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    Summary
    EudraCT Number:2020-004093-21
    Sponsor's Protocol Code Number:AT148003
    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:2021-07-30
    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 number2020-004093-21
    A.3Full title of the trial
    A PHASE 2 STUDY OF ALX148 IN COMBINATION WITH PEMBROLIZUMAB IN PATIENTS WITH ADVANCED HEAD AND NECK SQUAMOUS CELL CARCINOMA (ASPEN-03)
    ESTUDIO EN FASE II DE ALX148 EN COMBINACIÓN CON PEMBROLIZUMAB EN PACIENTES CON CARCINOMA DE CÉLULAS ESCAMOSAS DE CABEZA Y CUELLO AVANZADO (ASPEN-03)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A trial in patients with advanced head and neck cancer looking at combining ALX148 and pembrolizumab
    Un ensayo clínico en pacientes con cáncer de cabeza y cuello que investiga la combinación de ALX148 y pembrolizumab
    A.3.2Name or abbreviated title of the trial where available
    ASPEN-03
    A.4.1Sponsor's protocol code numberAT148003
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04675294
    A.5.4Other Identifiers
    Name:IND NumberNumber:139180
    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 SponsorALX Oncology 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 supportALX Oncology Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationALX Oncology Inc.
    B.5.2Functional name of contact pointVP, Clinical Development
    B.5.3 Address:
    B.5.3.1Street Address866 Malcolm Rd., Suite 100
    B.5.3.2Town/ cityBurlingame, CA
    B.5.3.3Post code94010
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1 650 226 8293
    B.5.5Fax number+1 650 466-7138
    B.5.6E-mailkatherine@alxoncology.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 nameALX148
    D.3.2Product code ALX148
    D.3.4Pharmaceutical form Solution for injection
    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 INNNA
    D.3.9.1CAS number 2484949-51-9
    D.3.9.2Current sponsor codeALX148
    D.3.9.3Other descriptive nameALX148
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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) No
    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 Yes
    D.2.1.1.1Trade name Keytruda
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationNetherlands
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePembrolizumab
    D.3.4Pharmaceutical form Concentrate for 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
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.3Other descriptive nameLambrolizumab
    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) No
    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
    Patients with metastatic or unresectable, recurrent HNSCC who have not yet been treated for their advanced disease
    Pacientes con carcinoma de células escamosas de cabeza y cuello recurrente, metastásico o irresecable, que no han sido tratados para su enfermedad avanzada
    E.1.1.1Medical condition in easily understood language
    Head and neck cancer
    Cáncer de cabeza y cuello
    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 LLT
    E.1.2Classification code 10007050
    E.1.2Term Cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10041823
    E.1.2Term Squamous cell carcinoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10007284
    E.1.2Term Carcinoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10060121
    E.1.2Term Squamous cell carcinoma of head and neck
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10067821
    E.1.2Term Head and neck cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 22.0
    E.1.2Level LLT
    E.1.2Classification code 10082179
    E.1.2Term Squamous cell carcinoma of head and neck metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To assess the effect of ALX148 plus pembrolizumab on overall response rate (ORR) in patients with metastatic or with unresectable, recurrent HNSCC that is CPS > o =1 and who have not yet been treated for their advanced disease.
    Evaluar el efecto de ALX148 más pembrolizumab en la tasa de respuesta global (TRG) en pacientes con CECC recurrente metastásico o no resecable que es positivo para PD-L1 (CPS > o = 1) y que aún no han sido tratados para su enfermedad en estadio avanzado.
    E.2.2Secondary objectives of the trial
    To assess secondary measures of efficacy for ALX148 administered in combination with pembrolizumab and for pembrolizumab alone.
    To assess the safety and tolerability of ALX148 administered in combination with pembrolizumab and for pembrolizumab alone.
    Evaluar las medidas secundarias de eficacia para ALX148 administrado en combinación con pembrolizumab y para pembrolizumab en monoterapia.
