E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Metastatic and/or recurrent PD-L1 positive cervical cancer |
Carcinoma cervicale positivo a PD-L1 (PD-L1+) metastatico e/o recidivante |
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E.1.1.1 | Medical condition in easily understood language |
Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. |
Il carcinoma cervicale è una malattia in cui le cellule della cervice diventano anormali e cominciano a crescere in maniera incontrollata, formando tumori. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10055094 |
E.1.2 | Term | Cervix cancer metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• To evaluate the efficacy of tiragolumab in combination with atezolizumab and of atezolizumab monotherapy based on the objective response rate • To evaluate the safety and tolerability of tiragolumab in combination with atezolizumab and of atezolizumab monotherapy. |
• Valutare l’efficacia dell’associazione atezolizumab e tiragolumab e di atezolizumab in monoterapia sulla base del tasso di risposta obiettiva (Objective Response Rate, ORR) • Valutare la sicurezza e la tollerabilità dell’associazione atezolizumab e tiragolumab e di atezolizumab in monoterapia |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the efficacy of tiragolumab in combination with atezolizumab and of atezolizumab based on the duration of response, disease control rate, best clinical response rate, progression-free survival (PFS) and overall survival (OS) after randomization, PFS rate at 6 months, and OS rate at 6 months and 12 months • To characterize the pharmacokinetics of tiragolumab and atezolizumab • To evaluate the immune response to tiragolumab and atezolizumab |
• Valutare l’efficacia dell’associazione atezolizumab e tiragolumab e di atezolizumab in monoterapia sulla base di: Durata della risposta (DOR), Tasso di controllo della malattia (DCR), Migliore risposta clinica (BCR), Sopravvivenza libera da progressione (PFS) e Sopravvivenza globale (OS) dopo la randomizzazione, tasso di PFS a 6 mesi, e tasso di OS a 6 mesi e a 12 mesi • Caratterizzare il profilo farmacocinetico dell’associazione di atezolizumab + tiragolumab • Valutare la risposta immunitaria all’associazione atezolizumab e tiragolumab e ad atezolizumab in monoterapia |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Age >= 18 years - Life expectancy >= 12 weeks - Ability to comply with the study protocol - Eastern Cooperative Oncology Group Performance Status of 0 or 1 - Histologically confirmed primary Stage IVB, recurrent, or persistent squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix after at least 1 line of prior systemic chemotherapy that is not amenable to curative treatment with systemic chemotherapy, surgery, and/or radiotherapy - Measurable disease - Adequate hematologic and end-organ function obtained within 14 days prior to randomization - Recovery from the effects of surgery, radiotherapy, or chemoradiotherapy - For women of childbearing potential: agreement to remain abstinent or use contraceptive methods with a failure rate of < 1% per year during the treatment period. |
- Età >= 18 anni - Aspettativa di vita >= 12 settimane - Capacità di rispettare il protocollo dello studio - PS secondo ECOG pari a 0 o 1 - Carcinoma a cellule squamose, carcinoma adenosquamoso o adenocarcinoma della cervice primitivo, recidivante o persistente, confermato all’esame istologico (istologie neuroendocrina, a cellule chiare e sarcome non sono consentite), dopo 1- 2 linee precedente di chemioterapia sistemica, non assoggettabile a trattamento curativo con chemioterapia sistemica, chirurgia e/o radioterapia. - Malattia misurabile - Adeguata funzionalità ematologica, epatica e renale in base ai seguenti risultati di laboratorio ottenuti nei 14 giorni prima della randomizzazione - Ripresa dagli effetti dell’intervento chirurgico, della radioterapia o della chemioradioterapia - Nelle pazienti in età fertile: consenso a praticare l’astinenza dai rapporti eterosessuali ad adottare metodi contraccettivi che garantiscano un tasso di insuccesso < 1% all’anno durante il periodo di trattamento. |
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E.4 | Principal exclusion criteria |
- Pregnant or breastfeeding or intending to become pregnant during study - Treatment with invest. therapy with therapeutic intent within 28 d prior to random. - Planned surgery during the study - Current treat. with anti-viral therapy for HBV or HCV - Subst. abuse within 12 m prior to screening, in the investigator's judgment - Any serious medical condition or abnormality in clinical lab tests that, in the investigator's judgment, precludes the patient's safe participation in and completion of the study - Bilateral hydronephrosis that cannot be alleviated by ureteral stents or percutaneous drainage - History of other malignancy within 5 y prior to screening, except for those with an expected negligible risk for metastases or death after curative treatment - Any CNS or brain metastases - Spinal cord compress. 