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    Summary
    EudraCT Number:2020-002464-31
    Sponsor's Protocol Code Number:KRT-232-111
    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:2021-06-04
    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 number2020-002464-31
    A.3Full title of the trial
    An Open-Label, Multicenter, Phase 1b/2 Study of the Safety and Efficacy of KRT-232 in Combination with Acalabrutinib in Subjects with Relapsed/Refractory Diffuse Large B-cell Lymphoma or Relapsed/Refractory Chronic Lymphocytic Leukemia
    Studio di fase 1b/2, in aperto, multicentrico, sulla sicurezza e sull’efficacia di KRT-232 in combinazione con acalabrutinib in soggetti affetti da linfoma diffuso a grandi cellule B recidivante/refrattario o leucemia linfatica cronica recidivante/refrattaria
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the safety and efficacy of KRT-232 in combination with Acalabrutinib in patients with Relapsed/Refractory Diffuse Large B-cell Lymphoma or Relapsed/Refractory Chronic Lymphocytic Leukemia.
    Studio per valutare la sicurezza e l'efficacia di KRT-232 in combinazione con acalabrutinib in pazienti con linfoma diffuso a grandi cellule B recidivante/refrattario o leucemia linfatica cronica recidivante/refrattaria
    A.3.2Name or abbreviated title of the trial where available
    A study to evaluate the safety and efficacy of KRT-232 in combination with Acalabrutinib n Subjects
    Studio di fase 1b/2, in aperto, multicentrico, sulla sicurezza e sull’efficacia di KRT-232 in combin
    A.4.1Sponsor's protocol code numberKRT-232-111
    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 SponsorKartos Therapeutics, Inc
    B.1.3.4CountryUnited States
    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 supportKartos Therapeutics, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationKartos Therapeutics, Inc.
    B.5.2Functional name of contact pointJohn Mei
    B.5.3 Address:
    B.5.3.1Street Address275 Shoreline Drive
    B.5.3.2Town/ cityRedwood City
    B.5.3.3Post codeCA 94065
    B.5.3.4CountryUnited States
    B.5.6E-mailjmei@kartosthera.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 nameKRT-232
    D.3.2Product code [KRT-232]
    D.3.4Pharmaceutical form 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.3.9.1CAS number 1352066-68-2
    D.3.9.2Current sponsor codeKRT-232
    D.3.9.4EV Substance CodeSUB123933
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number15 to 60
    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.2.1.1.1Trade name IMODIUM - 2 MG COMPRESSE OROSOLUBILI 12 COMPRESSE
    D.2.1.1.2Name of the Marketing Authorisation holderJOHNSON e JOHNSON S.P.A.
    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 nameLoperamide
    D.3.2Product code [Loperamide]
    D.3.4Pharmaceutical form 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 INNLOPERAMIDE
    D.3.9.2Current sponsor code-
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number16
    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.2.1.1.1Trade name ONDANSETRONE MYLAN GENERICS - 4 MG COMPRESSE RIVESTITE CON FILM 10 COMPRESSE IN BLISTER PVC/AL
    D.2.1.1.2Name of the Marketing Authorisation holderMYLAN S.P.A.
