento habitual que ofrezca beneficio clínico o pacientes que no sean candidatos a recibir dicho tratamiento.
    Para la parte 1B:
    2. CMP-ES confirmado histológicamente o por citología (según el sistema de estadios del VALG —Veterans Administration Lung Study Group—) sin quimioterapia previa para el cáncer en estadio extendido.
    3. Los pacientes tratados con quimioterapia o radioterapia anteriormente para eliminar el carcinoma microcítico de pulmón en estadio limitado (CMP-EL) deben estar sin tratamiento durante al menos 6 meses desde la última sesión de quimio/radioterapia.
    4. Ausencia de enfermedad pulmonar intersticial o neumonía no infecciosa activa.
    Tanto para la parte 1A como para la parte 1B
    5. Hombres y mujeres ≥18 años.
    6. Deben firmar un FCI en el que se indique que entienden la finalidad del estudio y los procedimientos necesarios para llevarlo a cabo y estar dispuestos a participar en el estudio antes de iniciarse cualquier evaluación o procedimiento asociados al mismo.
    7. Estado funcional ECOG de 0 o 1.
    8. Enfermedad mensurable con arreglo a los criterios RECIST 1.1.
    9. Concentración de albúmina ≥3 mg/dl en la selección.
    10. Actividad coagulatoria satisfactoria en la selección determinada por:
    a. cociente internacional normalizado (CIN) o tiempo de protrombina ≤1,5 veces el límite superior de la normalidad (LSN), a menos que tome anticoagulantes dentro del margen terapéutico,
    b. tiempo de tromboplastina parcial activado (TTPa) ≤1,5 veces el límite superior de la normalidad (LSN), a menos que tome anticoagulantes dentro del margen terapéutico.
    11. Actividad hematológica satisfactoria en la selección determinada por:
    a. cifra de leucocitos ≥3 × 109/l,
    b. recuento absoluto de neutrófilos (RAN) ≥1,5 × 109/l (el paciente no puede utilizar factor estimulante de las colonias de granulocitos [G-CSF] ni factor estimulante de las colonias de granulocitos y macrófagos [GM-CSF] para alcanzar dicha concentración de leucocitos y RAN),
    c. cifra de plaquetas ≥100 × 109/l,
    d. hemoglobina (Hb) ≥9,0 g/dl (no pueden realizarse transfusiones ni usarse eritropoyetina para alcanzar dicha concentración de Hb).
    12. Actividad hepática satisfactoria en la selección determinada por:
    a. bilirrubina total ≤1,5 mg/dl (o ≤2,0 mg/dl en el caso de pacientes con síndrome de Gilbert conocido),
    b. aspartato-aminotransferasa (AST) y alanina-aminotransferasa (ALT) ≤2,5 veces el LSN o ≤5 veces el LSN en pacientes con metástasis hepática.
    13. Actividad renal satisfactoria en la selección determinada por:
    a. filtración glomerular (FG) ≥60 ml/min/1,73 m², por ejemplo, según la ecuación de la modificación de la dieta en enfermedad renal (MDRD) abreviada:
    FG = 186 × (CrS^-1,154) × (edad^-0,203) (donde CrS, la concentración de creatinina sérica, se expresa en mg/dl;
    multiplicado por 0,742 si el paciente es mujer y multiplicado por 1,212 si el paciente es afroamericano.
    14. Deben poder asistir a las visitas del estudio conforme a lo exigido en el protocolo.
    15. Las mujeres en edad fértil (MEF) deben obtener un resultado negativo en una prueba en suero (subunidad β de la gonadotropina coriónica humana [β-hCG]) en la selección. Las pacientes posmenopáusicas o esterilizadas de forma permanente (véase el apartado 10.4 del protocolo) pueden considerarse sin capacidad reproductiva.
    16. Las MEF deben acceder a no donar óvulos (ovocitos) para reproducción asistida durante todo el estudio, hasta que hayan transcurrido 6 meses desde el último tratamiento con BNT411.
