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    Summary
    EudraCT Number:2020-003063-26
    Sponsor's Protocol Code Number:1634
    National Competent Authority:France - ANSM
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2023-01-27
    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 ConcernedFrance - ANSM
    A.2EudraCT number2020-003063-26
    A.3Full title of the trial
    PersoMed-I: Personalized Risk-Adapted Therapy in Post-Pubertal Patients with Newly Diagnosed Medulloblastoma
    PersoMed-I : Thérapie adaptée au risque personnalisée chez les patients post-pubertaires nouvellement diagnostiqués avec un médulloblastome
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Trial investigating a personalized treatment, based on age and tumor characteristics , of newly diagnosed medullablastoma in patients that are postpubertal and/or adult consisting of lowering RT,chemotherapy doses and adding an investigative drug.
    Essai portant sur un traitement personnalisé, basé sur l'âge et les caractéristiques de la tumeur, du médullablastome nouvellement diagnostiqué chez des patients post-pubertaires et/ou adultes, consistant à réduire les doses de RT et de chimiothérapie et à ajouter un médicament expérimental.
    A.3.2Name or abbreviated title of the trial where available
    PersoMed-I
    A.4.1Sponsor's protocol code number1634
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04402073
    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 SponsorEuropean Organisation for Research and Treatment of
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportEORTC-BTG
    B.4.2CountryBelgium
    B.4.1Name of organisation providing supportSunpharmaceuticals
    B.4.2CountryNetherlands
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationOrganisation for Research and Treatment of
    B.5.2Functional name of contact pointRegulatory Affairs Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenue E. Mounier 83/11
    B.5.3.2Town/ cityBrussels
    B.5.3.3Post code1200
    B.5.3.4CountryBelgium
    B.5.4Telephone number0032 2 7741597
    B.5.5Fax number00322 7727063
    B.5.6E-mailregulatory@eortc.org
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Odomzo
    D.2.1.1.2Name of the Marketing Authorisation holderSun Pharmaceutical Industries Europe 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.3.1Product nameSonidegib
    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 INNsonidegib
    D.3.9.1CAS number 956697-53-3
    D.3.9.3Other descriptive nameSONIDEGIB
    D.3.9.4EV Substance CodeSUB123432
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationFrance
    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 nameCisplatin
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPConcentrate for solution for infusion (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCisplatin
    D.3.9.1CAS number 15663-27-1
    D.3.9.2Current sponsor codeCispatin
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationFrance
    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 nameLomustine
    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 INNLOMUSTINE
    D.3.9.2Current sponsor codeLomustine
    D.3.9.4EV Substance CodeSUB08567MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 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.2.1.2Country which granted the Marketing AuthorisationFrance
    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 nameVincristine
    D.3.4Pharmaceutical form
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSolution for injection (Noncurrent)
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVINCRISTINE
    D.3.9.1CAS number 57-22-7
    D.3.9.2Current sponsor codeVincristine
    D.3.9.4EV Substance CodeSUB00059MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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
    Newly Diagnosed Medulloblastoma
    Médulloblastome nouvellement diagnostiqué
    E.1.1.1Medical condition in easily understood language
    A malignant tumor originating from brain cells during embryo phase of life and grows in the area of brain stem.
    Tumeur maligne provenant des cellules du cerveau pendant la phase embryonnaire de la vie et se développant dans la zone du tronc cérébral.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10027107
    E.1.2Term Medulloblastoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare progression-free survival (PFS) by central review of a personalized intensity-modulated therapy (experimental arm; sonidegib) vs. standard therapy in the SHH-activated subgroup in post-pubertal patients with newly diagnosed standard risk medulloblastoma.
    • Comparer la survie sans progression (PFS) évaluée en relecture centralisée, d’une thérapie personnalisée (bras expérimental ; sonidégib) versus une thérapie standard (NOA-07 modifié) dans le sous-groupe de patients post-pubères porteurs d’un médulloblastome avec activation de SHH, à risque standard nouvellement diagnostiqué.