    Evaluar la seguridad y la tolerabilidad de ALX148 administrado en combinación con pembrolizumab y de pembrolizumab en monoterapia.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patients with metastatic or unresectable, recurrent head and neck squamous cell carcinoma (HNSCC) that is PD-L1 positive (CPS > 1 by an FDA-approved test utilizing the 22C3 antibody) and who have not received prior systemic therapy for their advanced disease.
    2. Patients must have at least one measurable lesion as defined by RECIST version 1.1. Lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions.
    3. Adequate Bone Marrow Function (obtained within 10 days of first planned dose), including:
    a. Absolute Neutrophil Count (ANC) > or =1,500/mm3 (> or =1.5 x 109/L);
    b. Platelets > or =100,000/mm3 (> or =100 x 109/L);
    c. Hemoglobin > or =9 g/dL (> or =90 g/L) - must be met without packed red blood cell (pRBC) transfusion within the prior 2 weeks. Participants can be on stable doses of erythropoietin (≥ approximately 3 months)
    4. Adequate Renal Function (obtained within 10 days of first planned dose), including:
    a. Estimated creatinine clearance (using Cockroft-Gault equation) > or =30 mL/min.
    5. Adequate Liver Function (obtained within 10 days of first planned dose), including:
    a. Total serum bilirubin < or =1.5 x ULN (< or =3.0 x ULN if the patient has documented Gilbert syndrome);
    b. Aspartate and Alanine transaminase (AST and ALT) < or =2.5 x ULN; < or =5.0 x ULN if there is liver involvement secondary to tumor
    6. Age > or =18 years.
    7. INR or PT and PTT <1.5X ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants.
    8. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) must be 0 or 1.
    9. Participants must have recovered from all AEs due to previous therapies, procedures, and surgeries to baseline or < or =Grade 1 per NCI CTCAE v. 5.0 except for AEs not constituting a safety risk by Investigator judgment (e.g. alopecia). Participants with ≤Grade 2 neuropathy may be eligible.
    10. Available biopsy sample prior to study entry that has been taken after the most recent therapy for HNSCC taken from either an unresectable recurrent lesion or a metastatic lesion. Either a fresh biopsy obtained during screening or an archival biopsy obtained within the 6 months prior to
    planned first day of study treatment.
    11. Serum pregnancy test (for females of childbearing potential) negative at screening.
    12. Male and female patients of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 120 days after the last dose of assigned treatment. A patient is of childbearing potential if, in the opinion of the Investigator, he/she is biologically capable of having children and is sexually active.
    13. Evidence of a personally signed and dated informed consent document, from a patient with the capacity to consent for themselves or from a legal representative, indicating that the patient or legal representative has been informed of all pertinent aspects of the study before any study specific
    activity is performed.
    14. Patients who are willing and able to comply with scheduled visits, treatment plans, laboratory, tests and other procedures.
    1. Pacientes con carcinoma epidermoide de cabeza y cuello (CECC) recurrente metastásico o no resecable positivo para PD-L1 (CPS > 1 según una prueba aprobada por la FDA que utiliza el anticuerpo 22C3) que no han recibido tratamiento sistémico previo para su enfermedad en estadio avanzado.
    2. Los pacientes deben tener al menos una lesión medible, según los criterios RECIST v1.1. Las lesiones situadas en una zona previamente irradiada se consideran medibles si se ha demostrado progresión en tales lesiones.
    3. Función adecuada de la médula ósea (determinada en un plazo de 10 días antes de la primera dosis prevista), incluyendo:
    a. Recuento absoluto de neutrófilos (RAN) > o =1500/mm3 (> o =1,5 x 109/l);
    b. Plaquetas > o = 100 000/mm3 (> o = 100 x 109/l);
    c. Hemoglobina > o =9 g/dl (> o = 90 g/l): debe cumplirse sin transfusión concentrado de eritrocitos (CE) en las 2 semanas anteriores. Los participantes pueden estar recibiendo dosis estables de eritropoyetina (≥3 meses aproximadamente)
    4. Función renal adecuada (determinada en un plazo de 10 días antes de la primera dosis prevista), incluyendo:
    a. Estimación del aclaramiento de creatinina (usando la ecuación de Cockcroft-Gault) ≥30 ml/min.
