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    Summary
    EudraCT Number:2020-001940-25
    Sponsor's Protocol Code Number:IFG-05-2019
    National Competent Authority:Germany - PEI
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-03-15
    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 ConcernedGermany - PEI
    A.2EudraCT number2020-001940-25
    A.3Full title of the trial
    A PHASE II OPEN-LABEL STUDY FOR THE COMPREHENSIVE ANALYSIS OF
    PREDICTORS OF THE TREATMENT WITH PEMBROLIZUMAB AND OLAPARIB IN
    PATIENTS WITH UNRESECTABLE OR METASTATIC HER2 NEGATIVE BREAST CANCER
    AND A DELETERIOUS GERMLINE MUTATION IN BRCA1/2, ATM, BARD1, CHEK2,
    FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2 OR A HOMOLOGOUS
    RECOMBINATION DEFICIENCY
    Eine offene Phase II-Studie zur umfassenden Analyse von Prädiktoren der
    Behandlung mit Pembrolizumab und Olaparib bei Patienten mit fortgeschrittenem
    HER2-negativen Brustkrebs und einer zum Funktionsverlust führenden
    Keimbahnmutation in BRCA1/2, ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C,
    RAD51D, SLX4, XRCC2 oder mit defekter homologer Rekombination
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    This is a trial for patients with diagnosed advanced HER2-negative breast cancer and a
    mutation in the genes BRCA1/2, ATM, BARD1, CHEK2, FANCC, PALB2,
    RAD51C, RAD51D, SLX4, XRCC2 or tumor tissue (homologous
    recombination deficiency). The patients will be treated with a combination
    of pembrolizumab and olaparib.
    Diese Studie richtet sich an Patienten mit fortgeschrittenem HER2-negativem Brustkrebs
    und einer Mutation in den Genen BRCA1/2, ATM, BARD1, CHEK2, FANCC,
    PALB2, RAD51C, RAD51D, SLX4, XRCC2 oder im Tumorgewebe (homologe
    Rekombinationsdefizienz). Die Patienten werden mit einer Kombination
    von Pembrolizumab und Olaparib behandelt.
    A.3.2Name or abbreviated title of the trial where available
    Comprendo - AGO B-51
    A.4.1Sponsor's protocol code numberIFG-05-2019
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT05033756
    A.5.4Other Identifiers
    Name:AGO B-NumberNumber:AGO B-51
    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 SponsorInstitut für Frauengesundheit GmbH
    B.1.3.4CountryGermany
    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 supportMerck Sharp & Dohme LLC
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationInstitut für Frauengesundheit GmbH
    B.5.2Functional name of contact pointComprendo Study Management
    B.5.3 Address:
    B.5.3.1Street AddressUniversitaetsstrasse 21-23
    B.5.3.2Town/ cityErlangen
    B.5.3.3Post code91054
    B.5.3.4CountryGermany
    B.5.4Telephone number+49091319278967
    B.5.5Fax number+49091319278949
    B.5.6E-mailcomprendo@ifg-erlangen.de
    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 KEYTRUDA
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme LLC
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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.3.4Pharmaceutical 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 INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.3Other descriptive nameMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 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) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameOlaparib
    D.3.2Product code MK-7339
    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 INNOLAPARIB
    D.3.9.1CAS number 763113-22-0
    D.3.9.3Other descriptive nameOLAPARIB
    D.3.9.4EV Substance CodeSUB32234
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    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: 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 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 nameOlaparib
    D.3.2Product code MK-7339
    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 INNOLAPARIB
    D.3.9.1CAS number 763113-22-0
    D.3.9.3Other descriptive nameOLAPARIB
    D.3.9.4EV Substance CodeSUB32234
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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.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
    patients with unresectable or metastatic HER2 negative breast cancer and a deleterious germline
    mutation in BRCA 1/2, ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2 or a
    homologous recombination deficiency
    Patienten mit nicht resezierbarem oder metatstasiertem Brustkrebs und einer zum Funktionsverlust
    führenden Keimbahnmutation in BRCA 1/2, ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2 oder einer defekten homologen Rekombination
    E.1.1.1Medical condition in easily understood language
    advanced HER2-negative breast cancer and alterations in
    particular genes or tissue (RCA 1/2, ATM, BARD1, CHEK2, FANCC, PALB2,
    RAD51C, RAD51D, SLX4, XRCC2 or a homologous recombination deficiency)
    fortgeschrittener HER2-negativer Brustkrebs und Veränderung in speziellen Genen / Gewebe (BRCA 1/2, ATM, BARD1, CHEK2,
    FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2, defekte homologe Rekombination)
    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 10057654
    E.1.2Term Breast cancer female
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10061020
    E.1.2Term Breast cancer male
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10006187
    E.1.2Term Breast cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10055113
    E.1.2Term Breast cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027475
    E.1.2Term Metastatic breast cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To investigate the efficacy of the combination of pembrolizumab and olaparib, as determined by overall response rate (ORR) using RECIST v1.1 criteria (time frame: baseline up to 27 weeks).
