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    Summary
    EudraCT Number:2020-002359-39
    Sponsor's Protocol Code Number:213406
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2020-07-20
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2020-002359-39
    A.3Full title of the trial
    A PHASE 1, MULTICENTRE, OPEN-LABEL, DOSE-ESCALATION AND COHORT EXPANSION STUDY OF NIRAPARIB AND DOSTARLIMAB IN PAEDIATRIC PATIENTS WITH RECURRENT OR REFRACTORY SOLID TUMOURS
    Estudio de fase 1, multicéntrico, abierto, con intensificación de dosis y expansión de cohorte con Niraparib y Dostarlimab en pacientes pediátricos con tumores sólidos recurrentes o refractarios
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 1, Multicentre, Open-Label, Dose-Escalation and Expansion Study of Niraparib and Dostarlimab in Paediatric Patients with Recurrent or Refractory Solid Tumours
    Estudio de fase 1, multicéntrico, abierto, con intensificación de dosis y de expansión con Niraparib y Dostarlimab en pacientes pediátricos con tumores sólidos recurrentes o refractarios
    A.3.2Name or abbreviated title of the trial where available
    Storytime
    A.4.1Sponsor's protocol code number213406
    A.5.4Other Identifiers
    Name:Project IDNumber:52699
    A.7Trial is part of a Paediatric Investigation Plan Yes
    A.8EMA Decision number of Paediatric Investigation PlanP/303/2019
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorGlaxoSmithKline Research & Development Limited
    B.1.3.4CountryUnited Kingdom
    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 supportGlaxoSmithKline Research & Development Limited
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGlaxoSmithKline Research & Development Limited
    B.5.2Functional name of contact pointGSK Clinical Support Help Desk
    B.5.3 Address:
    B.5.3.1Street Address1-3 Iron Bridge Road, Stockley Park
    B.5.3.2Town/ cityWest Uxbridge, Middlesex
    B.5.3.3Post codeUB11 1BT
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+448007839733
    B.5.6E-mailGSKClinicalSupportHD@gsk.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDostarlimab
    D.3.2Product code GSK4057190
    D.3.4Pharmaceutical form 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 INNDostarlimab
    D.3.9.1CAS number 2022215-59-2
    D.3.9.2Current sponsor codeGSK4057190
    D.3.9.3Other descriptive nameTSR-042, WBP-285, Anti-PD-1 (Programmed Cell Death Protein 1) mAb, IgG4
    D.3.9.4EV Substance CodeSUB195307
    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.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 nameNiraparib
    D.3.2Product code GSK3985771
    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 INNNIRAPARIB
    D.3.9.1CAS number 1038915-60-4
    D.3.9.2Current sponsor codeGSK3985771
    D.3.9.3Other descriptive nameniraparib tosylate monohydrate
    D.3.9.4EV Substance CodeSUB177208
    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
    Recurrent or refractory solid tumour
    Tumor sólido recurrente o refractario
    E.1.1.1Medical condition in easily understood language
    Cancer
    Cancer
    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 LLT
    E.1.2Classification code 10065147
    E.1.2Term Malignant solid tumor
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10065252
    E.1.2Term Solid tumor
    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 1A: to establish the recommended Phase 2 dose (RP2D) of the combination of niraparib tablet and dostarlimab in paediatric participants
    • Part 1B: to establish the RP2D of the combination of niraparib age-appropriate oral liquid formulation (AAOLF) and dostarlimab in paediatric participants
    • Parte 1A: establecer la dosis de fase 2 recomendada (DF2R) de la combinación del comprimido de niraparib y dostarlimab en participantes pediátricos
    • Parte 1B: establecer la DF2R de la combinación de formulación líquida oral apropiada para la edad (FLOAE) de niraparib y dostarlimab en participantes pediátricos
    E.2.2Secondary objectives of the trial
    Secondary objectives for Part 1 of this study:
    • to evaluate additional measures of anticancer activity including objective response rate (ORR) and duration of response (DOR)