    5. Función hepática adecuada (determinada en un plazo de 10 días antes de la primera dosis prevista), incluyendo:
    a. Bilirrubina sérica total < o = 1,5 x LSN (< o =3,0 x LSN si el paciente tiene síndrome de Gilbert documentado);
    b. Aspartato y alanina transaminasa (AST y ALT) < o =2,5 x LSN; < o =5,0 x LSN si hay afectación hepática secundaria al tumor.
    6. Edad > o = 18 años.
    7. INR o TP y TTP <1,5 × LSN a menos que el paciente esté recibiendo tratamiento anticoagulante siempre y cuando el TP o TTPa esté dentro del intervalo terapéutico de uso previsto de anticoagulantes.
    8. El estado general (EG) debe ser de 0 o 1 según la escala del Grupo de Oncología Cooperativo del Este (Eastern Cooperative Oncology Group, ECOG).
    9. Los participantes deben haberse recuperado de todos los AA debidos a tratamientos anteriores, procedimientos y cirugías hasta el nivel inicial o grado ≤1 según los CTCAE del NCI v5.0, excepto para los AA que no constituyan un riesgo para la seguridad a criterio del investigador (p. ej., alopecia). Los participantes con neuropatía de grado < o = 2 pueden ser aptos.
    10. Muestra de biopsia disponible antes de entrar en el estudio que se haya tomado después del tratamiento más reciente para el CECC extraída de una lesión recurrente no resecable o de una lesión metastásica. Una biopsia reciente obtenida durante la selección o una biopsia de archivo obtenida en los 6 meses anteriores al primer día previsto del tratamiento del estudio.
    11. Prueba de embarazo en suero (para las mujeres en edad fértil) negativa en la selección.
    12. Los pacientes en edad fértil de ambos sexos deben aceptar utilizar un método anticonceptivo altamente eficaz durante todo el estudio y durante al menos 120 días después de la última dosis del tratamiento asignado. Un/a paciente está en edad fértil si, en opinión del investigador, es biológicamente capaz de tener hijos y es sexualmente activo/a.
    13. Evidencia de un documento de consentimiento informado firmado y fechado personalmente de un paciente con la capacidad para dar su consentimiento por sí mismo o de un representante legal, lo que indica que el paciente o el representante legal han sido informados de todos los aspectos pertinentes del estudio antes de que se realice cualquier actividad específica del estudio.
    14. Los pacientes deben estar dispuestos a cumplir con las visitas programadas, los planes de tratamiento, las pruebas analíticas y otros procedimientos del estudio, y poder hacerlo.
    E.4Principal exclusion criteria
    1. Patients with disease suitable for local therapy with curative intent.
    2. Patients with progressive disease within 6 months of completion of curative therapy.
    3. Patients with nasopharyngeal carcinoma (NPC).
    4. Patients with known symptomatic CNS metastases or leptomeningeal disease requiring steroids. Patients with previously diagnosed brain metastases are eligible if they have completed their treatment and have recovered from the acute effects of radiation therapy or surgery prior to study
    entry, have discontinued corticosteroid treatment for these metastases and are clinically stable off anticonvulsants for at least 4 weeks and are neurologically stable before enrollment.
    5. Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
    6. Prior radiotherapy within 2 weeks of start of study treatment. Note: Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (defined as ≤2 weeks of radiotherapy) to non-CNS disease.
    7. Prior treatment with any anti-CD47 or anti-SIRPapha agent.
    8. Systemic anticancer therapy within 4 weeks of starting study treatment. If systemic anticancer therapy was given within 4 weeks, patient may be included if 4-5 times elimination half-life of the drug has passed.
    9. Prior treatment with a PD-1 or PD-L1, or anti PD L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (e.g., CTLA-4, OX 40, CD137).
    10. Has a diagnosis of immunodeficiency (with the exception of hypogammaglobulinemia) or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug.
