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    Summary
    EudraCT Number:2020-000209-10
    Sponsor's Protocol Code Number:D8731C00002
    National Competent Authority:France - ANSM
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2020-06-10
    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 ConcernedFrance - ANSM
    A.2EudraCT number2020-000209-10
    A.3Full title of the trial
    A Phase II, Open-label, Study to Assess the Efficacy, Safety, and Tolerability of AZD4635 in Combination with Durvalumab and in Combination with Cabazitaxel and Durvalumab in Patients Who Have Progressive Metastatic Castrate-Resistant Prostate Cancer (AARDVARC)
    Étude de phase II ouverte évaluant l’efficacité, la tolérance et la sécurité d’emploi de l’AZD4635 en association au durvalumab et en association au cabazitaxel et au durvalumab chez des patients présentant un cancer de la prostate évolutif métastatique résistant à la castration (AARDVARC)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase II two-arm study of AZD4635 in combination with durvalumab and in combination with cabazitaxel and durvalumab in patients with mCRPC
    Étude de phase II à deux groupes sur l’AZD4635 en association au durvalumab et en association au cabazitaxel et au durvalumab chez des patients atteints de CPRCm
    A.3.2Name or abbreviated title of the trial where available
    AARDVARC
    A.4.1Sponsor's protocol code numberD8731C00002
    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 SponsorAstraZeneca AB
    B.1.3.4CountrySweden
    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 supportAstraZeneca AB
    B.4.2CountrySweden
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAstraZeneca
    B.5.2Functional name of contact pointInformation Center
    B.5.3 Address:
    B.5.3.1Street AddressUSA
    B.5.3.2Town/ cityUSA
    B.5.3.3Post codeUSA
    B.5.3.4CountryUnited States
    B.5.6E-mailinformation.centre@astrazeneca.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.3.2Product code AZD4635
    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 INNNot applicable
    D.3.9.1CAS number 1321514-06-0
    D.3.9.2Current sponsor codeAZD4635
    D.3.9.3Other descriptive nameSSP002388X, SPD559
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation 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 nameDurvalumab
    D.3.2Product code MEDI4736
    D.3.4Pharmaceutical form Capsule, hard
    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 INNDurvalumab
    D.3.9.1CAS number 1428935-60-7
    D.3.9.2Current sponsor codeMEDI4736
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product 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
    Progressive Metastatic Castrate-Resistant Prostate Cancer
    Cancer de la prostate métastatique résistant à la castration
    E.1.1.1Medical condition in easily understood language
    Prostate Cancer
    Cancer de la prostate
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10036909
    E.1.2Term Prostate cancer metastatic
    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 efficacy (as assessed by radiographic progression free survival [rPFS]) of AZD4635 plus durvalumab and separately of AZD4635 plus durvalumab plus cabazitaxel in participants with mCRPC.
    Déterminer l’efficacité (évaluée par la survie sans progression radiographique [SSPrS]) du traitement par AZD4635 plus durvalumab et séparément du traitement par AZD4635 plus durvalumab plus cabazitaxel chez des participants atteints de CPRCm.
    E.2.2Secondary objectives of the trial
    *To determine the efficacy of AZD4635 plus durvalumab and separately of AZD4635 plus durvalumab plus cabazitaxel by assessment of overall survival (OS), objective response rate (ORR), duration of response (DoR), prostate-specific antigen (PSA) response in participants with mCRPC.
    *Investigate the PK of AZD4635 when given in combination with durvalumab, and when given in combination with durvalumab plus cabazitaxel.
    *To determine the efficacy of AZD4635 plus durvalumab and AZD4635 plus durvalumab plus cabazitaxel in participants with mCRPC, by adenosine (ADO) gene expression in high and low subgroups in each arm separately.
    *To determine the efficacy of AZD4635 plus durvalumab and AZD4635 plus durvalumab plus cabazitaxel in participants with mCRPC, by adenosine deaminase (ADA) gene expression in high and low subgroups in each arm separately.
    *To explore the effects of AZD4635 on pain and other prostate cancer-related symptoms.
