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    Summary
    EudraCT Number:2020-002729-27
    Sponsor's Protocol Code Number:MK-3475-A86
    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:2021-09-02
    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 number2020-002729-27
    A.3Full title of the trial
    A Randomized, Phase 3, Open-label Study to Investigate the Pharmacokinetics and Safety of Subcutaneous Pembrolizumab versus Intravenous Pembrolizumab, Administered with Platinum Doublet Chemotherapy, in the First-Line Treatment of Participants with Metastatic Squamous or Nonsquamous Non-Small-Cell Lung Cancer
    Estudio de fase 3, abierto y aleatorizado para investigar la farmacocinética y la seguridad de pembrolizumab subcutáneo en comparación con pembrolizumab intravenoso, administrado con quimioterapia doble a base de platino, en el tratamiento de primera línea de participantes con cáncer de pulmón no microcítico, epidermoide o no epidermoide, metastásico
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 3 study of pembrolizumab SC versus pembrolizumab IV, administered with platinum doublet chemotherapy, in 1L metastatic squamous or nonsquamous NSCLC
    Estudio de fase 3 de pembrolizumab SC en comparación con pembrolizumab IV, administrado con quimioterapia doble a base de platino, en el tratamiento de primera línea del CPNM epidermoide o no epidermoide metastásico.
    A.4.1Sponsor's protocol code numberMK-3475-A86
    A.5.4Other Identifiers
    Name:INDNumber:147059
    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 SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., 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 supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co.,Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España SA
    B.5.2Functional name of contact pointInvestigación clínica
    B.5.3 Address:
    B.5.3.1Street AddressCalle Josefa valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491321 06 00
    B.5.5Fax number+3491321 05 90
    B.5.6E-mailensayos_clinicos@merck.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 namePEMBROLIZUMAB
    D.3.2Product code MK-3475
    D.3.4Pharmaceutical form Solution for injection in pre-filled syringe
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous 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.3.9.2Current sponsor codeMK-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 number165
    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 RoleComparator
    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 (pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    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 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.3.9.2Current sponsor codeMK-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.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Metastatic Squamous or Nonsquamous Non-Small-Cell Lung Cancer
    Cáncer de pulmón no microcítico epidermoide o no epidermoide metastásico
    E.1.1.1Medical condition in easily understood language
    Metastatic non-small cell lung cancer
    Cáncer de pulmón metastásico de células no pequeñas
    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 10059515
    E.1.2Term Non-small cell lung cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1.To compare Area under the curve (AUC) between pembrolizumab (MK-3475) subcutaneous (SC) vs pembrolizumab intravenous (IV)
    2. To compare minimal concentration (Ctrough) between pembrolizumab SC vs pembrolizumab IV.
    1.Comparar el área bajo la curva (AUC) entre pembrolizumab (MK-3475) subcutáneo (SC) y pembrolizumab intravenoso (IV)
    2. Comparar la concentración mínima (Cmín) entre pembrolizumab SC y pembrolizumab IV.
    E.2.2Secondary objectives of the trial
    1.To evaluate pembrolizumab SC and pembrolizumab IV with respect to objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by blinded independent central review (BICR)
    2.To evaluate exposure of pembrolizumab SC compared to pembrolizumab IV
    3.To evaluate the safety and tolerability of pembrolizumab SC compared to pembrolizumab IV
    4.To evaluate pembrolizumab SC and pembrolizumab IV with respect to progression-free survival (PFS) per RECIST 1.1 as assessed by BICR
    5.To evaluate pembrolizumab SC and pembrolizumab IV with respect to overall survival (OS)
    6.To evaluate pembrolizumab SC and pembrolizumab IV with respect to duration of response (DOR) per RECIST 1.1 as assessed by BICR
    7.To evaluate the development of antidrug antibodies (ADAs) following administration of pembrolizumab SC compared to pembrolizumab IV.
    1.Determinar la Tasa de respuesta objetiva (TRO) con pembrolizumab SC y pembrolizumab IV conforme a los criterios de evaluación de respuesta en tumores sólidos versión 1.1(RECIST 1.1), según una evaluación central independiente y con enmascaramiento (ECIE).
