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    Summary
    EudraCT Number:2020-000923-37
    Sponsor's Protocol Code Number:TriComB
    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:2021-06-08
    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 number2020-000923-37
    A.3Full title of the trial
    A phase 1/2 study exploring the safety and activity of Trifluridine/tipiracil in combination with capecitabine and bevacizumab in metastatic colorectal cancer patients.
    Studio di fase 1/2 su tolleranza e attività di trifluridina/tipiracile in combinazione con capecitabina e bevacizumab come trattamento di prima linea in pazienti con tumore colorettale metastatico.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A phase 1/2 study exploring the safety and activity of Trifluridine/tipiracil in combination with capecitabine and bevacizumab in metastatic colorectal cancer patients.
    Studio di fase 1/2 su tolleranza e attività di trifluridina/tipiracile in combinazione con capecitabina e bevacizumab come trattamento di prima linea in pazienti con tumore colorettale metastatico.
    A.3.2Name or abbreviated title of the trial where available
    TriComB
    TriComB
    A.4.1Sponsor's protocol code numberTriComB
    A.5.4Other Identifiers
    Name:TriComBNumber:TriComB
    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 SponsorG.O.N.O. - GRUPPO ONCOLOGICO DEL NORD OVEST
    B.1.3.4CountryItaly
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportServier Italia Spa
    B.4.2CountryItaly
    B.4.1Name of organisation providing supportServier Affaires Medicales
    B.4.2CountryFrance
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationClinical Research Technology
    B.5.2Functional name of contact pointRegulatory and Clinical Operations
    B.5.3 Address:
    B.5.3.1Street AddressVia San Leonardo trav Migliaro
    B.5.3.2Town/ citySalerno
    B.5.3.3Post code84131
    B.5.3.4CountryItaly
    B.5.4Telephone number089301545
    B.5.5Fax number0897724155
    B.5.6E-mailtricomb@cr-technology.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 Yes
    D.2.1.1.1Trade name LONSURF - 15 MG/6,14 MG - COMPRESSA RIVESTITA CON FILM - USO ORALE - BLISTER AL/AL - 60 COMPRESSE
    D.2.1.1.2Name of the Marketing Authorisation holderLES LABORATOIRES SERVIER
    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 nameLONSURF
    D.3.2Product code [TAS-102]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTRIFLURIDINA
    D.3.9.1CAS number 70-00-8
    D.3.9.2Current sponsor codeS95005
    D.3.9.4EV Substance CodeSUB11291MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTIPIRACIL HYDROCHLORIDE
    D.3.9.1CAS number 183204-74-0
    D.3.9.2Current sponsor codeS95005
    D.3.9.4EV Substance CodeSUB174128
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6140
    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 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 nameCapecitabina
    D.3.2Product code [L01BC06]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCAPECITABINA
    D.3.9.1CAS number 154361-50-9
    D.3.9.2Current sponsor codeNAP
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    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.2.1.2Country 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 namebevacizumab
    D.3.2Product code [L01XC07]
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNBEVACIZUMAB
    D.3.9.1CAS number 216974-75-3
    D.3.9.2Current sponsor codeNAP
    D.3.10 Strength
    D.3.10.1Concentration unit mg/kg milligram(s)/kilogram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name LONSURF - 20 MG/8,19 MG - COMPRESSA RIVESTITA CON FILM - USO ORALE - BLISTER AL/AL - 20 COMPRESSE
    D.2.1.1.2Name of the Marketing Authorisation holderLES LABORATOIRES SERVIER
    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 nameLonsurf
    D.3.2Product code [TAS-102]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTRIFLURIDINA
    D.3.9.1CAS number 70-00-8
    D.3.9.2Current sponsor codeS95005
    D.3.9.4EV Substance CodeSUB11291MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTIPIRACIL HYDROCHLORIDE
    D.3.9.1CAS number 183204-74-0
    D.3.9.2Current sponsor codeS95005
    D.3.9.4EV Substance CodeSUB174128
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number8190
    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
    metastatic colorectal cancer
    tumore colorettale metastatico
    E.1.1.1Medical condition in easily understood language
    metastatic colorectal cancer
    tumore colorettale metastatico
    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 10052362
    E.1.2Term Metastatic colorectal cancer
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    • Part 1:
    To evaluate the safety and to determine the recommended dose of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab) in previously untreated metastatic colorectal cancer (mCRC) patients deemed unfit for intensive chemotherapy.