    Untersuchung der Effektivität der Kombination von Pembrolizumab und Olaparib definiert als allgemeine Ansprechrate (ORR) nach RECIST v1.1-Kriterien (Zeitrahmen: Baseline bis zu 27 Wochen).
    E.2.2Secondary objectives of the trial
    (1) To investigate the duration of response (DOR) time for the three cohorts.
    (2) To investigate the progression free survival (PFS) time for the three cohorts.
    (3) To investigate the overall survival (OS) time for the three cohorts.
    (4) To investigate the safety and tolerability of pembrolizumab in combination with olaparib.
    (1) Untersuchung der Ansprechdauer (DOR) in den drei Kohorten
    (2) Untersuchung des progressionsfreien Überlebens (PFS) in den drei Kohorten
    (3) Untersuchung des Gesamtüberlebens (OS) in den drei Kohorten
    (4) Untersuchung der Sicherheit und Verträglichkeit von Pembrolizumab in Kombination mit Olaparib.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    •To investigate the health-related quality of life (HRQoL) compared with baseline in all subjects using the Functional Assessment of Cancer Therapy Breast (FACT-B) Questionnaire and 5-level EQ-5D (EQ-5D-5L) utility index, and visual analogue scale (EQ VAS).
    • To perform whole genome sequencing of the tumor and the germline as well as RNAseqencing from peripheral blood.
    • To analyse circulating DNA and RNA analyses will be performed from peripheral blood.
    • To assess immunogenicity of pembrolizumab in combination with olaparib and to explore exposure measures, safety, and efficacy endpoints.
    • To perform microbiome analyses of the gut.
    • To assess immune responsivity (IR) as the percentage of CD3 positive T cells in peripheral
    blood during the course of therapy at multiple timepoints.
    • To perform immune profiling of peripheral blood monocytes (PBMC) during the course of therapy at multiple timepoints (Quantification of antigen presenting cells and T cells).
    • To perform multispectral imaging (multiplex immunohistochemistry) of tumor tissue to assess the spatial relation between tumor cells and immune cells before and during the course of therapy.
    • To compare different methods of HRD testing
    • To correlate neoantigen quantity, expression of immunological markers and HLA-binding patterns with therapy efficacy
    •Untersuchung der gesundheitsbezogenen Lebensqualität (HRQoL) verglichen mit der Baseline bei allen Teilnehmern mit Hilfe des Functional Assessment of Cancer Therapy Breast (FACT-B) Fragebogens und des 5-level EQ-5D (EQ-5D-5L) utility index und der visuellen Analogskala (EQ VAS).