    2. Determinar la exposición a pembrolizumab SC en comparación con pembrolizumab IV.
    3. Determinar la seguridad y la tolerabilidad de pembrolizumab SC en comparación con pembrolizumab IV.
    4. Determinar la Supervivencia sin progresión (SSP) con pembrolizumab SC y pembrolizumab IV conforme a los criterios RECIST 1.1, según una ECIE.
    5. Determinar la supervivencia global (SG) con pembrolizumab SC y pembrolizumab IV.
    6. Determinar la duración de respuesta (DR) con pembrolizumab SC y pembrolizumab IV conforme a los criterios RECIST 1.1, según una ECIE
    7. Determinar la aparición de anticuerpos contra el fármaco (ACF) tras la administración de pembrolizumab SC en comparación con pembrolizumab IV.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Time & Motion pharmacoeconomic sub-study
    Subestudio farmacoeconómico de Time & Motion












































    Subestudio farmacoeconómico de Time & Motion
    E.3Principal inclusion criteria
    1. Has pathologically (histologically or cytologically) confirmed diagnosis of squamous or nonsquamous NSCLC
    2. Has Stage IV (T any, N any, M1a, M1b, or M1c - American Joint Committee on Cancer 8th Edition) squamous or nonsquamous NSCLC
    3. Has confirmation that EGFR, ALK, or ROS1-directed therapy is not indicated (documentation of absence of tumor-activating EGFR mutations AND absence of ALK and ROS1 gene rearrangements, OR presence of a KRAS mutation) in nonsquamous NSCLC as well as mixed nonsquamous/squamous NSCLC. Participants with purely squamous NSCLC do not require testing
    4. Has not received prior systemic treatment for their metastatic NSCLC. Participants who received adjuvant or neoadjuvant therapy are eligible if the adjuvant/neoadjuvant therapy was completed at least 12 months prior to the development of metastatic disease
    5. Participants are at least 18 years of age on the day of signing the informed consent
    6. Has an ECOG PS of 0 or 1 (as assessed within 7 days prior to randomization)
    7. Male participants are eligible to participate if they agree to the following during the intervention period and for at least 95 days from the last dose of chemotherapy:
    • Refrain from donating sperm
    PLUS either:
    • Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent
    OR
    • Must agree to use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause) as detailed below:
    Agree to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a WOCBP who is not currently pregnant
    8. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    • Is not a WOCBP
    OR
    • Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis), during the intervention period and for at least 180 days after the last dose of chemotherapy or 120 days after the last dose of pembrolizumab, whichever occurs last, and agrees not to donate eggs (ova, oocytes) to others or freeze/store for her own use for the purpose of reproduction during this same time period after the last dose of study intervention. The investigator should evaluate the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention
    • A WOCBP must have a negative highly sensitive pregnancy test (as required by local regulations) within 24 hours for urine or within 72 hours for serum before the first dose of study intervention. If a urine test is positive or not evaluable, a serum test will be required
    • The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy
    9. The participant (or legally acceptable representative) provides documented informed consent/assent for the study. The participant may also provide consent/assent for future biomedical research. However, the participant may participate in the main study without participating in future biomedical research
    10. Has measurable disease per RECIST 1.1 as assessed by the local site investigator/radiology. Lesions situated in a previously irradiated area are considered measurable if progression has been shown in such lesions
    11. Submit an archival tumor tissue sample or newly obtained core or incisional biopsy of a tumor lesion not previously irradiated for PD-L1 status determination prior to randomization. FFPE tissue blocks are preferred to slides. Biopsies obtained prior to receipt of adjuvant/neoadjuvant chemotherapy will be permitted if recent biopsy is not feasible
    12. Has adequate organ function as detailed in the protocol. Specimens must be collected within 10 days prior to the start of study intervention
    1. Diagnóstico confirmado anatomopatológicamente (histológica o citológicamente) de CPNM epidermoide o no epidermoide.
    2. Presencia de un CPNM epidermoide o no epidermoide en estadio IV (cualquier T, cualquier N, M1a, M1b o M1c; criterios del American Joint Committee on Cancer, 8ª edición).