    11. Has an active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed.
    12. History of autoimmune hemolytic anemia or autoimmune thrombocytopenia, or hemolytic transfusion reaction.
    13. Patients with intolerance to or who have had a severe allergic or anaphylactic reaction to antibodies or infused therapeutic proteins or patients who have had a severe allergic or anaphylactic reaction to any of the substances included in the study drugs (including excipients).
    14. Any experimental antibodies or live vaccines in the last 30 days prior to the first dose of study drug. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster, yellow fever, rabies, Bacillus Calmette–Guérin (BCG), and typhoid
    vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed.
    15. Patients with active, uncontrolled, clinically significant bacterial, fungal, or viral infection, including hepatitis B (HBV), hepatitis C (HCV), known infection with SARS-CoV-2, known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)related illness.
    16. Has an active infection requiring systemic therapy.
    17. Has had an allogenic tissue/solid organ transplant.
    18. Any of the following in the previous 6 months: myocardial infarction, unstable angina, coronary/peripheral artery bypass graft, NYHA Class II or greater congestive heart failure, cerebrovascular accident, or transient ischemic attack, deep venous thrombosis, arterial thrombosis, symptomatic pulmonary embolism, or any other significant thromboembolism. Any major surgery within 28 days prior to enrollment.
    19. Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment.
    Note: Participants who have entered the follow-up phase of an investigational study may participate as long as it has been 4 weeks after the last dose of the previous investigational agent.
    20. Diagnosis of any other malignancy within the last 3 years prior to enrollment except for adequately treated non-melanomatous skin cancer, or carcinoma in situ (e.g., breast carcinoma in situ, cervical cancer in situ, prostate carcinoma in situ) that have undergone potentially curative therapy.
    1. Enfermedad adecuada para un tratamiento local con intención curativa.
    2. Progresión de la enfermedad en el plazo de 6 meses después de la finalización del tratamiento curativo.
    3. Carcinoma nasofaríngeo (CNF).
    4. Metástasis sintomáticas conocidas del SNC o enfermedad leptomeníngea que requiere corticoesteroides. Los pacientes con metástasis cerebrales previamente diagnosticadas son aptos si han concluido su tratamiento y se han recuperado de los efectos agudos de la radioterapia o la cirugía antes de la entrada en el estudio, han cesado el tratamiento con corticoesteroides para dichas metástasis y están clínicamente estables sin anticonvulsivos durante al menos 4 semanas y son estables neurológicamente antes de la inscripción.
    5. Neumonitis (no infecciosa), que precisó corticoesteroides, o neumonitis actual.
    6. Radioterapia previa en el plazo de 2 semanas antes del inicio del tratamiento del estudio. Nota: Los participantes deben de haberse recuperado de todas las toxicidades relacionadas con la radioterapia, no necesitar corticoesteroides y no haber tenido neumonitis por la radioterapia. Está permitido el reposo farmacológico de 1 semana para radioterapia paliativa (definida como ≤2 semanas de radioterapia) de enfermedad que no sea del SNC.
    7. Tratamiento previo con algún fármaco anti-CD47 o anti-SIRPalfa
    8. Tratamiento antineoplásico sistémico en el plazo de 4 semanas antes de iniciar el tratamiento del estudio. Si tratamiento antineoplásico sistémico se administró en el plazo de 4 semanas, el paciente puede ser incluido si han transcurrido 4-5 veces de la semivida de eliminación del fármaco
    9. Tratamiento con un fármaco anti-PD-1 o anti-PD-L1 o anti-PD-L2 o con un fármaco dirigido a otros receptores estimuladores o co-inhibidores de linfocitos T (p. ej., CTLA-4, OX 40, CD137).