    • Gesamt-Genomsequenzierung des Tumors und der Keimbahn sowie RNA-Sequenzierung aus peripherem Blut
    • Analyse freier DNA und RNA aus peripherem Blut
    • Beurteilung der Immunogenität von Pembrolizumab in Kombination mit Olaparib und Untersuchung von Exposition, Sicherheit und Wirksamkeit
    • Mikrobiomanalyse des Darms
    • Untersuchung des Immun-Ansprechverhaltens (IR) als prozentualer Anteil an CD3-positiven T-Zellen im peripheren Blut während des Therapieverlaufs zu mehreren Zeitpunkten
    • Immunprofiling von peripheren Blut-Monozyten während des Therapieverlaufs zu mehreren Zeitpunkten (Quantifizierung von Antigen-präsentierenden Zellen und T-Zellen)
    • Durchführung von multispektraler Bildgebung (multiplexe Immun-histochemie) von Tumorgewebe zur Beurteilung des räumlichen Zusammenhangs zwischen Tumorzellen und Immunzellen vor und während der Therapie
    • Vergleich von Methoden zur HRD-Bestimmung
    • Korrelation von Neoantigenmenge, Expression von immunologischen Markern und HLA-Bindungsmustern mit der Therapiewirksamkeit
    E.3Principal inclusion criteria
    In order to be eligible for participation in this trial, participants must fulfill all of the following criteria:
    1. The participant (or legally acceptable representative if applicable) must provide written informed consent.
    2. Male/Female participants must be ≥18 years of age at the day of signing informed consent and must be willing to comply with the study specific procedures.
    3. Histologically confirmed metastatic or advanced, unresectable HER2 negative (0, 1+ by IHC or ISH amplified < 2.0) breast cancer which is not eligible for curative treatment..
    4. Cohort 1: Germline mutation in BRCA1 or BRCA2 that is predicted to be deleterious (known or predicted to be detrimental/leads to loss of function) irrespective of HRD status.
    5. Cohort 2: Germline mutation in ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2 that is predicted to be deleterious (known or predicted to be detrimental/leads to loss of function) irrespective of HRD status.
    6. Cohort 3: High HRD status and no germline mutation in one of the above mentioned genes of cohort 1 or cohort 2.
    7. Cohort 3: Availability of FFPE tumor material for further validation of HRD status (bridging tests).
    8. Cohorts 2 and 3 Patients must have been treated with first line chemotherapy, if this chemotherapy is standard of care in this therapy situation
    9. Prior platinum in the (neo)adjuvant setting is allowed as long as 12 months from last dose to study entry have elapsed.
    10. Participants with hormone receptor positive breast cancer must have exhausted previous combination therapy of CDK4/6 inhibitors with endocrine treatment.
    11. Measurable disease based on RECIST v1.1.
    12. Provision of a recently obtained (within 12 months before study inclusion) core or excisional biopsy of a tumor lesion. Note: If submitting unstained cut slides, newly cut slides should be submitted to the testing laboratory within 14 days from the date slides are cut.
    13. ECOG performance status 0-1.
    14. Female participants must have a negative urine or serum pregnancy test within 72 h prior to first dose of trial treatment, no breastfeeding.
    15. Female participants of childbearing potential must agree to use sufficient methods of contraception as outlined in section 12.3.2 Contraception Requirements during treatment plus an additional 120 days after the last dose of study medication.
    16. Male participants must agree to use sufficient methods of contraception as outlined in section 12.3.2 Contraception Requirements during treatment plus an additional 120 days after the last dose of study medication.
    17. Adequate organ function defined as:
    o Absolute neutrophile count ≥1500/µL
    o Platelets ≥100 000/µL
    o Hemoglobin ≥10.0 g/dL or ≥6.2 mmol/L
    o Patients must have creatinine clearance estimated of ≥51 mL/min using the Cockcroft-Gault equation or based on a 24 hour urine test
    o Total bilirubin ≤1.5 ×ULN OR direct bilirubin ≤ULN for participants with total bilirubin levels >1.5 × ULN
    o AST (SGOT) and ALT (SGPT) ≤2.5 × ULN (≤5 × ULN for participants with liver metastases)
    o International normalized ratio (INR) OR prothrombin time (PT) ≤1.5 × ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants
    Um für die Studienteilnahme in Frage zu kommen, müssen folgende Bedingungen erfüllt sein:
    1. Teilnehmer (oder deren gesetzlicher Vertreter) müssen vor Studienbeginn die Einverständniserklärung unterzeichnet haben.
