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    Summary
    EudraCT Number:2019-004554-29
    Sponsor's Protocol Code Number:KRT-232-109
    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:2020-10-22
    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 number2019-004554-29
    A.3Full title of the trial
    An Open-Label, Multicenter, Phase 1b/2 Study of the Safety and Efficacy of KRT-232 Combined with Ruxolitinib in Patients with Primary Myelofibrosis (PMF), Post–Polycythemia Vera MF (Post–PV-MF), Or Post–Essential Thrombocythemia MF (Post-ET-MF) Who Have a Suboptimal Response to Ruxolitinib
    Studio di fase 1b/2 in aperto, multicentrico per valutare la sicurezza e l’efficacia di KRT-232 in combinazione con ruxolitinib in pazienti con mielofibrosi primaria (PMF), MF post-policitemia vera (Post-PV-MF) o MF post-trombocitemia essenziale (Post-ET-MF) che rispondono a ruxolitinib in maniera subottimale
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of the Safety and Efficacy of KRT-232 Combined with Ruxolitinib in Patients with Primary Myelofibrosis (PMF), Post–Polycythemia Vera MF (Post–PV-MF), Or Post–Essential Thrombocythemia MF (Post-ET-MF) Who Have a Suboptimal Response to Ruxolitinib
    Studio della sicurezza e dell'efficacia di KRT-232 combinato con Ruxolitinib in pazienti con mielofibrosi primaria (PMF), Post-Policitemia Vera MF (Post – PV-MF) o Trombocitemia MF Post-essenziale(Post-ET-MF) che hanno una risposta non ottimale a Ruxolitinib
    A.3.2Name or abbreviated title of the trial where available
    KRT-232-109
    KRT-232-109
    A.4.1Sponsor's protocol code numberKRT-232-109
    A.5.4Other Identifiers
    Name:IND NumberNumber:119156
    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 SponsorKartos Therapeutics, 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 supportKartos Therapeutics, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationKartos Therapeutics, Inc.
    B.5.2Functional name of contact pointClinical Operations- Josh Martino
    B.5.3 Address:
    B.5.3.1Street Address275 Shoreline Drive
    B.5.3.2Town/ cityRedwood City
    B.5.3.3Post codeCA 94065
    B.5.3.4CountryUnited States
    B.5.4Telephone number+16505420136
    B.5.6E-mailjmartino@kartosthera.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 nameKRT-232
    D.3.2Product code [KRT-232 (formerly AMG-232)]
    D.3.4Pharmaceutical form 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 INNKRT-232
    D.3.9.2Current sponsor codeKRT-232
    D.3.9.3Other descriptive nameAMG 232
    D.3.9.4EV Substance CodeSUB123933
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    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: 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 nameKRT-232
    D.3.2Product code [KRT-232 (formerly AMG-232)]
    D.3.4Pharmaceutical form 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 INNKRT-232
    D.3.9.2Current sponsor codeKRT-232
    D.3.9.3Other descriptive nameAMG 232
    D.3.9.4EV Substance CodeSUB123933
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    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: 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 Jakavi
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Europharm Limited
    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 nameJakavi (Ruxolitinib)
    D.3.2Product code [Jakavi (Ruxolitinib)]
    D.3.4Pharmaceutical form 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 INNRUXOLITINIB
    D.3.9.1CAS number 941678-49-5
    D.3.9.2Current sponsor codeRUXOLITINIB
    D.3.9.3Other descriptive nameRUXOLITINIB
    D.3.9.4EV Substance CodeSUB32273
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number5 to 20
    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.2.1.2Country 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 nameLoperamide
    D.3.2Product code [Loperamide]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLOPERAMIDE CLORIDRATO
    D.3.9.1CAS number 34552-83-5
    D.3.9.2Current sponsor codeLoperamide
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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.2.1.2Country 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 nameOndansetron
    D.3.2Product code [NA]
    D.3.4Pharmaceutical form 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 INNONDANSETRON CLORIDRATO DIIDRATO
    D.3.9.1CAS number 103639-04-9
    D.3.9.2Current sponsor codeOndansetron
