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    Summary
    EudraCT Number:2020-003973-23
    Sponsor's Protocol Code Number:213831
    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:2021-06-09
    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 number2020-003973-23
    A.3Full title of the trial
    A Randomized Phase 3 Double-Blinded Study Comparing the Efficacy and Safety of Niraparib to Placebo in Participants with Either HER2-Negative BRCA-Mutated or Triple-Negative Breast Cancer with Molecular Disease Based on Presence of Circulating Tumor DNA After Definitive Therapy (ZEST)
    Estudio de Fase 3, aleatorizado, doble ciego, para comparar la eficacia y seguridad de niraparib frente a placebo en participantes con cáncer de mama HER2 negativo con mutación en BRCA o cáncer de mama triple negativo, con enfermedad molecular basada en la presencia de ADN tumoral circulante después de una terapia definitiva (ZEST).
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    The Efficacy and Safety of Niraparib vs Placebo to Treat Breast Cancer in Participants Who Have Tumour DNA in Their Blood After Completing Treatment (ZEST)
    La eficacia y seguridad de niraparib frente a placebo para el tratamiento de participantes con cáncer de mama con enfermedad molecular basada en la presencia de ADN tumoral circulante después de una terapia definitiva (ZEST).
    A.3.2Name or abbreviated title of the trial where available
    Niraparib vs Placebo in Participants with HER2- BRCAmut breast cancer or TNBC with Detectable ctDNA
    A.4.1Sponsor's protocol code number213831
    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 SponsorGlaxoSmithKline, S.A.
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportGlaxoSmithKline Research & Development Ltd.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGlaxoSmithKline
    B.5.2Functional name of contact pointCentro de Información
    B.5.3 Address:
    B.5.3.1Street AddressC/Severo Ochoa, 2 (P.T.M.)
    B.5.3.2Town/ cityTres Cantos (Madrid)
    B.5.3.3Post code28760
    B.5.3.4CountrySpain
    B.5.4Telephone number+34902202700
    B.5.5Fax number+34918070479
    B.5.6E-mailes-ci@gsk.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameNiraparib
    D.3.2Product code GSK3985771
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNIRAPARIB
    D.3.9.1CAS number 1038915-60-4
    D.3.9.2Current sponsor codeGSK3985771
    D.3.9.3Other descriptive nameNiraparib tosylate monohydrate
    D.3.9.4EV Substance CodeSUB177208
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Breast Cancer
    cáncer de mama
    E.1.1.1Medical condition in easily understood language
    Breast cancer that is either triple negative or hormone-positive. Participants with hormone-positive disease must also have a BRCA mutation in the tumour.
    Cáncer de mama que puede ser tanto triple negativo como receptor hormonal positivo. Los pacientes con cáncer de mama receptor hormonal positivo deben tener mutación BRCA en tumor.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 23.0
    E.1.2Level PT
    E.1.2Classification code 10083232
    E.1.2Term HER2 negative breast cancer
    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
    Evaluation of the efficacy of niraparib relative to placebo as measured by disease-free survival (DFS)
    Evaluación de la eficacia de niraparib frente a placebo en la supervivencia libre de enfermedad (SLE)
    E.2.2Secondary objectives of the trial
    -Evaluation of overall survival (OS)
    -Evaluation of time to progression on next anticancer therapy
    -Evaluation of distant recurrence-free survival (DRFS)
    -Evaluation of the safety and tolerability of niraparib
    -Evaluation of disease-related symptoms that impact participant daily functioning
    -Evaluation of patient-reported treatment-related symptoms
    - Evaluación de la supervivencia global (SG)
    - Evaluación del tiempo hasta la progresión con el siguiente tratamiento frente al cáncer
    - Evaluación de la supervivencia libre de recurrencia distante (SLRD)
    - Evaluación de la seguridad y la tolerabilidad de niraparib
    - Evaluación de síntomas relacionados con la enfermedad que pueden afectar el rendimiento diario del participante
    - Evaluación de los síntomas relacionados con el tratamiento referidos por el paciente
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Objective of PK sub-study is to assess the effect of niraparib on endocrine therapy (anastrozole, letrozole, exemestane, and tamoxifen) steady-state exposure.
    El objetivo del sub-estudio de farmacocinética es evaluar el efecto de la exposición en equilibrio del agente del tratamiento endocrino (anastrozol, letrozol, exemestano y tamoxifeno) cuando se administra con niraparib.