    2. Männliche/weibliche Teilnehmer müssen, zum Zeitpunkt der Einveständniserklärung ≥18 Jahre alt sein und ihr Einverständnis für die studienspezifischen Maßnahmen geben.
    3. Histologisch bestätigtes HER2-negatives (0, 1+ nach IHC oder ISH Amplifikation < 2.0), fortgeschrittenes (nicht-resezierbares oder metastasiertes) Mammakrazinom für welches keine kurative Behandlung in Frage kommt..
    4. Kohorte 1: Keimbahnmutation in BRCA1 oder BRCA2, welche voraussichtlich zum Funktionsverlust führt unabhängig vom HRD-Status.
    5. Kohorte 2: Keimbahnmutation in ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2, welche voraussichtlich zum Funktionsverlust führt, unabhängig vom HRD-Status.
    6. Kohorte 3: Hoher HRD-Status und keine zum Funktionsverlust führende Keimbahnmutation in einem der oben genannten Gene aus Kohorte 1 oder Kohorte 2.
    7. Kohorte 3: Vorliegen von FFPE-Tumorgewebe zur weiteren Validierung des HRD-Status (Bridging Tests).
    8. Teilnehmer der Kohorte 2 und 3 müssen eine Chemotherapie zur Behandlung des fortgeschritttenen Mammakarzinoms erhalten haben, sofern dies dem Therapiestandard entspricht .
    9. Vorherige Therapie mit Platin in der (Neo-)Adjuvanz ist erlaubt, wenn die letzte Dosis mindestens 12 Monate vor Studieneinschluss gegeben wurde.
    10. Teilnehmer mit hormonrezeptorpositivem Brustkrebs müssen Therapiemöglichkeiten bestehend aus CDK4/6-Inhibitor plus endokrine Therapie ausgeschöpft haben
    11. Messbare Krankheit nach RECIST v1.1.
    12. Vorhandensein einer neuen (innerhalb von 12 Monaten vor Studieneinschluss) Gewebeprobe (Kern- oder exzisionale Biopsie) einer Tumorläsion. Achtung: Falls nicht eingefärbte Präparate abgegeben wurden, sollten dem zentralen Testlabor innerhalb von 14 Tagen nachdem die Tumorblöcke geschnitten wurden, neue zugesendet werden
    13. ECOG performance status 0-1.
    14. Negativer Urin- oder Serum-Schwangerschaftstest innerhalb von 72h vor der ersten Dosis der Studienmedikation bei weiblichen Teilnehmern, kein Stillen
    15. Weibliche Teilnehmerinnen im gebärfähigen Alter müssen während der gesamten Behandlungsdauer sowie 120 Tage nach Ende der Studienmedikation zu einer adäquaten Verhütung gemäß Sektion 12.3.2 Contraception Requirements bereit sein.
    16. Männliche Teilnehmer müssen während der gesamten Behandlungs¬dauer sowie 90 Tage nach Ende der Studienmedikation zu einer adequaten Verhütung gemäß Sektion 12.3.2 Contraception Requirements bereit sein.
    17. Adäquate Organfunktion gemäß folgender Definition:
    o Absolute Neutrophilenzahl ≥1500/µL
    o Thrombozyten ≥100 000/µL
    o Hämoglobin ≥10.0 g/dL
    o Geschätzte Kreatinin-Clearance ≥51 mL/min berechnet mit der Cockcroft-Gault-Gleichung oder basierend auf dem 24-Stunden-Sammelurin
    o Gesamtbilirubin ≤1.5 ×ULN ODER direktes Bilirubin ≤ULN für Teilnehmer mit Gesamtbilirubin >1.5 × ULN
    o AST (SGOT) and ALT (SGPT) ≤2.5 × ULN (≤5 × ULN für Teilnehmer mit Lebermetastasen)
    o International normalized ratio (INR) ODER Prothrombinzeit (PT) ≤1.5 × ULN außer der Teilnehmer erhält antikoagulatorische Therapie, solange PT oder aPTT innerhalb der therapeutischen Breite der beabsichtigt eingesetzten Antikoagulanzien liegt
    E.4Principal exclusion criteria
    1. Has histologically confirmed HER2 positive (3+ by IHC or ISH amplified ≥ 2.0) breast cancer.
    2. Cohorts 1 and 2: germline mutations in BRCA1, BRCA2, ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2 that are considered to be non-detrimental (e.g., “variants of uncertain/unknown clinical significance” or “benign polymorphism” etc.).