    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 nameOndansetrone
    D.3.2Product code [Ondansetrone]
    D.3.4Pharmaceutical form 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 INNONDANSETRON
    D.3.9.2Current sponsor code-
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number16
    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: 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 CALQUENCE
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca Pharmaceuticals LP
    D.2.1.2Country which granted the Marketing AuthorisationUnited States
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/16/1624
    D.3 Description of the IMP
    D.3.1Product nameCalquence
    D.3.2Product code [NDC 0310-0512]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNACALABRUTINIB
    D.3.9.1CAS number 1420477-60-6
    D.3.9.2Current sponsor codeACP-196
    D.3.9.4EV Substance CodeSUB182073
    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 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
    - Relapsed/Refractory (R/R) de novo TP53 ABC (non-GCB) or GCB diffuse large B-cell lymphoma (DLBCL)
    - R/R TP53 chronic lymphocytic leukemia (CLL) naïve to prior Bruton's tyrosine kinase (BTK) inhibitor
    - R/R DLBCL with non-germinal center B-cell like(GCB) subtype
    - R/R DLBCL with double-expressor lymphoma subtype
    - Linfoma diffuso a grandi cellule B (DLBCL) recidivante/refrattario (R/R) de novo con PT53 e profilo di espressione genica in cellula B attivata (ABC) non GCB o GCB
    - Leucemia linfatica cronica (LLC) R/R con TP53 naïve al trattamento con inibitore della BTK
    - Linfoma diffuso a grandi cellule B (DLBCL) recidivante/refrattario (R/R) sottotipo non centro germinativo simile (non GCB)
    - Linfoma diffuso a grandi cellule B (DLBCL) recidivante/refrattario (R/R) sottotipo di linfoma doppio espressore
    E.1.1.1Medical condition in easily understood language
    - Relapsed/Refractory Diffuse Large B-cell Lymphoma
    - Relapsed/Refractory Chronic Lymphocytic Leukemia
    - Linfoma diffuso a grandi cellule B (DLBCL) recidivante/refrattario (R/R)
    - Leucemia linfatica cronica (LLC) recidivante/refrattaria (R/R)
    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 PT
    E.1.2Classification code 10012821
    E.1.2Term Diffuse large B-cell lymphoma recurrent
    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 21.0
    E.1.2Level PT
    E.1.2Classification code 10012822
    E.1.2Term Diffuse large B-cell lymphoma refractory
    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 21.0
    E.1.2Level LLT
    E.1.2Classification code 10008956
    E.1.2Term Chronic lymphatic leukaemia
    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
    Phase Ib:
    To determine the KRT-232 maximum tolerated dose/ maximum administered dose (MTD/MAD) and recommended Phase 2 dose (RP2D) in combination with acalabrutinib in subjects with R/R DLBCL (Cohort 1) or R/R CLL (Cohort 2)
    To determine the safety and tolerability of KRT-232 in combination with acalabrutinib in subjects with R/R DLBCL (Cohort 1) or R/R CLL(Cohort 2)
    Phase II:
    Cohort 1 (R/R DLBCL): To determine the complete response (CR) rate in R/R DLBCL.
    Cohort 2 (R/R CLL): To determine the rate of CR/complete remission with incomplete hematologic recovery (CRi) in R/R CLL.
    Fase Ib:
    Determinare la dose massima tollerata/dose massima somministrata (MTD/MAD) e la dose raccomandata di Fase 2 (RP2D) di KRT-232 in combinazione con acalabrutinib in soggetti affetti da DLBCL R/R (Coorte 1) o da LLC R/R (Coorte 2).
    Determinare la sicurezza e la tollerabilità di KRT-232 in combinazione con acalabrutinib in soggetti affetti da DLBCL R/R (Coorte 1) o da LLC R/R (Coorte 2).
    Fase II:
    Coorte 1 (DLBCL R/R): determinare il tasso di risposta completa (CR) nel DLBCL R/R.
    Coorte 2 (LLC R/R): determinare il tasso di CR/remissione completa con recupero ematologico incompleto (CRi) nella LLC R/R.
    E.2.2Secondary objectives of the trial
    Phase Ib:- To monitor the PK of KRT-232 and acalabrutinib
    Phase II:
    Cohort 1 (R/R DLBCL): To determine the overall response rate (ORR) for R/R DLBCL subjects
    Cohort 2 (R/R CLL): To determine the ORR for R/R CLL subjects
    To evaluate the duration of response (DOR) among subjects who achieve a response of PR or better by cohort.
    Cohort 2 (R/R CLL): To determine the rate of measurable residual disease (MRD)
    To determine the safety and tolerability of KRT-232 in combination with acalabrutinib
    To monitor the PK of KRT-232 and acalabrutinib using sparse sampling
    Fase Ib:
    Monitorare la farmacocinetica (PK) di KRT-232 e acalabrutinib.
    Fase II:
    Coorte 1 (DLBCL R/R): determinare il tasso di risposta complessiva (ORR) per i soggetti affetti da DLBCL R/R.
    Coorte 2 (LLC R/R): Determinare l’ORR per i soggetti affetti da LLC R/R.
    Valutare la durata della risposta (DOR) tra i soggetti che ottengono una risposta PR o migliore per ciascuna coorte.
    Coorte 2 (LLC R/R): determinare il tasso di malattia residua misurabile (MRD)
    Determinare la sicurezza e la tollerabilità di KRT-232 in combinazione con acalabrutinib.