    E.3Principal inclusion criteria
    Participants are eligible to be included in Cohorts 1 and 2 of the study only if all of the following criteria are met:
    1.Stage I to III breast cancer per AJCC for breast cancer staging criteria 8th edition with surgical resection of the primary tumor that is confirmed to be either:
    - TNBC, irrespective of BRCA status
    - HR+/HER2− breast cancer with a known and documented tBRCA mutation
    2.Completed prior standard therapy for curative intent, including all of the following, if indicated: neoadjuvant treatment, surgery, adjuvant radiotherapy, and adjuvant chemotherapy
    3.Participants with HR+ breast cancer must be on a stable regimen of endocrine therapy, if indicated, for at least 3 months prior to enrollment. Ovarian suppression, if indicated, must also have been started at least 3 months prior to enrollment.
    4.Detectable ctDNA as measured by central Signatera testing
    5.An archival tumour tissue specimen of the primary tumor sufficient in quality and quantity for ctDNA assay design and tBRCA and HRD testing (a minimum of fifteen 5-μm sections or 1 FFPE tumour block for ctDNA assay design and tBRCA testing and a minimum of 1 FFPE tumour block for HRD testing) is required. Sponsor requirements for tissue sufficiency are outlined in the Study Laboratory Manual.
    6.An Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
    7.Must be ≥18 years of age.
    8.Must have adequate organ and bone marrow function, as defined below. If these criteria are not met, randomization and treatment may be delayed up to 3 weeks.
    Absolute neutrophil count:≥1,500/μL
    Platelets:≥100,000/μL
    Hemoglobin:≥9 g/dL or 5.6 mmol/L
    Serum creatinine:<2× ULN
    Total bilirubin:≤3×ULN
    Alanine aminotransferase: ≤2.5×ULN
    Note: complete blood count (CBC) should be obtained without transfusion or receipt of colony stimulating factors within 4 weeks prior to obtaining the sample. Participants with current active liver or biliary disease are excluded (with the exception of Gilbert’s syndrome or asymptomatic gallstones or otherwise stable chronic liver disease per Investigator assessment).
    9.Participants with toxicity from prior cancer therapy must have recovered to Grade 1. (A participant with Grade 2 neuropathy or Grade 2 alopecia is an exception to this criterion and may qualify for this study.) Randomization and treatment may be delayed up to 3 weeks to allow for this criterion to be met.
    10.Must be able to swallow and retain orally administered study treatment.
    11.A female participant is eligible if she is not pregnant or breastfeeding, and at least 1 of the following conditions applies:
    -Is not a woman of childbearing potential (WOCBP), as defined in Appendix 1.
    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, as described in Appendix 1, during the Treatment Period and for at least 180 days after the last dose of study treatment and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction during this period. The Investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment.
    -A WOCBP must have a negative pregnancy test (highly sensitive urine test or serum test as required by local regulations) within 72 hours before the first dose of study treatment.
    -If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
    -Additional requirements for pregnancy testing during and after study treatment are described in Section 8.4.6.
    -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.
    See Appendix 1 for a list of acceptable birth control methods. Information must be captured appropriately within the site’s source documents.
    12.Male participants are eligible if they agree to the following during the Treatment Period and for at least 180 days after the last dose of study treatment (see Appendix 1 for a list of acceptable birth control methods):
    -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/barrier as detailed below:Agree to use a male condom (and should also be advised of the benefit for a female partner to use a highly effective method of contraception as a condom may break or leak) when having sexual intercourse with a WOCBP who is not currently pregnant
    PLUS
    -Male participants must refrain from donating sperm for at least 90 days after the last dose of study treatment
    Please refer protocol for detailed inclusion criteria
    Los participantes son elegibles para su inclusión en las cohortes 1 y 2 el estudio solo si cumplen todos los criterios dispuestos a continuación:
    1.Cáncer de mama de estadio I a III, según la 8ª edición de los criterios de estadificación del cáncer de mama del AJCC, con resección quirúrgica del tumor primario que se confirma como:
    - CMTN, independientemente del estado de BRCA
    - Cáncer de mama RH+/HER2− con una mutación en tBRCA conocida o documentada
    2.Finalización de un tratamiento estándar previo con intención curativa, incluyendo todas las opciones dispuestas a continuación, si estuviera indicado: tratamiento neoadyuvante, intervención quirúrgica, radioterapia adyuvante y quimioterapia adyuvante.