    17. Los hombres que mantengan relaciones sexuales con una mujer en edad fértil y no se hayan sometido a una vasectomía deben acceder a usar un método anticonceptivo de barrera, por ejemplo, un preservativo con espuma, gel, película, crema o supositorio espermicida, o su pareja debe usar un capuchón oclusivo (diafragma o capuchón cervicouterino/cúpula vaginal) con espuma, gel, película, crema o supositorio espermicida. Además, todos los hombres deben abstenerse de donar semen durante el estudio y durante los 6 meses siguientes a la última dosis de BNT411 (véase el apartado 10.4 del protocolo para obtener información sobre métodos anticonceptivos eficaces).
    18. Todos los pacientes deben proporcionar una muestra FFIP (fijada en formol e incluida en parafina) del tejido tumoral de archivo disponible más reciente. Si no puede facilitarse dicho tejido, será necesario que el promotor autorice la inclusión del paciente.
    E.4Principal exclusion criteria
    1. Has received prior systemic therapy with a TLR7 agonist.
    2. Has been receiving: radiotherapy, chemotherapy, or molecularly-targeted agents or tyrosine kinase inhibitors within 2 weeks or 5 half-lives (whichever is longer) of the start of trial treatment; immunotherapy/monoclonal antibodies within 3 weeks of the start of trial treatment; nitrosoureas, antibody-drug conjugates, or radioactive isotopes within 6 weeks of the start of trial treatment.
    3. Receives concurrent systemic (oral or intravenous) steroid therapy >10 mg prednisone daily or its equivalent for an underlying condition.
    4. Receives concurrent strong inhibitors or inducers of the cytochrome P450 enzymes.
    5. Has had major surgery within the 4 weeks before the first dose of BNT411
    6. Has ongoing or active infection requiring intravenous treatment with anti-infective therapy that has been administered less than two weeks prior to first dose of trial treatment.
    7. Has side effects of any prior therapy or procedures for any medical condition not recovered to NCI CTCAE v.5 Grade ≤1
    8. Current evidence of new or growing brain or leptomeningeal metastases during screening. Patients with known brain or leptomeningeal metastases may be eligible if they:
    a. had radiotherapy, surgery or stereotactic surgery for the brain or leptomeningeal metastases,
    b. have no neurological symptoms (excluding Grade ≤2 neuropathy),
    c. have stable brain or leptomeningeal disease on the CT or MRI scan within 4 weeks before signing the informed consent,
    d. are not undergoing acute corticosteroid therapy or steroid taper.
    9. Has history of seizures other than isolated febrile seizure in childhood; has a history of a cerebrovascular accident or transient ischemic attack less than 6 months ago.
    10. Has effusions (pleural, pericardial, or ascites) requiring drainage.
    11. Has eye pathology likely to confound observation of potential ocular AEs.
    12. Has a fever ≥38°C within 3 days before signing the ICF.
    13. Has a history of autoimmune disease active or past including but not limited to inflammatory bowel disease, systemic lupus erythematosus (SLE), ankylosing spondylitis, scleroderma, or multiple sclerosis. Has any active immunologic disorder requiring immunosuppression with steroids or other immunosuppressive agents (see protocol for further details).
    14. Known history of seropositivity for human immunodeficiency virus (HIV) with CD4+ T-cell (CD4+) counts <350 cells/uL and with a history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic infections.
    15. Known history/positive serology for hepatitis B requiring active anti-viral therapy (unless immune due to vaccination or resolved natural infection or unless passive immunization due to immunoglobulin therapy). Patients with positive serology must have Hepatitis B virus (HBV) viral load below the limit of quantification.
    16. Active Hepatitis C virus (HCV) infection; patients who have completed curative antiviral treatment with HCV viral load below the limit of quantification are allowed.