    Monitorare la PK di KRT-232 e acalabrutinib utilizzando un campionamento sparso
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Adults =18 years of age;
    2. Patient population:
    Cohort 1 (R/R DLBCL): a) Histologically confirmed diagnosis of de novo TP53^wt ABC (nonGCB) or GCB DLBCL based on 2016 WHO Classification;
    i ) Phase 2: 25 or more subjects with non-GCB and 10 or more subjects with double-expressor lymphoma will be enrolled as described in Section 10.2 of the study protocol;
    b) R/R DLBCL after treatment with at least 2 prior lines of systemic therapy or at least 1 prior line of systemic therapy in subjects who are ineligible for hematopoietic stem cell transplantation (autologous or allogeneic) for reasons other than active disease;
    c) At least 1 measurable site of disease on computed tomography (CT) (defined as >1.5 cm in longest transverse diameter of a lesion [LDi]) and clearly measurable in 2 perpendicular dimensions);
    Cohort 2 (R/R CLL):
    d) Histologically confirmed diagnosis of TP53^wt CLL according to iwCLL criteria;
    e) Previously treated with at least 1 prior regimen according to current guidelines;
    f) Active disease meeting at least 1 of the iwCLL 2008 criteria for requiring treatment;
    3. ECOG performance status of 0 to 2;
    4. Adequate hematologic function independent of growth factor support for at least 7 days with the exception of pegylated G-CSF and darbepoetin which require at least 14 days, defined as:
    a) Absolute neutrophil count (ANC) =1,000/mm^3;
    b) Platelet count =50,000/mm^3;
    5. Adequate hepatic function within 28 days prior to first dose defined as:
    a) Total bilirubin within normal limits (WNL); if total bilirubin is > upper limit of normal (ULN) then patients are eligible if the direct bilirubin is = 2.0 x ULN;
    b) Aspartate transaminase/serum glutamic oxaloacetic transaminase (AST/SGOT) and alanine transaminase/serum glutamic pyruvic transaminase (ALT/SGPT) =2.5 ULN;
    6. Adequate renal function within 28 days prior to the first dose definedas an estimated creatinine clearance =30 mL/min by Cockcroft Gault;
    7. Female subjects of childbearing potential and their male partners, or male subjects who have female partners of childbearing potential must both use an effective contraception method during the study. In addition, both male and female subjects must continue to use contraception for 6 months after the last dose of study drug. Effective birth control for males includes either vasectomy or use of condoms. Effective birth control for females includes (a) combined estrogen- and progestogen-containing hormonal contraception (oral, intravaginal, transdermal); (b) intrauterine device combined with a barrier method; (c) intrauterine hormone-releasing system combined with a barrier method; (d) bilateral tubal occlusion or ligation; (e) vasectomized partner; and (f) sexual abstinence, when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.
    Note: Marketed drugs administered concomitantly in this study may have different contraception requirements, including required duration of contraception use. The contraception requirements in the prescribing information (PI) or summary of product characteristics (SmPC) must be followed for all concomitant drugs administered in this study.
    1. Adulti di età =18 anni
    2. Popolazione di pazienti
    Coorte 1 (DLBCL R/R)
    a) Diagnosi istologicamente confermata di DLBCL non GCB o DLBCL GCB de novo con TP53wt in base alla classificazione del 2016 dell’Organizzazione Mondiale della Sanità (OMS)
    i. Fase 2: saranno arruolati 25 o più soggetti affetti dalinfoma non GCB e 10 o più soggetti affetti da linfoma con doppio espressore, come riportato nel Paragrafo 10.2 del Protocollo di studio.
    b) DLBCL R/R dopo il trattamento con almeno 2 linee pregresse di terapia sistemica o almeno 1 linea pregressa di terapia sistemica in soggetti non idonei al trapianto di cellule staminali
    ematopoietiche (autologo o allogenico) per motivi diversi dalla malattia attiva.
    c) Almeno 1 sito misurabile di malattia mediante tomografia computerizzata (TC) (definito come lesione con diametro maggiore [LDi] avente lunghezza >1,5 cm) e chiaramente misurabile in 2 dimensioni perpendicolari.
    Coorte 2 (LLC R/R)
    d) Diagnosi istologicamente confermata di LLC con TP53wt secondo i criteri iwCLL.
    e) Trattamento precedente con con almeno 1 regime pregresso secondo le linee guida attuali.
    f) Malattia attiva che soddisfi almeno 1 dei criteri iwCLL del 2008 in merito alla necessità di ricorrere al trattamento.
