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    Summary
    EudraCT Number:2020-003742-36
    Sponsor's Protocol Code Number:MK-3475-02D
    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:2022-03-08
    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 number2020-003742-36
    A.3Full title of the trial
    A Phase 1/2 Open-Label Rolling-Arm Umbrella Platform Design of Investigational Agents With or Without Pembrolizumab or Pembrolizumab Alone in Participants With Melanoma (KEYMAKER-U02): Substudy 02D
    Diseño adaptativo de ramas tipo paraguas, fase 1/2 y abierto, con fármacos en investigación con o sin pembrolizumab o de pembrolizumab en monoterapia en participantes con melanoma (KEYMAKER-U02): Subestudio 02D.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Ph 1/2 Substudy of Oncological Treatment(s) in PD-1 naïve or PD-1 exposed participants with MBM
    Subestudio de fase 1/2 de tratamientos oncológicos en participantes con MMC con o sin tratamiento previo con anti-PD-1
    A.3.2Name or abbreviated title of the trial where available
    Ph 1/2 Substudy of Oncological Treatment(s) in PD-1 naïve or PD-1 exposed participants with MBM
    Subestudio fase 1/2 de ttos. oncológicos participantes con MMC con o sin tto. previo con anti-PD-1
    A.4.1Sponsor's protocol code numberMK-3475-02D
    A.5.4Other Identifiers
    Name:INDNumber:144546
    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 S.A.
    B.5.2Functional name of contact pointInvestigación Clínica
    B.5.3 Address:
    B.5.3.1Street AddressC/ Josefa Valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+34913210600
    B.5.5Fax number+34913210590
    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 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.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib
    D.3.2Product code E7080
    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 INNLENVATINIB MESILATE
    D.3.9.1CAS number 857890-39-2
    D.3.9.2Current sponsor codeMK-7902
    D.3.9.3Other descriptive nameLENVATINIB MESILATE
    D.3.9.4EV Substance CodeSUB72971
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib
    D.3.2Product code E7080
    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 INNLENVATINIB MESILATE
    D.3.9.1CAS number 857890-39-2
    D.3.9.2Current sponsor codeMK-7902
    D.3.9.3Other descriptive nameLENVATINIB MESILATE
    D.3.9.4EV Substance CodeSUB72971
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    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 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 nameMK-1308/Pembrolizumab
    D.3.2Product code MK-1308A
    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 INNN/A
    D.3.9.2Current sponsor codeMK-1308
    D.3.9.3Other descriptive nameMK-1308
    D.3.9.4EV Substance CodeSUB191936
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1.43
    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 number22.86
    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
    Melanoma
    Melanoma
    E.1.1.1Medical condition in easily understood language
    Melanoma
    Melanoma
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10053571
    E.1.2Term Melanoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To assess the safety and tolerability of investigational treatment combinations based on the proportion of participants with adverse events (AEs)
    2. To evaluate the objective response rate (ORR) as assessed by blinded independent central review (BICR) per Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1)
    1. Evaluar la seguridad y la tolerabilidad de combinaciones de tratamientos en investigación en función de la proporción de participantes con acontecimientos adversos (AA).
    2. Determinar la tasa de respuestas objetivas (TRO), evaluada mediante una revisión central independiente y enmascarada (RCIE) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1).
    E.2.2Secondary objectives of the trial
    1. To evaluate the duration of response (DOR) as assessed by BICR per RECIST 1.1
    2. To evaluate brain metastasis response rate (BMRR) as assessed by BICR per Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM)
    3. To evaluate the brain metastasis duration of response (BM-DOR) as assessed by BICR per RANO-BM
    4. To evaluate progression-free survival (PFS) as assessed by BICR per RECIST 1.1
    1. Determinar la duración de la respuesta (DR) evaluada conforme a los criterios RECIST 1.1 según una RCIE.
    2. Evaluar la tasa de respuesta de las metástasis cerebrales (TRMC) mediante una RCIE conforme a los criterios de evaluación de la respuesta en neurooncología-metástasis cerebrales (RANO-BM).
    3. Evaluar la duración de la respuesta de las metástasis cerebrales (DR-MC) mediante una RCIE según los criterios RANO-BM.