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number8
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Primary Myelofibrosis (PMF), Post–Polycythemia Vera MF (Post–PV-MF), Or Post–Essential Thrombocythemia MF (Post-ET-MF)
    Mielofibrosi primaria (PMF), Post – Policitemia Vera MF (Post – PV-MF) o Trombocitemia post-essenziale MF (Post-ET-MF)
    E.1.1.1Medical condition in easily understood language
    Patients with Primary Myelofibrosis (PMF), Post–Polycythemia Vera MF (Post–PV-MF), Or Post–Essential Thrombocythemia MF (Post-ET-MF)
    Pazienti con Mielofibrosi Primaria (PMF), Post – Policitemia vera MF (post – PV-MF) o Trombocitemia Post-Essenziale MF (Post-ET-MF)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10074689
    E.1.2Term Post polycythemia vera myelofibrosis
    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 10074690
    E.1.2Term Post essential thrombocythemia myelofibrosis
    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 21.1
    E.1.2Level LLT
    E.1.2Classification code 10074691
    E.1.2Term Post polycythaemia vera myelofibrosis
    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 10074692
    E.1.2Term Post essential thrombocythaemia myelofibrosis
    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 20.0
    E.1.2Level PT
    E.1.2Classification code 10077161
    E.1.2Term Primary myelofibrosis
    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 determine the recommended phase 2 dose (RP2D) of KRT-232 in combination with ruxolitinib
    Determinare la RP2D di KRT-232 in combinazione con ruxolitinib
    E.2.2Secondary objectives of the trial
    • To determine spleen response
    • To determine the change in Total Symptom Score (TSS) based on Myelofibrosis Symptom Assessment Form version 4.0 (MFSAF v4.0)
    • To determine the duration of spleen response (DoR-spleen)
    • To determine spleen size reduction as measured by palpation
    • To determine red blood cell (RBC) transfusion usage
    • To determine the clinical response rate: complete response (CR) and partial response (PR)
    • To determine the overall survival (OS) rate
    • To determine progression-free survival (PFS)
    • To determine the leukemia-free survival rate
    • To determine the safety and tolerability of KRT-232
    • To monitor the PK of KRT-232, KRT-232 glucuronide and ruxolitinib
    • Determinare la risposta della milza
    • Determinare la variazione nel punteggio totale dei sintomi (TSS) in base alla versione 4.0 del Modulo di valutazione dei sintomi della mielofibrosi (MFSAF v4.0)
    • Determinare la durata della risposta della milza (DoR-milza)
    • Determinare la riduzione delle dimensioni della milza valutata mediante palpazione
    • Determinare il ricorso all’uso di trasfusioni di globuli rossi (GR)
    • Determinare il tasso di risposta clinica: risposta completa (CR) e risposta parziale (PR)
    • Determinare il tasso di sopravvivenza globale (OS)
    • Determinare la sopravvivenza libera da progressione (PFS)
    • Determinare il tasso di sopravvivenza libera da leucemia
    • Determinare la sicurezza e la tollerabilità di KRT-232
    • Monitorare la farmacocinetica (PK) di KRT-232, KRT-232 glucuronide e ruxolitinib
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Adults >18 years of age.
    2. Confirmed diagnosis of PMF, post–PV-MF, or post–ET-MF, as assessed by treating physician according to the World Health Organization (WHO) criteria.
    3. Treatment with ruxolitinib for = 18 weeks prior to study entry, and on a stable dose of ruxolitinib in the 8 weeks prior to Sponsor approval of the enrollment form.
    4. Spleen = 5 cm palpable below the LLCM or =450 cm3 by MRI or CT
    5. Patients must have at least 2 symptoms with a score of at least 1 on the MFSAF v4.0
    6. An MRI or CT scan for spleen volume must be performed no more than 14 days prior to the first dose of KRT-232.
    7. ECOG performance status of 0 to 2.
    8. Adequate hematological, hepatic, and renal organ function (as per protocol definition and within 28 days prior to the first dose of KRT-232).
    9. Female subjects of childbearing potential and their male partners, or male subjects who have female partners of childbearing potential must both use an effective contraception method during the study. In addition, both male and female subjects must continue to use contraception for 6 months after the last dose of study drug.