    10. Inmunodeficiencia (con la excepción de hipogammaglobulinemia) o está recibiendo tratamiento crónico con corticoesteroides sistémicos (con dosis superiores a 10 mg al día de prednisona o equivalente) o cualquier otra forma de tratamiento inmunodepresor en el plazo de 7 días antes de la primera dosis del fármaco del estudio
    11. Enfermedad autoinmunitaria activa que ha necesitado tratamiento sistémico en los últimos 2 años (es decir, con fármacos modificadores de la enfermedad, corticoesteroides o fármacos inmunodepresores). El tratamiento de restitución (p. ej., tratamiento de restitución con tiroxina, insulina o corticoesteroides con dosis fisiológicas para la insuficiencia suprarrenal o pituitaria) no se considera una forma de tratamiento sistémico y está permitido
    12. Anemia hemolítica autoinmunitaria o trombocitopenia autoinmunitaria, o reacción hemolítica a transfusión.
    13. Intolerancia o que han tenido una reacción alérgica o anafiláctica grave a anticuerpos o proteínas terapéuticas perfundidas o pacientes que han tenido una reacción alérgica o anafiláctica grave a alguna de las sustancias que se incluyen en los fármacos del estudio
    14. Anticuerpo experimental o vacuna viva en los últimos 30 días antes de la primera dosis del fármaco del estudio. Ejemplos de vacuna de microorganismos vivos son, entre otras, las siguientes: sarampión, paperas, rubéola, varicela/zóster, fiebre amarilla, rabia, antituberculosa y tifus. Las vacunas inyectables contra la gripe estacional, por lo general, son vacunas elaboradas con microbios muertos y están permitidas. Sin embargo, las vacunas antigripales intranasales son vacunas vivas atenuadas y no están permitidas
    15. Infección vírica, fúngica o bacteriana activa, no controlada y clínicamente significativa, incluidas enfermedades relacionadas con hepatitis B, hepatitis C, infección conocida por SARS-CoV-2, infección conocida por VIH o síndrome de inmunodeficiencia adquirida
    16. Infección activa que requiere tratamiento sistémico
    17. Trasplante alógeno
    18. Afecciones en los 6 meses anteriores: infarto de miocardio, angina inestable, injerto de derivación arterial coronario/periférico, insuficiencia cardíaca congestiva de clase II o superior según la NYHA,ictus, o AIT, TVP, trombosis arterial, embolia pulmonar sintomática, o cualquier otra tromboembolia significativa. Cirugía mayor en los 28 días anteriores a la inscripción.
    19. Participando o ha participado en un estudio de un fármaco en investigación o ha utilizado un dispositivo en investigación en el plazo de 4 semanas antes de la primera dosis del tratamiento del estudio.
    Nota: los participantes que han entrado en la fase de seguimiento de un estudio de investigación podrán participar, siempre que hayan transcurrido 4 semanas desde la última dosis del fármaco en investigación anterior.
    20. Cualquier otra neoplasia maligna en los últimos 3 años antes de la inscripción, excepto el cáncer de piel no melanomatoso tratado adecuadamente o el carcinoma in situ (p. ej., carcinoma de mama in situ, cáncer de cuello uterino in situ, carcinoma de próstata in situ) que se han sometido a tratamiento potencialmente curativo.
    E.5 End points
    E.5.1Primary end point(s)
    Objective response rate at any time of ALX148 plus pembrolizumab (ORR; CR or PR using the Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1 for solid tumors).
    Tasa de respuesta objetiva en cualquier momento de ALX148 más pembrolizumab (TRO; RC o RP utilizando los Criterios de Evaluación de la Respuesta en Tumores Sólidos [RECIST] versión 1.1 para tumores sólidos).
    E.5.1.1Timepoint(s) of evaluation of this end point
    The primary endpoint of the study is the objective response rate (ORR) at any time (ORR: CR or PR using the Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1 for solid tumors). The analysis population for the primary analysis will be the ITT population. An additional analysis will be done, using the evaluable population.
    El criterio de valoración principal del estudio es la tasa de respuesta objetiva (ORR) en cualquier momento (ORR: CR o PR utilizando los Criterios de evaluación de respuesta en tumores sólidos [RECIST] versión 1.1 para tumores sólidos. La población para el análisis primario será la población ITT. Se realizará un análisis adicional, utilizando la población evaluable.