    17. Has a known hypersensitivity to a component of BNT411 drug product, or another similar compound.
    18. Has another primary malignancy that has not been in remission for at least 2 years, with the exception of those with a negligible risk of metastasis or death (such as adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer, or ductal carcinoma in situ)
    19. Has abnormal electrocardiograms (ECGs) that are clinically significant, such as Framingham-corrected QT interval >480 ms.
    20. In the opinion of the treating investigator, has any concurrent conditions that could pose an undue medical hazard or interfere with the interpretation of the trial results; these conditions include, but are not limited to:
    a. ongoing or active infection requiring antibiotic/antiviral/antifungal therapy,
    b. concurrent congestive heart failure (New York Heart Association [NYHA] Functional Classification Class III or IV),
    c. concurrent unstable angina,
    d. concurrent cardiac arrhythmia requiring treatment (excluding asymptomatic atrial fibrillation),
    e. acute coronary syndrome within the previous 6 months,
    f. significant pulmonary disease (shortness of breath at rest or on mild exertion) for example due to concurrent severe obstructive pulmonary disease.
    21. Has a cognitive, psychological or psychosocial impediment that would impair the ability of the patient to receive therapy according to the protocol or adversely affect the ability of the patient to comply with the informed consent process, protocol, or protocol-required visits and procedures.
    22. Is pregnant or breastfeeding.
    1. Haber recibido tratamiento sistémico previo con un agonista del TLR7.
    2. Haber estado recibiendo: radioterapia, quimioterapia, fármacos con dianas moleculares específicas o inhibidores de las tirosina-cinasas en las 2 semanas o 5 semividas (el de mayor duración) anteriores al inicio del tratamiento del estudio; inmunoterapia/anticuerpos monoclonales en las 3 semanas anteriores al inicio del tratamiento del estudio; nitrosoureas, conjugados de anticuerpo y fármaco o isótopos radioactivos en las 6 semanas anteriores al inicio del tratamiento del estudio.
    3. Estar recibiendo tratamiento con corticoesteroides sistémicos (por vía oral o intravenosa) con >10 mg de prednisona diaria o su equivalente para una enfermedad subyacente.
    4. Estar recibiendo inhibidores o inductores potentes de las principales enzimas del citocromo P450.
    5. Haberse sometido a cirugía mayor en las 4 semanas anteriores a la primera dosis de BNT411.
    6. Padecer una infección continua o activa que requiera tratamiento intravenoso con antibióticos administrado menos de dos semanas antes de la primera dosis del tratamiento del estudio.
    7. Presentar efectos secundarios de un tratamiento o procedimiento anterior para un problema médico no recuperado a grado ≤1 según los criterios NCI CTCAE v.5.
    8. Presentar signos de metástasis cerebrales o leptomeníngeas nuevas o en crecimiento durante la selección. Los pacientes con metástasis cerebrales o
    leptomeníngeas conocidas podrán cumplir los requisitos para participar en el estudio si : (ver protocolo)
    9. Tener antecedentes de convulsiones, salvo convulsiones febriles aisladas durante la infancia; haber sufrido un accidente cerebrovascular o un accidente isquémico transitorio menos de 6 meses antes.
    10. Sufrir derrames (pleurales, pericárdicos o ascitis) que requieran drenaje.
    11. Padecer una patología ocular que probablemente dificulte la observación de posibles AA oculares.
    12. Tener fiebre ≥38 °C en los 3 días previos a la firma del FCI.
    13. Tener antecedentes o presencia activa de enfermedad autoinmunitaria, incluidas, entre otras, la enfermedad inflamatoria intestinal, el lupus eritematoso sistémico (LES), la espondilitis anquilosante, la esclerodermia y la esclerosis múltiple. Padecer cualquier trastorno inmunitario activo que requiera inmunodepresión con corticoides o con otros inmunodepresores (consulte el protocolo para saber más detalles).
    14. Tener antecedentes conocidos de seropositividad para el virus de la inmunodeficiencia humana (VIH) con cifras de linfocitos T CD4+ <350 células/μl y de infecciones oportunistas definitorias del síndrome de inmunodeficiencia adquirida (SIDA).