    • Part 2:
    To evaluate the activity of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab) in previously untreated mCRC patients deemed unfit for intensive chemotherapy in terms of Objective Response Rate (ORR) per RECIST v1.1.
    • Parte 1:
    Valutare la sicurezza e determinare la dose raccomandata della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab) in pazienti con tumore colorettale metastatico (mCRC) precedentemente non trattati considerati unfit per chemioterapia intensiva.
    • Parte 2:
    Valutare l’attività della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab) in pazienti con mCRC precedentemente non trattati considerati unfit per chemioterapia intensiva in termini di tasso di risposta obiettiva (ORR) secondo i RECIST v1.1.
    E.2.2Secondary objectives of the trial
    • Part 1:
    -To gather preliminary activity results of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab) in terms of ORR per RECIST v1.1 at the recommended dose.
    -To assess the quality of life as measured by PROs questionnaires (EORTC QLQ-C30 EORTC, QLQ-CR29 and EuroQol EQ-5D).
    • Part 2:
    -To evaluate the safety of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab).
    -To evaluate the efficacy of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab) in terms of Progression Free Survival (PFS) and Overall Survival (OS).
    -To assess the quality of life as measured by PROs questionnaires (EORTC QLQ-C30 EORTC, QLQ-CR29 and EuroQol EQ-5D).
    • Parte 1:
    Acquisire risultati preliminari di attività della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab) alla dose raccomandata in termini di ORR secondo i RECIST v1.1.
    Valutare la qualità della vita misurata dai questionari PROs (Patient Reported Outcomes: EORTC QLQ-C30 EORTC QLQ-CR29 e EuroQol EQ-5D).
    • Parte 2:
    Valutare la sicurezza della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab).
    Valutare l’efficacia della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab) in termini di sopravvivenza libera da progressione (PFS) e sopravvivenza globale (OS).
    Valutare la qualità della vita misurata dai questionari PROs (Patient Reported Outcomes: EORTC QLQ-C30, EORTC QLQ-CR29 e EuroQol EQ-5D).
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Pharmacogenetics
    Version: 1.2
    Date: 01/06/2020
    Title: A Phase 1/2 Study Exploring the Safety and Activity of Trifluridine/Tipiracil in Combination with Capecitabine and Bevacizumab in Metastatic Colorectal Cancer Patients
    Objectives: To characterize the effect of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab) based on TK1, TP and TS levels on pre-treatment tissue samples and pre-and post-treatment blood samples.

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: A Phase 1/2 Study Exploring the Safety and Activity of Trifluridine/Tipiracil in Combination with Capecitabine and Bevacizumab in Metastatic Colorectal Cancer Patients - v.1.2 01Jun2020

    -To evaluate the pharmacokinetics (PK) of the combination trifluridine/tipiracil plus capecitabine plus bevacizumab.
    -To characterize the effect of the combination (trifluridine/tipiracil plus capecitabine plus bevacizumab) based on TK1, TP and TS levels on pre-treatment tissue samples and pre-and post-treatment blood samples.

    Farmacogenetica
    Versione: 1.2
    Data: 01/06/2020
    Titolo: STUDIO DI FASE 1/2 SU TOLLERANZA E ATTIVITÀ DI TRIFLURIDINA/TIPIRACILE IN COMBINAZIONE CON CAPECITABINA E BEVACIZUMAB COME TRATTAMENTO DI PRIMA LINEA IN PAZIENTI CON TUMORE COLORETTALE METASTATICO
    Obiettivi: Caratterizzare l’effetto della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab) sulla base dei livelli di TK1, TP e TS su campioni ematici pre- e post-trattamento e su campioni tissutali pre-trattamento.

