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    Summary
    EudraCT Number:2019-004200-35
    Sponsor's Protocol Code Number:CO41863
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2020-10-26
    Trial results View 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 number2019-004200-35
    A.3Full title of the trial
    A PHASE Ib/II, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER STUDY EVALUATING THE SAFETY, TOLERABILITY, PHARMACOKINETICS, AND EFFICACY OF VENETOCLAX IN COMBINATION WITH TRASTUZUMAB EMTANSINE IN PATIENTS WITH PREVIOUSLY TREATED HER2-POSITIVE LOCALLY ADVANCED OR METASTATIC BREAST CANCER
    STUDIO DI FASE Ib/II, RANDOMIZZATO, IN DOPPIO CIECO, CONTROLLATO CON PLACEBO, MULTICENTRICO VOLTO A VALUTARE SICUREZZA, TOLLERABILITÀ, FARMACOCINETICA ED EFFICACIA DI VENETOCLAX IN ASSOCIAZIONE A TRASTUZUMAB EMTANSINE, IN PAZIENTI CON TUMORE MAMMARIO LOCALMENTE AVANZATO O METASTATICO, HER2-POSITIVO, PRECEDENTEMENTE TRATTATO
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study Evaluating the Safety, Tolerability, Pharmacokinetics, and Efficacy of Venetoclax in Combination with Trastuzumab Emtansine in Patients with Previously Treated HER2-Positive Locally Advanced or Metastatic Breast Cancer
    Uno studio volto a valutare sicurezza, tollerabilità, farmacocinetica ed efficacia di Venetoclax in associazione a Trastuzumab Emtasine, in pazienti con tumore mammario localmente avanzato o metastatico, HER2-positivo, precedentemente trattato
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    A.4.1Sponsor's protocol code numberCO41863
    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 SponsorF. HOFFMANN - LA ROCHE LTD.
    B.1.3.4CountrySwitzerland
    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 supportF. Hoffmann-La Roche Ltd
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationF. Hoffmann-La Roche Ltd
    B.5.2Functional name of contact pointTrial Information Support Line-TISL
    B.5.3 Address:
    B.5.3.1Street AddressGrenzacherstrasse 124
    B.5.3.2Town/ cityBasel
    B.5.3.3Post code4070
    B.5.3.4CountrySwitzerland
    B.5.4Telephone number000000
    B.5.5Fax number000000
    B.5.6E-mailglobal.rochegenentechtrials@roche.com
    D. IMP Identification
    D.IMP: 1
    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 KADCYLA® 160 mg powder for concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH - AIC: EU/1/13/885/002
    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 nameTrastuzumab Emtansine
    D.3.2Product code [RO5304020]
    D.3.4Pharmaceutical form Powder for 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 INNTRASTUZUMAB EMTANSINE
    D.3.9.1CAS number 1018448-65-1
    D.3.9.2Current sponsor codeRO5304020
    D.3.9.3Other descriptive nameT-DM1, trastuzumab-MCC-DM1
    D.3.9.4EV Substance CodeSUB35467
    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) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product 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 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 nameVenclexta®, Venclyxto® or GDC- 0199
    D.3.2Product code [RO5537382]
    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 INNVENETOCLAX
    D.3.9.1CAS number 1257044-40-8
    D.3.9.2Current sponsor codeRO5537382
    D.3.9.3Other descriptive nameGDC-0199, Venclexta, Venclyxto
    D.3.9.4EV Substance CodeSUB176260
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Locally advanced or metastatic breast cancer
    Tumore mammario localmente avanzato o metastatico
    E.1.1.1Medical condition in easily understood language
    Breast cancer is a cancer that develops in the tissues of the breast and continues to grow locally or spread to other parts of the body (metastatic)
    Il tumore mammario è un tumore che si sviluppa nei tessuti del seno e continua a crescere localmente oppure si diffonde ad altre parti del corpo (metastatico)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027475
    E.1.2Term Metastatic breast cancer
    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 23.0
    E.1.2Level PT
    E.1.2Classification code 10065430
    E.1.2Term HER2 positive breast cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Dose-Escalation Phase
    - To evaluate the safety and tolerability of trastuzumab emtansine in combination with venetoclax-including estimation of the maximum tolerated dose (MTD), determination of the recommended Phase II dose (RP2D), and characterization of dose-limiting toxicities (DLTs)