    1. Adulti di età >18 anni
    2. Diagnosi confermata di PMF, post–PV-MF o post– ET-MF, come valutata dal medico curante secondo i criteri dell’Organizzazione mondiale della sanità (OMS)
    3. Trattamento con ruxolitinib per =18 settimane prima dell’ingresso nello studio e assunzione di una dose stabile di ruxolitinib nelle 8 settimane precedenti l’approvazione del modulo di arruolamento da parte dello sponsor.
    4. Milza =5 cm palpabile al di sotto del margine costale sinistro inferiore (LLCM) o =450 cm3 come valutato mediante RM o TC
    5. I pazienti devono presentare almeno 2 sintomi con un punteggio di almeno 1 nel modulo MFSAF v4.0
    6. Una RM o TC per il volume della milza deve essere eseguita non più di 14 giorni precedenti la prima dose di KRT-232
    7. Stato di validità secondo il Gruppo cooperativo orientale di oncologia (ECOG) da 0 a 2
    8. Adeguata funzione d’organo ematologica, epatica e renale (secondo la definizione riportata nel protocollo e nei 28 giorni precedenti la prima dose di KRT-232).
    9. Sia i soggetti di sesso femminile in età fertile (e i rispettivi compagni), sia i soggetti di sesso maschile che hanno compagne in età fertile devono utilizzare un
    metodo contraccettivo efficace durante lo studio. Inoltre, i soggetti di sesso maschile e femminile devono continuare a usare il metodo contraccettivo per 6 mesi dopo l’ultima dose del farmaco sperimentale.
    E.4Principal exclusion criteria
    1. Patients who are positive for TP53 mutations.
    2. Documented disease progression or clinical deterioration any time while on ruxolitinib treatment.
    3. Patients who have had a documented spleen response to ruxolitinib.
    4. Participation in another interventional clinical trial within the past 4 weeks of the first dose of KRT-232 (participation in observational studies is permitted).
    5. Other JAK inhibitors, except for ruxolitinib treatment; other recent/concurrent treatment such as a major surgery, chemotherapy, immunomodulating therapy, biologic therapy, radiation therapy, or investigational therapy within 4 weeks or approximately 5 half-lives before the first dose of KRT-232, whichever is shorter. Hydroxyurea is permitted up until the day prior to study Day 1 of study treatment with KRT-232.
    6. Prior splenectomy.
    7. Splenic irradiation within 3 months prior to the first dose of KRT-232.
    8. Prior allogeneic stem-cell transplantation or eligible for allogeneic stem cell transplantation
    9. Prior MDM2 inhibitor therapy or p53-directed therapy
    10. Women who are pregnant or breastfeeding
    11. History of major organ transplant
    12. Subjects must be negative for HIV-1 antibody, negative for HbsAg, negative for Hepatitis B core antibody, and negative for viral RNA if HCV antibody is positive. Subjects must be negative for Hepatitis B DNA, if either HbsAg or Hepatitis B core antibody is positive.
    13. Active serious viral, mycobacterial, parasitic, fungal, and bacterial infections, including acute hepatitis A, herpes zoster, and progressive multifocal leukoencephalopathy (PML). Active serious infections must be resolved before screening/enrollment. Subjects with acute infections requiring systemic antibiotic use should delay screening/enrollment until the course of antibiotic therapy has been completed.
    14. Patients with uncontrolled intercurrent illness including, but not limited to; clinically significant cardiac disease (New York Heart Association Class III or IV); symptomatic congestive heart failure; unstable angina pectoris; ventricular arrhythmia; or patients with psychiatric illness/social situations that would limit compliance with study requirements; or patients who have been committed to an institution by judicial or administrative authority.
    15. Other malignancy within the last 3 years, other than curatively treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, organ-confined or treated nonmetastatic prostate cancer with normal prostate-specific antigen, in situ breast carcinoma after complete surgical resection, or superficial transitional cell bladder carcinoma.