    3. Cohort 3: no high tumor HRD.
    4. Rapidly progressive disease which requires combination chemotherapy.
    5. Current participation in another investigational trial within 4 weeks prior to the first dose of trial treatment
    6. Known hypersensitivity to pembrolizumab or olaparib or any of its excipients.
    7. Prior systemic anti-cancer therapy within 4 weeks prior to allocation or no recovery from all AEs due to previous therapies to ≤ grade 1, excluding alopecia and ≤ grade 2 peripheral neuropathy.
    8. Prior treatment with a checkpoint inhibitor or a PARP inhibitor.
    9. No complete recovery from prior surgery or radiotherapy. Starting study treatment is allowed not before 2 weeks after major surgery.
    10. Prior malignancy unless curatively treated and disease-free for less than 3 years prior to study entry. Within this timeframe, prior adequately treated non-melanoma skin cancer, transitional cell carcinoma, carcinoma in situ of the prostate, of the cervix, of the breast or in situ or stage I grade 1 endometrial cancer is eligible.
    11. Uncontrolled brain metastases (Participants with previously treated brain metastases may participate provided they are radiologically stable, i.e. without evidence of progression for at least 4 weeks (note that the assessment of the brain metastases should be performed during study screening for this purpose), clinically stable and without requirement of steroid treatment for at least 14 days prior to first dose of study treatment).
    12. Live vaccination within 30 days prior to study entry.
    13. Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is allowed.
    14. Has an active infection requiring systemic therapy.
    15. Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
    16. Known history of the following infections:
    o Human Immunodeficiency Virus (HIV).
    o Acute or chronic Hepatitis B or Hepatitis C
    o Active Tuberculosis
    17. Resting ECG indicating uncontrolled, potentially reversible cardiac conditions, as judged by the investigator (e.g., unstable ischemia, uncontrolled symptomatic arrhythmia, congestive heart failure, QTcF prolongation >500 ms, electrolyte disturbances, etc.), or patients with congenital long QT syndrome.
    18. Patients with myelodysplastic syndrome (MDS) or acute myeloid leukaemia (AML) or with features suggestive of MDS/AML.
    19. Preexisting use of known strong CYP3A inhibitors (e.g. itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (e.g. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil). The required washout period prior to starting trial treatment is 2 weeks.
    20. Preexisting use of known strong (e.g. phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John’s Wort ) or moderate CYP3A inducers (e.g. bosentan, efavirenz, modafinil). The required washout period prior to starting trial treatment is 5 weeks for enzalutamide or phenobarbital and 3 weeks for other agents.
    21. Previous allogenic bone marrow transplant or double umbilical cord blood transplantation (dUCBT).
    22. Poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection; any condition that interferes with pembrolizumab or olaparib treatment.
    23. Unability to swallow or gastrointestinal disorders with reduced absorption of olaparib.
    24. Psychiatric or substance abuse disorders.
    25. A woman of childbearing potential who has a positive urine pregnancy test within 72 hours prior to inclusion. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
    26. Participants being pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of trial treatment.
    27. Any other condition in opinion of the investigator that would interfere with applied systemic treatment or other trial procedures
    Von der Studienteilnahme ausgeschlossen werden Teilnehmer in folgenden Fällen:
    1.HER2-positives Mammakarzinom (3+ nach IHC oder ISH Amplifikation ≥ 2.0).
    2.Kohorten 1 und 2: Keimbahnmutationen in BRCA1, BRCA2, ATM, BARD1, CHEK2, FANCC, PALB2, RAD51C, RAD51D, SLX4, XRCC2 die nicht zum Funktionsverlust führen
    3.Kohorte 3: keine hohe Tumor-HRD.