    Expansion phase
    - To evaluate the efficacy of venetoclax at the RP2D in combination with trastuzumab emtansine on the basis of objective response rate (ORR)
    - To evaluate the safety and tolerability of venetoclax at the RP2D in combination with trastuzumab emtansine

    Randomized Phase II Stage
    - To evaluate the efficacy of trastuzumab emtansine in combination with venetoclax compared with trastuzumab emtansine plus placebo on the basis of ORR and progression-free survival (PFS)
    Fase di aumento progressivo della dose
    - valutare la sicurezza e la tollerabilità di trastuzumab emtasine in associazione a venetoclax, comprese la stima della massima dose tollerata (MTD), la determinazione della dose raccomandata di fase II (RP2D) e la caratterizzazione delle tossicità dose-limitanti (DLT)

    Fase di espansione
    - valutare l’efficacia di venetoclax alla RP2D in associazione a trastuzumab emtasine sulla base del tasso di risposta obiettiva (ORR)
    - valutare la sicurezza e la tollerabilità di venetoclax alla RP2D in associazione a trastuzumab emtasine

    Stadio randomizzato di fase II
    - valutare l’afficacia di trastuzumab emtasine in associazione a venetoclax rispetto a trastuzumab emtasine in associazione a placebo sulla base del ORR e della sopravvivenza libera da progressione
    E.2.2Secondary objectives of the trial
    Dose-Escalation Phase
    - To make a preliminary assessment of the anti-tumor activity of trastuzumab emtansine and venetoclax
    - To characterize the pharmacokinetics of venetoclax and trastuzumab emtansine

    Expansion phase
    - To evaluate the efficacy of venetoclax at the RP2D in combination with trastuzumab emtansine on the basis of duration of response (DOR)
    - To characterize the pharmacokinetics of venetoclax and trastuzumab emtansine

    Randomized Phase II Stage
    - To evaluate safety of trastuzumab emtansine in combination with venetoclax compared with trastuzumab emtansine plus placebo
    - To evaluate the efficacy of trastuzumab emtansine in combination with venetoclax compared with trastuzumab emtansine plus placebo on the basis DOR and overall survival (OS)
    - To characterize the pharmacokinetics and evaluate the immune response to trastuzumab emtansine and venetoclax
    - To identify biomarkers that characterize the activity of and response to trastuzumab emtansine and venetoclax
    Fase aumento progressivo dose
    - effettuare valutazione preliminare dell’attività antitumorale di trastuzumab emtasine e venetoclax
    - caratterizzare PK venetoclax somministrato in ass. a trastuzumab emtasine

    Fase espansione
    - valutare efficacia di venetoclax alla RP2D in ass. a trastuzumab emtasine sulla base della DOR
    - caratterizzare PK venetoclax somministrato in ass. a trastuzumab emtasine

