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    Summary
    EudraCT Number:2020-004231-25
    Sponsor's Protocol Code Number:MS201923_0050
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2021-06-21
    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 number2020-004231-25
    A.3Full title of the trial
    A Phase II, open-label, single-arm study of berzosertib (M6620) in combination with topotecan in participants with relapsed platinum-resistant small-cell lung cancer
    Estudio en fase II, abierto y de un solo grupo de berzosertib (M6620) en combinación con topotecán en participantes con carcinoma microcítico de pulmón recidivante y resistente al platino.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Berzosertib + topotecan in relapsed platinum resistant small cell lung cancer (SCLC)
    Berzosertib + topotecán en el carcinoma microcítico de pulmón (CMP) recidivante y resistente al platino.
    A.3.2Name or abbreviated title of the trial where available
    Berzosertib + topotecan in relapsed platinum-resistant small-cell lung cancer (SCLC)
    Berzosertib + topotecán en el carcinoma microcítico de pulmón (CMP) recidivante y resistente al plat
    A.4.1Sponsor's protocol code numberMS201923_0050
    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 Healthcare KGaA
    B.1.3.4CountryGermany
    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 Healthcare KGaA
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Healthcare KGaA
    B.5.2Functional name of contact pointCommunication Center Merck KGaA
    B.5.3 Address:
    B.5.3.1Street AddressFrankfurter Strasse 250
    B.5.3.2Town/ cityDarmstadt
    B.5.3.3Post code64293
    B.5.3.4CountryGermany
    B.5.4Telephone number0034900 810 844
    B.5.5Fax number+49 6151 72 2000
    B.5.6E-mailservice@merckgroup.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 nameBerzosertib
    D.3.2Product code M6620
    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 INNBERZOSERTIB
    D.3.9.2Current sponsor codeM6620
    D.3.9.4EV Substance CodeSUB189292
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nametopotecan
    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 INNTOPOTECAN
    D.3.9.1CAS number 123948-87-8
    D.3.9.3Other descriptive nameTOPOTECAN
    D.3.9.4EV Substance CodeSUB11191MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Relapsed platinum resistant small-cell lung cancer
    Carcinoma microcítico de pulmón (CMP) recidivante y resistente al platino.
    E.1.1.1Medical condition in easily understood language
    Lung cancer
    Cancer de Pulmón
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10041067
    E.1.2Term Small cell lung 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
    To assess efficacy of intervention in terms of objective response with berzosertib + topotecan
    Evaluar la eficacia de la intervención en términos de respuesta objetiva con el berzosertib en combinación con el topotecán
    E.2.2Secondary objectives of the trial
    -To assess efficacy of intervention in terms of duration of response with berzosertib + topotecan
    - To assess efficacy of intervention interms of PFS with berzosertib + topotecan
    - To assess efficacy of intervention in terms of OS with berzosertib + topotecan followed by subsequent therapy
    - To evaluate the safety and tolerability of berzosertib + topotecan
    - To collect plasma concentration data via sparse PK sampling to contribute to population PK and exposure-response analyses of efficacy and safety of berzosertib and topotecan (and associated metabolites).
    - To investigate the relationship between exposure of berzosertib and QTc
    - To evaluate molecular and morphological biomarkers of response in tumor tissue and in plasma during berzosertib + topotecan
    - To identify germline genetic polymorphisms that may be predictive of differences in the berzosertib + topotecan PK and efficacy (PGx).