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: STUDIO DI FASE 1/2 SU TOLLERANZA E ATTIVITÀ DI TRIFLURIDINA/TIPIRACILE IN COMBINAZIONE CON CAPECITABINA E BEVACIZUMAB COME TRATTAMENTO DI PRIMA LINEA IN PAZIENTI CON TUMORE COLORETTALE METASTATICO - v.1.2 del 01 giugno 2020

    -Valutare la farmacocinetica (PK) della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab).
    -Caratterizzare l’effetto della combinazione (trifluridina/tipiracile più capecitabina più bevacizumab) sulla base dei livelli di timidina chinasi 1 (TK1), timidina fosforilasi (TP) e timidilato sintasi (TS) su campioni ematici pre- e post-trattamento e su campioni tissutali pre-trattamento.
    E.3Principal inclusion criteria
    Both Part 1 and 2:
    - Written informed consent to study procedures.
    - Histologically proven diagnosis of colorectal cancer.
    - Metastatic colorectal cancer not previously treated with chemotherapy for metastatic disease.
    - At least one measurable lesion according to RECIST1.1.
    - Age = 18 years.
    - ECOG PS = 1.
    - Life expectancy of at least 12 weeks.
    - Previous adjuvant fluoropyrimidine-based chemotherapy allowed only if more than 12 months elapsed between the end of adjuvant and first relapse.
    - Availability of archival tumour tissue (primary tumour and metastases or at least one of the two) for biomarker analysis.
    - Availability of blood sample for biomarker analysis.
    - Previously not eligible for a chemotherapy doublet or triplet (oxaliplatin and/or irinotecan-based combination).
    - Neutrophils =1.5 x 109/L, Platelets =100 x 109/L, Hemoglobin = 9 g/dl.
    - Total bilirubin =1.5 fold the upper-normal limits (UNL), AST (SGOT) and/or ALT (SGPT) = 2.5 x UNL (or <5 x UNL in the case of liver metastases), alkaline phosphatase = 2.5 x UNL (or <5 x UNL in case of liver metastases).
    - Creatinine clearance = 50 mL/min or serum creatinine =1.5 x UNL.
    - Male subjects with female partners of childbearing potential must be willing to use adequate contraception as approved by the investigator (barrier contraceptive measure or oral contraception).
    - Women of childbearing potential must have a negative blood pregnancy test at the baseline visit. For this trial, women of childbearing potential are defined as all women after puberty, unless they are postmenopausal for at least 12 months, are surgically sterile, or are sexually inactive. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient.
    - Subjects and their partners must be willing to avoid pregnancy during the trial and until 6 months after the last trial treatment.
    - Will and ability to comply with the protocol.
    Parte 1 e Parte 2
    - Diagnosi confermata istologicamente di adenocarcinoma del colon-retto;
    - Consenso informato scritto alle procedure dello studio;
    - Malattia metastatica inizialmente non resecabile e non precedentemente trattata con chemioterapia per lo stadio avanzato;
    - Almeno una lesione misurabile secondo i criteri RECIST 1.1;
    - Disponibilità di campione tissutale (tumore primitivo e/o metastasi) per le analisi dei biomarcatori;
    - Disponibilità di campioni ematici per le analisi dei biomarcatori;
    - Uomo o donna di età = 18 anni;
    - ECOG PS = 1;
    - Aspettativa di vita di almeno 12 settimane;
    - Una precedente chemioterapia adiuvante con fluoropirimidine in monoterapia è permessa se sono trascorsi almeno 12 mesi tra la fine dell’adiuvante e la prima recidiva;
    - Paziente non eleggibile per doppietta o tripletta chemioterapica (con oxaliplatino e/o irinotecano);
    - Adeguata funzione ematologica: neutrofili >1.5 x 109/L, piastrine >100 x 109/L, emoglobina >9 g/dl;
    - Adeguata funzione epatica e renale: bilirubina totale <1.5 volte il limite superiore del valore normale (UNL), AST (SGOT) e/o ALT (SGPT) <2.5 volte l’UNL (o <5 volte l’UNL in caso di metastasi epatiche), fosfatasi alcalina <2.5 volte l’UNL (o <5 volte l’ULN in caso di metastasi epatiche);
    - Clearance della creatinina =50 mL/min o creatinina sierica <1.5 volte l’UNL;
    - Le donne fertili devono avere test di gravidanza su campione ematico negativo eseguito alla visita basale. Per questo studio si intendono fertili tutte le donne dopo la pubertà, eccetto quelle in menopausa da almeno 12 mesi, quelle chirurgicamente sterili o sessualmente inattive. Un alto livello di ormone follicolo stimolante (FSH) può essere usato per confermare uno stato post-menopausa in donne che non usano contraccettivi ormonali o terapia ormonale sostitutiva. Tuttavia in assenza di 12 mesi di amenorrea, una singola misurazione dell'FSH è insufficiente;
    - I soggetti e i loro partner devono essere disposti ad evitare la gravidanza durante lo studio e fino a 6 mesi dopo l'ultimo trattamento;
    - I soggetti maschi con partner di sesso femminile in età fertile e soggetti femminili in età fertile devono pertanto essere disposti a utilizzare una contraccezione adeguata approvata dallo sperimentatore (misure contraccettive di barriera o contraccettivo orale);
    - Volontà e capacità di aderire il protocollo.