    Stadio randomizzato fase II
    - valutare sicurezza di trastuzumab emtasine in ass. a venetoclax rispetto a trastuzumab emtasine in associazione a placebo
    - valutare efficacia di trastuzumab emtasine in ass. a venetoclax rispetto a trastuzumab emtasine in ass. a placebo sulla base della DOR e OS
    - caratterizzare PK e valutare la risposta immunitaria a trastuzumab emtasine somministrato in ass. a venetoclax
    - identificare biomarcatori che siano predittivi dell’attività e della risposta a venetoclax in ass. a trastuzumab emtasine
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    - Age >= 18 years
    - Ability to comply with the study protocol, in the investigator's judgment
    - Histologically or cytologically confirmed invasive MBC or LABC that is incurable, unresectable, and previously treated with multimodality therapy
    • Prior treatment for BC in the adjuvant, unresectable locally advanced, or metastatic settings, which must include a taxane, trastuzumab (alone or in combination with another agent), and pertuzumab
    - Measurable disease that is evaluable per RECIST v1.1
    - Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1
    - Willing to provide tumor biopsy sample at the time of screening
    - Local histological or cytological confirmation of ER and/or progesterone receptor status as defined by using IHC per American Society of Clinical Oncology/College of American Pathologists criteria
    - Percentage of ER and/or progesterone receptor positivity, if available
    - Willing to provide blood samples at the time of screening, on-study, and at progression for exploratory research on biomarkers
    - HER2-positive BC as defined by an IHC score of 3+ or gene amplified by ISH as defined by a ratio of >= 2.0 for the number of HER2 gene copies to the number of chromosome 17 copies
    - Adequate hematologic and end-organ function
    - Screening left ventricular ejection fraction (LVEF) >=50% on echocardiogram (ECHO) or multiple-gated acquisition (MUGA) scan
    - Negative HIV test, hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (HBcAb) test at screening, or positive total HBcAb test followed by a negative hepatitis B virus (HBV) DNA test at screening
    - Negative hepatitis C virus (HCV) antibody test at screening, or positive HCV antibody test followed by a negative HCV RNA test at screening
    - For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 30 days after the last dose of venetoclax or 7 months after the last dose of trastuzumab emtansine
    - For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods, and agreement to refrain from donating sperm during the treatment period and for at least 30 days after the last dose of venetoclax or 7 months after the last dose of trastuzumab emtansine

    Inclusion Criteria for Dose-Escalation Phase Only
    - Prior exposure to trastuzumab emtansine in any setting (advanced/metastatic or early breast cancer) is required

    Inclusion Criteria for Expansion Phase Only
    • Trastuzumab emtansine experienced cohort:
    - Disease progression during or after trastuzumab emtansine treatment in the advanced/metastatic setting or disease recurrence in the neoadjuvant/adjuvant setting
    - At least 50% patients in the expansion cohort (e.g., 10 out of 20) must have tumor that is Bcl-2 high
    • Trastuzumab deruxtecan (DS-8201a) experienced cohort:
    - Disease progression during or after trastuzumab deruxtecan in the advanced/ metastatic setting
    - Prior trastuzumab emtansine in any setting is allowed
    - At least 50% patients in the expansion cohort (e.g., 10 out of 20) must have tumor that is Bcl-2 high