    • to evaluate the safety and tolerability of the combination of niraparib (tablet or AAOLF) and dostarlimab in paediatric participants
    • to characterise the pharmacokinetics (PK) of the combination of niraparib and dostarlimab in paediatric participants
    • to assess the acceptability and palatability of niraparib tablets and AAOLF in paediatric participants
    Objetivos secundarios para la Parte 1 de este estudio:
    •evaluar medidas adicionales de actividad anticancerígena, incluida la tasa de respuesta objetiva (TRO) y la duración de la respuesta (DR)
    •evaluar la seguridad y la tolerabilidad de la combinación de niraparib (comprimido o FLOAE) y dostarlimab en participantes pediátricos
    •caracterizar la farmacocinética (FC) de la combinación de niraparib y dostarlimab en participantes pediátricos
    •evaluar la aceptabilidad y palatabilidad de los comprimidos y la FLOAE de niraparib en participantes pediátricos
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    • Supplement A: Expansion cohort of participants with osteosarcoma (the “OS cohort”) to assess the antitumour activity of the combination of niraparib and dostarlimab, assessed primarily by the progression-free survival rate at 6 months using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria.
    The primary objective of this cohort is as follows:
    - to assess the antitumour activity of the combination of niraparib and dostarlimab, assessed primarily by the progression-free survival rate at 6 months (PFS6) (using Response Evaluation Criteria in Solid Tumors [RECIST] v1.1 criteria)
    The secondary objectives of this cohort are as follows:
    - to evaluate additional measures of anticancer activity, including objective response rate (ORR), duration of response (DOR), disease control rate (DCR), and progression-free survival (PFS)
    - to evaluate the safety of the combination of niraparib (tablet or age-appropriate oral liquid formulation [AAOLF]) and dostarlimab in paediatric participants
    - to characterise the pharmacokinetics (PK) of the combination of niraparib and dostarlimab in paediatric participants
    - to assess the acceptability and palatability of niraparib tablets and AAOLF in paediatric participants
    The exploratory objective of this cohort is as follows:
    - to assess the correlation between clinical outcome and biomarkers related to poly(adenosine diphosphate-ribose) polymerase (PARP) inhibition and/or anti-programmed cell death protein 1 (anti-PD-1) therapy


    • Supplement B: Expansion cohort of participants with neuroblastoma (the “NB cohort”) to assess the antitumour activity of the combination of niraparib and dostarlimab, assessed primarily by ORR using International Neuroblastoma Response Criteria (INRC).
    The primary objective of this cohort is as follows:
    - to assess the antitumour activity of the combination of niraparib and dostarlimab, assessed primarily by objective response rate (ORR) (using International Neuroblastoma Response Criteria [INRC])
    Secondary:
    The secondary objectives of this cohort are as follows:
    - to evaluate additional measures of anticancer activity, including duration of response (DOR), disease control rate (DCR), and progression-free survival (PFS)
    - to evaluate the safety of the combination of niraparib (tablet or age-appropriate oral liquid formulation [AAOLF]) and dostarlimab in paediatric participants
    - to characterise the pharmacokinetics (PK) of the combination of niraparib and dostarlimab in paediatric participants
    - to assess the acceptability and palatability of niraparib tablets and AAOLF in paediatric participants
    The exploratory objective of this cohort is as follows:
    - to assess the correlation between clinical outcome and biomarkers related to poly(adenosine diphosphate-ribose) polymerase (PARP) inhibition and/or anti-programmed cell death protein 1 (anti-PD-1) therapy
    •Suplemento A: Cohorte de aumento de participantes con osteosarcoma (la "cohorte OS") para evaluar la actividad antitumoral de la combinación de niraparib y dostarlimab, evaluada principalmente por la tasa de supervivencia sin progresión a los 6 meses conforme a los criterios de evaluación de la respuesta en tumores sólidos (RECIST) v.1.1.