    E.5.2Secondary end point(s)
    • Disease control rate (DCR), duration of response (DOR), time to tumor progression (TTP).
    • Progression-free survival (PFS), and overall survival (OS).
    • Adverse Events as characterized by type, frequency, severity (as graded by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v. 5.0), timing, seriousness, and relationship to study therapy;
    • Laboratory abnormalities as characterized by type, frequency, severity (as graded by NCI CTCAE v. 5.0) and timing;
    • Pharmacokinetic parameters of ALX148 such as Cmax, Tmax, AUC, CL, and t1/2 as data permit;
    • Immunogenicity; Human serum ADA (anti-ALX148 antibody) samples will be analyzed for
    the presence or absence of anti-ALX148 antibodies.
    • Tasa de control de la enfermedad (TCE), duración de la respuesta (DR), tiempo hasta la progresión del tumor (TPT).
    • Supervivencia sin progresión (SSP) y supervivencia general (SG).
    • Acontecimientos adversos caracterizados por tipo, frecuencia, intensidad (clasificada según los Criterios Terminológicos Comunes para Acontecimientos Adversos del Instituto Nacional del Cáncer (CTCAE del NCI v.5.0), momento de aparición, gravedad y relación con el tratamiento del estudio;
    • Anomalías analíticas caracterizadas por tipo, frecuencia, intensidad (clasificada según los CTCAE del NCI v.5.0) y momento de aparición;
    • Parámetros farmacocinéticos de ALX148 como Cmáx., Tmáx., ABC, CL y t1/2 según lo permitan los datos;
    • Inmunogenia; las muestras de AAF en suero humano (anticuerpo anti ALX148) se analizarán para la presencia o ausencia de anticuerpos anti ALX148.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Secondary endpoints will be analyzed primarily in the ALX+pembrolizumab treatment arm. The comparisons with the pembrolizumab treatment arm will be performed as exploratory analyses.
    Adverse events, ECGs, blood pressure, pulse rate, cardiac monitoring, and safety laboratory data will be reviewed and summarized on an ongoing basis during the study to evaluate the safety of patients.
    Los criterios de valoración secundarios se analizarán principalmente en el grupo de tratamiento con ALX + prembrolizumab. Las comparaciones con el grupo de tratamiento con pembrolizumab se realizarán como análisis exploratorios.
    Los datos de laboratorio de eventos adversos, ECG, presión arterial, frecuencia del pulso, monitoreo cardíaco y seguridad serán revisados ​​y resumidos de manera continua durante el estudio para evaluar la seguridad de los pacientes.
    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 Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Tolerability; Immunogenicity
    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 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
    No comparado
    Non-comparative
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA14
    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
    Canada
    Korea, Republic of
    Singapore
    United States
    Belgium
    Netherlands
    Spain
    United Kingdom
    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
    EoT in a Member State of the EU is defined as the time at which it is deemed that sufficient patients have been recruited and completed the study as stated in the regulatory application and EC application in the Member State. Poor recruitment (recruiting less than the anticipated number in the CTA) by a Member State is not a reason for premature termination but is considered a normal conclusion to the study in that Member State. EoT in all participating countries is defined as LSLV.
    El final del ensayo en un estado miembro de la Unión Europea será el momento en el que se han incluido suficientes pacientes y completado el ensayo según la solicitud a la autoridad competente y al comité ético del estado miembro. Bajo reclutamiento (menos de lo anticipado) en un estado miembro no se considera motivo para una terminación anticipada sino una finalización normal en el estado miembro. El fin del ensayo en todos los países participantes será la última visita del último paciente.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days18
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months1
    E.8.9.2In all countries concerned by the trial days18
    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: 56
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 55
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Subjects with no physical capacity to consent for themselves having an officially assigned legal representative authorised to consent on behalf/for the patient.
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state22
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 47
    F.4.2.2In the whole clinical trial 111
    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)
    Usual care
    Tratamiento habitual
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-05-05
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-05-05
    P. End of Trial
    P.End of Trial StatusOngoing
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