    *Déterminer l’efficacité du traitement par AZD4635 plus durvalumab et séparément celle du traitement par AZD4635 plus durvalumab plus cabazitaxel, en évaluant la survie globale, le TRO, DdR, PSA, chez des participants atteints de CPRCm
    *Évaluer la pharmacocinétique de l’AZD4635 administré en association au durvalumab, et administré en association au durvalumab plus cabazitaxel.
    *Déterminer l’efficacité du traitement par AZD4635 plus durvalumab et séparément celle du traitement par AZD4635 plus durvalumab plus cabazitaxel chez des participants atteints de CPRCm, d’après la signature de l’expression génique de l’adénosine dans les sous-groupes à taux élevés et faibles dans chaque groupe séparément.

    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1 Participant must be 18 years of age inclusive at the time of signing the informed consent.
    2 Histologically confirmed adenocarcinoma of the prostate
    - Disease must be metastatic and inoperable and for which there is no curative intervention available. Participants may have bone-only disease.
    - Participants presenting with treatment-emergent neuroendocrine differentiation, but not primary small-cell features, are eligible.
    3 Known castrate-resistant disease, defined as:
    - Testosterone level in the castration range (levels <50 ng/dl) because of a previous, and ongoing, androgen-deprivation with luteinizing hormone-releasing hormone (LHRH) agonists or antagonists or bilateral orchiectomy. Participants must have developed progression of metastases following surgical castration or during medical androgen ablation therapy. Participants receiving medical castration therapy with gonadotropin-releasing hormone (GnRH) analogues should continue this treatment during this study.
    4 Evidence of disease progression ≤6 months defined by one or more of the following:
    - Progression as defined by RECIST v1.1 criteria for assessment of malignant soft tissue disease and lymph nodes
    - Progression of bone lesions on bone scan from a previous or baseline assessment per PCWG3
    - Rising PSA
    5 Must have measurable disease:
    - At least 1 documented lesion on either a bone scan or a computed tomography (CT)/magnetic resonance imaging (MRI) scan that can be followed for response is suitable for repeated measurement
    Or
    - Non-measurable disease must have measurable PSA ≥1.0 ng/mL as the minimum starting level for trial entry if the confirmed rise is the only indication of progression (excluding small cell carcinoma)
    6 Body weight >30 kg at screening.
    7 Willingness to adhere to the study treatment-specific contraception requirements: Participants must be surgically sterile or using an acceptable method of contraception (defined as barrier methods in conjunction with spermicides) for the duration of the study (from the time they sign ICF) and for 3 months after the last dose of AZD4635 and/or durvalumab and/or cabazitaxel to prevent pregnancy in a female partner. Participants must not donate or bank sperm for 24 weeks after treatment.
    8 Adequate bone marrow reserve and organ function as demonstrated by all of the following laboratory values:
    - Absolute neutrophil count (ANC) ≥1.5 × 10^9/L
    - Platelet count ≥100 × 10^9/L
    - Haemoglobin ≥9.0 g/dL
    - Creatinine ≤1.5 × ULN concurrent with creatinine clearance >50 mL/min (measured or calculated by Cockcroft and Gault equation); confirmation of creatinine clearance is only required when creatinine is >1.5 × ULN.
    Additional Inclusion Criteria Specific for Arm A
    9 Adequate organ function for Arm A as demonstrated by all of the following laboratory values:
    - Alanine aminotransferase (ALT) ≤2.5 × the upper limit of normal (ULN) if no demonstrable liver metastases or ≤5 × ULN in the presence of liver metastases.