    El objetivo primario de esta cohorte es el siguiente:
    - evaluar la actividad antitumoral de la combinación de niraparib y dostarlimab, evaluada principalmente por la tasa de supervivencia sin progresión a los 6 meses (TSP6) (usando los criterios de evaluación de la respuesta en tumores sólidos [RECIST] v.1.1)
    Los objetivos secundarios de esta cohorte son los siguientes:
    - evaluar las medidas adicionales de actividad anticancerígena, incluyendo la tasa de respuesta objetiva (TRO), duración de la respuesta (DR), tasa de control de la enfermedad (TCE), y supervivencia sin progresión (SP)
    -evaluar la seguridad de la combinación de niraparib (comprimido o formulación líquida oral apropiada para la edad [FLOAE]) y dostarlimab en participantes pediátricos
    - caracterizar la farmacocinética (FC) de la combinación de niraparib y dostarlimab en participantes pediátricos
    - evaluar la aceptabilidad y palatabilidad de los comprimidos y la FLOAE de niraparib en participantes pediátricos.
    El objetivo exploratorio de esta cohorte es el siguiente:
    - evaluar la correlación entre el resultado clínico y los biomarcadores relacionados con la inhibición de la poli(adenosina difosfato-ribosa) polimerasa (PARP) y/o la terapia anti-proteína de muerte celular programada 1 (anti-PD-1)


    •Suplemento B: Cohorte de aumento de participantes con neuroblastoma (la "cohorte NB") para evaluar la actividad antitumoral de la combinación de niraparib y dostarlimab, evaluada principalmente por TRO conforme a los criterios internacionales de respuesta en neuroblastoma (CIRN).
    El objetivo primario de esta cohorte es el siguiente:
    - evaluar la actividad antitumoral de la combinación de niraparib y dostarlimab, evaluada principalmente por la tasa de respuesta objetiva (TRO) (usando los criterios internacionales de respuesta en neuroblastoma [CIRN])
    Secundario:
    Los objetivos secundarios de esta cohorte son los siguientes:
    - evaluar las medidas adicionales de actividad anticancerígena, incluyendo la duración de la respuesta (DR), tasa de control de la enfermedad (TCE), y supervivencia sin progresión (SP)
    -evaluar la seguridad de la combinación de niraparib (comprimido o formulación líquida oral apropiada para la edad [FLOAE]) y dostarlimab en participantes pediátricos
    - caracterizar la farmacocinética (FC) de la combinación de niraparib y dostarlimab en participantes pediátricos
    - evaluar la aceptabilidad y palatabilidad de los comprimidos y la FLOAE de niraparib en participantes pediátricos.
    El objetivo exploratorio de esta cohorte es el siguiente:
    - evaluar la correlación entre el resultado clínico y los biomarcadores relacionados con la inhibición de la poli(adenosina difosfato-ribosa) polimerasa (PARP) y/o la terapia anti-proteína de muerte celular programada 1 (anti-PD-1)
    E.3Principal inclusion criteria
    1. Participant has recurrent or refractory osteosarcoma, neuroblastoma, adrenocortical carcinoma, Ewing sarcoma, rhabdomyosarcoma, or any other solid tumour (excluding tumours of the CNS) previously documented to have BRCAness mutational signature (mutational signature 3) on DNA sequencing of tumour obtained in the relapsed/recurrent disease setting, within 6 (preferably 3) months prior to enrolment. For participants with documented BRCAness mutational signature: Existing information on molecular profiling of the participant’s tumour tissue must be through a molecular profiling platform such as Individualized Therapy for Relapsed Malignancies in Childhood (INFORM). Molecular profile information must contain information from whole exome sequencing or whole genome sequencing, including the mutation status of breast cancer susceptibility gene (BRCA) 1 and BRCA2 and other homologous recombination DNA repair pathway genes, mutational signatures including signature 3, and tumour mutational burden.