    3.Las participantes con cáncer de mama RH+ deben recibir una pauta estable del tratamiento endocrino, si estuviera indicado, durante un mínimo de 3 meses antes de la inclusión. Si estuviera indicado, también es necesario haber empezado la supresión ovárica al menos 3 meses antes de la inclusión.
    4.Disponer de ADNtc detectable conforme a lo determinado por el análisis central Signatera.
    5.Se requiere una muestra de tejido tumoral de archivo del tumor primario suficiente en calidad y cantidad para el diseño del ensayo de ADNtc y las pruebas de tBRCA y DRH (un mínimo de 15 secciones de 5 μm o un bloque tumoral FFIP para el diseño del ensayo de ADNtc y pruebas de tBRCA y un mínimo de un bloque tumoral FFIP para las pruebas de DRH). Los requisitos del promotor con respecto a la suficiencia de tejido se disponen en el manual de laboratorio del estudio.
    6. Estado funcional del Eastern Cooperative Oncology Group (ECOG) de 0 o 1.
    7.Edad ≥18 años.
    8.Debe presentar una función de médula ósea y orgánica adecuada, conforme a la definición indicada a continuación. Se pueden retrasar la aleatorización y el tratamiento hasta 3 semanas para permitir el cumplimiento de estos criterios.
    Recuento absoluto de neutrófilos: ≥1.500/μl
    Plaquetas: ≥100.000/μl
    Hemoglobina: ≥9 g/dl o 5,6 mmol/l
    Creatinina sérica: <2 × LSN
    Bilirrubina total: ≤3 × LSN
    Alanina aminotransferasa: ≤2,5 × LSN
    Nota: Se obtendrá un hemograma completo (HC) sin transfusión o recepción de factores estimuladores de colonias en las 4 semanas anteriores a la obtención de la muestra. Los participantes con enfermedad biliar o hepática actualmente activa se excluirán (salvo por el síndrome de Gilbert, cálculos asintomáticos u otra enfermedad hepática crónica estable conforme a la evaluación del investigador).
    9.Los participantes con toxicidad por una terapia previa contra el cáncer deben haberse recuperado al grado 1. (Un sujeto con neuropatía de grado 2 o alopecia de grado 2 se considera una excepción a este criterio y puede ser apto para este estudio). La aleatorización y el tratamiento se pueden retrasar un máximo de 3 semanas para permitir el cumplimiento de este criterio.
    10.Debe ser capaz de ingerir o retener el tratamiento del estudio de administración oral.
    11.Una paciente femenina es elegible si no está embarazada o en periodo de lactancia y se cumple al menos una de las siguientes condiciones:
    - No es una mujer en edad fértil (MEF), conforme a la definición del Apéndice 4. O BIEN
    - Es una MEF y utiliza un método anticonceptivo altamente eficaz (con una tasa de fracaso de <1% al año), preferiblemente con una baja dependencia del usuario, según lo descrito en el Apéndice 4, durante el periodo terapéutico y, al menos, en los 180 días posteriores a la última dosis del tratamiento del estudio y acepta no donar óvulos (huevos, ovocitos) con fines de reproducción durante este periodo. El investigador debe evaluar la eficacia del método anticonceptivo en relación con la primera dosis de la terapia del estudio.
    - Una MEF debe presentar una prueba de embarazo con resultado negativo (prueba en suero o en orina de elevada sensibilidad, según lo requerido por la normativa local) en las 72 horas antes de la primera dosis del tratamiento del estudio.
    - Si no se confirma el resultado negativo de la prueba en orina (p. ej., resultado ambiguo), se requerirá una prueba sérica de embarazo. En tales casos, la paciente no podrá participar si el resultado es positivo.
    - En la Sección 8.4.6 del Protocolo se indican los requisitos adicionales para las pruebas de embarazo durante y después del tratamiento del estudio.
    - El investigador es responsable de revisar el historial médico, antecedentes menstruales y actividad sexual reciente para reducir el riesgo de inclusión de una mujer con un embarazo no detectado precozmente.
    Véase el Apéndice 4 para una lista completa de métodos anticonceptivos aceptables. La información se debe registrar de manera adecuada en los documentos fuente del centro.
    Consulte el protocolo para un detalle de todos los criterios de inclusión.
    E.4Principal exclusion criteria
    Participants are excluded from Cohorts 1 and 2 of the study if any of the following criteria are met:
    1.Prior treatment with a PARP inhibitor.
    2.Current treatment with a CDK4/6 inhibitor or endocrine therapy other than anastrozole, letrozole, exemestane, and tamoxifen.