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 >= 1 week prior to randomization - Leptomeningeal disease - Uncontrolled or symptomatic hypercalcemia - Known, clinically significant liver disease, including act. viral, alcoholic, or other hepatitis, cirrhosis, and inherited liver disease, or current alcohol abuse - Active or history of autoimm. disease or imm. def., including, but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid antibody syndrome, Wegener granulomatosis, Sjögren syndrome, Guillain-Barré syndrome, or multiple sclerosis - Active tuberculosis - Severe infection at the time of randomization - Significant cardiovascular disease, such as cardiac disease New York Heart Association Class-II or greater, myocardial infarction, or cerebrovascular accident within 3 m prior to randomization, unstable arrhythmias, or unstable angina - Major surgical procedure other than for diagnosis within 28 d prior to randomization or anticipation of need for a major surgical procedure during the study - Prior allogeneic bone marrow transplantation or solid organ transplant - Any other diseases, metabolic dysfunction, physical examination finding, or clinical lab finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or renders the patient at high risk for treatment complications - Illnesses or conditions that interfere with the patient’s capacity to understand, follow, and/or comply with study procedures - Administration of a live, attenuated vaccine within 4 w before randomization or anticipation that such a live attenuated vaccine will be required during the study - Prior treatment with CD137 agonists or immune checkpoint blockade therapies, anti-CTLA-4, anti-TIGIT, anti-PD-1, and anti-PD-L1 therapeutic ab - Treatment with systemic immunostimulatory agents within 4 w or 5 drug-elimination half-lives prior to randomization - Treatment with systemic immunosuppressive medications within 1 w prior to randomization or anticipation of need for systemic immunosuppressive medication during study treatment - History of severe allergic anaphylactic reactions to chimeric, fully humanized, or humanized antibodies or fusion proteins - Known hypersensitivity to Chin. hamster ovary cell products or to any component of the tiragolumab or atezo formulations. |
- Gravid. o allatt. o intenzione di iniziare una gravid. durante lo studio - Tratt. con qualsiasi farmaco sperim. con intento terapeutico nei 28 gg precedenti la random. - Procedura chir. in progr. nel corso dello studio - Attuale terapia con farmaci antivirali per l’HBV o l’HCV - Abuso di sostanze nei 12 mm prec.i lo screening, secondo giudizio dello sperim. - Q.siasi grave condizione med. o anomalia negli esami clinici di lab. che, secondo il parere dello sperim., precluda alla paz. di partecipare allo studio e portarlo a termine in sicurezza - Idronefrosi bilat. i cui sintomi non possono essere alleviati con il posiz. di stent ureterali o di drenaggio percutaneo - Anamnesi positiva per altra neoplasia maligna nei 5 aa precedenti lo screening, fatta eccezione per i casi che presentano un rischio trascurabile di metastasi o decesso dopo tratt. con intento curativo - Presenza di metastasi a carico del SNC o cerebrali - Compress. del mid. spinale non definitivamente trattata con chir. e/o radiot., o diagnosticata e trattata in prec. senza evidenze di malattia clinicam. stabile per >= 1 settimana prima della random. - Malattia leptomeningea - Ipercalcemia non controllata o sintomatica - Epatopatia nota e clinic. significativa, tra cui epatite virale attiva, alcolica o di altro tipo, cirrosi, epatopatia ereditaria o abuso corrente di alcol - Pres. att. di o anamnesi pos. per malattia autoimm. o imm.def., tra cui, a mero titolo es., miastenia grave, miosite, epatite autoimm., lupus eritem. sist., artrite reum., malattia infiamm. intestinale, sindrome da ab antifosfolipidi, granulomatosi di Wegener, sindr. di Sjo¨gren, sindr. di Guillain-Barré o scl. Multipla - Infez. cronica att. nota o sospetta da EBV allo screen. - Tubercolosi att. - Infezione severa al momento della random izzazione - Cardiovasculop. significativa, quale mal. cardiaca (di classe II o superiore) secondo i criteri della NYHA, infarto del miocardio o acc. cerebrovascolare nei 3 mm precedenti la random., aritmie inst.o angina inst. - Proced. chir. magg., non a scopo diagn., nei 28 gg precedenti la random. o necessità prevista di una proced. chirur. magg. durante lo studio - Prec. trapianto allog. di mid. osseo o di organi solidi - Q.siasi altra malattia, disf. metabolica, obiettività o referto di lab. che ponga il ragionevole sospetto di una malattia, che rappresenti una controindicaz. all’uso di un farmaco sper., che possa interferire con l’interpretaz. dei risultati o che esponga la paz. ad alto rischio di compl. correlate al tratt. - Malattia o cond. med. che interferisca con la capacità della paz. di comprendere, seguire e/o rispettare le proc. previste dallo studio - Somm. di un vaccino vivo attenuato nelle 4 sett. precedenti la random. o necessità prevista di somm. un tale