    2. Participant is child or adolescent ≥6 months to <18 years old at the time of informed consent/assent.
    3. In order to be eligible to receive the niraparib tablet formulation, participant must be able to swallow the 100 mg niraparib tablet and have a baseline body weight of ≥20 kg. Participants who are unable to swallow the 100 mg niraparib tablet or who have a baseline body weight <20 kg are eligible to receive the niraparib AAOLF only.
    4. Performance status must be ≥70% on the Karnofsky scale for participants >16 years of age and ≥50% on the Lansky scale for participants ≤16 years of age. Note: Neurologic deficits in participants with brain metastases must have been stable for at least 7 days prior to study enrollment. Participants who are unable to walk because of paralysis, but who are upright in a wheelchair, will be considered ambulatory for the purpose of assessing the performance status.
    5. Participant has adequate organ function, defined as follows: Note: CBC should be obtained without transfusion or receipt of colony-stimulating factors in the 2 weeks before obtaining sample.
    a. absolute neutrophil count (ANC) ≥1,500/μL
    b. platelets ≥100,000/μL
    c. haemoglobin ≥9 g/dL or ≥5.6 mmol/L
    d. serum creatinine ≤1.5 × upper limit of normal (ULN) for age or calculated creatinine clearance or radioisotope glomerular filtration rate ≥60 mL/min/1.73 m2
    e. total bilirubin ≤1.5 × ULN or direct bilirubin ≤1 × ULN
    f. aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 × ULN unless liver metastases are present, in which case AST and ALT must be ≤5 × ULN
    g. international normalised ratio or prothrombin time (PT) ≤1.5 × ULN unless the participant is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants
    h. activated PTT ≤1.5 × ULN unless the participant is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants
    6. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    a. Is not a woman of childbearing potential (WOCBP). OR
    b. Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), preferably with low user dependency, as described in Appendix 3, from the Screening Visit through at least 180 days after the last dose of study drug and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction during this period. The Investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment.
    - A WOCBP must have a negative highly sensitive pregnancy test (urine or serum, as required by local regulations) within 72 hours before the first dose of study drug.

    Please review study protocol for further Part 1 inclusion criteria.
    Inclusion criteria for Part 2 of the study are described in each cohort-specific supplement.
    1.El participante tiene osteosarcoma recurrente o refractario, neuroblastoma, carcinoma adrenocortical, sarcoma de Ewing, rabdomiosarcoma o cualquier otro tumor sólido (excluyendo tumores del SNC) con firma mutacional BRCAness (firma mutacional 3) documentada previamente en la secuenciación de ADN del tumor obtenido en la recaída/enfermedad recurrente, dentro de los 6 (preferiblemente 3) meses anteriores a la inscripción. Para participantes con firma mutacional BRCAness documentada: La información existente sobre el perfil molecular del tejido tumoral del participante debe ser a través de una plataforma de perfil molecular, como la Terapia individualizada para tumores malignos recurrentes en la infancia (INFORM). La información del perfil molecular debe contener información de la secuenciación del exoma completo o la secuenciación del genoma completo, incluido el estado de mutación del gen de susceptibilidad al cáncer de mama (BRCA) 1 y BRCA2 y otros genes de la ruta de reparación del ADN de recombinación homóloga, firmas mutacionales, incluida la firma 3, y la carga mutacional tumoral.
    2. El participante es un niño o un adolescente ≥ 6 meses a < 18 años en el momento del consentimiento informado.
    3. Para ser apto para recibir la formulación del comprimido de niraparib, el participante debe ser capaz de tragar el comprimido de 100 mg de niraparib y tener un peso corporal inicial ≥ 20 kg. Los participantes incapaces de tragar el comprimido de 100 mg de niraparib o con un peso corporal inicial < 20 kg solo podrán recibir la FLOAE de niraparib.