    3. Scala di valutazione secondo il Gruppo cooperativo orientale di oncologia (ECOG) compreso tra 0-2.
    4. Adeguata funzione ematologica indipendente dal supporto del fattore di crescita per almeno 7 giorni, ad eccezione del fattore stimolante le colonie di granulociti (G-CSF) pegilato e della darbepoetina richiedenti almeno 14 giorni, definita come:
    a) Conta assoluta dei neutrofili (CAN) =1.000/mm^3
    b) Conta piastrinica =50.000/mm^3
    5. Funzione epatica adeguata nei 28 giorni precedenti la prima dose definita come:
    a) Bilirubina totale entro i limiti normali (WNL); se la bilirubina totale è >limite superiore dell’intervallo normale (ULN), i pazienti sono idonei se la bilirubina diretta è =2,0 volte l’ULN.
    b) Aspartato transaminasi/transaminasi glutammica-ossaloacetica sierica (AST/SGOT) e alanina transaminasi/transaminasi glutammica piruvica sierica (ALT/SGPT) =2,5 volte l’ULN.
    6. Adeguata funzione renale nei 28 giorni precedenti la prima dose, definita come clearance della creatinina stimata =30 ml/min secondo l’equazione Cockcroft Gault.
    7. I soggetti di sesso femminile in età fertile e i rispettivi partner di sesso maschile o i soggetti di sesso maschile con partner di sesso femminile in età fertile devono utilizzare un metodo contraccettivo efficace durante lo studio. Inoltre, soggetti di sesso sia maschile che femminile devono continuare a utilizzare i contraccettivi per 6 mesi dopo l’ultima dose del farmaco dello studio. Un metodo contraccettivo efficace per gli uomini include la vasectomia o l’utilizzo di preservativi. Un metodo contraccettivo efficace per le donne include (a) contraccezione ormonale combinata contenente estrogeni e progestinici (orale, intravaginale, transdermica); (b) dispositivo intrauterino combinato con un metodo barriera; (c) sistema intrauterino di rilascio combinato con un metodo barriera; (d) occlusione o legatura tubarica bilaterale; (e) partner di sesso maschile vasectomizzato e (f) astinenza sessuale, qualora ciò sia in linea con lo stile di vita preferito e abituale del soggetto. L’astinenza periodica (per esempio, metodi del calendario, dell’ovulazione, sintotermico o post-ovulazione) e il coito interrotto non sono metodi di contraccezione accettabili.
    Nota: i farmaci commercializzati somministrati in concomitanza in questo studio potrebbero presentare requisiti contraccettivi diversi, compresa la durata richiesta di utilizzo della contraccezione. I requisiti di contraccezione contemplati nel foglio illustrativo (FI) o nel riassunto delle caratteristiche del prodotto (RCP) devono essere seguiti per tutti i farmaci concomitanti somministrati in questo studio.
    E.4Principal exclusion criteria
    1. Subjects with a history of CNS involvement;
    2. Any recent prior therapy meeting one or more of the following criter: a) Concurrent anticancer treatment, such as chemotherapy, cytoreductive therapy, immune therapy, or cytokine therapy:
    i) DLBCL: Within 14 days prior to the first dose of study treatment;
    ii) CLL: Within 28 days prior to the first dose of study treatment;
    b) Allogeneic stem cell transplant within the last 6 months, or active graft versus host disease following allogeneic transplant, or autologous stem cell transplant within 3 months prior to the first dose of study treatment;
    c) Subjects who have received immunosuppressive therapy for graftversus-host disease within 6 months prior to first dose of study treatment;
    Subjects previously treated with:
    3. MDM2 antagonist therapies;
    4. BTK inhibitor;
    5. Subjects with a history of bleeding diathesis or major hemorrhage within 6 months prior to first dose of study treatment;
    6. History of stroke or intracranial hemorrhage within 6 months before first dose of study drug;
    7. Uncontrolled intercurrent illness including but not limited to clinically significant cardiac disease (New York Heart Association Class III or IV); symptomatic congestive heart failure, unstable angina pectoris; unstable ventricular arrhythmia; or psychiatric illness/social situations that would limit compliance with study requirements;
    8. Grade 2 or higher QTc prolongation
    9. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach; or extensive small bowel resection that is likely to affect absorption; symptomatic inflammatory bowel disease, or partial or complete bowel obstruction; or gastric restrictions and bariatric surgery, such as gastric bypass;#
    10. Subjects with uncontrolled bacterial, fungal, parasitic, or viral infection.

    For the remaining exclusion criteria (11 to 19) please refer to the study protocol.