    E.2.2Secondary objectives of the trial
    In experimental versus standard arm and in the 3 molecular subgroups separately (except otherwise stated):
    • To compare PFS by central reviewer in WNT & Group 4 subgroups
    • To compare PFS by local investigator in 3 molecular subgroups
    • To compare overall survival (OS) in 3 molecular subgroups
    • To evaluate safety and tolerability profile
    o To evaluate short- and long-term health-related quality of life (HRQoL) with a particular emphasis on the social functioning scale
    • To evaluate issues linked to survivorship (fear of recurrence, having problems with insurance/mortgage, work opportunities, life plans/goals and relationships with family or friends)
    • To evaluate short- and long-term neurocognitive function (NCF)
    • To evaluate short- and long-term endocrine function
    ... See the protocol
    Dans le bras expérimental versus le bras standard et dans 3 sous-groupes moléculaires séparément (sauf indication contraire) :
    • Comparer la PFS selon la relecture centralisée dans le sous-groupe WNT et le Groupe 4 ;
    • Comparer la PFS selon la relecture locale par l’investigateur dans chacun des 3 sous-groupes moléculaires ;
    • Comparer la survie globale (OS) entre 3 sous-groupes moléculaires ;
    • Évaluer le profil d’innocuité et de tolérance
    o Évaluer la qualité de vie liée à la santé (HRQoL) avec une insistance particulière sur l’échelle du fonctionnement social à court et à long terme
    • Évaluer les problèmes liés à la survie (crainte d’une récidive, avoir des problèmes avec l’assurance/prêt hypothécaire, opportunités professionnelles, plans/objectifs de la vie et relations avec la famille ou les amis)
    • Évaluer la fonction neurocognitive (NCF) à court et à long terme
    • Évaluer la fonction endocrine à court et à long terme
    ... Voir le protocole
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Fertility sub-study
    Sous-étude sur la fertilité
    E.3Principal inclusion criteria
    Step 1: Registration
    • Before patient registration/randomization/enrollment, written informed consent must be given according to ICH/GCP, and national/local regulations. For patients under age of legal consent, consent has to be obtained from the parent(s) or legal representative according to ICH/GCP, and national/local regulations.
    • FFPE tumor tissue from surgical resection and whole blood for central pathology review

    Step 2: Enrollment/randomization
    • Newly diagnosed, histologically proven, genetically classified, centrally confirmed medulloblastoma (WNT M0-1, SHH (p53wt) M0-1, Group 4 M0-1)
    • Molecular subtype: medulloblastoma, SHH-activated and TP53-wildtype, M0-1; medulloblastoma, WNT-activated, M0-1; medulloblastoma, Group 4, M0-1
    • Histologic subtype: medulloblastoma, classic (CMB); medulloblastoma, desmoplastic/nodular (DNMB); medulloblastoma, with extensive nodularity (MBEN); medulloblastoma, large cell/anaplastic (LCA)
    • Adults (≥ 18 years) in WNT-activated and Group 4 medulloblastoma
    • Post-pubertal patients (<18y of age), or adults (18 y of age and above) in SHH-activated and TP53-wildtype medulloblastoma
    • Patients (<18 years) must have completed puberty
    • Patients (<18 years) must have a radiologically confirmed bone age of minimum 15 years for females and 17 years for males

    Non-SHH dependent patients under age 18 should be transferred to a paediatric site for inclusion in the PNET5 trial in countries where PNET5 is open. SHH-activated patients under age 18 with M1 disease or above should be transferred to a paediatric site for inclusion in the HRMB trial in countries where HRMB is open.

    • Clinical status within 2 weeks of randomization/enrollment: Karnofsky 50-100. NANO-score 0 to 9 (allowing full-blown cerebellar symptoms)
    • Clinically standard-risk (centrally assessed MRI review) defined as: total or near total surgical resection with less than or equal to 1.5 cm2 (measured in axial plane) of residual tumour on early post-operative MRI, without and with contrast; no CNS metastasis on MRI (cranial and spinal); Chang stage M0-1 with no clinical evidence of extra-CNS metastasis
    • Full recovery from surgery or any post-surgical complication (e.g. bleeding, infections etc.)
    • Post-surgery (within 72h) MRI available (pre-surgery MRI upload is encouraged if available)
    • Baseline brain MRI and spinal MRI for uploading available within 2 weeks of randomization/enrollment
    • Normal liver, renal and haematological function within 2 weeks of randomization/enrollment.