    4. La escala de valoración debe ser ≥ 70 % en la escala de Karnofsky para participantes > 16 años de edad y ≥ 50 % en la escala de Lansky para participantes de 16 años o menos.
    Nota: Los déficits neurológicos en participantes con metástasis cerebrales deben haber sido estables durante, al menos, 7 días antes de la inscripción en el estudio. Los participantes incapaces de caminar debido a una parálisis, pero que puedan mantenerse erguidos en una silla de ruedas, serán considerados ambulatorios con el fin de evaluar la escala de valoración.
    5. El participante tiene una función orgánica adecuada, definida de la siguiente manera: Nota: El RSC debe obtenerse sin transfusión o sin recibir factores estimulantes de colonias en las 2 semanas anteriores a la obtención de la muestra.
    a. recuento absoluto de neutrófilos (RAN) ≥ 1500/μL
    b. plaquetas ≥ 100 000/μL
    c. hemoglobina ≥ 9 g/dL o ≥ 5,6 mmol/L
    d. creatinina en suero ≤ 1,5 × límite superior de la normalidad (LSN) para la edad o aclaramiento de creatinina calculado o tasa de filtración glomerular radioisotópica ≥ 60 ml/min/1,73 m2
    e. bilirrubina total ≤ 1,5 × LSN o bilirrubina directa ≤ 1 × LSN
    f. aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) ≤ 2,5 × LSN a menos que haya metástasis hepáticas, en cuyo caso AST y ALT deben ser ≤ 5 × LSN
    g. relación internacional normalizada o tiempo de protrombina (TP) ≤ 1,5 × LSN a menos que el participante esté recibiendo terapia con anticoagulantes, siempre que el TP o el tiempo de tromboplastina parcial (TTP) esté dentro del rango terapéutico del uso previsto de los anticoagulantes
    h. TTP activado ≤ 1,5 × LSN a menos que el participante esté recibiendo terapia con anticoagulantes, siempre que TP o TTP esté dentro del rango terapéutico del uso previsto de los anticoagulantes
    6. Una participante femenina será apta para participar si no está embarazada o en período de lactancia, y es aplicable, al menos, una de las siguientes condiciones:
    a. No es una mujer en edad fértil (MEF). O
    b. Es una MEF y utiliza un método anticonceptivo altamente efectivo (con una tasa de fallos < 1 % al año), preferiblemente con baja dependencia del usuario, como se describe en el apéndice 3, desde la visita de selección hasta, al menos, 180 días después de la última dosis del fármaco del estudio y acepta no donar óvulos (ovocitos) para su reproducción durante este período. El investigador debe evaluar la efectividad del método anticonceptivo en relación con la primera dosis del tratamiento del estudio.
    - Una MEF debe disponer de una prueba de embarazo negativa altamente sensible (orina o suero, según lo exijan las normativas locales) dentro de las 72 horas anteriores a la primera dosis del fármaco del estudio.

    Por favor, consulte el protocolo del estudio para los criterios de inclusión adicionales de la Parte 1.
    Los criterios de inclusión para la Parte 2 del estudio son descritos en cada suplemento cohorte-específico.
    E.4Principal exclusion criteria
    1.Participation presents unacceptable risk to the prospective participant based on the Investigator’s judgment.
    2.Participant has known hypersensitivity to dostarlimab or niraparib, their components or excipients.
    3.Participant has a known history of myelodysplastic syndrome (MDS) or AML.
    4.Participant has active autoimmune disease that has required systemic treatment in the past 2 years (ie, with use of disease-modifying antirheumatic drugs, corticosteroids, or immunosuppressive drugs). Replacement therapy (eg thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal/pituitary insufficiency) is not considered a form of systemic treatment.