    15. Tener antecedentes conocidos/resultado positivo en las pruebas serológicas de la hepatitis B que requieran tratamiento antivírico activo (salvo que el paciente sea inmune por haberse vacunado, por infección natural ya resuelta o por inmunización pasiva debida a un tratamiento con inmunoglobulinas). En los pacientes con resultado positivo en las pruebas serológicas, la concentración del virus de la hepatitis B (VHB) debe estar por debajo del límite de cuantificación.
    16. Padecer infección activa por el virus de la hepatitis C (VHC); se permite la participación de pacientes que hayan terminado un tratamiento antivírico curativo y tengan una concentración del VHC por debajo del límite de cuantificación.
    17. Tener hipersensibilidad conocida a algún componente del medicamento BNT411 u otro compuesto similar.
    18. Tener otra neoplasia maligna primaria que no haya permanecido en remisión durante un mínimo de 2 años, salvo aquellas con un riesgo insignificante de metástasis o muerte (como el carcinoma cervicouterino localizado, el carcinoma cutáneo basocelular o epidermoide, el cáncer de próstata localizado o el carcinoma ductal localizado satisfactoriamente tratados).
    19. Presentar anomalías en el electrocardiograma (ECG) clínicamente significativas, como un intervalo QT corregido mediante la fórmula de Framingham >480 ms.
    20. Padecer, en opinión del investigador, enfermedades simultáneas que podrían suponer un riesgo médico excesivo o interferir en la interpretación de los resultados del estudio; algunos ejemplos de dichas enfermedades son:
    a. infección persistente o activa que requiera tratamiento antibiótico, antivírico o antifúngico,
    b. insuficiencia cardíaca congestiva simultánea (de clase III o IV de acuerdo con la clasificación funcional de la New York Heart Association [NYHA]),
    c. angina inestable simultánea,
    d. e. f. Ver protocolo
    21. Tener un trastorno cognitivo, psicológico o psicosocial que alteraría la capacidad del paciente para recibir tratamiento de conformidad con
    el protocolo o que afectaría negativamente a la capacidad del paciente para cumplir con el proceso de consentimiento informado, el protocolo o las visitas y procedimientos exigidos por el protocolo.
    22. Estar embarazada o en periodo de lactancia.
    E.5 End points
    E.5.1Primary end point(s)
    -Occurrence of dose limiting toxicities (DLTs) within a patient during the DLT evaluation period
    -Occurrence of treatment-emergent adverse events (TEAEs) within a patient including grade ≥3, serious, fatal TEAE by relationship
    -Occurrence of dose reduction and discontinuation of IMP within a patient due to treatment emergent adverse events (TEAE)
    -MTD –defined as the highest tolerated dose
    -Recommended phase 2 dose (RP2D) based on integrated evaluation of safety, tolerability, clinical benefit, Pharmacokinetic (PK), and Pharmacodynamic (PD) data, for all dose levels tested.
    - La incidencia de la TLD en un paciente durante el periodo de evaluación de la TLD.
    - La incidencia de los AAST en un paciente, incluidos los de grado ≥3, graves y mortales por relación.
    - La incidencia de la reducción de la dosis y la suspensión del PEI en un paciente por causa de los AAST.
    - La DMT definida como la dosis más elevada tolerada.
    - La DRFII basada en la evaluación conjunta de la seguridad, la tolerabilidad, el beneficio clínico, la FC y los datos de FD de todos los niveles evaluados.
    E.5.1.1Timepoint(s) of evaluation of this end point
    DLTs-during the DLT evaluation period (cycle 1: 21 days)
    TEAE occurrence- from the first dose of BNT411 until the safety follow-up visit.
    Occurrence of dose reduction and discontinuation of IMP within a patient due to treatment emergent adverse events (TEAEs) will be assessed from the first dose of BNT411 until the safety follow-up visit.
    MTD-at the end of Part 1A and Part 1B.