    3. Confirmación de que no está indicado el tratamiento dirigido contra EGFR, ALK o ROS1 (ausencia documentada de mutaciones de EGFR activadoras del tumor Y ausencia de reordenamientos génicos de ALK y ROS1 O presencia de una mutación de KRAS) en el CPNM no epidermoide, así como en el CPNM no epidermoide/epidermoide mixto. En los participantes con CPNM puramente epidermoide no serán necesarios estos análisis.
    4. No haber recibido previamente tratamiento sistémico para el CPNM metastásico. Los pacientes que hayan recibido tratamiento adyuvante o neoadyuvante podrán participar en el estudio siempre que dicho tratamiento se haya completado al menos 12 meses antes de la aparición de la enfermedad metastásica.
    5. Edad mínima de 18 años el día de la firma del consentimiento informado.
    6. Estado funcional del ECOG de 0 o 1 (determinado en los 7 días previos a la aleatorización).
    7. Podrán participar en el estudio los varones que se comprometan a todo lo siguiente durante el período de intervención y hasta, como mínimo, 95 días después de recibir la última dosis de quimioterapia:
    • Abstenerse de donar semen.
    Y:
    • Abstenerse de mantener relaciones heterosexuales, como modo de vida habitual y preferido (abstinencia a largo plazo y persistente), y compromiso de mantener dicha abstinencia.
    O
    • Comprometerse a utilizar métodos anticonceptivos, a menos que se confirme la presencia de azoospermia (por vasectomía o secundaria a una causa médica), tal como se detalla a continuación:
    Comprometerse a utilizar preservativo masculino más uso por parte de la pareja de un método anticonceptivo adicional cuando mantengan relaciones sexuales con penetración vaginal con mujeres en edad fértil que no estén embarazadas.
    8. En el estudio podrán participar mujeres que no estén embarazadas ni en período de lactancia y que cumplan al menos una de las condiciones siguientes:
    • No es una mujer en edad fértil.
    O
    • Es una mujer en edad fértil y utiliza un método anticonceptivo muy eficaz (con un índice de fallos < 1% anual), con baja dependencia de la usuaria, o practica la abstinencia de relaciones heterosexuales como modo de vida preferido y habitual (abstinencia a largo plazo y persistente), según se describe en el apéndice 5, durante el período de intervención y hasta, como mínimo, 120 días después de la última dosis de pembrolizumab o 180 días después de la última dosis de quimioterapia, lo que suponga más tiempo, y se compromete a no donar óvulos a otras personas y a no congelarlos/conservarlos para su propio uso con fines de reproducción durante este período. El investigador deberá evaluar la posibilidad de fracaso del método anticonceptivo (es decir, incumplimiento o inicio reciente) en relación con la primera dosis de la intervención del estudio.
    • Las MEF deberán dar negativo en una prueba de embarazo de alta sensibilidad (según exija la normativa local) realizada en las 24 horas (orina) o las 72 horas (suero) previas a la primera dosis de la intervención del estudio. Cuando una prueba en orina sea positiva o dudosa, tendrá que hacerse una prueba en suero.
    • El investigador es responsable de revisar los antecedentes médicos, los antecedentes menstruales y la actividad sexual reciente para reducir el riesgo de incluir a una mujer con un embarazo de poco tiempo no detectado.
    9. Consentimiento/asentimiento informado para el estudio otorgado por el participante (o su representante legal) y documentado. El participante también podrá otorgar su consentimiento/asentimiento para investigaciones biomédicas futuras. No obstante, podrá participar en el estudio principal sin necesidad de hacerlo en las investigaciones biomédicas futuras.
    10. Presencia de enfermedad mensurable conforme a los criterios RECIST 1.1, según la evaluación del investigador o radiólogo del centro. Las lesiones ubicadas en una zona irradiada previamente se considerarán mensurables siempre que se haya constatado progresión en dichas lesiones.
    11. Envío de una muestra de tejido tumoral de archivo o de una biopsia reciente, con aguja gruesa o por incisión, de una lesión tumoral no irradiada previamente para determinar la expresión de PD-L1 antes de la aleatorización. Se prefieren los bloques de tejido FFIP a las extensiones. Se permitirá el uso de biopsias obtenidas antes de recibir quimioterapia adyuvante/neoadyuvante cuando no sea viable una biopsia reciente.
    12. Función orgánica adecuada, tal como se define en el protocolo. Las muestras se obtendrán en los 10 días previos al comienzo de la intervención del estudio.