    Inclusion Criteria for Randomized Phase II Stage
    - Bcl-2 expression status by IHC either from fresh tissue or the most recent archival tissue by a central laboratory using the Ventana Bcl-2 IHC assay prior to randomization.
    - Età >/= 18 anni
    - Capacità di rispettare il protocollo di studio secondo il giudizio dello sperimentatore
    - MBC o LABC invasino confermato dall’esame istologico o citologico incurabile, non resecabile e precedentemente trattato con terapia multimodale
    • Precedente trattamento per il tumore mammario (BC) nel setting adiuvante, localmente avanzato non resecabile o metastatico, che deve includere un taxano, trastuzumab (da solo o in associazione con un altro agente) e pertuzumab.
    - Malattia misurabile valutabile in base ai criteri RECIST v1.1
    - Performance status secondo l’Eastern Cooperative Oncology Group (ECOG) pari a 0 o 1
    - Disponibilità a fornire un campione tumorale bioptico al momento dello screening
    - Conferma istologica o citologica locale dello status di espressione del recettore degli estrogeni (ER) e/o del progesterone (PR), definita in base all’immunoistochimica (IHC) secondo i criteri dell’American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP)
    - Se disponibile, percentuali di positività per ER e/o PR
    - Disponibilità a fornire campioni di sangue al momento dello screening, durante lo studio e alla progressione per ricerche esplorative sui biomarcatori
    - BC HER2-positivo definito da un punteggio IHC di 3+ o amplificazione genica all’ibridazione in situ (ISH) in base a un rapporto tra il numero di copie del gene HER2 e il numero di copie del cromosoma 17 >/= 2,0
    - Adeguata funzionalità ematologica e di organo
    - Frazione di eiezione del ventricolo sinistro (LVEF) allo screening >/= 50% all’ecocardiogramma (ECO) o all’angiocardioscintigrafia (MUGA)
    - Test negativo per il virus dell’immunodeficienza umana (HIV), per l’antigene di superficie dell’epatite B (HbsAg) e per gli anticorpi diretti contro l’antigene core dell’epatite B (BhcAb) totali allo screening, o test positivo per gli HbcAb totali seguito da un test negativo per il DNA del virus dell’epatite B (HBV) allo screening
    - Test negativo per gli anticorpi diretti contro il virus dell’epatite C (HCV) allo screening o test positivo per gli anticorpi anti-HCV seguito da un test negativo per l’HCV-RNA allo screening
    - Nelle donne in età fertile: consenso a praticare l’astinenza dai rapporti eterosessuali o ad adottare metodi contraccettivi che garantiscano un tasso di insuccesso < 1% all’anno durante il periodo di trattamento e per almeno 30 giorni dopo l’ultima dose di venetoclax o 7 mesi dopo l'ultima dose di trastuzumab emtansine
    - Per gli uomini: consenso a praticare l’astinenza dai rapporti eterosessuali o ad adottare metodi contraccettivi, nonché consenso ad astenersi dalla donazione del seme durante il periodo di trattamento e per almeno 30 giorni dopo l’ultima dose di venetoclax o 7 mesi dopo l’ultima dose di trastuzumab emtansine

    Criteri di inclusione della sola fase di dose escalation:
    - È richiesta precedente esposizione a trastuzumab emtansine in qualsiasi setting (avanzato/metastatico o neoadiuvante/adiuvante)

    Criteri di inclusione della sola fase di espansione
    • Coorte pretrattata con trastuzumab emtansine:
    - Progressione di malattia durante o dopo il trattamento con trastuzumab emtansine nel setting avanzato/metastatico o ricorrenza di malattia nel setting neoadiuvante/adiuvante
    - Almeno 50% dei pazienti nella coorte di espansione (ovvero per esempio 10 su 20) devono avere Bcl-2 alto
    • Coorte pretrattata con trastuzumab deruxtecan (DS-8201a):
    - Progressione di malattia durante o dopo trastuzumab deruxtecan nel setting avanzato/metastatico
    - È ammesso il precedente trattamento con trastuzumab emtansine nel qualsiasi setting
    - Almeno il 50% dei pazienti nella coorte di espansione ovvero per esempio 10 su 20) deve avere un tumore con Bcl-2 alto