    • WBC ≥ 3×10^9/L
    • ANC ≥ 1.5×10^9/L
    • Platelet count of ≥ 100×10^9/L independent of transfusion
    • Hemoglobin ≥ 10 g/dl
    • Total Bilirubin ≤ 1.5 × ULN
    • ALT (SGPT), AST (SGOT), alkaline phosphatase (ALP) ≤ 2.5 × ULN
    • Serum creatinine < 1.5 × ULN or creatinine clearance (CrCl) >60 ml/min (using the MDRD formula)
    • According to CTFG recommendations related to contraception and pregnancy testing during clinical trials, a negative serum or urine pregnancy test within 7 days before randomization/enrollment for WOCBP
    • Patients of childbearing / reproductive potential (WOCBP) must use two methods of adequate birth control, including a highly effective method and a barrier method during the study treatment period and for at least 20 months after the last study treatment is mandatory for the patients that received sonidegib, for all other patients this period is at least 12 months after the last study treatment. A highly effective method of birth control is defined as those which result in low failure rate (i.e. less than 1% per year) when used consistently and correctly. Male patients even those who have had a vasectomy must always use a condom during treatment and for 12 months after last treatment. Men should not donate semen during treatment and for at least 12 months after ending treatment (donation of semen for the semen analyses in the 1 b fertility project is allowed).
    • Female subjects who are breast feeding must discontinue nursing prior to the first dose of study treatment and until 20 months after the last study treatment
    Étape 1 : Enregistrement
    • Avant l’enregistrement du patient, une notice d’information et un consentement éclairé de participation doivent lui être remis conformément aux bonnes pratiques cliniques (BPC), aux (recommandations ICH) et réglementations nationales. Pour les patients n’ayant pas encore l’âge légal pour consentir, le consentement doit être obtenu auprès des parents ou du représentant légal conformément aux ICH/BPC et aux réglementations nationales.
    • Relecture centralisée du tissu tumoral FFPE issu de la résection chirurgicale + sang total

    Étape 2 : Inclusion/randomisation
    • Médulloblastome nouvellement diagnostiqué (confirmation histologique et génétique centralisée) :
    • Médulloblastome appartenant à l’un des sous-groupes moléculaires suivants :
    o SHH-activé et TP53-type sauvage, M0-1
    o WNT-activé, M0-1
    o Groupe 4, M0-1
    • Sous-type histologique :
    o médulloblastome classique (CMB) ;
    o médulloblastome desmoplastique/nodulaire (DNMB)
    o médulloblastome avec nodularité extensive (MBEN)
    o médulloblastome à grandes cellules/anaplasique (LCA)
    • Médulloblastome WNT-activé et de Groupe 4 chez l’adulte (≥ 18 ans)
    • Médulloblastome SHH-activé et TP53-type sauvage chez les patients post-pubères (< 18 ans) ou adultes (18 ans et plus)
    • Les patients (<18 ans) doivent avoir terminé leur puberté
    • Les patients (<18 ans) doivent avoir un âge osseux radiologiquement confirmé d'au moins 15 ans pour les femmes et 17 ans pour les hommes

    Les patients non SHH-dépendants de moins de 18 ans doivent être transférés à un centre pédiatrique pour être inclus dans l’essai PNET5 dans les pays où il est ouvert. Les patients à médulloblastome SHH-activé de moins de 18 ans avec maladie M1 ou plus doivent être transférés à un centre pédiatrique pour être inclus dans l’essai HRMB dans les pays où il est ouvert.

    • Statut clinique dans les 2 semaines précédant l’inclusion/ randomisation : Karnofsky 50-100. Score NANO- de 0 à 9 (autorisant tous les symptômes cérébelleux)
    • Risque clinique standard (IRM revue en relecture centralisée) défini comme : une résection chirurgicale totale ou quasi totale avec un résidu tumoral inférieur ou égal à 1,5 cm2 (mesuré en coupe axiale) sur l’IRM post-opératoire précoce, avec et sans produit de contraste ; absence de métastases du SNC à l’IRM (crâniennes et rachidiennes) ; stade de Chang M0-1, absence de signes cliniques évocateurs de métastases extra-cérébrales
    • Rétablissement complet après une intervention chirurgicale et toute complication post-opératoire (p. ex. saignement, infections, etc.)
    • IRM post-opératoire (dans les 72 h) (le transfert de l’IRM pré-opératoire est encouragé, si disponible)
    • IRM cérébrale et médullaire de référence dans les 2 semaines précédant l’inclusion/ la randomisation
    • Fonctions hépatique, rénale et hématologique normales dans les 2 semaines précédant l’inclusion /randomisation.
    • GB ≥ 3 × 10^9/l
    • NAN ≥ 1,5 × 10^9/l
    • Numération plaquettaire ≥ 100 x 10^9/l indépendamment de toute transfusion
    • Hémoglobine ≥ 10 g/dl
    • Bilirubine totale ≤ 1,5 x LSN
    • Taux de SGOT (ASAT), de SGPT (ALAT) et de phosphatases alcalines ≤ 2,5 × LSN.