    16. Grade 2 or higher QTc prolongation (>480 milliseconds per NCICTCAE criteria, version 5.0).
    17. Active or chronic bleeding within 4 weeks prior to the first dose of KRT-232.
    1. Pazienti positivi per mutazioni di TP53
    2. Progressione della malattia documentata o deterioramento clinico in qualsiasi momento durante il trattamento con ruxolitinib,
    3. Pazienti che hanno manifestato una risposta della milza documentata a ruxolitinib.
    4. Partecipazione a un’altra sperimentazione clinica interventistica nelle ultime 4 settimane che precedono la prima dose di KRT-232 (la partecipazione a studi osservazionali è consentita)
    5. Altri inibitori di JAK, fatta eccezione per il trattamento con ruxolitinib; altri trattamenti recenti/concomitanti come un intervento di chirurgia maggiore, chemioterapia, terapia immunomodulante, terapia biologica, radioterapia o terapia sperimentale entro 4 settimane o circa 5 emivite precedenti la prima dose di KRT-232, a seconda di quale sia il periodo più breve. L’uso di idrossiurea è consentito fino al giorno precedente il Giorno 1 dello studio di trattamento dello studio con KRT-232.
    6. Precedente splenectomia
    7. Irradiazione splenica nei 3 mesi precedenti la prima dose di KRT-232
    8. Precedente trapianto allogenico di cellule staminali o idoneità a ricevere un trapianto allogenico di cellule staminali
    9. Precedente terapia con un inibitore di MDM2 o terapia diretta contro p53
    10. Donne in gravidanza o in fase di allattamento al seno
    11. Anamnesi di trapianto di un organo importante
    12. I soggetti devono essere negativi agli anticorpi anti-virus dell’immunodeficienza umana 1 (HIV-1), negativiall’antigene di superficie dell’epatite B (HBsAg), negativi
    agli anticorpi anti-proteina core dell’epatite B e negativi all’RNA virale in caso di positività agli anticorpi antivirus dell’epatite C (HCV). I soggetti devono essere
    negativi al DNA dell’epatite B in caso di positività all’HBsAg o agli anticorpi anti-proteina core dell’epatite B.
    13. Infezioni virali, micobatteriche, parassitarie, fungine e batteriche serie in fase attiva, comprese epatite A acuta, herpes zoster e leucoencefalopatia multifocale progressiva (LMP). Eventuali infezioni serie in fase attiva devono essersi risolte prima dello screening/dell’arruolamento. I soggetti con infezioni acute che richiedono l’uso di antibiotici per via sistemica devono posticipare lo screening/l’arruolamento fino al completamento del ciclo di terapia antibiotica.
    14. Pazienti con malattia intercorrente non controllata tra cui, a titolo esemplificativo; malattia cardiaca clinicamente significativa (di classe III o IV secondo la New York
    Heart Association); insufficienza cardiaca congestizia sintomatica; angina pectoris instabile; aritmia ventricolare; o pazienti con malattia psichiatrica/situazioni sociali che potrebbero limitare la conformità ai requisiti dello studio; o pazienti che sono stati affidati a un istituto da un’autorità giudiziaria o amministrativa.
    15. Altro tumore maligno negli ultimi 3 anni diverso da carcinoma cutaneo a cellule basali o squamose trattato con intento curativo, carcinoma in situ del collo dell’utero, carcinoma prostatico non metastatico confinato all’organo o trattato con livelli normali di antigene prostatico specifico, carcinoma mammario in situ dopo resezione chirurgica completa, o carcinoma superficiale della vescica a cellule transizionali
    16. Prolungamento dell’intervallo QTc di grado =2 (>480 millisecondi secondo la versione 5.0 dei Criteri terminologici comuni per gli eventi avversi del National Cancer Institute [NCI-CTCAE])
    17. Sanguinamento attivo o cronico nelle 4 settimane precedenti la prima dose di KRT-232
    E.5 End points
    E.5.1Primary end point(s)
    Dose-limiting toxicity (DLTs) will be used to establish the maximum tolerated dose (MTD) of KRT-232 in combination with ruxolitinib. The SRC will determine the recommended phase 2 dose (RP2D) based on safety and efficacy data of the combination of KRT-232 and ruxolitinib
    Le DLT saranno utilizzate per stabilire la MTD di KRT-232 in combinazione con ruxolitinib. L’SRC stabilirà la RP2D sulla base dei dati di sicurezza ed efficacia della combinazione di KRT-232 e ruxolitinib.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Dose-limiting toxicity (DLT) evaluation period is the first cycle (i.e., the first 28 days). All AEs should be considered for DLTs unless reported as unrelated to the study drugs. Specific DLT criteria for nonhematologic toxicity, neutropenia, and thrombocytopenia can be referred from Clinical Protocol
    Il periodo di valutazione della tossicità dose-limitante (DLT) è il primo ciclo (cioè i primi 28 giorni). Tutti gli eventi avversi dovrebbero essere presi in considerazione per le DLT a meno che non siano segnalati come non correlati ai farmaci in studio. Criteri DLT specifici per tossicità non ematologica, neutropenia e trombocitopenia possono essere riferiti dal protocollo clinico
    E.5.2Secondary end point(s)
    - The proportion of subjects achieving = 35% SVR at any time point from Baseline while on study, as assessed by MRI (or by CT scan for applicable subjects).