    E.4Principal exclusion criteria
    1. Has a known additional malignancy that is progressing or has required active treatment within the past 3 years
    2. Has known central nervous system (ie, brain and/or spinal cord) metastases and/or carcinomatous meningitis. Participants with treated brain metastases (eg, whole brain radiation treatment [WBRT], stereotactic radiosurgery, or equivalent) may participate only if they satisfy all of the following:
    • Have no evidence of new or enlarging brain metastases confirmed by post-treatment repeat brain imaging (using the same modality) performed at least 4 weeks after pretreatment brain imaging, and
    • Are neurologically stable without the need for steroids for at least 14 days before first dose of trial treatment as per local site assessment
    3. Has severe hypersensitivity (≥Grade 3) to study intervention and/or any of its excipients
    4. Has an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed
    5. Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease. Lymphangitic spread of the NSCLC is not exclusionary
    6. Has an active infection requiring systemic therapy
    7. Has a known history of HIV infection. No HIV testing is required unless mandated by local health authority
    8. Has a known history of Hepatitis B (defined as HBsAg reactive) or known active Hepatitis C virus (defined as HCV RNA [qualitative] is detected) infection
    9. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator
    10. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study
    11. Has symptomatic ascites or pleural effusion. A participant who is clinically stable after treatment for these conditions (including therapeutic thoraco- or paracentesis) is eligible
    12. Before the first dose of study intervention:
    • Has received prior systemic cytotoxic chemotherapy for metastatic NSCLC
    • Has received antineoplastic biological therapy (eg, erlotinib, crizotinib, cetuximab) for metastatic NSCLC
    • Has had major surgery (<3 weeks prior to first dose)
    • Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX-40, CD137)
    13. Received radiation therapy to the lung that is >30 Gray within 6 months of the first dose of study intervention
    14. Is expected to require any other form of antineoplastic therapy while on study
    15. Is unable to interrupt aspirin or other NSAIDs, other than an aspirin dose ≤1.3 g/day, for a 5-day period (8-day period for long acting agents, such as piroxicam)
    16. Is unable or unwilling to take folic acid or vitamin B12 supplementation
    17. Has received prior radiotherapy within 2 weeks of start of study intervention. Participants must have recovered from all radiation related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤2 weeks of radiotherapy) to non-CNS disease
    18. Has received a live or live attenuated vaccine within 30 days prior to the first dose of study intervention
    19. Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study intervention
    20. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study intervention
    21. Has had an allogenic tissue/solid organ transplant
    1. Presencia de otra neoplasia maligna conocida que esté en progresión o que haya precisado Tto. activo en los últimos 3 años.
    2. Presencia de metástasis conocidas en el sistema nervioso central (es decir, cerebro y/o médula espinal) y/o meningitis carcinomatosa. Los posibles participantes con metástasis cerebrales tratadas (Ej: radioterapia panencefálica [RTPE], radiocirugía estereotáctica o equivalente) solo podrán participar si cumplen todos los criterios siguientes:
    • Ausencia de signos de metástasis cerebrales nuevas o que hayan aumentado de tamaño confirmado mediante nuevos EECCs de imagen cerebrales posteriores al Tto. (utilizando la misma modalidad) realizados al menos 3 semanas después de los EECCs de imagen cerebrales previos al Tto.
    • Estado neurológicamente estable sin necesidad de esteroides durante al menos 14 días antes de recibir la 1ª del Tto. del EECC según la evaluación del centro local.
    3. Hipersensibilidad grave (grado ≥3) a la intervención del EECC y/o a cualquiera de sus excipientes
    4. Presencia de una enfermedad autoinmunitaria activa que haya precisado Tto. sistémico (es decir, fármacos modificadores de la enfermedad, corticoides o inmunodepresores) en los 2 últimos años. El Tto. de reposición (Ej: tiroxina, insulina o corticoides en dosis fisiológicas por insuficiencia suprarrenal o hipofisaria) no se considera una forma de Tto. sistémico y se permitirá su uso.
    5. Antecedentes de neumonitis (no infecciosa)/neumopatía intersticial que precisó esteroides o presencia de una neumonitis/neumopatía intersticial. La diseminación linfangítica del CPNM no será motivo de exclusión.