    Criteri di inclusione della sola fase II
    - Stato di espressione di BCL-2 alla IHC effettuata su un campione di tessuto fresco o sul campione di tessuto conservato più recente da un laboratorio centrale mediante test Ventana BCL-2 IHC prima dell’arruolamento
    E.4Principal exclusion criteria
    - Receipt of any anticancer drug/biologic or investigational treatment 21 days prior to C1D1 except hormone therapy, which can be given up to 7 days prior to C1D1
    - Radiation therapy within 2 weeks prior to C1D1
    - History of exposure to the following cumulative doses of anthracyclines as specified below:
    • Doxorubicin >500 mg/m2
    • Liposomal doxorubicin >500 mg/m2
    • Epirubucin >720 mg/m2
    • Mitoxantrone >120 mg/m2
    • Idarubicin >90 mg/m2
    If another anthracycline or more than one anthracycline has been used, then the cumulative dose must not exceed the equivalent of 500 mg/m doxorubicin.
    - History of other malignancy within the previous 5 years
    - Cardiopulmonary dysfunction
    - Current severe, uncontrolled systemic disease
    - Major surgical procedure or significant traumatic injury within 28 days prior to randomization or anticipation of the need for major surgery during the course of study treatment
    - Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) at study enrollment, or any major episode of infection requiring treatment with IV antibiotics or hospitalization (relating to the completion of the course of antibiotics) within 4 weeks prior to C1D1
    - Clinically significant history of liver disease, including cirrhosis, current alcohol abuse, autoimmune hepatic disorders, sclerosis cholangitis, or active infection with HBV or HCV
    - Uncontrolled autoimmune hemolytic anemia or immune thrombocytopenia
    - Known HIV infection or human T-cell leukemia virus 1 infection
    - Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for > 2 weeks prior to randomization
    - Known CNS disease
    - Leptomeningeal disease
    - Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures
    - Uncontrolled hypercalcemia or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy
    - Current Grade >= 3 peripheral neuropathy
    - History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies, excipients of any drugs formulated in polysorbate 80 or 20 or fusion proteins
    - Prior allogeneic stem cell or solid organ transplantation
    - Pregnant or breastfeeding, or intending to become pregnant during the study or within 30 days after the last dose of venetoclax or 7 months after the last dose of trastuzumab emtansine after the final dose of study treatment, whichever is later
    - Consumption of grapefruit, grapefruit products, Seville oranges, or starfruit within 3 days before anticipated first dose of study drug until the last dose of study drug
    - Administration of a live, attenuated vaccine within 4 weeks prior to initiation of study treatment or anticipation of need for such a vaccine during the study
    - Illicit drug or alcohol abuse within 12 months prior to screening
    - Malabsorption syndrome or other condition that would interfere with enteral absorption
    - History of active inflammatory bowel disease requiring specific medication in the 12 months prior to randomization, or active and uncontrolled bowel inflammation at time of randomization
    - Inability or unwillingness to swallow a large number of tablets
    - Known hypersensitivity to venetoclax or trastuzumab emtansine or to any of their excipients
    - Any serious medical condition or abnormality in clinical laboratory tests that precludes the patient's safe participation in and completion of the study
    - Other medical or psychiatric conditions that may interfere with the patient’s participation in the study
    - Blood transfusions if performed within 2 weeks prior to screening