    - The percentage change in TSS as measured by the MFSAF v4.0 at any time point from Baseline while on study.
    - Duration of a = 35% reduction in SVR from Baseline as measured by MRI (or by CT scan for applicable subjects).
    - Reduction in spleen size from Baseline to each visit at which spleen is palpated, including the proportion of subjects who have a = 50% decrease in spleen size
    - Red blood cell (RBC) transfusion usage:
    • Rate of RBC transfusion usage (average number of RBC units per patient-month)
    • Rate of change from RBC transfusion dependent to transfusion independent
    - The proportion of subjects with CR and PR at any time point, from Baseline while on study, defined according to International Working Group-Myeloproliferative Neoplasms Research and Treatment(IWG-MRT) and modified European Leukemia Net (ELN) criteria
    - OS is defined as the interval from randomization to death from any cause
    - PFS is the interval from Cycle 1 Day 1 to: • Disease progression (= 25% increase in spleen volume) or • Leukemic transformation (bone marrow blasts =20% or peripheral blood blasts = 20% associated with an absolute blast count of at least 1 x 109/L that lasts for at least 2 weeks) or • Death from any cause
    - Leukemia-free survival is defined as the interval from Cycle 1 Day 1 to the date of first documented transformation to leukemia (bone marrow blasts =20% or peripheral blood blasts =20% associated with an absolute blast count of at least 1 x 109/L that lasts for at least 2 weeks).
    - Analyses of the safety endpoints will include the following measurements or assessments: physical examinations, laboratory tests, adverse events (AEs), serious AEs (SAEs), electrocardiograms (ECGs), and vital signs
    - KRT-232, acyl glucuronide metabolite (M1) and ruxolitinib PK parameters will be determined, including but not limited to:
    • Maximum observed concentration (Cmax)
    • Minimum observed concentration (Cmin)
    • Area under the plasma concentration-time curve (AUC)
    • Time of maximum plasma concentration; - La percentuale di soggetti che raggiungono una risposta virologica sostenuta (SVR) =35% in qualsiasi punto temporale rispetto al basale durante lo studio, come valutato mediante risonanza magnetica (RM) (o mediante scansione di tomografia computerizzata [TC] per gli opportuni soggetti)
    - La variazione percentuale nel TSS misurato tramite il MFSAF v4.0 in qualsiasi punto temporale rispetto al basale durante lo studio.
    - Durata di una riduzione =35% nella SVR rispetto al basale misurata mediante RM (o mediante esame TC per gli opportuni soggetti).
    - Riduzione delle dimensioni della milza dal basale a ciascuna visita in cui la milza viene esaminata mediante palpazione, compresa la percentuale di soggetti che presentano una riduzione =50% nelle dimensioni della milza.