    4. Determinar la supervivencia sin progresión (SSP) evaluada conforme a los criterios RECIST 1.1 según una RCIE.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. AJCC Stage IV (any T, any N, M1D) melanoma
    2. Has at least 1 and no more than 5 measurable brain metastasis disease lesions as defined by RECIST 1.1, confirmed by BICR:
    -The measurable lesion(s) must be ≥10 mm and ≤30 mm in greatest diameter
    - Prior SRT in ≤3 MBM, if there has been complete recovery and there are no neurologic sequelae. Growth or change in any lesion previously irradiated will not be considered measurable for study eligibility but is allowable
    - History of excision of ≤2 melanoma brain metastases if there has been complete recovery and there are no neurologic sequelae. Regrowth in cavity of any previously excised lesion will not be considered measurable for study eligibility but is allowable
    - The CIV will confirm this eligibility criterion prior to treatment randomization/allocation
    3. Has provided a tumor biopsy of an extracranial and/or intracranial lesion to confirm histologic or cytologic diagnosis and for biomarker analysis
    a) It is strongly preferred that if extracranial disease is present, a tumor sample should be freshly obtained. In cases where newly obtained tissue is not possible to provide or if only intracranial disease is present; an archival sample may be acceptable after discussion with the Sponsor. For participants who have been treated with PD-1/L1 therapy, archival samples that have been obtained after treatment on a PD-1/L1 agent are preferred but not required
    b) If a fresh tissue sample is submitted, it is preferred that the tumor biopsy is not obtained from a lone extracranial or intracranial target lesion. If the biopsy specimen was obtained from a lone target lesion, a repeat screening MRI (intracranial lesion) or CT (extracranial lesion) must be obtained postbiopsy and measurable disease confirmed by BICR
    4. Neurologically asymptomatic from brain metastases and must not have required or received systemic corticosteroid therapy in the 10 days prior to beginning study intervention
    5. Able to undergo MRI with Gadolinium contrast agent
    6. Has not received more than 3 lines of therapy for their metastatic melanoma, inclusive of an adjuvant therapy regimen
    7. Allowable prior systemic therapy: Previous treatment for unresectable or metastatic disease may include approved adjuvant regimens, IFN-α, anti-PD-1/PD-L1, anti- CTLA-4, and approved molecularly targeted agents. Steroids for physiological replacement are allowed
    - Participants who have received anti-PD-1/PD-L1 therapy must have received at least 2 prior doses of an anti-PD-1/L1 mAb
    8. Is male or female, from 18 to 120 years of age inclusive, at the time of providing documented informed consent
    9. Has an ECOG performance status 0 to 1
    10. Contraceptive use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
    Male participants are eligible to participate if they agree to the following during treatment with the investigational agents
    - 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)
    11. Contraceptive use by women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
    -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
    * A WOCBP must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 24 hours before the first dose of study intervention
    * If a urine test cannot be confirmed as negative, a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive
    - 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
    12. The participant (or legally acceptable representative if applicable) has provided documented informed consent/assent for the study
    13. Has adequate organ function. Specimens must be collected within 7 days prior to the first dose of study intervention. Laboratory samples collected within 3 days prior to the first dose of study intervention need not be repeated on C1D1; results must be known and acceptable prior to dosing
    1.Melanoma en estadio IV (cualquier T,N,M1D) del AJCC
    2.Presencia de al menos una y no más de 5 metástasis cerebrales mensurables según los criterios RECIST 1.1,confirmadas mediante RCIE:
    -Las lesiones mensurables deben tener un diámetro ≥10 y ≤30mm
    -Radioterapia estereotáctica previa en ≤3 MMC si se ha producido una recuperación completa y no hay secuelas neurológicas.El crecimiento o la variación de cualquier lesión irradiada previamente no se considerarán mensurables a efectos de elegibilidad,pero son admisibles
    -Antecedentes de extirpación de ≤2 MMC si se ha producido una recuperación completa y no hay secuelas neurológicas.La regeneración en la cavidad de cualquier lesión extirpada previamente no se considerará mensurable a efectos de elegibilidad,pero es admisible
    -El laboratorio central de imagen confirmará este criterio de elegibilidad antes de la aleatorización/asignación del tto.