    4.Schnell fortschreitende Krankheit mit Indikation einer kombinierten Chemotherapie
    5.Gleichzeitige Teilnahme in einer anderen Studie mit einem Prüfpräparat innerhalb von 4 Wochen vor Beginn der Studienmedikation.
    6.Bekannte Überempfindlichkeit gegenüber Pembrolizumab oder Olaparib oder einem seiner Hilfsstoffe
    7.Vorherige systemische Krebstherapie innerhalb von 4 Wochen vor Studieneinschluss oder noch Andauern von AEs aufgrund einer vorherigen Therapie (Kein Rückgang auf ≤ Grad 1), ausgenommen sind Haarausfall und ≤ Grad 2 periphere Neuropathie.
    8.Vorherige Behandlung mit einem Checkpoint-Inhibitor oder einem PARP-inhibitor.
    9.Keine vollständige Erholung von vorherigen Operationen oder Strahlentherapie. Nach einer OP müssen bis zum Beginn der Studienmediaktion min 2 Wochen vergangen sein.
    10.Maligne Erkrankung in der Anamnese, welche zum Studieneinschluss weniger als 3 Jahre zurückliegt, außer unter kurativer Behandlung. Ausgenommen sind, sofern adäquat behandelt, Karzinome der Haut (außer Melanom), Urothelkarzinom, duktales Karzinom in situ der Prostata, Zervixkarzinom und Brust oder Stage I Grad 1 Endometriumskarzinom.
    11.Unkontrollierte Hirnmetastasen
    12.Impfung mit einem Lebendimpfstoff innerhalb von 30 Tagen vor Studieneinschluss.
    13.Aktive Autoimmunerkrankung, die innerhalb der letzten 2 Jahre eine systemische Behandlung erforderte (z.B. Immunsuppressiva, Corticosteroide). Hormonersatztherapie (z.B. mit Thyroxin, Insulin oder Corticosteroiden zur Behandlung einer Nebennieren¬insuffizienz oder Hypophyseninsuffizienz) ist erlaubt.
    14.Aktive Infektion, die eine systemische Therapie erfordert.
    15.Bestehende oder durchgemachte (nicht-infektiöse) Pneumonitis, welche eine Steroid-Therapie erforderte.
    16.Folgende Infektionen in der Anamnese:
    o Humanes Immundefizienz-Virus (HIV)
    o Akute oder chronische Hepatitis B oder C
    o Aktive Tuberkulose
    17.Ruhe-EKG, welches, nach Beurteilung durch den Prüfarzt, auf eine unkontrollierte, potenziell reversible Herz-Kreislauferkrankung hindeutet (z.B. unkontrollierte Ischämie, symtomiatische Arrhythmie, kongestive Herzinsuffizienz, QT-Zeit-Verlängerung >500 ms, Leitungsstörungen, etc.) oder Patientinnen mit angeborenem Long-QT-Syndrom.
    18.Patientinen mit Myelodysplastischem Syndrom (MDS), akuter myelogischer Leukämie (AML) oder mit Verdacht auf MDS/AML.
    19.Vorbestehende Anwendung starker CYP3A-Inhibitoren (z.B. Itraconazol, Telithromycin, Clartithromycin, Protease-Inhibitoren verstärkt durch Ritonavir, oder Cobicistat, Indinavir, Saquinavir, Nelfinavir, Boceprevir, Telaprevir) oder moderater CYP3A-Inhibitoren (z.B. Ciprofloxacin, Erythromycin, Diltiazem, Fluconazol, Verapamil). Die erforderliche Wash-out-Phase bis zum Beginn der Studienmedikation beträgt 2 Wochen.