    - Utilizzo trasfusionale di globuli rossi (RBC):
    • Tasso di utilizzo di trasfusioni di GR (numero medio di unità di GR per paziente/mese)
    • Tasso di variazione da dipendenza da trasfusioni a indipendenza da trasfusioni di GR
    - La percentuale di soggetti con CR e PR in qualsiasi punto temporale, rispetto al basale durante lo studio, definita in base ai criteri del Gruppo di lavoro internazionale-Ricerca e trattamento di neoplasie mieloproliferative (IWG-MRT) e ai criteri modificati della European LeukemiaNet (ELN)
    - L’OS è definita come l’intervallo di tempo che va dalla randomizzazione al decesso per qualsiasi causa
    - La PFS è definita come l’intervallo di tempo che va dal Giorno 1 del Ciclo 1 a: • progressione della malattia (aumento =25% del volume della milza, oppure • trasformazione leucemica (blasti nel midollo osseo =20% o blasti nel sangue periferico =20% associati a una conta assoluta dei blasti di almeno 1 x 109/l che si protrae per almeno 2 settimane) oppure • decesso per qualsiasi causa
    - La sopravvivenza libera da leucemia è definita come l’intervallo di tempo che va dal Giorno 1 del Ciclo 1 alla data della prima documentazione di trasformazione in leucemia (blasti nel midollo osseo =20% o blasti nel sangue periferico =20% associati a una conta assoluta dei blasti di almeno 1 x 109/l che si protrae per almeno 2 settimane)
    - Le analisi degli endpoint di sicurezza includeranno le seguenti misurazioni o valutazioni: esami obiettivi, test di laboratorio, eventi avversi (EA), EA seri (SAE), elettrocardiogrammi (ECG) e segni vitali
    - Saranno determinati i parametri PK di KRT-232, metabolita acil-glucuronide (M1) e ruxolitinib, inclusi ma non limitati a:
    • concentrazione massima osservata (Cmax);
    • concentrazione minima osservata (Cmin);
    • area sotto la curva concentrazione plasmatica-tempo (AUC);
    • tempo al raggiungimento della concentrazione plasmatica massima.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Bone marrow aspirate and biopsy: At Screening visit and at Week 24.
    Palpation of Spleen Size: Performed at Screening and at each physical exam till end of treatment period
    MRI (or CT) of abdomen and Volumetric Measurement of Spleen: Week 12, Week 24, and every 12 weeks, and anytime splenic progression is suspected (this may be at an unscheduled imaging visit)
    Response assessment per IWG-MRT: At Week 24, and every 24 weeks
    PRO MFSAF TSS v4.0 Questionnaire: Daily until End of Treatment
    Transfusion dependence: At Screening and on Day 1 of every cycle
    Hematology: Cycle 1, 2, and 3 (Days 1, 8, 15, 22); Cycle 4 and beyond on Day 1 of each cycle
    AEs: Every visit
    Biomarkers: Subjects will have a blood sample collected and stored at the time points indicated in Table-3 of protocol.
    Aspirato midollare e biopsia: screening e settim 24. Palpazione della dimensione della milza: screening e ad ogni esame fino alla fine del trattamento. TC addome e misurazione volumetrica della milza: settim 12, 24 e ogni 12 settim, e in qualsiasi momento la progressione è sospetta (per esempio durante una visita di imaging non programmata). Valutazione della risposta secondo IWG-MRT: settim 24 e ogni 24 settim. Questionario PRO MFSAF TSS v4.0: tutti i giorni fino alla fine del trattamento. Dipendenza da trasfusione: screening e il primo giorno di ogni ciclo. Ematologia: ciclo 1, 2 e 3 (giorni 1, 8, 15, 22); Ciclo 4 e oltre il giorno 1 di ciascun ciclo. AE: ogni visita. Biomarcatori: i soggetti avranno un campione di sangue raccolto e conservato nei punti della Tabella 3 protocollo.
    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 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 No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    To determine MTD of KRT-232 in combination with ruxolitinib in a 3+3 dose-escalation design
    Per determinare l'MTD di KRT-232 in combinazione con ruxolitinib in uno studio di aumento della dose
    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 No
    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 Yes
    E.8.1.7.1Other trial design description
    Sicurezza ed efficacia di KRT-232 con Ruxolitinib nei pazienti con PMF, Post – PV-MF, Post-ET-MF
    Safety and Efficacy of KRT-232 with Ruxolitinib in Patients with PMF, Post–PV-MF, Post-ET-MF
    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.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA33
    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
    Bulgaria
    France
    Germany
    Italy
    Poland
    Spain
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The study will be considered complete 2 years after the last subject is enrolled, at which time subjects who remain on study treatment will be evaluated for eligibility to enroll in a rollover study
    Lo studio sarà considerato completato 2 anni dopo l’arruolamento dell’ultimo soggetto, momento in cui i soggetti che proseguono il trattamento dello studio saranno valutati per l’idoneità ad arruolarsi in uno studio di rollover.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years6
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years6
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial 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: 39
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 39
    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 state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 50
    F.4.2.2In the whole clinical trial 78
    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
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-11-03
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-09-08
    P. End of Trial
    P.End of Trial StatusOngoing
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