    3.Participants have any sign of metastasis or local recurrence after comprehensive assessment conducted per protocol.
    4.Participants have shown no definitive response to preoperative chemotherapy by pathologic or radiological evaluation, in cases where preoperative chemotherapy was administered (see Appendix 3).
    5.Participants have systolic BP >140 mmHg or diastolic BP >90 mmHg.
    6.Participants have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach and/or bowels.
    7.Participants have received colony-stimulating factors (eg, granulocyte macrophage colony-stimulating factor or recombinant erythropoietin) within 4 weeks prior to the first dose of study treatment.
    8.Participants have previously or are currently participating in a treatment study of an investigational agent within 4 weeks of the first dose of therapy preceding the study.
    9.Participants have received live vaccine within 30 days of planned start of study randomization. The use of live Corona virus disease 2019 (COVID-19) adenoviral vaccines within 30 days of randomization must be discussed with the GSK Medical Monitor.
    10.Participants have known hypersensitivity to the components of niraparib, placebo, or their formulation excipients.
    11.Participants have undergone major surgery within 4 weeks of starting the first dose of study treatment or have not recovered from any effects of any major surgery.
    12.Participants have a second primary malignancy. Exceptions are the following:
    -Adequately treated nonmelanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS) of the breast, Stage I Grade 1 endometrial carcinoma
    -Other solid tumors and lymphomas (without bone marrow involvement) diagnosed ≥5 years prior to randomization and treated with no evidence of disease recurrence and for whom no more than 1 line of chemotherapy was applied
    13.Participants have current active pneumonitis or any history of pneumonitis requiring steroids (any dose) or immunomodulatory treatment within 90 days of planned start of the study.
    14.Participants have any clinically significant concomitant disease or condition (such as transfusion-dependent anemia or thrombocytopenia) that could interfere with, or for which the treatment might interfere with, the conduct of the study or that would, in the opinion of the Investigator, pose an unacceptable risk to the participants in this study.
    15.Participants have any psychological, familial, sociological, or geographical condition potentially hampering compliance with the study requirements and/or follow up procedures. Those conditions should be discussed with the participants before study entry.
    16.Participants have high medical risk due to a serious, uncontrolled medical disorder; nonmalignant systemic disease; or active, uncontrolled infection (including COVID-19). Examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 90 days) myocardial infarction, uncontrolled major seizure disorder, unstable spinal cord compression, superior vena cava syndrome, active uncontrolled coagulopathy, bleeding disorder, or any psychiatric disorder that prohibits obtaining informed consent.
    17.Participant is pregnant, breastfeeding, or expecting to conceive children while receiving study treatment and/or for up to 180 days after the last dose of study treatment.
    18.Participants have presence of hepatitis B surface antigen or a positive hepatitis C antibody test result at Screening or within 3 months prior to first dose of study treatment. For potent immunosuppressive agents, participants with presence of hepatitis B core antibody should also be excluded.
    19.Participants have a history of human immunodeficiency virus (HIV) disease.
    20.Participants have a known history of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).
    Los participantes se excluirán de las cohortes 1 y 2 del estudio si cumplen alguno de los siguientes criterios:
    1.Tratamiento previo con un inhibidor de PARP.
    2.Tratamiento en curso con inhibidor de CDK4/6 o tratamiento endocrino distinto de anastrozol, letrozol, exemestano y tamoxifeno.
    3.Los participantes presentan cualquier signo de metástasis o recurrencia local después de una evaluación exhaustiva por protocolo.
    4.Las pacientes no han demostrado una respuesta definitiva a la quimioterapia preoperatoria en la evaluación patológica o radiológica, en casos en los que se administró dicha quimioterapia (véase el Apéndice 3).
    5.Los participantes disponen de una TA sistólica >140 mmHg o una TA diastólica >90 mmHg sin un control o tratamiento adecuado.
    6.Los pacientes presentan anomalías gastrointestinales clínicamente significativas que pueden alterar la absorción, como el síndrome de mala absorción o una resección importante del estómago y/o los intestinos.
    7.Los sujetos han recibido factores estimulantes de colonias (p. ej., factor estimulante de colonias de granulocitos-macrófagos o eritropoyetina recombinante) en las 4 semanas antes de la primera dosis del tratamiento del estudio.
    8.Los pacientes han participado anteriormente o participan en la actualidad en un estudio terapéutico con un agente en investigación en las 4 semanas de la primera dosis de la terapia que precede al estudio.