    - Aspartate aminotransferase (AST) ≤2.5 × ULN if no demonstrable liver metastases or ≤5 × ULN in the presence of liver metastases
    - Total bilirubin (TBL) ≤1.5 × ULN
    - TBL ≤2.0 × ULN in the case of known Gilbert syndrome with normal direct bilirubin
    10 Participants in Arm A must have received the following prior therapy:
    - Maximum of 3 lines of therapy in the mCRPC setting
    - Prior therapy with one or more NHAs (eg, abiraterone acetate, enzalutamide, apalutamide, darolutamide) in either hormone-sensitive or hormone-refractory settings
    - Prior therapy with one or more lines of taxanes (eg, docetaxel and/or cabazitaxel)
    - Alternatively, must be taxane-ineligible
    - Prior therapy can be in either the hormone-sensitive or the hormone-refractory setting
    Additional Inclusion Criteria Specific for Arm B
    11 Adequate organ function for Arm B as demonstrated by all of the following laboratory values:
    - AST and/or ALT ≤1.5 × ULN
    - TBL ≤ ULN
    - TBL ≤2.0 × ULN in the case of known Gilbert syndrome with normal direct bilirubin
    12 Participants in Arm B must have received the following prior therapy:
    - Prior docetaxel (taxane) in either hormone-sensitive or hormone-refractory settings
    - Received no prior cytotoxic chemotherapy other than docetaxel for prostate cancer except for estramustine and except adjuvant/neo-adjuvant treatment completed >3 years ago.
    - Prior therapy with only one NHAs (eg, abiraterone acetate or enzalutamide; prior apalutamide is not permitted) for treatment of mCRPC in either hormone-sensitive or hormone-refractory settings.
    - Be suitable to receive concomitant GCSF during all cycles of cabazitaxel.
    Other Inclusion Criteria
    13 World Health Organisation (WHO) performance status of 0-1 with no clinical deterioration over the previous 2 weeks prior to the 28-day screening period and likely able to complete at least 12 weeks of treatment.
    1 Les participants devront être âgés de 18 ans inclus au moment de la signature du formulaire de consentement.
    2Adénocarcinome de la prostate confirmé histologiquement
    -Atteinte métastatique et inopérable pour laquelle il n’existe pas de traitement curatif Les participants pourront ne présenter qu’une atteinte osseuse.
    -Les participants présentant une différenciation neuroendocrinienne émergeant sous traitement mais pas de caractéristiques primitives à petites cellules sont éligibles.
    3 Cancer connu de la prostate résistant à la castration, défini ainsi :
    -Testostéronémie comprise dans les valeurs correspondant à une castration (taux < 50 ng/dl) en raison d’un traitement par privation androgénique antérieur et en cours par agonistes ou antagonistes de l’hormone de libération de la lutéinostimuline (LHRH, luteinizing hormone-releasing hormone) ou orchidectomie bilatérale. Progression des métastases après une castration chirurgicale ou pendant le traitement médical par privation androgénique. Les participants sous castration médicale par analogues de gonadolibérine (GnRH, gonadotropin-releasing hormone) devront continuer ce traitement pendant cette étude.
    4 Signes de progression de la maladie datant de ≤ 6 mois, définie par l’un ou plusieurs des critères suivants :
    -Progression définie selon les critères RECIST v1.1 pour l’atteinte maligne des tissus mous et des ganglions lymphatiques
    -Progression des lésions osseuses sur la scintigraphie par rapport à une évaluation précédente ou effectuée à l’inclusion conformément aux critères PCWG3
    - Augmentation du taux de PSA
    5 Présence d’une atteinte mesurable :
    -La présence d’au moins 1 lésion documentée sur une scintigraphie osseuse ou un examen par tomodensitométrie (TDM)/imagerie par résonance magnétique (IRM) pouvant faire l’objet d’un suivi de la réponse convient pour les mesures répétées
    ou
    Une atteinte non mesurable devra présenter un taux mesurable de PSA ≥ 1,0 ng/ml comme taux initial minimum pour l’entrée dans l’étude si l’élévation confirmée est la seule indication de la progression (en excluant le carcinome à petites cellules)
    Poids
    6 Poids corporel > 30 kg à la sélection.
    7 Accord pour respecter les exigences relatives à la contraception spécifiques au traitement à l’étude : Les participants doivent avoir été stérilisés chirurgicalement ou doivent utiliser des moyens de contraception acceptables (définis comme des méthodes mécaniques [« barrière »] en association à des spermicides) pendant la durée de l’étude (à partir du moment de la signature du FCE) et pendant 3 mois après la dernière dose d’AZD4635 et/ou de durvalumab et/ou de cabazitaxel, pour éviter toute grossesse chez la partenaire. Les participants ne devront pas effectuer de dons de sperme ou de dépôt dans une banque de sperme pendant 24 semaines après le traitement.