    3.Ha proporcionado una biopsia tumoral de una lesión extracraneal y/o intracraneal para confirmar el diagnóstico histológico o citológico y para análisis de biomarcadores
    a)Es muy recomendable que,si hay enfermedad extracraneal,se obtenga una muestra tumoral reciente. En caso de que no sea posible proporcionar tejido de obtención reciente o de que solo exista enfermedad intracraneal,podrá aceptarse una muestra de archivo previa consulta con el promotor. En el caso de los participantes que hayan recibido tto. con anti-PD-1/L1 se prefieren,pero no son obligatorias,las muestras de archivo que se hayan obtenido después del tto. anti-PD-1/L1
    b)Si se envía una muestra de tejido reciente,es preferible que la biopsia tumoral no se obtenga de una lesión diana extracraneal/intracraneal aislada. Si la muestra de biopsia se obtuvo de una lesión diana aislada, deberá repetirse la RM (lesión intracraneal) o la TC (lesión extracraneal) de selección después de la biopsia y confirmarse la presencia de enfermedad mensurable mediante una RCIE
    4.Ausencia de síntomas neurológicos por metástasis cerebrales y no haber necesitado ni recibido tto. con corticosteroides sistémicos en los 10d previos al comienzo de la intervención del estudio
    5.Capacidad de someterse a una RM con un medio de contraste de gadolinio
    6.No ha recibido más de 3 líneas de tto. para el melanoma metastásico,incluida una pauta de tto. adyuvante
    7.Tto. sistémico previo permitido: El tto. previo de la enfermedad irresecable o metastásica puede consistir en pautas adyuvantes aprobadas,IFN-α,anti-PD-1/PD-L1,anti-CTLA-4 y fármacos dirigidos contra dianas moleculares aprobados. Se permite el uso de corticoides para reposición fisiológica
    -Los participantes que hayan recibido tto. anti-PD-1/PD-L1 deberán haber recibido al menos 2 dosis previas de un AcM anti-PD-1/L1
    8.Varón/mujer de entre 18 y 120 años,ambos inclusive,en el momento de otorgar el consentimiento informado documentado
    9.Estado funcional del ECOG de 0 o 1
    10.El uso de anticonceptivos por los varones deberá cumplir la normativa local sobre métodos anticonceptivos para participantes en estudios clínicos.
    Podrán participar varones que se comprometan a todo lo siguiente durante el tto. con los fármacos en investigación.
    -Abstenerse de mantener relaciones heterosexuales (abstinencia a largo plazo y persistente), y compromiso de mantener dicha abstinencia; O
    -Utilizar métodos anticonceptivos a menos que se confirme presencia de azoospermia (por vasectomía/secundaria a causa médica)
    11.El uso de anticonceptivos por las mujeres deberá cumplir la normativa local sobre métodos anticonceptivos para participantes en estudios clínicos.
    -Podrán participar mujeres que no estén embarazadas, ni en período de lactancia y que cumplan al menos una de las condiciones siguientes:
    *No es MEF; O
    *Es MEF y utiliza un método anticonceptivo muy eficaz (índice fallos <1% anual),con escasa dependencia de la usuaria,o practica la abstinencia de relaciones heterosexuales
    *Las MEF deberán dar negativo en una prueba de embarazo de alta sensibilidad (orina o suero,según normativa local) realizada en las 24h previas a la 1a dosis de la intervención del estudio
    *Cuando no pueda confirmarse el resultado negativo de una prueba en orina será necesario hacer una prueba en suero. En tales casos,la posible participante será excluida si el resultado es positivo
    -El investigador es responsable de revisar los antecedentes médicos,menstruales y la actividad sexual reciente para reducir el riesgo de incluir a una mujer con un embarazo de poco tiempo no detectado
    12.El participante (o su representante legal) ha otorgado su consentimiento/asentimiento informado documentado para el estudio
    13.Función orgánica adecuada. Las muestras se obtendrán en los 7d previos a la 1a dosis de la intervención del estudio.No será necesario repetir el D1C1 en las pruebas analíticas obtenidas en los 3d anteriores a la 1a dosis de la intervención del estudio; los resultados deberán conocerse antes de la administración y ser aceptables.