    E.4Principal exclusion criteria
    • Radiotherapy to any site within 4 weeks before the study.
    • Previous treatment with trifluridine/tipiracil, bevacizumab and capecitabine (previous
    • treatment with capecitabine was permitted only in the adjuvant setting and if more than 12
    • months elapsed between the end of adjuvant and first relapse).
    • Untreated brain metastases or spinal cord compression or primary brain tumors.
    • History or evidence upon physical examination of CNS disease unless adequately treated.
    • Clinical signs of malnutrition.
    • Active uncontrolled infections or other clinically relevant concomitant illness
    • contraindicating chemotherapy administration.
    • Evidence of bleeding diathesis or coagulopathy.
    • Uncontrolled hypertension and prior history of hypertensive crisis or hypertensive
    • encephalopathy.
    • Clinically significant (i.e. active) cardiovascular disease for example cerebrovascular accidents (=6 months), myocardial infarction (=6 months), unstable angina, New York Heart Association (NYHA) grade II or greater congestive heart failure, serious cardiac arrhythmia equiring medication.
    • Significant vascular disease (e.g. aortic aneurysm requiring surgical repair or recent arterial thrombosis) within 6 months of study enrolment.
    • Any previous venous thromboembolism = NCI CTCAE Grade 4.
    • History of abdominal fistula, GI perforation, intra-abdominal abscess or active GI bleeding within 6 months prior to the first study treatment.
    • Treatment with any investigational drug within 30 days prior to enrolment or 2 investigational agent half-lives (whichever is longer).
    • Other co-existing malignancies or malignancies diagnosed within the last 5 years with the exception of localized basal and squamous cell carcinoma or cervical cancer in situ.
    • Lack of physical integrity of the upper gastrointestinal tract, malabsorption syndrome, or inability to take oral medication.
    • Known hypersensitivity to trial drugs or hypersensitivity to any other component of the trial drugs.
    • Any concomitant drugs contraindicated for use with the trial drugs according to the product information of the pharmaceutical companies.
    • Pregnant or lactating women. Women of childbearing potential with either a positive or no pregnancy test at baseline. Postmenopausal women must have been amenorrheic for at least 12 months to be considered of non-childbearing potential. Sexually active males and females (of childbearing potential) unwilling to practice contraception (barrier contraceptive measure or oral contraception) during the study and until 6 months after the last trial treatment.