    5.Participant has known active CNS metastases, carcinomatous meningitis, or both. Note: Participants with previously treated brain metastases may participate provided they are clinically stable (without evidence of progression by imaging [using the identical imaging modality for each assessment, either MRI or CT scan] for at least 4 weeks prior to the first dose of study drug and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and have not been using steroids for at
    least 7 days prior to the first dose of study drug. Carcinomatous meningitis precludes a participant from study participation regardless of clinical stability.
    6.Participant had a known additional malignancy that progressed or required active treatment within the last 2 years.
    7.Participant is considered a poor medical risk due to a serious, uncontrolled medical disorder, nonmalignant systemic disease, or active infection that requires systemic therapy. Specific examples include but are not limited to, history of (noninfectious) pneumonitis that required steroids or current pneumonitis, uncontrolled ventricular arrhythmia, uncontrolled major seizure disorder, unstable spinal cord compression, superior vena cava syndrome, or any psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study (including obtaining consent).
    8.Participant has a condition (such as transfusion-dependent anaemia or thrombocytopenia), therapy, or laboratory abnormality that might confound the study results or interfere with the participant’s participation for the full duration of the study treatment including the following:
    a.Participants who received a transfusion (platelets or red blood cells) within 6 weeks of the first dose of study drug are not eligible.
    b.Participants who received colony-stimulating factors (eg, granulocyte-colony stimulating factor [G-CSF], granulocyte-macrophage colony-stimulating factor, or recombinant erythropoietin) within 4 weeks prior to the first dose of study drug are not eligible.
    9.Participant is expecting to conceive within the projected duration of the study, starting with the Screening Visit through 180 days after the last dose of study drug. No data are available regarding the presence of dostarlimab or niraparib or its metabolites in human milk or on its effects on the breastfed infant or milk production. Because of the potential for serious adverse reactions in breastfed infants from dostarlimab and/or niraparib, female participants should not breastfeed during treatment with dostarlimab and/or niraparib and for 1 month after receiving the final dose.
    10.Participant has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug.
    11.Participant has a known history of HIV (type 1 or 2 antibodies).
    12.Participant has known active hepatitis B (eg, hepatitis B surface antigen reactive) or hepatitis C (eg, hepatitis C virus ribonucleic acid [qualitative] is detected).
    13.Participant is currently participating and receiving study treatment or has participated in a study of an investigational agent and received study treatment or used an investigational device within 4 weeks of the first dose of study drug.
    14.Participant has had any known Grade 3 or 4 anaemia, neutropenia, or thrombocytopenia due to prior chemotherapy that persisted >4 weeks related to the most recent prior treatment.
    Please review study protocol for further Part 1 exclusion criteria.
    Exclusion criteria for Part 2 of the study are described in each cohort-specific supplement.
    1.La participación presenta un riesgo inaceptable para el posible participante según el criterio del investigador.
    2.El participante tiene hipersensibilidad conocida al dostarlimab o niraparib, sus componentes o excipientes.
    3.El participante tiene antecedentes conocidos de síndrome mielodisplásico (SMD) o LMA.
    4.El participante tiene una enfermedad autoinmune activa que ha requerido tratamiento sistémico en los últimos 2 años (ed. con el uso de fármacos antirreumáticos modificadores de la enfermedad, corticosteroides o fármacos inmunosupresores). La terapia de reemplazo (p.ej. tiroxina, insulina o terapia fisiológica de reemplazo de corticosteroides para la insuficiencia suprarrenal/hipofisaria) no se considera una forma de tratamiento sistémico.
    5.El participante tiene metástasis activas conocidas en el SNC, meningitis carcinomatosa o ambas. Nota: Participantes con metástasis cerebrales tratadas previamente podrán participar siempre que estén clínicamente estables (sin evidencia de progresión mediante técnicas de imagen [usando la misma modalidad de imagen para cada evaluación, sea RMN o TC] durante al menos 4 semanas antes de la primera dosis del fármaco del estudio y cualquier síntoma neurológico haya vuelto a la fase inicial), no tengan evidencia de metástasis cerebrales nuevas o aumentadas, y no hayan estado usando esteroides durante, al menos, 7 días antes de la primera dosis del fármaco del estudio. La meningitis carcinomatosa impide la participación de un participante en el estudio independientemente de su estabilidad clínica.