    E.4Principal exclusion criteria
    1. 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 10 days before the first dose of study intervention (based upon 5 times the expected half-life of dexamethasone). Participants with asthma that require intermittent use of bronchodilators, inhaled steroids, or local steroid injections would not be excluded from the study
    2. Current or history of known leptomeningeal involvement. Participants with suspected LMD by clinical symptoms only (without imaging findings) should undergo CSF analysis to substantiate the diagnosis of LMD unless CSF analysis is contraindicated
    3. Previous stereotactic or highly conformal radiotherapy within 2 weeks before the start of dosing for this study
    4. Has clinically significant hemoptysis or tumor bleeding within 2 weeks prior to the first dose of study drug
    5. Untreated or unresolved intracranial hemorrhage from CNS metastasis of more than punctate size on MRI assessment obtained within 28 days prior to study enrollment
    6. Has any active infection requiring systemic therapy
    7. Has a known additional malignancy that is progressing or requires active treatment within the past 2 years. Exceptions to the secondary malignancy exclusion include basal cell carcinoma of the skin, squamous cell carcinoma of the skin, new nonulcerated primary melanoma <1 mm in depth with no nodal involvement, Grade 1 follicular lymphoma or carcinoma in situ (eg, breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy
    8. Has ocular melanoma
    9. Has known hypersensitivity to active substances or any of their excipients including previous clinically significant hypersensitivity reaction to treatment with another mAb
    10. Has an active autoimmune disease that has required systemic treatment in the 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
    11. Has known history of human immunodeficiency virus (HIV; HIV 1/2 antibodies). No testing of HIV is required unless mandated by local health authority
    12. Has known history of hepatitis B (defined as HBsAg reactive) or known hepatitis C virus (defined as HCV RNA [qualitative] is detected) infection
    13. Has a history of (noninfectious) pneumonitis that required steroids or current pneumonitis
    14. Has received prior systemic anticancer therapy including investigational agents within 4 weeks prior to randomization/allocation
    15. Has resolution of toxic effect(s) of the most recent prior therapy to Grade 1 or less (except alopecia). If the participant received major surgery or radiation therapy of >30 Gy, they must have recovered from the toxicity (resolved to ≤ Grade 1) and/or complications from the intervention prior to starting study intervention
    16. History of whole brain irradiation
    17. Prior treatment with anti-PD-L2, anti-CD137, any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways (except for study interventions noted in inclusion criteria)
    18. Has received prior radiotherapy within 2 weeks of first dose of study intervention. Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis
    19. Has had major surgery (<3 weeks prior to first dose of study intervention)
    20. Has received a live or live-attenuated vaccine within 30 days prior to the first dose of study intervention. Administration of killed vaccines are allowed
    21. 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
    22. Has a known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the study
    23. Has a history or has current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the substudy, interfere with the participation for the full duration of the substudy, or is not in the best interest of the participant to participate, in the opinion of the treating investigator
    24. Has had an allogeneic tissue/solid organ transplant
    1.Diagnóstico de inmunodeficiencia o está recibiendo tto. sistémico crónico con corticoides (en dosis superiores a 10mg diarios de equivalente de prednisona) o cualquier otra forma de tto. inmunodepresor en los 10d previos a la 1a dosis del estudio (basándose en un tiempo de 5 veces la semivida prevista de la dexametasona). No se excluirá del estudio a los participantes con asma que necesiten un uso intermitente de broncodilatadores,corticoides inhalados o inyecciones locales de corticoides
    2.Presencia actual/antecedentes de afectación leptomeníngea conocida.Los participantes con sospecha de enfermedad leptomeníngea (ELM) basada únicamente en síntomas clínicos (sin hallazgos de imagen) deberán someterse a un análisis de LCR para confirmar el diagnóstico de ELM a menos que el análisis de LCR esté contraindicado
    3.Radioterapia estereotáctica o altamente conformada previa,administrada en las 2sem anteriores al comienzo de la administración en este estudio
    4.Hemoptisis/hemorragia tumoral clínicamente significativa en las 2sem previas a la 1a dosis del fármaco del estudio
    5.Hemorragia intracraneal no tratada/no resuelta debida a las metástasis del SNC de tamaño superior al puntiforme en una RM obtenida en los 28d previos a la inclusión en el estudio
    6.Infección activa con necesidad de tto. sistémico
    7.Presencia de otra neoplasia maligna conocida que está en progresión o que ha precisado tto. activo en los 2 últimos años.Son excepciones a la exclusión por neoplasia maligna secundaria el carcinoma basocelular de piel, carcinoma espinocelular de piel,melanoma primario no ulcerado nuevo de <1mm de profundidad sin afectación ganglionar,linfoma folicular de grado 1 o el carcinoma in situ (ej.,carcinoma mama,cáncer cuello uterino in situ) que hayan recibido tto. potencialmente curativo
    8.Melanoma ocular
    9.Hipersensibilidad conocida a los principios activos o a cualquiera de sus excipientes,incluida una reacción previa de hipersensibilidad de importancia clínica al tto. con otro AcM
    10.Presencia de enfermedad autoinmunitaria activa que ha precisado tto. sistémico (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/hipofisaria) no se considera una forma de tto. sistémico y se permite su uso