    Parte 1 e Parte 2
    • Trattamento radioterapico in qualunque sede nelle 4 settimane precedenti lo studio;
    • Trattamento precedente con trifluridina/tipiracile, bevacizumab e capecitabina (un precedente trattamento con capecitabina è permesso solo se eseguito nel setting adiuvante e se trascorsi più di 12 mesi tra la fine dell’adiuvante e la prima recidiva di malattia);
    • Metastasi encefaliche non trattate o compressione midollare o tumori primitivi encefalici;
    • Storia o evidenza all'esame obiettivo di malattia del SNC a meno che non sia adeguatamente trattata;
    • Segni clinici di malnutrizione;
    • Infezioni attive non controllate o altre patologie concomitanti clinicamente rilevanti che controindichino la somministrazione di chemioterapia;
    • Coagulopatia non controllata;
    • Ipertensione non controllata o storia di crisi ipertensive o di encefalopatia ipertensiva;
    • Malattie cardiovascolari clinicamente significative (in atto), per esempio: eventi cerebrovascolari (=6 mesi), attacco ischemico transitorio, infarto del miocardio (=6 mesi), angina severa/instabile, innesto di bypass di arterie coronorie o periferiche, scompenso cardiaco grado New York Heart Association (NYHA) > II, gravi aritmie che necessitano di terapia medica;
    • Malattia vascolare significativa (ad esempio: aneurisma aortico che richiede riparazione chirurgica o recente trombosi arteriosa) entro 6 mesi dall'arruolamento nello studio;
    • Qualsiasi precedente tromboembolia venosa = NCI CTCAE Grado 4;
    • Storia di fistola addominale, perforazione gastrointestinale, ascesso intra-addominale o sanguinamento gastrointestinale attivo entro 6 mesi precedenti al primo ciclo trattamento nello studio;
    • Trattamento con qualsiasi farmaco sperimentale entro 30 giorni prima l’arruolamento oppure entro la durata di 2 emivite dell’agente sperimentale (quale dei due periodi sia il più lungo);
    • Altri tumori maligni coesistenti o precedenti diagnosticati negli ultimi 5 anni, fatta eccezione per il basalioma, il carcinoma squamocellulare della cute e il carcinoma in situ della cervice uterina;
    • Mancanza di integrità fisica del tratto gastrointestinale superiore, sindrome da malassorbimento o incapacità di assumere farmaci per via orale;
    • Nota precedente severa ipersensibilità ad un prodotto in sperimentazione o a qualsiasi componente nella sua formulazione;
    • Qualsiasi farmaco concomitante controindicato per l'uso con i farmaci dello studio in base alle informazioni sul prodotto delle società farmaceutiche;
    • Donne in gravidanza o in allattamento. Le donne in età fertile con un test positivo di gravidanza o che non hanno effettuato un test di gravidanza alla visita basale. Donne in post-menopausa devono essere amenorroiche per almeno 12 mesi per essere considerate non fertili. Uomini e donne (in età fertile) sessualmente attivi che rifiutano di utilizzare metodi contraccettivi (metodi di barriera o contraccettivi orali) durante lo studio e fino a 6 mesi dopo l’ultima dose.
    E.5 End points
    E.5.1Primary end point(s)
    • Part 1:
    .Overall Toxicity Rate is defined as the percentage of patients, relative to the total of enrolled subjects, experiencing any adverse event (AE), according to National Cancer Institute Common Toxicity Criteria (version 5.0).
    -Toxicity Rate is defined as the percentage of patients, relative to the total of enrolled subjects, experiencing a specific adverse event of grade 3/4, according to National Cancer Institute Common Toxicity Criteria (version 5.0).
    -Safety will be assessed by monitoring the frequency, duration, and severity of AEs through physical examinations, clinical laboratory blood and urine sample evaluations and electrocardiograms.
    • Part 2:
    - Objective Response Rate (ORR) is defined as the percentage of patients, relative to the total of enrolled subjects, achieving a complete (CR) or partial (PR) response, according to RECIST 1.1 criteria, determined by investigator reported measurements. According to RECIST 1.1 criteria and the non-randomised nature of the study, a confirmation of CR and PR is required.
    • Parte 1:
    Il tasso globale di tossicità è definito come la percentuale di pazienti, rispetto al totale dei soggetti arruolati, in cui si verifica uno specifico evento avverso, secondo i criteri del National Cancer Institute Common Toxicity (versione 5.0).
    Il tasso di tossicità è definito come la percentuale di pazienti, rispetto al totale dei soggetti arruolati, in cui si verifica uno specifico evento avverso di grado 3/4, secondo i criteri del National Cancer Institute Common Toxicity (versione 5.0).