    • Créatinine sérique < 1,5 x LSN ou clairance de la créatinine (ClCr) > 60 ml/min (à l’aide de la formule MDRD)
    • Pour les femmes en âge de procréer : un test de grossesse sérique ou urinaire négatif dans les 7 jours précédant l’inclusion /randomisation), selon les recommandations du CTFG relatives à la contraception et aux tests de grossesse pendant les essais cliniques.
    • Les patientes en âge de procréer doivent obligatoirement utiliser deux méthodes de contraception adéquates, y compris une méthode très efficace*, et une méthode barrière pendant la période de traitement et ce jusqu’ au moins 20 mois après la dernière administration du sonidégib. Pour toutes les autres patientes, cette période est au moins 12 mois après la dernière administration du traitement.
    *Une méthode contraceptive hautement efficace est définie comme une méthode associée à un faible taux d’échec (c’est-à-dire moins de 1 % par an) lorsqu’elle est utilisée de manière régulière et correcte. Les hommes, même ceux ayant subi une vasectomie, doivent toujours utiliser un préservatif pendant le traitement et jusque 12 mois après la dernière administration du traitement. Les hommes ne doivent faire de don de sperme pendant le traitement et jusqu’ au moins 12 mois après la fin du traitement (le recueil de sperme requis pour les analyses
    dans le cadre du projet de fertilité 1 b est autorisé).
    • Pour les patientes allaitantes : interruption de l’allaitement avant la première dose du traitement et pendant 20 mois après la dernière administration du traitement.
    E.4Principal exclusion criteria
    Step 2: Enrollment/randomization
    • Prior treatment for medulloblastoma
    • Unavailability of central review pathology results
    • Known prognostic markers (MYC/MYCN amplification, MYC/MYCN mutation)
    •Exclusion of germline alterations prognostically linked to medulloblastoma (e.g., TP53, PTCH, SUFU, BRCA2, PALB2), if known before randomization
    • Inability to start radiotherapy within 43 days after surgery
    • Significant sensorineural hearing deficit as defined by pure tone audiometry with bone conduction or air conduction and normal tympanogram showing impairment ≥ 20 dB at 1-3 kHz
    • Any medical contraindication to radiotherapy or chemotherapy
    • Hypersensitivity to contrast medium for MRI
    • Hypersensitivity towards the active substance of any of study drugs or their excipients
    • Prior or current use of mitoxantrone, methotrexate, topotecan, imatinib, irinotecan or statins
    • Concurrent severe or uncontrolled medical disease (e.g., active systemic infection, diabetes, psychiatric disorder) that, in the opinion of the investigator, would compromise the safety of the patient or compromise the ability of the patient to complete the study
    • Prior or second invasive malignancy, except non-melanoma skin cancer, completely resected cervical carcinoma in situ, low risk prostate cancer (cT1-2a N0 and Gleason score ≤ 6 and PSA < 10 ng/mL), either totally resected or irradiated with curative intent (with PSA of less than or equal to 0.1 ng/mL) or under active surveillance as per ESMO guidelines. Other cancers for which the subject has completed potentially curative treatment more than 5 years prior to diagnosis of medulloblastoma study entry are allowed
    • Known history or current evidence of active Hepatitis B (e.g., positive HBV surface antigen) or C (e.g., HCV RNA [qualitative] is detected)
    • Known or current evidence of Human Immunodeficiency Virus (HIV) infection (positive HIV-1/2 antibodies)
    • Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial.
    All eligibility criteria must be adhered to. A deviation of 5% for hematological and 10% for biochemistry values will be acceptable.
    The randomization/enrollment process can start after central pathology results are available.
    Treatment must start within 14 days of randomization/enrollment BUT the latest on day 43 after surgery.