    6.El participante tenía una neoplasia maligna adicional conocida que progresó o requirió tratamiento activo en los últimos 2 años.
    7.Se considera que el participante presenta un riesgo médico bajo debido a un trastorno médico grave no controlado, enfermedad sistémica no maligna o infección activa que requiere terapia sistémica. Ejemplos específicos incluyen entre otros, antecedentes de neumonitis (no infecciosa) que requirió esteroides o neumonitis actual, arritmia ventricular no controlada, trastorno convulsivo importante no controlado, compresión inestable de la médula espinal, síndrome de la vena cava superior o cualquier trastorno psiquiátrico o de abuso de sustancias que interferiría en la cooperación con los requisitos del estudio (incluida la obtención del consentimiento).
    8.El participante presenta una afección (como anemia dependiente de transfusión o trombocitopenia), terapia o datos analíticos anormales que podrían afectar a los resultados del estudio o interferir en la participación del participante durante toda la duración del tratamiento del estudio, entre los que se incluyen:
    a.No serán aptos los participantes que recibieron una transfusión (plaquetas o glóbulos rojos) durante las 6 semanas posteriores a la primera dosis del fármaco del estudio.
    b.No serán aptos aquellos participantes que recibieron factores estimulantes de colonias (p.ej. factor estimulante de colonias de granulocitos, factor estimulante de colonias de granulocitos macrófagos o eritropoyetina recombinante) en las 4 semanas previas a la primera dosis del fármaco del estudio.
    9.El participante espera concebir dentro de la duración prevista del estudio, comenzando con la visita de selección hasta 180 días después de la última dosis del fármaco del estudio. No hay datos disponibles sobre la presencia de dostarlimab o niraparib o sus metabolitos en la leche materna o sobre sus efectos en el lactante o la producción de leche. Debido a la posibilidad de que se produzcan reacciones adversas graves en los lactantes con dostarlimab y/o niraparib, las participantes femeninas no deben amamantar durante el tratamiento con dostarlimab y/o niraparib y durante 1 mes tras recibir la dosis final.
    10.El participante tiene un diagnóstico de inmunodeficiencia o está recibiendo terapia con esteroides sistémicos o cualquier otra forma de terapia inmunosupresora en los 7 días previos a la primera dosis del fármaco del estudio.
    11.El participante tiene antecedentes conocidos de VIH (anticuerpos tipo 1 o 2).
    12.El participante tiene hepatitis B activa conocida (p.ej. reactivo antígeno de superficie de la hepatitis B) o hepatitis C (p.ej. se detecta ácido ribonucleico del virus de la hepatitis C [cualitativo]).
    13.El participante actualmente participa y recibe un tratamiento en estudio o ha participado en un estudio de un agente en investigación y recibió un tratamiento en estudio o utilizó un dispositivo de investigación dentro de las 4 semanas anteriores a la primera dosis del fármaco del estudio.
    14.El participante ha padecido anemia, neutropenia o trombocitopenia de grado 3 o 4 conocida debido a quimioterapia previa que persistió >4 semanas en relación con el tratamiento previo más reciente.
    Por favor, consulte el protocolo del estudio para los criterios de exclusión adicionales de la Parte 1.
    Los criterios de exclusión para la Parte 2 del estudio son descritos en cada suplemento cohorte-específico.
    E.5 End points
    E.5.1Primary end point(s)
    Part 1A and 1B: Assess the incidence of DLTs by study part and cohort for the DLT-evaluable population to establish the RP2D of the combination of niraparib (both tablet in Part 1a and age-appropriate oral formulation AAOF in Part 1b) and dostarlimab.