    Evaluar eficacia de:
    - intervención en términos de duración de respuesta con berzosertib con topotecán
    -intervención según criterios SSP con berzosertib en combinación con topotecán
    -intervención en función de SG con berzosertib en combinación con topotecán seguidos de tto posterior/
    -Evaluar seguridad y tolerabilidad de berzosertib con topotecán
    -Recoger datos de concentración plasmática mediante muestras aisladas para FC con objeto de contribuir a los análisis de farmacocinética de la población y de exposición-respuesta de eficacia y seguridad de berzosertib y topotecán(y metabolitos asociados)
    -Investigar relación entre exposición al berzosertib y el QTc
    -Evaluar biomarcadores moleculares&morfológicos para predecir respuesta en tejido tumoral y en plasma durante el tratamiento con berzosertib con topotecán
    -Identificar los polimorfismos genéticos de la línea germinal que pueden ser predictivos de las diferencias en la FC y eficacia del berzosertib con topotecán (PGx).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Are ≥ 18 years of age at the time of signing the informed consent. Type of Participant and Disease Characteristics
    2. Histologically confirmed SCLC
    3. Radiologically confirmed progression after first-line or chemoradiation platinum-based
    treatment (carboplatin or cisplatin), with or without immunotherapy, for treatment of limited
    or extensive stage SCLC, with a PFI < 90 days. The PFI is measured by the elapsed time
    from the last day of the regimen of a platinum-based treatment until the first day of
    documented disease progression
    4. Measurable disease according to RECIST 1.1 at Screening. Evidence of measurable disease
    must be confirmed by the IRC prior to start of treatment
    5. Tumor tissue provision: archival (collected within 12 months before date of informed consent
    form [ICF]) signature for Screening) or fresh biopsy specimen, if medically feasible
    6. Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≤ 2 and Karnofsky
    Scale ≥ 60% (see Appendix 8)
    7. Have adequate hematologic function as indicated by:
    - Platelet count ≥ 100,000/mm3
    - Hemoglobin ≥ 9.0 g/L. Prior red blood transfusions are allowed
    - Absolute neutrophil count ≥ 1,500/μL with no growth factor treatment within 14 days of
    obtaining the screening blood sample
    - Total bilirubin level ≤ 1.5 × upper limit of normal (ULN), except in the case of known
    Gilbert syndrome, in which case total bilirubin must be ≤ 2 ULN, an aspartate
    aminotransferase (AST) and an alanine aminotransferase (ALT) level ≤ 3.0 × ULN or
    ≤ 5 × ULN in presence of liver metastases
    -Adequate renal function defined as creatinine clearance ≥ 60 mL/min by calculation
    using the Cockcroft-Gault formula or measured by 24-hour urine collection. The
    Cockcroft-Gault formula is (l40 - age) × weight [kg]) / (72 × serum creatinine [mg/dL])
    × 0.85 (if female)
    Sex
    8. Are male or female
    9. Contraceptive use by males or females will be consistent with local regulations on
    contraception methods for those participating in clinical studies
    Male participants:
    Agree to the following during the Study Intervention Period and for at least 6 months after the
    last study intervention dose:
    -Refrain from donating sperm
    PLUS, either:
    -Abstain from any activity that allows for exposure to ejaculate
    OR
    -Use a male condom: When having sexual intercourse with a woman of childbearing
    potential (WOCBP), who is not currently pregnant, and advise her to use a highly
    effective contraceptive method with a failure rate of < 1% per year, as described in
    Appendix 3, since a condom may break or leak.
    -Male participants must use a condom with pregnant female partners
    Female participants:
    Are not pregnant or breastfeeding, and at least 1 of the following conditions applies:
    -Not a WOCBP
    OR
    -If a WOCBP, use a highly effective contraceptive method (i.e., with a failure rate of < 1%
    per year), preferably with low user dependency, as described in Appendix 3 for the
    following time periods:
    o Before the first dose of the study intervention, if using hormonal contraception:
    -Has completed at least one 4-week cycle of an oral contraception pill and either
    had or has begun her menses
    OR
    -Has used a depot contraceptive or extended-cycle oral contraceptive for least
    28 days and has a documented negative pregnancy test using a highly sensitive
    assay
    AND
    A barrier method, as described in Appendix 3.
    o During the Study Intervention Period
    o After the Study Intervention Period (i.e., after the last study intervention dose is
    administered) for at least 6 months after the last study intervention dose and agree
    not to donate eggs (ova, oocytes) for reproduction during this period
    The Investigator evaluates the effectiveness of the contraceptive method in relationship
    to the first dose of study intervention.
    o Have a negative serum pregnancy test, as required by local regulations, within
    24 hours before the first study intervention dose.
    Additional requirements for pregnancy testing during and after study intervention are in
    Appendix 5.
    Informed Consent
    10. Capable of giving signed informed consent, as indicated in Appendix 2, which includes
    compliance with the requirements and restrictions listed in the ICF and this protocol.
    1.18 años o más en el momento de firmar el consentimiento informado.