    Réserve médullaire et fonction organique
    8 Réserve médullaire suffisante et fonction organique appropriée, mises en évidence par tous les paramètres biologiques suivants :
    -Numération absolue des neutrophiles (NAN) ≥ 1,5 × 109/l
    -Numération plaquettaire ≥ 100 × 109/l
    -Hémoglobine ≥ 9,0 g/dl
    -Créatinine ≤ 1,5 × LSN avec clairance de la créatinine > 50 ml/min (mesurée ou calculée selon l’équation de Cockcroft et Gault) ; confirmation d’une clairance de la créatinine uniquement exigée lorsque la créatinine est > 1,5 × LSN.
    Autres critères d’inclusion spécifiques au groupe A
    9 Fonction organique appropriée pour le Groupe A, mise en évidence par tous les paramètres biologiques suivants :
    -Taux d’alanine aminotransférase (ALAT) ≤ 2,5 x la limite supérieure de la normale (LSN) en absence de métastases hépatiques démontrables ou ≤ 5 × LSN en présence de métastases hépatiques.
    - Taux d’aspartate aminotransférase (ASAT) ≤ 2,5 x LSN en absence de métastases hépatiques démontrables ou ≤ 5 × LSN en présence de métastases hépatiques.
    -Bilirubine totale (BLT) ≤ 1,5 x LSN.
    -BLT ≤ 2,0 × LSN en cas de syndrome de Gilbert connu avec bilirubine directe normale
    10Les participants du Groupe A devront avoir reçu le traitement antérieur suivant :
    -Maximum de 3 lignes de traitement dans le contexte de CPRCm
    -Traitement antérieur par au moins un NAH (par exemple, acétate d’abiratérone, enzalutamide, apalutamide, darolutamide) dans un contexte hormonosensible ou hormonoréfractaire
    -Traitement antérieur par au moins une ligne de taxanes (par exemple, docétaxel et/ou cabazitaxel)
    -Sinon, les participants doivent être inéligibles aux taxanes.
    -Le traitement antérieur peut être administré dans un contexte de cancer hormonosensible ou hormonoréfractaire.
    11Fonction organique appropriée pour le Groupe B, mise en évidence par tous les paramètres biologiques suivants :
    -ASAT et/ou ALAT ≤ 1,5 × LSN
    -BLT ≤ LSN
    -BLT ≤ 2,0 × LSN en cas de syndrome de Gilbert connu avec bilirubine directe normale
    Cf Protocole pour 12 et 13

    E.4Principal exclusion criteria
    1 Active brain metastases or leptomeningeal metastases. Participants with brain metastases are eligible if treated and there is no evidence of progression for at least 8 weeks after treatment is completed and within 28 days prior to the first dose of study intervention.
    2 There must be no requirement for immunosuppressive doses of systemic corticosteroids (>10 mg/day prednisone/equivalent) for at least 2 weeks prior to study enrollment.
    3 Participant with a history of pneumonitis requiring corticosteroids.
    4 History of a second malignancy that is progressing and/or received active treatment ≤3 years before the first dose of study intervention.
    5 As judged by the Investigator, any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, active bleeding diatheses, or active infection including hepatitis B, hepatitis C, and human immunodeficiency virus. Screening for chronic conditions is not required.
    6 Creatinine clearance <50 mL/min (calculated by Cockcroft-Gault equation).
    7 Prior exposure to immune-mediated therapy including, but not limited to anti-CTLA-4, anti-PD-1, anti-PD-L1 and anti-PD-L2 antibodies, excluding therapeutic anti-cancer vaccines.