    Part 2: Please refer to the separate cohort-specific supplements for this information.
    Parte 1A y 1B: Evaluar la incidencia TLDs por parte del estudio y por cohorte para la población TLD-evaluable para establecer DF2R de la combinación de niraparib (en ambos comprimido en la Parte 1a y formulación oral apropiada a la edad FOAE en la Parte 2b) y dostarlimab.

    Parte 2: Por favor, consulte los suplementos específicos de cada cohorte para obtener esta información.
    E.5.1.1Timepoint(s) of evaluation of this end point
    The DLT observation period is 42 days following the initiation of study drugs (ie, the first 2 treatment cycles) in Part 1
    El periodo de observación de TLD es de 42 días tras la iniciación de los medicamentos de estudio (ed., los 2 primeros ciclos de tratamiento) en la Parte 1
    E.5.2Secondary end point(s)
    • ORR based on Investigator assessment is defined as the proportion of participants with a BOR of confirmed CR or PR as
    determined by the Investigator using RECIST v1.1 or INRC (for participants with neuroblastoma only).
    • DOR is defined as the time from first documentation of response (CR or PR) until the time of first documented PD by RECIST v1.1 or INRC (for participants with neuroblastoma only) based on Investigator assessment or death (whichever occurs first).

    Part 1: Please refers to main study protocol for further Endpoints
    Part 2: Please refer to the separate cohort-specific supplements for this information.
    • La TRO basada en la evaluación del Investigador se define como la proporción de participantes con una MRG confirmada por la RC o RP determinadas por el investigador usando RECIST v1.1 o CIRN (sólo para pacientes con neuroblastoma).
    • La DR se define como el tiempo desde la primera documentación de la respuesta (RC o RP) hasta el momento de la primera PE documentada por RECIST v1.1 o CIRN (sólo para pacientes con neuroblastoma) basada en la evaluación del Investigador o la defunción (aquella que ocurra primero).

    Parte 1: Por favor, consulte el protocolo de estudio principal para más puntos finales
    Parte 2: Por favor, consulte los suplementos específicos de cada cohorte para obtener esta información.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Timepoint is included in each Endpoint
    El intervalo de tiempo se incluye en cada Criterio de Evaluación
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Toxicity - Tolerability - Acceptability and Palatability - Immunogenecity and Exploratory Biomarkers - ORR - ADA
    Toxicidad - Tolerabilidad - Aceptabilidad y Palatabilidad - Inmunogenicidad y Biomarcadores Exploratorios - TRO - AAF
    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
    dose escalation and cohort expansion study
    estudio de escalada de dosis y expansión de cohortes
    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.8.2.4Number 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 concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA17
    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 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
    The end of the study is defined as the date of the last scheduled procedure for the last participant in any part of the study. A participant is considered to have completed the study if he/she has completed all study assessments, including the last scheduled procedure shown in Table 1 for Part 1 and in the SOAs specific to the cohorts provided in the supplements
    El final del estudio se define como la fecha del último procedimiento programado para el último participante en cualquier parte del estudio. Se considera que un participante ha completado el estudio si él/ella ha completado todas las evaluaciones del estudio, incluyendo el último procedimiento programado mostrado en la Tabla 1 de la Parte 1 y en los CDAs específcos de las cohortes proporcionadas en los suplementos
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years9
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years9
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 116
    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) Yes
    F.1.1.4.1Number of subjects for this age range: 33
    F.1.1.5Children (2-11years) Yes
    F.1.1.5.1Number of subjects for this age range: 50
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 33
    F.1.2Adults (18-64 years) No
    F.1.2.1Number of subjects for this age range: 0
    F.1.3Elderly (>=65 years) No
    F.1.3.1Number of subjects for this age range: 0
    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 state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 116
    F.4.2.2In the whole clinical trial 116
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    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 Decision2020-09-18
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-07-23
    P. End of Trial
    P.End of Trial StatusOngoing
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