    Il profilo di sicurezza verrà analizzato monitorando la frequenza, la durata e la severità degli eventi avversi attraverso analisi fisiche, valutazioni clinico-laboratoristiche su campioni di sangue e urine ed ECG.
    • Parte 2:
    Il tasso di risposta obiettiva (ORR) è definito come la percentuale di pazienti, rispetto al totale dei soggetti arruolati, che raggiungono una risposta completa (CR) o parziale (PR), secondo i criteri RECIST 1.1. La valutazione della risposta clinica sarà basata su misure riportate dagli sperimentatori. Sulla base dei criteri RECIST 1.1 e data la natura non-randomizzata dello studio è richiesta la conferma della risposta parziale o completa.
    E.5.1.1Timepoint(s) of evaluation of this end point
    • Part 1:
    Overall Toxicity Rate and Toxicity Rate: From consent signing up to 16 months. Data will be presented considering the number of patients reporting related adverse events, divided by grade according to the National Cancer Institute Common Toxicity Criteria (version 5.0)

    • Part 2:
    ORR: at 6 and 12 months from first dose
    • Parte 1:
    Il tasso globale di tossicità e il Il tasso di tossicità : Dalla firma del consenso fino ai 16 mesi successivi. I dati saranno presentati considerando il numero di pazienti che hanno riportato eventi avversi correlati, divisi per grado secondo i National Cancer Institute Common Toxicity Criteria (versione 5.0)

    • Parte 2:
    ORR: a 6 e 12 mesi dalla prima dose
    E.5.2Secondary end point(s)
    • Part 1:
    -Objective Response Rate (ORR) is defined as the percentage of patients, relative to the total of enrolled subjects, achieving a CR or PR response, according to RECIST 1.1 criteria, determined by investigator reported measurements at the recommended dose.
    -The analysis of PROs endpoints (assessed using the EORTC QLQ-C30, the EORTC QLQCR29 and theEuroQol EQ-5D questionnaires) will be performed according to the EORTC Scoring and Reference Values Manual. All scores and subscales will be assessed through descriptive summary statistics.
    • Part 2:
    -Overall Toxicity Rate is defined as the percentage of patients, relative to the total of enrolled subjects, experiencing any adverse event, according to National Cancer Institute Common Toxicity Criteria (version 5.0).
    -Toxicity Rate is defined as the percentage of patients, relative to the total of enrolled subjects, experiencing a specific adverse event of grade 3/4, according to National Cancer Institute Common Toxicity Criteria (version 5.0).
    -Progression Free Survival (PFS) is defined as the time from enrolment to the first documentation of objective disease progression determined by investigator assessment or death due to any cause, whichever occurs first. PFS will be censored on the date of the last evaluable on study tumour assessment documenting absence of progressive disease for patients who are alive, on study and progression free at the time of the analysis. Alive patients having no tumour assessments after baseline will have time to event censored on the date of enrolment.
    -Overall Survival (OS) is defined as the time from enrolment to the date of death due to any cause. For patients still alive at the time of analysis, the OS time will be censored on the last date the patients were known to be alive.
    -The analysis of PROs endpoints (assessed using the EORTC QLQ-C30, the EORTC QLQCR29 and theEuroQol EQ-5D questionnaires) will be performed according to the EORTC Scoring and Reference Values Manual. All scores and subscales will be assessed through descriptive summary statistics.
    • Parte 1:
    -Il tasso di risposta obiettiva (ORR) è definito come la percentuale di pazienti, rispetto al totale dei soggetti arruolati, che raggiungono una CR o PR, secondo i criteri RECIST 1.1. La valutazione della risposta clinica alla dose raccomandata sarà basata su misure riportate dagli sperimentatori.
    -L'analisi degli endpoint PROs (valutata utilizzando i questionari EORTC QLQ-C30, EORTC QLQ-CR29 e EuroQol EQ-5D) verrà eseguita secondo il manuale dei punteggi e dei valori di riferimento dell’EORTC. Tutti i punteggi e le sottoscale saranno valutati attraverso statistiche descrittive.
    • Parte 2:
    -Il tasso globale di tossicità è definito come la percentuale di pazienti, rispetto al totale dei soggetti arruolati, in cui si verifica uno specifico evento avverso, secondo i criteri del National Cancer Institute Common Toxicity (versione 5.0).