    6. Presencia de una infección activa con necesidad de Tto. sistémico.
    7. Antecedentes de infección por el VIH. No será necesario realizar pruebas de VIH a menos que lo exijan las autoridades sanitarias locales.
    8. Antecedentes de infección por el virus de la hepatitis B (reactividad del antígeno de superficie del virus de la hepatitis B [HBsAg]) o de infección activa por el virus de la hepatitis C (definida como detección de ARN del virus de la hepatitis C [VHC] [cualitativo]).
    9. Antecedentes o datos presentes de cualquier proceso Tto. o anomalía analítica que, en opinión del IP. responsable del Tto., podría confundir los resultados del EECC, dificultar la participación durante la totalidad del EECC o motivar que la participación no sea lo más conveniente para el posible participante.
    10. Presencia de un trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante para colaborar en el cumplimiento de los requisitos del EECC.
    11. Ascitis o derrame pleural sintomáticos. Podrán participar candidatos que se encuentren clínicamente estables tras recibir Tto. por estos procesos (como toracocentesis o paracentesis terapéuticas).
    12. Antes de la 1ª de la intervención del EECC:
    • Recepción de quimioterapia citotóxica sistémica previa por CPNM metastásico.
    • Recepción de Tto. biológico antineoplásico (Ej:, erlotinib, crizotinib o cetuximab) por CPNM metastásico.
    • Antecedentes de una intervención de cirugía mayor (en las 3 semanas previas a la 1ª).
    • Recepción de Tto. previo con un fármaco anti-PD-1, anti-PD-L1 o anti- PD-L2 o con un fármaco dirigido contra otro receptor de los linfocitos T estimulador o coinhibidor (como CTLA-4, OX-40 o CD137).
    13. Recepción de radioterapia previa sobre el pulmón >30 Gy en los 6 meses previos a la 1ª de la intervención del EECC.
    14. Previsión de que se precise cualquier otra forma de Tto. antineoplásico durante el EECC. Imposibilidad de interrumpir el Tto. con ácido acetilsalicílico u otros antiinflamatorios no esteroideos, excepto 1 dosis de ácido acetilsalicílico ≤1,3 g al día durante 5 días (8 días en caso de fármacos de acción prolongada, como piroxicam).
    16. Incapacidad o falta de disposición a tomar un suplemento de ácido fólico o vitamina B12.
    17. Recepción de radioterapia en las 2 sem. previas al comienzo de la intervención del EECC. Los participantes deberán haberse recuperado de toda la toxicidad relacionada con la radioterapia, no precisar corticoides y no haber sufrido neumonitis por radiación. Se permite un reposo farmacológico de 1 semana en caso de radioterapia paliativa (≤2 semanas de radioterapia) por enfermedad que no afecta al SNC.
    18. Recepción de 1 vacuna de microorganismos vivos o vivos atenuados en los 30 días previos a la 1ª de la intervención del EECC.
    19. Participación activa o pasada en un EECC de un fármaco experimental o uso de un dispositivo experimental en las 4 semanas previas a la administración de la 1ª de la intervención del EECC.
    20. Diagnóstico de inmunodeficiencia o recepción de Tto. sistémico crónico con esteroides (en dosis superiores a 10 mg diarios de prednisona o equivalente) o cualquier otra forma de Tto. inmunodepresor en los 7días previos a la 1ª de la intervención del EECC.
    21. Recepción de un alotrasplante de órgano sólido o tejidos.
    E.5 End points
    E.5.1Primary end point(s)
    1.Area Under the Curve From 0-3 Weeks (AUC0-3wks) of Pembrolizumab for Cycle 1
    2.Minimal Concentration (Ctrough) of Pembrolizumab at the End of Cycle 6
    1. Area bajo la curva desde 0-3 semanas de Pembrolizumab para Ciclo 1.
    2.Concentración minima (Cmín) de Pembrolizumab al final del Ciclo 6.
    E.5.1.1Timepoint(s) of evaluation of this end point
    1.Pharmacokinetic (PK) collection at designated timepoints in Cycle 1 (Up to approximately 3 weeks; cycle length = 3 weeks)
    2.PK collection at end of Cycle 6 (approximately at end of Week 18; cycle length = 3 weeks)
    1. Obtención de muestras de Farmacocinética (FC) en los momentos establecidos en el Ciclo 1 (hasta aproximadamente 3 semanas; duración del ciclo: 3 semanas).