    Tipo de participante y características de la enfermedad
    2.CMP histológicamente confirmado
    3.Evolución confirmada mediante radiografía después del tratamiento de primera línea o quimiorradioterapia con platino (carboplatino o cisplatino), con o sin inmunoterapia, para el tratamiento del CMP de estadio limitado o extendido, con intervalo sin platino < 90 días. El intervalo sin platino se mide teniendo en cuenta el tiempo transcurrido desde el último día de la administración de un tratamiento con platino hasta el primer día de evolución confirmada de la enfermedad
    4.Enfermedad cuantificable de acuerdo con los criterios RECIST 1.1 en la selección. Los indicios de enfermedad cuantificable deben ser confirmados por el CEI antes del inicio del tratamiento
    5.Muestra de tejido tumoral: muestras de archivo (recogidas en los últimos 12 meses antes de la fecha de la firma del formulario de consentimiento informado [FCI] para la selección) o recientes, si es viable desde el punto de vista médico
    6.Estado funcional según el Grupo Oncológico Cooperativo del Este (EF de ECOG) ≤2 y escala de Karnofsky ≥60 % (consultar el apéndice 8)
    7.Función hematológica adecuada indicada por:
    - Recuento plaquetario ≥100 000/mm3
    - Hemoglobina ≥ 9,0 g/l. Se permiten las transfusiones previas de glóbulos rojos
    - Recuento absoluto de neutrófilos ≥ 1500/μl sin tratamiento con factores de crecimiento en los 14 días siguientes a la obtención de la muestra de sangre de selección
    - Nivel de bilirrubina total ≤ 1,5 × límite superior de la normalidad (LSN), excepto en el caso de síndrome de Gilbert comprobado, en cuyo caso la bilirrubina total debe ser ≤ 2 LSN, niveles de aspartato aminotransferasa (AspAT) y de alanina aminotransferasa (AAT) ≤ 3,0 × LSN o ≤ 5 × LSN en presencia de metástasis hepáticas
    - Función renal adecuada definida como una depuración de la creatinina ≥ 60 ml/min medida según la fórmula de Cockcroft-Gault o mediante una recogida de orina de 24 horas. La fórmula de Cockcroft-Gault es (l40 - edad) × peso [kg]) / (72 × serocreatinina [mg/dl]) × 0,85 (en mujeres)
    Sexo - 8. Hombre o mujer
    9.El uso de anticonceptivos por parte de los hombres o mujeres será coherente con las normativas locales sobre métodos anticonceptivos para los participantes en estudios clínicos
    Participantes varones:
    Aceptar lo siguiente durante el periodo de intervención del estudio y durante al menos 6 meses después de la
    última dosis de medicación del estudio:
    - Abstenerse de donar esperma Y, demás, escoger entre:
    -Abstenerse de cualquier actividad que permita la exposición a una eyaculación O BIEN -Utilizar un preservativo masculino: En relaciones sexuales con mujeres en edad fértil (MEF), que no estén embarazadas actualmente, se les aconsejará que utilicen un método anticonceptivo altamente eficaz, con una tasa de ineficacia <1 % anual, según lo descrito en el apéndice 3, ya que un preservativo puede romperse o pueden producirse fugas.
    -Los participantes varones deben usar un preservativo con parejas que estén embarazadas. Participantes mujeres: No deben estar embarazadas ni en fase de lactancia materna, y cumplir al menos 1 de las siguientes condiciones: -No ser una MEF O BIEN
    -Si es una MEF, utilizar un método anticonceptivo altamente eficaz (con una tasa de ineficacia <1 % por año), a ser posible poco dependiente del usuario, según lo descrito en el apéndice 3, durante los siguientes períodos:
    o Antes de la primera dosis de la medicación del estudio, si se utiliza un anticonceptivo hormonal:
    -Ha completado al menos un ciclo de 4 semanas con píldora anticonceptiva y haber tenido o comenzado la menstruación
    O BIEN - Ha utilizado un anticonceptivo inyectable o un anticonceptivo oral de ciclo extendido durante al menos 28 días y disponer de una prueba confirmada de embarazo negativa mediante un análisis de alta sensibilidad Y Un método de barrera, según lo descrito en el apéndice 3.
    o Durante el período de intervención del estudio
    o Tras el período de intervención del estudio (después de la administración de la última dosis de la medicación del estudio) durante un mínimo de 6 meses después de la última dosis de la medicación del estudio y aceptar no donar óvulos para fines reproductivos durante este periodo
    El investigador evalúa la eficacia del método anticonceptivo en relación con la primera dosis de la medicación del estudio.
    o Disponer de un resultado negativo en una prueba de embarazo en sangre, según lo exigido por la normativa local, en las 24 horas previas a la primera dosis de la medicación del estudio.