    Additional Exclusion Criteria Specific for Arm B: Medical Conditions
    8 Participant with active grade ≥2 peripheral neuropathy
    9 Participant with active grade ≥2 stomatitis
    10 Any small-molecule, biologic, or hormonal agent from a previous treatment regimen or clinical study within 21 days or 5 half-lives (whichever is shorter) prior to the first dose of study intervention. At least 7 days must have elapsed between the last dose of such agent and the first dose of study intervention. Exception: androgen-deprivation therapy is permitted.
    11 History of hypersensitivity to polysorbate-80 if allocated to cabazitaxel.
    12 Nitrosourea or mitomycin C within 6 weeks of the first dose of study intervention.
    13 Prescription or non-prescription drugs or other products known to be sensitive BCRP or OAT1 substrates or to be strong inhibitors/inducers of CYP1A2, which cannot be discontinued 2 weeks prior to Day 1 of dosing and withheld throughout the study, until 2 weeks after the last dose of study intervention.
    14 Exclusion Criteria for Arm B: Concurrent or planned treatment with strong inhibitors or strong inducers of cytochrome P450 3A4/5 (CYP3A4/5) are excluded (a 2-week washout period is required for participants already on these treatments).
    15 Herbal preparations/medications are not allowed throughout the study. These herbal medications include but are not limited to St. John’s wort, kava, ephedra (ma huang), gingko biloba, dehydroepiandrosterone, yohimbe, saw palmetto, and ginseng. Participants should stop using these herbal medications 7 days prior to the first dose of study intervention. Exceptions may be agreed, but the circumstances must be reviewed by the Medical Monitor/AZ Study Physician in advance.
    16 Ongoing treatment with warfarin (Coumadin).
    17 Receipt of live attenuated vaccine within 30 days prior to the first dose of study intervention.
    18 Major surgery (excluding placement of vascular access) within 4 weeks of the first dose of study intervention.
    19 Radiotherapy with a wide field of radiation within 4 weeks or radiotherapy with a limited field of radiation for palliation within 2 weeks of the first dose of study intervention.
    20 AZD4635 in the present study (i.e., dosing with AZD4635 previously initiated in a different arm in this study) or prior therapy with AZD4635 or any other A2AR antagonist or other CD73/CD39 antagonists.
    21 History of allogeneic transplant
    22 With the exception of alopecia, any unresolved toxicities from prior therapy greater than Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 Grade 1 at the time of starting study treatment. Participant with chronic Grade 2 unresolved toxicities may be eligible following discussion with the Medical Monitor/AZ Study Physician.
    23 Concurrent enrollment into another therapeutic clinical trial.
    24 Concomitant treatment with another A2R2 antagonist that would increase risk of seizure (e.g., theophylline, aminophylline).
    25 Any of the following cardiac criteria :
    - Mean resting corrected QT interval (QTcF) >470 msec obtained from 3 ECGs
    - Any clinically important abnormalities in rhythm, conduction, or morphology of resting ECGs, e.g., complete left bundle branch block, third-degree heart block
    - Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalaemia, congenital long QT syndrome, or family history of long QT syndrome or unexplained sudden death under 40 years-of-age
    - Ejection fraction <55% or the lower limit of normal of the institutional standard
    26 Judgment by the Investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures, restrictions and requirements
    1 Métastases cérébrales ou leptoméningées actives. Les participants ayant des métastases cérébrales sont éligibles s’ils ont été traités et qu’il n’y a pas de signe de progression pendant au moins 8 semaines après la fin du traitement et dans les 28 jours précédant la première dose de traitement à l’étude.
    2 Aucune dose immunosuppressive de corticoïdes systémiques (> 10 mg/jour de prednisone/équivalent) ne doit être nécessaire pendant au moins 2 semaines avant le recrutement dans l’étude.
    3 Antécédents de pneumonite nécessitant des corticoïdes.
    4 Antécédents de deuxième cancer en cours de progression et/ou de traitement antérieur actif ≤ 3 ans avant la première dose de traitement à l’étude.