    11.Antecedentes de infección por VIH (VIH;anticuerpos contra el VIH 1/2).No será necesario realizar pruebas de VIH a menos que lo exijan las autoridades sanitarias locales
    12.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 por el virus de la hepatitis C (detección de ARN del virus de la hepatitis C [VHC] [cualitativo])
    13.Antecedentes de neumonitis (no infecciosa) que haya precisado la administración de corticoides o presencia de una neumonitis activa
    14.Tto. antineoplásico sistémico previo,incluidos fármacos en investigación,en las 4sem. anteriores a la aleatorización/asignación
    15.Resolución de los efectos tóxicos del tto. previo más reciente hasta un grado 1 o inferior (excepto la alopecia). Cuando el participante se haya sometido a una intervención de cirugía mayor o haya recibido >30Gy de radioterapia,tendrá que haberse recuperado de la toxicidad (resolución a un grado≤1) y/o de las complicaciones de la operación antes de empezar con la intervención del estudio
    16.Antecedentes de irradiación cerebral total
    17.Tto. previo con anti-PD-L2,anti-CD137,cualquier otro anticuerpo o fármaco dirigido específicamente a la coestimulación de los linfocitos T o vías de puntos de control inmunológico (excepto intervenciones del estudio indicadas en los criterios de inclusión)
    18.Recepción de radioterapia en las 2sem. previas a 1a dosis del estudio.Los participantes deberán haberse recuperado de toda toxicidad relacionada con la radioterapia,no precisar corticoides y no haber sufrido neumonitis por radiación
    19.Antecedentes de intervención de cirugía mayor (<3sem. antes de la 1a dosis del estudio)
    20.Recepción de una vacuna de microorganismos vivos o vivos atenuados en los 30d previos a la 1a dosis del estudio.Se permite la administración de vacunas inactivadas.
    21.Está participando/ha participado en un estudio de un fármaco en investigación o ha usado un dispositivo en investigación en las 4sem. previas a la administración de la 1a dosis del estudio
    22.Trastorno psiquiátrico o por abuso de sustancias conocido que pueda dificultar el cumplimiento de los requisitos del estudio
    23.Antecedentes/datos actuales de cualquier proceso,tto. o anomalía analítica que,en opinión del investigador responsable del tto.,podría confundir los resultados del subestudio,dificultar la participación durante la totalidad del subestudio o hacer que la participación no sea lo más conveniente para el posible participante
    24.Recepción de alotrasplante de órgano sólido/tejidos.
    E.5 End points
    E.5.1Primary end point(s)
    1. Percentage of participants who experience an adverse event (AE)
    2. Percentage of participants who discontinue study treatment due to an AE
    3. Objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1)
    1. Porcentaje de participantes que experimentan un acontecimiento adverso (AA).
    1. Porcentaje de participantes que suspenden la intervención del estudio por AA.
    3. Tasa de respuestas objetivas (TRO) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1).
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to ~28 months
    2. Up to ~24 months
    3. Up to ~30 months
    1. Hasta ~28 meses
    2. Hasta ~24 meses
    3. Hasta ~30 meses
    E.5.2Secondary end point(s)
    1. Duration of response (DOR) per RECIST 1.1
    2. Brain metastasis response rate (BMRR) per Response Assessment in Neuro- Oncology Brain Metastases (RANO-BM)
    3. Brain metastasis duration of response (BM-DOR) per RANO-BM
    4. Progression-free survival (PFS) per RECIST 1.1
    1. Duración de la respuesta (DR) según los criterios RECIST 1.1
    2. Tasa de respuesta de las metástasis cerebrales (TRMC) según los criterios de evaluación de la respuesta en neurooncología-metástasis (RANO-BM)
    3. Duración de la respuesta de las metástasis cerebrales (DR-MC) según los criterios RANO-BM
    4. Supervivencia sin progresión (SSP) según los criterios RECIST 1.1
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to ~30 months
    2. Up to ~30 months
    3. Up to ~30 months
    4. Up to ~30 months
    1. Hasta ~30 meses
    2. Hasta ~30 meses
    3. Hasta ~30 meses
    4. Hasta ~30 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 Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    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
    first administration of the investigational agents COMBINATION in the specified melanoma population
    1ª administración combinación de fármacos en investigación en población de melanoma especificada
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised Yes
    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
    Diseño adaptativo de ramas
    Rolling arm, adaptive design
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the 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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA13
    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
    Israel
    Russian Federation
    South Africa
    United States
    France
    Italy
    Spain
    Switzerland
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years7
    E.8.9.1In the Member State concerned months10
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years10
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 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: 125
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 125
    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 state3
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 159
    F.4.2.2In the whole clinical trial 250
    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)
    At Investigator’s discretion
    A criterio del investigador
    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 Decision2022-04-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-04-08
    P. End of Trial
    P.End of Trial StatusOngoing
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