    1. Soggetti con anamnesi di coinvolgimento del SNC.
    2. Qualsiasi terapia precedente pregressa che soddisfi uno o più dei seguenti criteri:
    a) Trattamento antitumorale concomitante, come chemioterapia, terapia citoriduttiva, immunoterapia o terapia citochinica:
    i. DLBCL: nei 14 giorni precedenti la prima dose del trattamento dello studio.
    ii. LLC: nei 28 giorni precedenti la prima dose del trattamento dello studio.
    b) Trapianto allogenico di cellule staminali negli ultimi 6 mesi o malattia del trapianto contro l’ospite a seguito di trapianto allogenico o trapianto autologo di cellule staminali nei 3 mesi precedenti la prima dose del trattamento dello studio.
    c) Soggetti che hanno ricevuto una terapia immunosoppressiva pemalattia da trapianto contro l’ospite nei 6 mesi precedenti la prima dose del trattamento dello studio.
    3. Soggetti precedentemente trattati con terapie con antagonisti di MDM2.
    4. Soggetti precedentemente trattati con un inibitore della BTK.
    5. Soggetti con anamnesi di diatesi emorragica o emorragia maggiore nei 6 mesi precedenti la prima dose del trattamento dello studio.
    6. Anamnesi di ictus o emorragia intracranica nei 6 mesi precedenti la prima dose del farmaco dello studio.
    7. Malattia intercorrente non controllata, tra cui, seppure non limitatamente, cardiopatia clinicamente significativa (Classe III o IV della New York Heart Association); insufficienza cardiaca congestizia sintomatica,angina pectoris instabile, aritmia ventricolare instabile o malattia psichiatrica/situazioni sociali che limiterebbero la compliance ai requisiti dello studio.
    8. Prolungamento dell’intervallo QTc di grado 2 o superiore (>480 millisecondi secondo la terminologia comune degli eventi avversi [v 5.0] del National Cancer Institute)
    9. Sindrome da malassorbimento, malattia che colpisce in modo significativo la funzione gastrointestinale o resezione gastrica o resezione estesa dell’intestino tenue che potrebbe influire sull’assorbimento, malattia infiammatoria intestinale sintomatica o ostruzione intestinale parziale o completa, o restrizioni gastriche e chirurgia bariatrica, come bypass gastrico.
    10. Soggetti con infezione batterica, fungina, parassitaria o virale non controllata. I soggetti con infezioni batteriche acute che richiedono l’utilizzo di antibiotici non devono arruolarsi fino a quando l’infezione non sia stabile a giudizio del medico curante; tali soggetti potrebbero essere trattati con antibiotici al momento dell’arruolamento.

    Per i restanti criteri di esclusione (da 11 a 19) si prega di fare riferimento al Protocollo di studio.
    E.5 End points
    E.5.1Primary end point(s)
    Phase Ib:
    1. Dose-limiting toxicities will be used to establish the MTD/MAD of KRT232 in combination with acalabrutinib. The Safety Review Committee will determine the RP2D based on safety data of the combination of KRT-232 and acalabrutinib;
    2. Analyses of the safety endpoints will include the following measurements or assessments: physical examinations, laboratory tests, adverse events (AEs), serious AEs (SAEs), electrocardiograms (ECGs), and vital signs.
    Phase II:
    1. The proportion of subjects with CR as assessed by investigators per the Lugano Classification;
    2. The proportion of subjects with CR/CRi as assessed by investigators per iwCLL Response Criteria.
    Fase Ib:
    1. Le tossicità dose-limitanti saranno utilizzate per stabilire la MTD/MAD di KRT-232 in combinazione con acalabrutinib. Il Comitato di revisione della sicurezza determinerà la RP2D sulla base dei dati sulla sicurezza della combinazione di KRT-232 e acalabrutinib.
    2.Le analisi degli endpoint di sicurezza includeranno le seguenti misurazioni o valutazioni: esami obiettivi, esami di laboratorio, eventi avversi (AE), AE seri (SAE), elettrocardiogrammi (ECG) e segni vitali.
    Fase II:
    -Percentuale di soggetti con CR valutata dagli sperimentatori secondo la Classificazione di Lugano.