    • Traitement antérieur du médulloblastome
    • Non-disponibilité des résultats de l’analyse centralisée anatomo-pathologique
    • Marqueurs pronostiques connus (amplification MYC/MYCN, mutation MYC/MYCN)
    • Altérations germinales liées au pronostic du médulloblastome (par exemple, TP53, PTCH, SUFU, BRCA2, PALB2), si elles sont connues avant la randomisation
    • Impossibilité de débuter une radiothérapie dans les 43 jours suivant l’intervention chirurgicale
    • Déficience auditive neurosensorielle significative telle que définie par l’audiométrie à sons purs avec conduction osseuse ou aérienne et un tympanogramme normal montrant une déficience ≥ 20 dB à 1-3 kHz
    • Toute contre-indication médicale à la radiothérapie ou la chimiothérapie
    • Hypersensibilité au produit de contraste utilisé pour l’IRM
    • Hypersensibilité à la substance active de l’un des médicaments à l’étude ou à leurs excipients
    • Traitement antérieur ou en cours par mitoxantrone, méthotrexate, topotécan, imatinib, irinotécan ou statines
    • Affection médicale sévère ou non contrôlée concomitante (p. ex. infection systémique active, diabète, affection psychiatrique) qui, selon l’investigateur, compromettrait la sécurité du patient ou le bon deroulement de l’étude
    • Antécédent de tumeur maligne invasive ou secondaire, à l’exception :
    o d’un cancer de la peau non mélanomateux, d’un carcinome in situ du col de l’utérus totalement réséqué,
    o d’un cancer de la prostate à faible risque (cT1-2a N0 et score de Gleason ≤ 6 et PSA < 10 ng/ml), totalement
    réséqué ou irradié à visée curative (avec PSA inférieur ou égal à 0,1 ng/ml) ou sous surveillance active conformément aux recommandations de l’ESMO.
    o Tout autre cancer traité de manière curative depuis au
    moins 5 ans, avant le diagnostic du médulloblastome et
    l’inclusion.
    • Antécédents connus ou hépatite B active (p. ex. test positif pour l’antigène de surface du VHB) ou C (p. ex. détection d’ARN du VHC [qualitatif])
    • Antécédents connus ou infection par le virus de l’immunodéficience humaine (VIH) (test positifs pour les anticorps VIH-1/2)
    • Situation psychologique, familiale, sociologique ou géographique pouvant entraver l’observance au protocole de l’étude et au calendrier de suivi. Ces situations doivent faire l’objet d’une discussion avec le patient avant son inclusion
    dans l’essai.
    Tous les critères d’éligibilité doivent être satisfaits. Un écart de 5 % pour les valeurs hématologiques et de 10 % pour les valeurs biochimiques seront acceptables.

    Le processus d’inclusion /randomisation peut commencer dès que les résultats de la relecture histologique centralisée sont disponibles.

    Le traitement doit commencer dans les 14 jours suivant la randomisation MAIS pas plus tard que dans les 43 jours post-chirurgie.
    E.5 End points
    E.5.1Primary end point(s)
    Progression-Free Survival (PFS) according to RAPNO assessed by central reviewer of a personalized intensity-modulated therapy (experimental arm; sonidegib) in SHH-activated patients.
    Survie sans progression (PFS) (critères RAPNO selon relecture centralisée d’imagerie) chez les patients porteurs d’un médulloblastome SHH-activé.
    E.5.1.1Timepoint(s) of evaluation of this end point
    [ Time Frame: 91 months after the date of recruitment of the first patient ]
    Compare progression-free survival (PFS) by central review of a personalized intensity-modulated therapy (experimental arm; sonidegib) vs. standard therapy in the SHH-activated subgroup in post-pubertal patients with newly diagnosed standard risk medulloblastoma

    [Période de temps : 91 mois après la date de recrutement du premier patient ].
    Comparer la survie sans progression (PSF) par examen central d'un traitement personnalisé à intensité modulée (bras expérimental ; sonidegib) par rapport à un traitement standard dans le sous-groupe activé par SHH chez des patients post-pubères présentant un médulloblastome à risque standard nouvellement diagnostiqué.
    E.5.2Secondary end point(s)
    • PFS by central reviewer in WNT and Group 4 patients.