    9.Los participantes han recibido una vacuna viva en los 30 días tras el inicio planificado de la aleatorización del estudio. El uso de las vacunas vivas adenovirales contra la enfermedad por coronavirus 2019 (COVID-19) en los 30 días de la aleatorización deben debatirse con el monitor médico de GSK.
    10.Los sujetos presentan hipersensibilidad conocida a los componentes de niraparib, placebo o los excipientes de la formulación.
    11.Los pacientes se han sometido a una cirugía mayor en las 4 semanas desde el inicio de la primera dosis del tratamiento del estudio o no se han recuperado de los efectos producidos por una cirugía mayor.
    12.Los participantes padecen una segunda neoplasia maligna primaria, con las siguientes excepciones:
    - Cáncer de piel no melanoma tratado adecuadamente, cáncer de cuello uterino in situ tratado con intención curativa, carcinoma ductal in situ (CDIS) de la mama, carcinoma endometrial de grado 1 y estadio I
    - Otros tumores sólidos y linfomas (sin afectación de la médula ósea) diagnosticados ≥5 años antes de la aleatorización y tratados sin evidencias de recurrencia de la enfermedad y para los cuales no se administró más de 1 línea de quimioterapia
    13.Los sujetos padecen neumonitis activa en la actualidad o tienen antecedentes de neumonitis que requiere la administración de corticoesteroides (cualquier dosis) o un tratamiento inmunomodulador en los 90 días del inicio planificado del estudio.
    14.Los participantes padecen una afección o una enfermedad concomitante clínicamente significativa (como anemia o trombocitopenia dependiente de transfusión) que puede interferir con, o cuyo tratamiento puede interferir con, la realización del estudio o que, en opinión del investigador, puede suponer un riesgo inaceptable para los sujetos del estudio.
    15.Los pacientes disponen de situaciones psicológicas, familiares, sociológicas o geográficas que pueden dificultar el cumplimiento con los requisitos del estudio y/o los procedimientos de seguimiento. Dichas situaciones deben debatirse con los participantes antes de la inclusión en el estudio.
    16.Los participantes presentan un riesgo médico elevado debido a un trastorno médico grave y no controlado; enfermedad sistémica no maligna o una infección activa no controlada (incluyendo COVID-19). Los ejemplos incluyen, entre otros, arritmia ventricular no controlada, infarto de miocardio reciente (en 90 días), trastorno epiléptico importante no controlado, compresión inestable de la médula espinal, síndrome de vena cava superior, coagulopatía activa no controlada, trastorno hemorrágico o cualquier trastorno psiquiátrico que prohíbe la obtención del consentimiento informado.
    17.La paciente está embarazada, en periodo de lactancia o espera quedarse embarazada durante la administración del tratamiento del estudio y/o hasta 180 días después de la última dosis del tratamiento del estudio.
    18.Los sujetos presentan antígenos de superficie de hepatitis B o un resultado positivo en la prueba de anticuerpos de hepatitis C en la selección o en los 3 meses previos a la primera dosis del tratamiento del estudio. Para agentes inmunosupresores potentes, los participantes con anticuerpo nuclear de hepatitis B también se excluirán.
    19.Los pacientes tienen antecedentes de enfermedad causada por el virus de la inmunodeficiencia humana (VIH).
    20.Los participantes disponen de antecedentes conocidos de SMD o LMA.
    E.5 End points
    E.5.1Primary end point(s)
    DFS is defined as the time until disease recurrence, measured from the time of randomization to the earliest date of assessment of disease recurrence or death by any cause, as assessed by Investigator using RECIST v1.1.
    La SLE se define como el tiempo hasta la recurrencia de la enfermedad, que se mide desde el momento de la aleatorización hasta la primera fecha de evaluación de la recurrencia de la enfermedad o muerte por cualquier causa, conforme a lo determinado por el investigador utilizando los criterios RECIST v1.1.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Median DFS for the placebo arm is expected to be ~9 months from randomization.
    La mediana de la SLE para la ramod e placebo se espera que sea aprox. 9 meses desde aleatorización.
    E.5.2Secondary end point(s)
    -OS is defined as the time of randomization to the date of death by any cause
    -Evaluation of time to progression on next anticancer therapy is defined as the time from randomization to the earliest progression event subsequent to that used for the primary variable DFS or death by any cause. The date of progression will be based on Investigator assessment during or after the next anticancer therapy and will be defined according to local standard clinical practice. Progression may involve any of the following: objective radiological, histopathological, or symptomatic progression or death.