    RP2D-at the end of Part 1A and Part 1B.
    TLD: durante el período de evaluación de TLD (ciclo 1: 21 días).
    Incidencia de AADT: desde la primera dosis de BNT411 hasta la visita de seguimiento de la seguridad.
    Se evaluarán la incidencia de la reducción de la dosis y la interrupción del PEI en un paciente debido a la aparición de acontecimientos adversos durante el tratamiento (AADT) desde la primera dosis de BNT411 hasta la visita de seguimiento de la seguridad.
    DMT: al final de la parte 1A y la parte 1B.
    DRFII: al final de la parte 1A y la parte 1B.
    E.5.2Secondary end point(s)
    -PK parameters (AUC, CL and VD, Cmax, Tmax, Ctrough, and T1/2)
    -Objective response rate (ORR) defined as the proportion of patients in whom a complete response (CR) or partial response (PR) is observed as best overall response.
    -Disease control rate (DCR) defined as the proportion of patients in whom a CR or PR or stable disease (SD) (assessed at least 6 weeks after first dose) is observed as best overall response.
    -Duration of response (DOR)
    - Los parámetros de FC (ABC, CL y VD, Cmáx, Tmáx, Cmín y T1/2).
    - El IRO definido como la proporción de pacientes en los que se observe una RC o RP como mejor respuesta general.
    - El ICE definido como la proporción de pacientes en los que se observe una RC, RP o EE (evaluadas al menos 6 semanas después de la primera dosis) como mejor respuesta general.
    - Duración de la respuesta (DDR)
    E.5.2.1Timepoint(s) of evaluation of this end point
    PK parameters-ongoing basis detailed in the schedule of PK sampling provided in table 1-3 (Part 1A) and table 1-4 (Part 1B) of the protocol.
    ORR- Efficacy will be assessed by on-treatment imaging at Week 6 (+7 days), every 6 weeks (±7 days) for 48 weeks, and every 12 weeks (±7 days) thereafter until disease progression is assessed by the investigator.
    DCR-at least 6 weeks after first dose until end of safety follow-up visit.
    DOR-From the time of occurrence from first objective response (CR or PR) to the date of the first occurrence of objective tumor progression or death from any cause, whichever occurs first.
    Parámetros de FC: de forma continuada según lo detallado en el calendario de obtención de muestras para FC que figura en la tabla 1-3 (parte 1A) y la tabla 1-4 (parte 1B) del protocolo.
    TRO: la eficacia se analizará mediante pruebas de diagnóstico por la imagen realizadas durante el tratamiento en la semana 6 (+7 días), cada 6 semanas (±7 días) durante 48 semanas y, a continuación, cada 12 semanas (±7 días) hasta que el investigador determine la progresión de la enfermedad.
    TCE: al menos 6 semanas después de la primera dosis hasta el final de la visita de seguimiento de la seguridad.
    DR: desde el momento de aparición de la primera remisión objetiva (RC o RP) hasta la fecha de la primera aparición de progresión objetiva del tumor o la muerte por cualquier causa, lo que ocurra primero.
    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 Yes
    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) Yes
    E.7.1.1First administration to humans Yes
    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 No
    E.8.1.1Randomised No
    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) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA4
    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
    Germany
    Spain
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The trial will be considered completed once all patients have completed treatment and safety follow-ups, and all patients have been followed up for survival for at least 1 year.
    El estudio se considerará finalizado cuando todos los pacientes hayan terminado el tratamiento y los seguimientos de la seguridad y se hayan sometido a un seguimiento de la supervivencia durante un mínimo de un año.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months5
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months5
    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: 13
    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 state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 30
    F.4.2.2In the whole clinical trial 63
    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 post-trial treatment for ongoing trial patients with a potential treatment benefit.
    El promotor garantizará el tratamiento posterior al estudio a los pacientes del estudio en curso que obtengan un posible beneficio del tratamiento.
    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 Decision2020-06-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-03-11
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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