    Los requisitos adicionales para las pruebas del embarazo durante y después de la intervención del estudio se encuentran recogidas en el apéndice 5.
    Consentimiento informado
    10.Tienen capacidad para firmar el consentimiento informado, según lo indicado en el apéndice 2, y cumplen con los requisitos y restricciones mencionados en el FCI y en este protocolo.
    E.4Principal exclusion criteria
    Medical Conditions
    1. Clinically relevant (i.e., active), uncontrolled intercurrent illness including, but not limited to, severe active infection including, severe acute respiratory syndrome coronavirus-2 infection/coronavirus disease 2019, immune deficiencies, uncontrolled diabetes, uncontrolled arterial hypertension, symptomatic congestive heart failure (New York Heart Association Classification ≥ Class II), unstable angina pectoris, myocardial infarction, uncontrolled cardiac arrhythmia, cerebral vascular accident/stroke, or any psychiatric illness/social situations that would limit compliance with study requirements. The following exceptions apply:
    a. Participants with human immunodeficiency virus infection are eligible if they are on effective antiretroviral therapy with undetectable viral load within 6 months, provided there is no expected drug-drug interaction. Human immunodeficiency virus testing is not mandated for study inclusion. If performed, the participant must be consented for testing as per local standard guidance.
    b. Participants with evidence of chronic hepatitis B virus (HBV) infection are eligible if the HBV viral load is undetectable on suppressive therapy (if indicated), and if they have ALT, AST, and total bilirubin levels < ULN, and provided there is no expected drug-drug interaction. Refer to the Schedule of Assessments (SoA; Table 1) for tests required at screening and during Study Intervention Period.
    c. Participants with a history of hepatitis C virus (HCV) infection are eligible if they have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load, and if they have ALT, AST, and total bilirubin levels < ULN. Refer to the SoA (Table 1) for tests required at screening and during Study Intervention Period.
    2. Unstable brain metastases; however, participants with known brain metastases may be enrolled in this clinical study if they are clinically stable (without evidence of progression by imaging for at least 4 weeks prior to the first study intervention dose and any neurologic
    symptoms have returned to baseline), have no evidence of new brain metastases, and are on a stable or decreasing dose of steroids for at least 14 days prior to study intervention. Participants with carcinomatous meningitis are excluded regardless of clinical stability. Screening central nervous system imaging is not mandatory
    3. Prior malignant disease within the last 3 years. Exceptions include fully resected basal cell carcinoma of the skin or squamous cell carcinoma of the skin, in situ cervical cancer, fully resected ductal carcinoma in situ of the breast, superficial or noninvasive bladder cancer, and Stage IA, Grade I endometrioid endometrial cancer with no myometrial invasion, that has undergone curative therapy. Participants with other localized malignancies treated with curative intent need to be discussed with the Medical Monitor.
    4. Participants not recovered from AEs Grade > 1 from prior anticancer therapies, including surgeries. Exception: Grade 2 AEs not constituting a safety risk (e.g., alopecia), based on the Investigator’s judgment; must consult with the medical Monitor prior to enrollment.
    Prior/Concomitant Therapy
    5. Two or more lines of prior systemic anticancer treatment, including retreatment with a platinum-based regimen
    6. Prior treatment with topoisomerase I inhibitor, including topotecan and irinotecan
    7. Prior treatment with an ATR inhibitor
    8. Prior or concurrent treatment with a nonpermitted drug/intervention:
    -Participants who may have received any of the following anticancer therapy(ies) within the following time windows from the first day of study interventions administration:
    o Small molecule inhibitor therapy (including investigational) within 2 weeks or 5 half-lives, whichever is longer
    o Any type of anticancer antibody or antibody drug conjugates within 4 weeks
    o Systemic chemotherapy within 4 weeks (within 6 weeks for nitrosoureas/ mitomycin C)
    o Prior curative-intent high-dose radiotherapy within 4 weeks. Prior palliative radiotherapy to metastatic lesion(s) is permitted provided it was completed at least 1 week prior to first day of study interventions administration and toxicities recovered to Grade ≤ 1.
    o Any other type of anticancer therapy, not listed above, within 4 weeks.