vaccino durante lo studio - Precedente tratt. con agon. di CD137 o terapie che blocc. i checkpoint immunitari, tra cui ab terapeutici anti-CTLA-4, anti-TIGIT, anti-PD-1 e anti-PD-L1 - Tratt. con immunostim.sistemici nelle 4 sett. o nelle 5 emivite del farmaco precedenti la random. - Tratt. con immunosoppr. sistemici nella sett. precedente la random. o necessità prevista di immunosoppr. sistemici durante il tratt. sperim. - Anamnesi positiva per reazioni allergiche o anafilattiche severe agli ab chimerici, compl.umani o umanizz. o alle prot. di fusione - Ipersensibilità nota ai prodotti sint. a partire da cellule ovariche di criceto cinese o a qualsiasi componente della formul. di tiragolumab o di atezo. |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Objective response rate as determined by the independent review committee (IRC) according to Response Evaluation Criteria in Solid Tumors, Version 1.1 (RECIST v1.1) 2. Incidence and severity of adverse events, with severity determined according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events, Version 5.0 (CTCAE v5.0) and the American Society for Transplantation and Cellular Therapy cytokine release syndrome (CRS) consensus grading scale. |
1. Tasso di risposta obiettiva (ORR), secondo quanto stabilito da un comitato radiologico indipendente (IRC) in funzione dei criteri di valutazione della risposta nei tumori solidi, versione 1.1. (RECIST v1.1). 2. Incidenza e severità degli eventi avversi, con severità stabilita in base ai criteri comuni di terminologia per gli eventi avversi del National Cancer Institute, versione 5.0 (NCI CTCAE v5.0). L’attribuzione del grado di severità della sindrome da rilascio di citochine (CRS) si baserà inoltre sui criteri definiti dalla consensus conference dell’American Society for Transplantation and Cellular Therapy (ASTCT CRS Consensus Grading). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1. Up to 36 months 2. Up to 90 days after the final dose of study treatment or until initiation of another anti-cancer therapy. |
1. Fino a 36 mesi 2. Fino a 90 giorni dopo l’ultima dose del trattamento in studio o fino all’inizio di un’altra terapia antitumorale |
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E.5.2 | Secondary end point(s) |
1. Duration of Response as determined by the IRC according to RECIST v1.1 2. Disease control rate as determined by the IRC according to RECIST v1.1 3. Best clinical response rate and Duration of Response as determined by the investigator 4. PFS after randomization as determined by the IRC according to RECIST v1.1 5. PFS rate at 6 months as determined by the IRC according to RECIST v1.1 6. OS after randomization 7. OS rate at 6 months and 12 months 8. Minimum serum concentration (Cmin) of tiragolumab 9. Maximum serum concentration (Cmax) of tiragolumab 10. Minimum serum concentration(Cmin) of atezolizumab 11. Maximum serum concentration (Cmax) of atezolizumab 12. Prevalence of ADAs at baseline and incidence of ADAs to tiragolumab and to atezolizumab during the study. |
1. Durata della risposta (DOR), valutata dall’IRC in funzione dei criteri RECIST v1.1 2. Tasso di controllo della malattia (DCR), secondo quanto stabilito dall’IRC in funzione dei criteri RECIST v1.1. 3. Migliore risposta clinica (BCR) e Durata della risposta (DOR), in funzione della valutazione clinica a cura dello sperimentatore. 4. PFS dopo la randomizzazione valutata dall’IRC in funzione dei criteri RECIST v1.1 5. Tasso di PFS a 6 mesi valutata dall’IRC in funzione dei criteri RECIST v1.1 6. OS dopo la randomizzazione 7. Tasso di OS a 6 mesi e a 12 mesi 8. Minima concentrazione sierica (Cmin) di tiragolumab 9. Massima concentrazione sierica (Cmax) di tiragolumab 10. Minima concentrazione sierica (Cmin) di atezolizumab 11. Massima concentrazione sierica (Cmax) di atezolizumab 12. Prevalenza di anticorpi anti-farmaco (ADA) al basale e incidenza degli ADA diretti contro tiragolumab e contro atezolizumab durante lo studio. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-4. Up to 36 months 5. At 6 months 6. Up to 36 months 7. At 6 and 12 months 8-12. Day 1 of Cycle 1-4, 8, 12 and 16 and at treatment discontinuation (TD) visit |
1-4. Fino 36 mesi 5. A 6 mesi 6. Fino a 36 mesi 7. A 6 e 12 mesi 8-12. Giorno 1 dei Cicli 1-4, 8, 12 e 16 e alla visita di interruzione del trattamento (TD ) |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Tolerability, Immunogenicity and Biomarker |
Tollerabilità, Immunogenicità e Biomarcatori |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 23 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Brazil |
Canada |
Costa Rica |
Korea, Republic of |
Mexico |
Russian Federation |
Taiwan |
Thailand |
United States |
France |
Italy |
Poland |
Spain |
United Kingdom |
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E.8.7 | Trial 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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 36 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 36 |
E.8.9.2 | In all countries concerned by the trial days | 0 |