    5 D’après le jugement de l’investigateur, tout signe de pathologie systémique sévère ou non contrôlée, y compris hypertension artérielle non contrôlée, diathèse hémorragique active ou infection active, y compris hépatite B, hépatite C, et infection par le virus de l’immunodéficience humaine. Un dépistage de pathologies chroniques n’est pas nécessaire.
    6 Clairance de la créatinine < 50 ml/min (calculée selon la formule de Cockroft-Gault).
    7 Exposition antérieure à un traitement à médiation immunitaire, notamment anticorps anti-CTLA-4, anti-PD-1, anti-PD-L1 et anti-PD-L2, en excluant les vaccins anticancéreux thérapeutiques.
    Autres critères de non inclusion spécifiques au groupe B : Pathologies médicales
    8 Neuropathie périphérique active de grade ≥ 2
    9 Stomatite active de grade ≥ 2
    Traitements antérieurs/concomitants
    10 Tout agent de type petite molécule, biologique ou hormonal inclus d’un schéma thérapeutique ou une étude clinique antérieur(e) dans les 21 jours ou 5 demi-vies (selon la durée la plus courte) avant la première dose de traitement à l’étude. La dernière dose administrée de ce type d’agent et la première dose de traitement à l’étude doivent être espacées d’au moins 7 jours. Exception : le traitement par privation androgénique est autorisé.
    11 Antécédents d’hypersensibilité au polysorbate-80 si affectation au traitement par cabazitaxel.
    12 Traitement par nitroso-urée ou mitomycine C dans les 6 semaines précédant la première dose de traitement à l’étude.
    13 Médicaments sur ordonnance ou vendus sans prescription ou autres produits connus pour être des substrats sensibles de BCRP ou OAT1 ou être des inhibiteurs/inducteurs puissants de CYP1A2 (voir Annexe I), ne pouvant pas être arrêtés 2 semaines avant le Jour 1 du traitement à l’étude et être suspendus pendant toute l’étude, jusqu’à 2 semaines après la dernière dose de traitement à l’étude.
    14 Critères de non inclusion pour le groupe B : Les traitements concomitants ou programmés par inhibiteurs puissants ou inducteurs puissants du P450 3A4/5 (CYP3A4/5) sont exclus (une période de sevrage de 2 semaines est exigée pour les participants recevant déjà ce traitement (se reporter à l’Annexe I).
    15 Les préparations/produits de phytothérapie ne sont pas autorisés pendant l’étude. Ces produits de phytothérapie incluent notamment : millepertuis, kava, éphédra (ma huang), gingko biloba, déhydroépiandrostérone (DHEA), yohimbée, palmier nain et ginseng. Les participants devront arrêter l’utilisation de ces produits de phytothérapie 7 jours avant la première dose de traitement à l’étude. Il peut y avoir des exceptions sur accord, mais les circonstances doivent être examinées au préalable par le moniteur médical/médecin-investigateur AZ.
    16 Traitement en cours par warfarine (Coumadine).
    17 Administration d’un vaccin vivant atténué dans les 30 jours précédant la première dose de traitement à l’étude.
    18 Intervention chirurgicale majeure (en dehors de la pose d’une voie d’abord vasculaire) dans les 4 semaines précédant la première dose de traitement à l’étude.
    19 Traitement par radiothérapie à champ large dans les 4 semaines précédant la première dose du traitement à l’étude ou par radiothérapie à champ limité dans les 2 semaines précédant la première dose du traitement à l’étude.
    Expérience d’étude clinique précédente/concomitante
    20 Administration d’AZD4635 dans la présente étude (c’est-à-dire administration d’AZD4635 commencée initialement dans un groupe différent dans cette étude) ou antécédent de traitement par AZD4635 ou de tout autre antagoniste d’A2AR ou d’autres antagonistes de CD73/CD39.