    -DRFS is defined as the time from randomization to the first detection of distant metastasis or death by any cause as assessed by Investigator either using RECIST v1.1.
    -Safety and tolerability as measured by the incidence of TEAEs, SAEs, TEAEs leading to death, and AEs leading to discontinuation will be assessed. Clinical laboratory parameters, vital signs, ECOG performance status, physical examinations, and use of concomitant medications will be collected.
    -Evaluation of disease- and treatment-related symptoms that impact participant daily functioning measured by change from baseline as assessed using the following instruments: EORTC-QLQ-C30
    -Evaluation of patient-reported treatment-related symptoms measured by descriptive data presented using items from the PRO-CTCAE and FACT-GP5
    - La SG se define como el tiempo desde la aleatorización hasta la fecha de muerte por cualquier causa.
    - El tiempo desde la aleatorización hasta el primer acontecimiento de progresión posterior al empleado para la variable principal de SLE o muerte por cualquier causa. La fecha de la progresión se basará en la evaluación realizada por el investigador durante o después del siguiente tratamiento antitumoral y se definirá conforme a la práctica clínica estándar local. La progresión puede implicar cualquiera de las siguientes opciones: progresión sintomática, histopatológica o radiológica objetiva o muerte.
    - La SLRD se define como el tiempo desde la aleatorización hasta la primera detección de metástasis distante o muerte por cualquier causa conforme a lo evaluado por el investigador utilizando los criterios RECIST v1.1.
    - Se evaluará la incidencia de AAAT, AAG, AAAT que producen la muerte y AA que conllevan la suspensión terapéutica.
    - Se registrarán los parámetros clínicos de laboratorio, constantes vitales, estado funcional ECOG, exploración física y el uso de fármacos concomitantes.
    - Cambio frente al valor inicial según la evaluación realizada utilizando el cuestionario QLQ-C30 de OEITC
    - Datos descriptivos presentados utilizando los ítems de PRO-CTCAE y FACT-GP5
    E.5.2.1Timepoint(s) of evaluation of this end point
    Median overall survival for the placebo arm is expected to be ~30 months from randomization; final OS analysis will be ~8 years after the date on which the first participant was randomized. Patient-reported outcomes to assess quality of life will be measured monthly during the trial, at end of treatment, and then post-dose at +30, +90, and +180 days
    La mediana de supervivencia para el brazo de los pacientes en placebo, se espera que sea de aproximadamente de 30 meses desde la randomización. El análisis de supervivenia global será 8 años después de la fecha del primer paciente randomizado. Se realizarán cuestionarios de calidad de vida mensualmente durante el estudio, también en fin de tratamiento, y después de que terminen la dosis a los 30 días, 90 días y 180 días.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    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 concerned15
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA107
    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
    Brazil
    Canada
    Chile
    Colombia
    Israel
    Mexico
    New Zealand
    Russian Federation
    South Africa
    United States
    Austria
    Belgium
    Finland
    France
    Germany
    Hungary
    Ireland
    Italy
    Netherlands
    Norway
    Poland
    Portugal
    Romania
    Spain
    Sweden
    Switzerland
    United Kingdom
    Argentina
    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
    The end of the study is defined as the date of the last scheduled procedure shown in the Schedule of Activities for the last participant in the study.
    Se define fin de estudio como la fecha del último procedimiento programado en el calendario de actividades del último participante del estudio.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years8
    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 years8
    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: 560
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 240
    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 state40
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 390
    F.4.2.2In the whole clinical trial 800
    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)
    Subjects are expected to discontinue study treatment upon disease recurrence, death, or unacceptable toxicity but will continue long-term follow-up visits/phone calls until discontinued from the study, which occurs upon death, loss to follow-up, withdrawal of consent, or investigator’s decision. After discontinuation from study drug, patients should receive treatment and care at the discretion of their treating physician.
    Se espera que los pacientes suspendan el tratamiento por recurrencia de la enfermedad, fallecimiento o toxicidad inaceptable, pero continuarán realizando visitas de seguimiento a largo plazo (presenciales o telefónicas) hasta que discontinúen del estudio, que podrá ser por fallecimiento, pérdida de seguimiento, retirada de consentimiento o decisión del investigador. Tras la discontinuación del tratamiento, los pacientes deberán recibir tratamiento y cuidados siguiendo el criterio de su médico.
    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 Frontage Laboratories, Inc.
    G.4.3.4Network Country United States
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-07-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-06-01
    P. End of Trial
    P.End of Trial StatusOngoing
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