    2. Obtención de muestras de FC al final del Ciclo 6 (aproximadamente al final de la Semana 18; duración del ciclo = 3 semanas
    E.5.2Secondary end point(s)
    1.Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR)
    2.Ctrough of Pembrolizumab at the End of Cycle 1
    3.Maximal concentration (Cmax) of Pembrolizumab for Cycle 1
    4.AUC0-3wks of Pembrolizumab for Cycle 6
    5.Cmax of Pembrolizumab for Cycle 6
    6.Number of Participants Who Experienced an Adverse Event (AE)
    7.Number of Participants Who Discontinued Study Treatment Due to an AE
    8.Progression-Free Survival (PFS) per RECIST 1.1 as Assessed by BICR
    9.Overall Survival (OS)
    10.Duration of Response (DOR) per RECIST 1.1 as Assessed by BICR
    11.Antidrug Antibodies (ADAs) Incidence After Administration of Pembrolizumab
    1. Tasa de respuestas objetivas (TRO) para Criterios de Evaluación de la respuesta en tumores sólidos versión 1.1 (RECIST 1.1) según evaluación Central Independiente y con enmascaramiento (ECIE)
    2. Cmín de Pembrolizumab al final del Ciclo 1.
    3. Concentración máxima (Cmax) de Pembrolizumab para Ciclo 1.
    4. AUC 0-3 semanas de Pembrolizumab para Ciclo 6.
    5. Cmax de Pembrolizumab para Ciclo 6.
    6. Número de participantes que han experimentado un Acontecimiento Adverso (AA)
    7. Número de participantes que han discontinuado el tratamiento del Estudio debido a un AA,
    8. Supervivencia sin progresión (SSP) por RECIST 1.1 según evaluación por ECIE.
    9. Supervivencia Global (SG)
    10. Duración de la Respuesta (DR) por RECIST 1.1 según evaluación por ECIE.
    11. Incidencia de Anticuerpos contra el fármaco (ACF) después de la administración de Pembrolizumab
    E.5.2.1Timepoint(s) of evaluation of this end point
    1.Up to approximately 5 years
    2.PK collection at end of Cycle 1 (approximately at end of Week 3; cycle length = 3 weeks)
    3.PK collection at designated timepoints in Cycle 1 (Up to approximately 3 weeks; cycle length = 3 weeks)
    4.PK collection at designated timepoints in Cycle 6 (Up to approximately 3 weeks; cycle length = 3 weeks)
    5.PK collection at designated timepoints in Cycle 6 (Up to approximately 3 weeks; cycle length = 3 weeks)
    6.Up to approximately 28 months
    7.Up to approximately 25 months
    8.Up to approximately 5 years
    9.Up to approximately 5 years
    10.Up to approximately 5 years
    11.Up to approximately 26 months
    1. hasta aproximadamente 5 años.
    2. Obtención de muestras de FC al final del Ciclo 1 (aproximadamente al final de la Semana 3; duración del ciclo = 3 semanas)
    3. Obtención de muestras de FC en el momento indicado en el Ciclo 1 (hasta aproximadamente 3 semanas; duración del ciclo = 3 semanas)
    4. Obtención de muestras de FC en el momento indicado en el Ciclo 6 (hasta aproximadamente 3 semanas; duración del ciclo = 3 semanas)
    5. Obtención de muestras de FC en el momento indicado en el Ciclo 1 (hasta aproximadamente 3 semanas; duración del ciclo = 3 semanas)
    6. hasta aproximadamente 28 meses
    7. hasta aproximadamente 25 meses
    8. hasta aproximadamente 5 años
    9. hasta aproximadamente 5 años
    10. hasta aproximadamente 5 años
    11. hasta aproximadamente 26 meses
    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 No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic Yes
    E.6.13Others No
    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) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA31
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Brazil
    Guatemala
    Japan
    Korea, Republic of
    Peru
    Russian Federation
    South Africa
    Taiwan
    Turkey
    Ukraine
    United States
    France
    Hungary
    Poland
    Romania
    Spain
    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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years5
    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: 236
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 214
    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 state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 146
    F.4.2.2In the whole clinical trial 450
    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 Decision2021-06-14
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-06-02
    P. End of Trial
    P.End of Trial StatusOngoing
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