    20.Vorbestehende Anwendnung starker CYP3A-Induktoren (z.B. Phenobarbital, Enzalutamid, Phenytoin, Rifampicin, Rifapentin, Carbamazepin, Nevirapin und Johanniskraut) oder moderater CPY3A-Induktioren (Bosentan, Efavirenz, Modafinil). Die erforderliche Wash-out-Phase bis zum Beginn der Studienmedikation beträgt 5 Wochen für Enzalutamid oder Phenobarbital und 3 Wochen für andere CYP3A-Induktoren.
    21.Vorherige allogene Knochenmarkstransplantation oder Trans-plantation von Nabelschnurblut (dUCBT).
    22.Hohes medizinisches Risiko aufgrund schwerer, unkontrollierter medizinischer Beschwerden, einer nicht-malignen systemischen Erkrankung oder einer aktiven, unkontrollierten Infektion; jede Erkrankung die die Behandlung mit Pembrolizumab oder Olaparib behindert
    23.Schluckunfähigkeit oder gastrointestinale Störungen mit reduzierter Absorption von Olaparib
    24.Psychische Störungen oder Substanzmissbrauch
    25.Gebärfähige Frauen mit positivem Schwangerschaftstest innerhalb von 72 Stunden vor Einschluss. Falls der Urin-Schwangerschaftstest positive ist oder nicht als negative bestätigt werden kann ist ein Serum-Schwangerschaftstest verpflichtend.
    26.Schwangere und stillende Frauen oder Teilnehmer, die nach Beginn des Screenings während der Dauer der Studienmedikation sowie 120 Tage danach erwarten, ein Kind zu zeugen.
    27.Jeglicher weitere, in den Augen des Prüfarztes für die Studienmedikation oder Studienuntersuchungen als kontraindiziert geltender Zustand.
    E.5 End points
    E.5.1Primary end point(s)
    • Overall response rate (ORR) is defined as the number of participants with a confirmed best response of complete response (CR) or partial response (PR) per RECIST v1.1.
    • Die Gesamt-Ansprechrate (overall response rate = ORR) wird definiert als Zahl der Patienten mit bestätigtem bestem Ansprechen, Totalansprechen, (complete response = CR) oder Teilansprechen (partial response = PR) nach RECIST v1.1.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Baseline up to 27 weeks
    Baseline bis 27 Wochen
    E.5.2Secondary end point(s)
    • DOR (median duration of response)
    • PFS (median progression free survival)
    • OS (median overall survival)
    • Incidence of AEs, SAEs, fatal events; ratio of AEs/SAEs
    • DOR (mediane Ansprechdauer)
    • PFS (medianes progressionsfreies Überleben)
    • OS (medianes Gesamtüberleben)
    • Inzidenz von AEs, SAEs, tödlichen Ereignissen, Verhältnis von AEs/SAEs
    E.5.2.1Timepoint(s) of evaluation of this end point
    • first response to the date of first tumor progression
    • until date of progression (after approximately 10 months)
    • time to the date of death due to any cause.
    • screening until 120 days post last dose
    Participants will be followed for survival for a maximum of 18 months.
    • erstes Ansprechen bis zum Datum der ersten Tumorprogression
    • bis zum Progress (nach ca. 10 Monaten)
    • Zeit bis zum Todeszeitpunkt aus jedem Grund
    • Screening bis 120 Tage nach der letzten Gabe von Studienmedikation
    TeilnehmerInnen werden maximal 18 Monate nachbeobachtet hinsichtlich des Überlebens.
    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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Correlation of biomarkers with efficacy of IMP.
    Korrelation von Biomarkern mit der Effektivität der Studienmedikation.
    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 No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    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 concerned7
    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 No
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last Visit OR last Contact bei Survival FU
    Letzter Besuch des/der Teilnehmenden (Overall Response) und letzter Kontakt beim Survival FU
    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 months
    E.8.9.1In the Member State concerned days
    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: 58
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 31
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state89
    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)
    No different treatment from the expected normal treatment of that condition.
    Die Weiterbehandlung weicht nicht von der Routinebehandlung der Indikation ab.
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation AGO-B BREAST STUDY GROUP
    G.4.3.4Network Country Germany
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-07-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-08-25
    P. End of Trial
    P.End of Trial StatusOngoing
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