    -Il tasso di tossicità è definito come la percentuale di pazienti, rispetto al totale dei soggetti arruolati, in cui si verifica uno specifico evento avverso di grado 3/4, secondo i criteri del National Cancer Institute Common Toxicity (versione 5.0).
    -La sopravvivenza libera da progressione (PFS) è definita come il tempo dall’arruolamento alla prima evidenza di progressione obiettiva della malattia basata sulla valutazione da parte dello sperimentatore o alla morte del paziente per qualsiasi causa, a seconda di quale si verifichi prima. La PFS sarà censorizzata alla data dell’ultima valutazione di malattia che documenti assenza di progressione per i pazienti vivi, in studio e non progrediti al momento dell’analisi. I pazienti vivi senza valutazione di malattia dopo il basale saranno censorizzati alla data di registrazione.
    -Sopravvivenza globale (OS) è definita come il tempo dalla registrazione alla data di morte per qualsiasi causa. I pazienti vivi al momento dell’analisi saranno censorizzati all’ultima data in cui i pazienti erano noti per essere vivi.
    -L'analisi degli endpoint PROs (valutata utilizzando i questionari EORTC QLQ-C30, EORTC QLQ-CR29 e EuroQol EQ-5D) verrà eseguita secondo il manuale dei punteggi e dei valori di riferimento dell’EORTC. Tutti i punteggi e le sottoscale saranno valutati attraverso statistiche descrittive.
    E.5.2.1Timepoint(s) of evaluation of this end point
    • Part 1:
    ORR: at 6 and 12 months from first dose
    PROs: every 8 weeks till PD. After 12 months of treatment, every 12 weeks

    • Part 2:
    Overall Toxicity Rate and toxicity rate: From consent signing up to 16 months. Data will be presented considering the number of patients reporting related adverse events, divided by grade according to the National Cancer Institute Common Toxicity Criteria (version 5.0)
    PFS: at 6 and 12 months from first dose
    OS: From consent signing up to 16 months.
    PROs: every 8 weeks till PD. After 12 months of treatment, every 12 weeks.
    • Parte 1:
    ORR: a 6 e 12 mesi dalla prima dose
    PROs: ogni 8 settimane fino a PD. Dopo 12 mesi di trattamento, ogni 12 settimane.

    • Parte 2:
    Il tasso globale di tossicità e il Il tasso di tossicità: Dalla firma del consenso fino ai 16 mesi successivi. I dati saranno presentati considerando il numero di pazienti che hanno riportato eventi avversi correlati, divisi per grado secondo i National Cancer Institute Common Toxicity Criteria (versione 5.0)
    PFS: a 6 e 12 mesi dalla prima dose
    OS: Dalla firma del consenso fino ai 16 mesi successivi.
    PROs: ogni 8 settimane fino a PD. Dopo 12 mesi di trattamento, ogni 12 settimane.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    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
    A PHASE 1/2 STUDY EXPLORING THE SAFETY AND ACTIVITY OF TRIFLURIDINE/TIPIRACIL IN COMBINATION WITH CA
    STUDIO DI FASE 1/2 SU TOLLERANZA E ATTIVITÀ DI TRIFLURIDINA/TIPIRACILE IN COMBINAZIONE CON CAPECITAB
    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
    Un disegno 3 + 3 sarà utilizzato per valutare la dose massima tollerata (MTD) e la dose massima somm
    A 3 + 3 design will be used to assess the maximum tolerated dose (MTD) and the maximum administered
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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 concerned20
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months4
    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: 40
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 30
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Subject incapable of giving consent for physical reasons or reason linked to their medical condition
    Soggetto incapace di dare il consenso per motivi fisici o motivi legati alla loro condizione medica
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state60
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 60
    F.4.2.2In the whole clinical trial 60
    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)
    survival and Adverse events and toxicity follow-up of 16 months
    16 mesi di follow-up di sopravvivenza e monitoraggio degli eventi avversi
    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 Decision2021-08-04
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-04-29
    P. End of Trial
    P.End of Trial StatusOngoing
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