    • PFS by local investigator in the 3 molecular subgroups
    • OS
    • Frequencies and percentages of worst adverse events (AEs) or laboratory event; grades according to CTCAE v.5 (with neurological, kidney, auditory, endocrine and radiotherapy associated as AE of special interest)
    • Patient reported outcomes:
    • Health-related Quality of life (HRQol): EORTC QLQ-C30 + BN20, social functioning as scale of special interest
    • Survivorship outcomes (five items from EORTC QLQ-SURV111)
    • Neurocognitive function (NCF): Hopkins Verbal Learning Test, Controlled Oral Word Association Trail Making Test Part A, Trail Making Test Part B, cerebellar cognitive affective/Schmahmann syndrome scale
    • Clinical endocrine function parameters: adynamia, tiredness, reduced concentration, depression, intolerance against cold, muscle weakness, obesity, oligomenorrhea, intermenstrual bleeding, sexual dysfunction, decline in libido, pain during intercourse, infertility, constipation, polydipsia, polyuria, hair loss, dry skin, osteoporosis, skin edema, decreased weight, and thyroid function parameters: TSH, if abnormal FT3 and FT4
    • Frequencies and percentages of second malignancies
    • PFS (selon relecture centralisée d’imagerie) chez les patients du groupe WNT et du Groupe 4
    • PFS (selon relecture locale) dans les 3 sous-groupes moléculaires
    • OS
    • Fréquences des événements indésirables (EI) sévères ou toxicités biologiques selon la classification NCI-CTCAE v.5 (les EI neurologiques, rénaux, auditifs, endocrines associés à radiothérapie sont considérés comme des EI d’intérêt)
    • Résultats rapportés par le patient
    • Qualité de vie liée à la santé (HRQoL) EORTC QLQ-C30 + BN20, l’échelle de fonctionnement social
    • Résultats de survie (cinq items de l’EORTC QLQ-SURV111)
    • Fonction neurocognitive (NCF) : Test d’apprentissage verbal de Hopkins, Test de création de chaînes d’association de mots oraux contrôlé Partie A, Test de création de chaînes Partie B, échelle du syndrome cérébelleux cognitivo-affectif/de Schmahmann
    • Paramètres cliniques de la fonction endocrinienne :extrême faiblesse musculaire, fatigue, baisse de la concentration, dépression, intolérance du froid, faiblesse musculaire, obésité, oligoménorrhée, saignements intermenstruels, dysfonctionnement sexuel, baisse de la libido, douleur
    pendant les rapports sexuels, infertilité, constipation, polydipsie, polyurie, alopécie, sécheresse de la peau, ostéoporose, œdème cutané, perte de poids, et paramètres de la fonction thyroïdienne : TSH, si FT3 et FT4 anormales
    • Fréquences des tumeurs malignes secondaires
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. (PFS) [ when 43 PFS events are observed estimated to occur 91 months after the date of recruitment of 1st patient]
    2. (OS) [ when 43 PFS events are observed estimated to occur 91 m after the date of recruitment of 1st patient]
    3. Safety and tolerability profile: CTCAE v5 [ when 43 PFS events are observed estimated to occur 91 months after the date of recruitment of 1st patient]
    4. (HRQoL) [ when 43 PFS events are observed estimated to occur 91 m after the date of recruitment of 1st patient]

    1. (PSF) [lorsque 43 événements de PSF sont observés et estimés se produire 91 mois après la date de recrutement du 1er patient].
    2. (OS) [lorsque 43 événements PFS sont observés, estimés à 91 mois après la date de recrutement du 1er patient].
    3. Profil de sécurité et de tolérance: CTCAE v5 [lorsque 43 événements de PFS sont observés, estimés se produire 91 mois après la date de recrutement du 1er patient] 4.
    4. Qualité de vie (HRQoL) [lorsque 43 événements de PFS sont observés et qu'ils devraient se produire 91 mois après la date de recrutement du 1er patient].
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Radiotherapy, QOL, radiogenomics, neurocognitive function, long term effects, impact on fertility, biobanking
    Radiothérapie, qualité de vie, radiogénomique, fonction neurocognitive, effets à long terme, impact sur la fertilité, biobanques.
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled 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 concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA36
    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
    Australia
    Austria
    France
    Netherlands
    Spain
    Switzerland
    Germany
    Italy
    Denmark
    United Kingdom
    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
    End of study occurs when all of the following criteria have been satisfied:
    • 5 months after all patients have stopped protocol treatment.
    • The trial is mature for the analysis of the primary endpoint as defined in the protocol.
    • The database has been fully cleaned and frozen for this analysis.
    L'étude se termine lorsque tous les critères suivants ont été atteints :
    - 5 mois après que tous les patients aient arrêté le traitement du protocole.
    - L'essai est bien avancé pour l'analyse du critère d'évaluation primaire tel que défini dans le protocole.
    - La base de données est entièrement propre et gelée pour cette analyse.
    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 months7
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years7
    E.8.9.2In all countries concerned by the trial months5
    E.8.9.2In all countries concerned by the trial days83
    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: 37
    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) Yes
    F.1.1.6.1Number of subjects for this age range: 37
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 164
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 4
    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 state30
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 163
    F.4.2.2In the whole clinical trial 205
    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)
    According to the discretion of the treating physician
    Selon l'appréciation du médecin traitant
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation University of Munich
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2023-04-07
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-04-03
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2024-03-14
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