    -Percentuale di soggetti con CR/CRi valutata dagli sperimentatori secondo i criteri di valutazione della risposta iwCLL.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Phase Ib:
    1-2. Throughout the study
    Phase II:
    1-2. Throughout the study
    Fase Ib:
    1-2. Durante tutto lo studio
    Fase II:
    1-2. Durante tutto lo studio
    E.5.2Secondary end point(s)
    Phase 1b:
    1. KRT-232, acyl glucuronide metabolite (M1), acalabrutinib, and metabolite ACP-5862 pharmacokinetic (PK) parameters will be determined, including but not limited to:
    • Maximum observed concentration (C^max)
    • Minimum observed concentration (C^min)
    • Area under the plasma concentration-time curve (AUC)
    • Time of maximum plasma concentration

    Phase II:
    1. The proportion of subjects who achieve a partial response (PR) or better at any time point while on study, as assessed by Lugano Classification;
    2. The proportion of subjects who achieve a PR or better at any time point while on study, as assessed by iwCLL Response Criteria;
    3. Median DOR (Kaplan-Meier estimate) defined as the time from the first observation of response to disease progression or death;
    4. The proportion of subject who achieve MRD negativity either in peripheral blood or bone marrow by flow cytometry and DNA sequencing;
    5. Analyses of the safety endpoints will include the following measurements or assessments: physical examinations, laboratory tests, adverse events (AEs), serious AEs (SAEs), electrocardiograms (ECGs), and vital signs;
    6. KRT-232, acyl glucuronide metabolite (M1), acalabrutinib, and metabolite ACP-5862 plasma concentrations will be monitored using sparse sampling.
    Fase Ib:
    1. Saranno determinati i parametri di farmacocinetica (PK) inerenti a KRT-232, metabolita acil-glucuronide (M1), acalabrutinib e metabolita ACP-5862, tra cui, seppure non limitatamente:
    • Concentrazione massima (Cmax) osservata
    • Concentrazione minima (Cmin) osservata
    • Area sottesa alla curva (AUC) della concentrazione plasmatica in funzione del tempo
    • Tempo di concentrazione plasmatica massima

    Fase II:
    1.Percentuale di soggetti che ottengono una risposta parziale (PR) o una risposta migliore in qualsiasi momento durante lo studio, come valutato secondo la Classificazione di Lugano.
    2.Percentuale di soggetti che ottengono una PR o una risposta migliore in qualsiasi momento durante lo studio, come valutato secondo i criteri di valutazione della risposta iwCLL.
    3.DOR mediana (stima secondo il metodo diKaplan-Meier) definita come il tempo trascorso dalla prima osservazione della risposta alla progressione della malattia o al decesso.
    4.La percentuale di soggetti che raggiunge la negatività rispetto alla MRD sia nel sangue periferico sia nel midollo osseo mediante valutazione con analisi citofluorimetrica e sequenziamento del DNA.
    5. Le analisi degli endpoint di sicurezza includeranno le seguenti misurazioni o valutazioni: esami obiettivi, esami di laboratorio, eventi avversi (AE), AE seri (SAE), elettrocardiogrammi (ECG) e segni vitali.
    6.Le concentrazioni plasmatiche di KRT-232, acil glucuronide metabolita (M1), acalabrutinib e metabolita ACP-5862 saranno monitorate mediante campionamento sparso.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Phase 1b:
    1. Throughout the study
    Phase II:
    1-6. Throughout the study
    Fase Ib:
    1. Durante tutto lo studio
    Fase II:
    1-6. Durante tutto lo studio
    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 Yes
    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
    Dose determining
    Determinazione della dose
    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 Yes
    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 Yes
    E.8.1.7.1Other trial design description
    Aumento della dose
    Dose escalation
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    NA: studio non controllato
    NA: not controlled study
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA57
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Korea, Republic of
    Belgium
    France
    Hungary
    Italy
    Poland
    Portugal
    Switzerland
    United Kingdom
    Czechia
    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 Patient Last Visit (LPLV)
    Last Patient Last Visit (LPLV)
    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 months5
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months10
    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: 36
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 54
    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 No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state12
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 94
    F.4.2.2In the whole clinical trial 114
    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)
    Patients may be given an opportunity to participate in future interventional trials if the complete the study.
    I pazienti potranno avere l'opportunità di partecipare a futuri studi interventistici se completano lo studio.
    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 Decision2021-02-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-05-12
    P. End of Trial
    P.End of Trial StatusOngoing
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