    21 Antécédents de greffe allogénique.
    22 À l’exception de l’alopécie, toute toxicité non résolue liée à un traitement antérieur supérieure à un Grade 1 selon les critères CTCAE (Common Terminology Criteria for Adverse Events, critères communs de terminologie relatifs aux événements indésirables), Version 5.0 au moment de commencer le traitement à l’étude. Les participants ayant des toxicités non résolues chroniques de Grade 2 pourront être éligibles après discussion avec le moniteur médical/médecin-investigateur AZ.
    23 Recrutement concomitant dans une autre étude clinique thérapeutique.
    Cf Protocole pour 24-26


    E.5 End points
    E.5.1Primary end point(s)
    rPFS, defined as the time from first dose to radiographic progression as assessed by the Investigator per Response Evaluation Criteria in Solid Tumours (RECIST v1.1) (soft tissue) and Prostate Cancer Working Group 3 criteria (PCWG3) (bone) or death from any cause, whichever occurs first.
    La SSPr, définie comme le temps écoulé entre la première dose et la progression radiographique évaluée par l’investigateur selon les critères d’évaluation de la réponse dans les tumeurs solides (RECIST [Response Evaluation Criteria in Solid Tumours] v1.1) (tissus mous) et les critères du Groupe de travail sur le cancer de la prostate (PCWG3, Prostate Cancer Working Group 3) (os) ou le décès de quelque cause que ce soit, selon l’événement survenant en premier.
    E.5.1.1Timepoint(s) of evaluation of this end point
    •Arm A: RECIST and PCWG3 measurements will be made every 8 weeks (±1 week) for the first 24 weeks relative to the start of study treatment (Cycle 1, Day 1) and every 12 weeks (±1 week) thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond disease progression).”
    •Arm B: RECIST and PCWG3 measurements will be made every 9 weeks (±1 week) for the first 27 weeks relative to the start of study treatment (Cycle 1, Day 1)
    and every 12 weeks (±1 week) thereafter until RECIST 1.1 defined disease progression or cessation of study treatment (if treating beyond disease progression).”
    E.5.2Secondary end point(s)
    - Overall survival (also within the gene expression subgroups)
    - Objective response rate (also within the gene expression subgroups)
    - Duration of response (also within the gene expression subgroups)
    - Prostate-specific antigen response (also within the gene expression subgroups)
    - AZD4635, durvalumab and cabazitaxel plasma concentration and derived PK parameters.
    - Radiographic progression free survival within the gene expression subgroups
    - Change from baseline in worst pain, general pain and pain interference in the daily activities scales of the BPI-SF and in the worst bone pain item.
    - Time to pain progression based on BPI-SF Item 3 “worse pain in 24-hours”.
    - Change from baseline in the FAPSI-8, as derived from 8 items within the FACT-P and the PCS, as derived from the 12 items in the prostrate-specific module of the FACT-P.
    E.5.2.1Timepoint(s) of evaluation of this end point
    •RECIST and PCWG3 measurements will be made every 8 ± 1 weeks (Arm A) or 9 ±1 weeks (Arm B) for the first 24 weeks (Arm A) or 27 weeks (Arm B) relative to the start of study treatment and every 12 ±1 weeks thereafter until RECIST 1.1 defined disease progression or cessation of study treatment
    •OS: will be determined every 3 months from disease progression until data cut-off or death
    •PK: will be measured at limited time points during treatment and up to follow up
    •PSA assessment at baseline and at the start of each new treatment cycle (every 4 weeks for arm A and every 3 weeks for first 10 cycles and then every 4 weeks arm B), at end of treatment, and at progression
    • BPI-SF and FACT-P assessments will be measured at limited time points during treatment and up to follow up
    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 No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarker assessment
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo 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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA35
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Belgium
    Denmark
    France
    Germany
    Italy
    Korea, Republic of
    Netherlands
    Spain
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last visit of the last patient.
    Dernière visite du dernier patient.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months8
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years3
    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: 32
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 128
    F.2 Gender
    F.2.1Female No
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state18
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 120
    F.4.2.2In the whole clinical trial 160
    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)
    Intervention after the end of the study will be at the discretion of the Investigator.
    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 Decision2020-08-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-07-07
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2022-08-08
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