    Exclusion Criteria for Randomized Phase II Stage
    - Prior treatment with:
    • trastuzumab emtansine in any setting
    • venetoclax in any setting
    • anti-HER2 antibody drug conjugates, margetuximab, pyrotinib, or tucatinib
    - Somministraz. di qualsiasi farmaco antitumorale/biologico o tratt. sperimentale 21 gg prima del G1C1, eccezione per terapia ormonale che può essere somminist. fino a 7 gg prima G1C1
    - Radioterapia nelle 2 sett. precedenti G1C1
    - Esposizione pregressa alle seguenti dosi cumulative di antracicline:
    • Doxorubicina >500 mg/m2
    • Doxorubicina liposomiale > 500 mg/m2
    • Epirubucina >720 mg/m2
    • Mitoxantrone >120 mg/m2
    • Idarubicina >90 mg/m2
    Qualora sia stata usata altra antraciclina o più di una antraciclina, la dose cumulativa non dovrà superare equivalente di 500 mg/m2 doxorubicina
    - Anamnesi positiva per altra neoplasia maligna nei 5 anni precedenti
    - Disfunzione cardiopolmonare
    - Malattia sistemica severa non controllata in atto
    - Procedura chirurgia maggiore o lesione traumatica significativa nei 28 gg precedenti la randomizzaz. o necessità prevista di intervento di chirurgia maggiore durante tratt. in studio
    - Infezione attiva nota batterica, virale, micotica, micobatterica, parassitaria o di altra natura al momento arruolamento nello studio o qualsiasi episodio maggiore di infezione che necessiti tratt. con antibiotici e.v. o ricovero ospedaliero nelle 4 sett. precedenti il G1C1
    - Anamnesi positiva clinicamente significativa per epatopatia, tra cui cirrosi, abuso corrente di alcol, malattie autoimmuni del fegato, colangite sclerosante o infezione attiva da HBV o HCV
    - Anemia emolitica autoimmune o trombocitopenia immune non controllata
    - Infezione nota da HIV o da HTLV-1
    - Compressione del MS non definitivamente trattata con chirurgia e/o radioterapia, oppure diagnosticata e trattata in precedenza senza evidenze di malattia clinicamente stabile per > 2 sett prima randomizzaz.
    - Malattia nota a carico SNC
    - Malattia leptomeningea
    - Versamento pleurico, versamento pericardico o ascite non controllato/a che necessita di ricorrenti procedure drenaggio
    - Ipercalcemia non controllata o ipercalcemia sintomatica che necessita di terapia continuativa a base di bifosfonati
    - Neuropatia periferica in atto di grado >/= 3
    - Anamnesi positiva per reazioni allergiche o anafilattiche severe, oppure altre reazioni ipersensibilità agli anticorpi chimerici o umanizzati, agli eccipienti di farmaci formulati in polisorbato 80 o 20 o alle proteine fusione
    - Precedente trapianto allogenico di cells staminali o di organi solidi
    - Gravidanza o allattamento o intenzione iniziare gravidanza durante studio o nei 30 gg successivi ultima dose venetoclax o nei 7 mesi successivi ultima dose trastuzumab emtansine, a seconda farmaco somminist. per ultimo
    - Consumo pompelmo, prodotti a base pompelmo, arance amare o carambola nei 3 gg precedenti prima dose prevista farmaco in studio e fino ultima dose farmaco in studio
    - Somministraz. vaccino vivo attenuato nelle 4 sett. precedenti inizio tratt. in studio o necessità prevista di tale vaccino durante sperimentazione
    - Abuso di sostanze illecite o alcol nei 12 mesi precedenti screening
    - Sindrome da malassorbimento o altra condizione che interferirebbe con assorbimento enterale
    - Anamnesi positiva per malattia infiammatoria intestinale attiva necessitante medicinali specifici nei 12 mesi precedenti randomizzaz. o infiammazione intestinale attiva e non controllata al momento randomizzaz.
    - Incapacità di o riluttanza a ingerire un alto numero compresse
    - Ipersensibilità nota a venetoclax, a trastuzumab emtansine o a uno qualsiasi dei loro eccipienti
    -Qualsiasi grave condizione medica o anomalia negli esami clinici di laboratorio che precluda al paziente di partecipare allo studio e portarlo a termine in sicurezza
    - Altre condizioni mediche o psichiatriche che potrebbero interferire con partecipazione paziente allo studio
    - Trasfusioni di sangue effettuate nelle 2 sett. precedenti screening

    Criteri esclusione del solo studio randomizzato di fase II:
    - Precedente tratt. con:
    • trastuzumab emtansine in qualsiasi contesto
    • venetoclax in qualsiasi setting
    • Ab coniugato anti-HER2, margetuximab, pyrotinib o tucaninib
    E.5 End points
    E.5.1Primary end point(s)
    Dose-Escalation Phase
    1. Incidence and severity of adverse events, including DLTs, with severity determined according to National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0)

    Expansion Phase
    2. ORR
    3. Incidence and severity of adverse events with severity determined according to NCI CTCAE v5.0

    Randomized Phase II Stage
    4. ORR
    5. Progression-free survival
    Fase di incremento progressive della dose
    1. Incidenza e severità degli eventi avversi, DLT comprese, con severità stabilita in funzione dei criteri comuni di terminologia per gli eventi avversi del National Cancer Institute, versione 5.0 (NCI CTCAE v5.0)

    Fase di espansione
    2. ORR
    3. Incidenza e severità degli eventi avversi con severità stabilita in funzione dei criteri NCI CTCAE v5.0

    Studio randomizzato di fase II
    4. ORR
    5. Sopravvivenza libera da progressione
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to 18 months
    2-5. Up to 30 months
    1. Fino a 18 mesi
    2-5. Fino a 30 mesi
    E.5.2Secondary end point(s)
    Dose-Escalation Phase
    1. ORR

    Expansion Phase
    2. Incidence and severity of adverse events with severity determined according to NCI CTCAE v5.0

    Randomized Phase II Stage
    3. DOR
    4. OS
    5. Changes in expression levels of biomarkers or biomarker panels and the relationship between biomarkers in blood, plasma, and tumor tissue and efficacy, safety, PK, or immunogenicity
    6. Serum concentrations of trastuzumab emtansine at specified timepoints
    7. Plasma concentrations of venetoclax at specified timepoints
    8. Prevalence of anti-drug antibodies (ADAs) at baseline and incidence of ADAs during the study
    Fase di incremento progressivo della dose
    1. ORR

    Fase di espansione
    2. Incidenza e severità degli eventi avversi con severità stabilita in funzione dei criteri NCI CTCAE v5.0

    Studio randomizzato di fase II
    3. DOR
    4. OS
    5. Variazioni dei livelli di espressione dei biomarcatori o dei pannelli di biomarcatori e correlazione tra i biomarcatori nel sangue, nel plasma e nel tessuto tumorale e gli endpoint di efficacia, sicurezza, PK, immunogenicità
    6. Concentrazioni sieriche di trastuzumab emtansine a specifici timepoint
    7. Concentrazioni plasmatiche di venetoclax a specifici timepoint
    8. Prevalenza di anticorpi anti-farmaco (ADA) al basale e incidenza degli ADA durante lo studio
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to 18 months
    2-4. Up to 30 months
    5. Screening and End of Study Treatment/Early Discontinuation
    6. Cycle 1 Day 1, Cycle 2 Day 1, Cycle 4 Day 1
    7. Cycle 2 Day 1, Cycle 4 Day 1
    8. Baseline, Cycle 1 Day 1, Cycle 4 Day 1, 120 days (>28 days) after treatment completion or discontinuation
    1. Fino a 18 mesi
    2-4. Fino a 30 mesi
    5. Allo Screening e al Completamento/Interruzione anticipata del trattamento in studio
    6. Al Ciclo 1 Giorno 1, Ciclo 2 Giorno 1, Cliclo 4 Giorno 1
    7. Al Ciclo 2 Giorno 1, Ciclo 4 Giorno 1
    8. Al basale, Ciclo 1 Giorno 1, Ciclo 4 Giorno 1, 120 giorni (>28 giorni) dopo il completamento/interruzione anticipata del trattamento in studio
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic Yes
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    First administartion to humans of IMP's combination Venetoclax/Trastuzumab emtansine
    Prima somministrazione nell'uomo dell'associazione di IMP Venetoclax/Trastuzumab emtasine
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    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 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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA51
    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
    Italy
    Spain
    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 end of this study is defined as the date when LPLV occurs or the date at which the last data point required for statistical analysis or safety follow-up is received from the last patient,whichever occurs later.The end of study is planned to occur approx.24 months after last patient in (LPI).In addition,the Sponsor may decide to terminate the study at any time.The total length of the study, from screening of the first patient to the end of the study, is expected to be approximately 48 months.
    Fine studio coinciderà con data in cui si terrà ultima visita ultimo paz. o con data di ricezione ultima oss. relativa ultimo paz. necessaria per analisi statistica o follow-up di sicurezza, a seconda della circostanza che si verifichi per prima. Lo studio dovrebbe terminare circa 24 m. dopo arruolamento ultimo paz. Lo sponsor potrà decidere di interrompere studio in qls momento. Si prevede che durata complessiva sperimentazione, dallo screening primo paz. alla fine studio, sarà di circa 48 m.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 231
    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 state49
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 81
    F.4.2.2In the whole clinical trial 244
    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 offer continued access to Roche IMPs venetoclax and trastuzumab emtansine free of charge to eligible patients in accordance with the Roche Global Policy on Continued Access to Investigational Medicinal Product.
    Lo Sponsor fornirà gratuitamente i medicinali sperimentali Roche, venetoclax e trastuzumab emtasine, ai pazienti eleggibili in accordo con le linee di condotta globali di Roche sull'accesso continuato ai medicinali sperimentali
    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 Decision2020-07-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-06-15
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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