    -Concomitant use of strong inhibitors or inducers of cytochrome P450 3A4 (CYP3A4)
    enzymes that cannot be discontinued for at least 1 week prior to administration of study
    intervention and for the duration of study intervention.
    -Other prohibited concomitant medications as listed in Section 6.5.3.
    Prior/Concurrent Clinical Study Experience 9. Concurrent participation in another interventional clinical study is not permitted. There are no restrictions on prior clinical study participation provided the above washout periods are followed.
    1.Enfermedades intercurrentes con relevancia clínica (activas), enfermedades intercurrentes no controladas, como:infecciones activas graves, infecciones por SARS-CoV-2/enf. coronavírica de 2019, inmunodeficiencias, diabetes no controlada, hipertensión arterial no controlada, insuficiencia cardíaca congestiva sintomática (clase ≥ II según la clasificación de la New York Hearth Association), angina de pecho inestable, infarto de miocardio, arritmia cardíaca no controlada, accidente cerebrovascular/ictus o cualquier enfermedad psiquiátrica o situación social que pudiera limitar el cumplimiento de los requisitos del estudio. Se establecen las siguientes excepciones: a. participantes con infección por el virus de la inmunodeficiencia humana son aptos si reciben tratamiento antirretrovírico eficaz con viremia indetectable en un plazo de 6 meses, siempre que no se prevea una interacción farmacológica. La prueba del virus de la inmunodeficiencia humana no es obligatoria para la inclusión en el estudio. Si se realiza, el participante debe dar su autorización para la prueba, según las directrices estándar locales. b. Participantes con indicios de infección crónica por el virus de la hepatitis B (VHB) son aptos si la viremia del VHB es indetectable en tratamiento depresivo (si procede), y si tienen niveles de AAT, AspATy bilirrubina total < LSN, y siempre que no se prevea una interacción farmacológica. Consulte el calendario de evaluaciones (tabla 1) para conocer las pruebas necesarias en la selección y durante la intervención del estudio. c. Participantes con antecedentes de infección por el virus de la hepatitis C (VHC) son aptas si han sido tratados y curados. En cuanto a los pacientes con infección por VHC que se encuentren actualmente en tratamiento, son aptos si tienen una viremia del VHC indetectable, y si tienen niveles de AAT, AspAT y bilirrubina total < LSN. Consulte el calendario de evaluaciones (tabla 1)para conocer las pruebas necesarias en el período de selección y durante la intervención del estudio.
    2.Metástasis cerebrales inestables; participantes con metástasis cerebrales confirmadas pueden inscribirse en este estudio clínico si permanecen clínicamente estables (sin signos de evolución visibles en pruebas de diagnóstico por imagen durante 4 semanas antes de la primera dosis de medicación y cuyos síntomas neurológicos hayan remitido hasta los valores iniciales), no presentan indicios de nuevas metástasis cerebrales y reciben una dosis sin modificaciones o decreciente de esteroides durante 14 días antes de la intervención del estudio. Los participantes con meningitis carcinomatosa están excluidos. Los estudios por imagen del SNC no son obligatorios.
    3. Neoplasia maligna previa en los últimos 3 años. Excepciones: carcinoma basocelular cutáneo completamente resecado o el carcinoma epidermoide, el cáncer de cuello uterino localizado, el carcinoma ductal localizado de la mama completamente resecado, el cáncer superficial o no invasivo de la vejiga y el cáncer endometrial de grado I en estadio IA sin invasión del miometrio, sometido a tratamiento curativo. El supervisor médico debe valorar la participación de pacientes con otras neoplasias malignas localizadas tratadas con intención curativa.
    4. Participantes que no se recuperen de los AA de grado >1 derivados de tratamientos antineoplásicos previos, incluidas las intervenciones quirúrgicas. Excepción: Los AA de grado 2 que no constituyan un riesgo para la seguridad (como la alopecia), según el criterio del investigador; deben consultarse con el supervisor médico antes de la inscripción.
    5.2 o más líneas de tratamiento antineoplásico sistémico previo, inc. la repetición del tratamiento con una pauta con platino
    6.Tratamiento previo con un inhibidor de la topoisomerasa I, inc. el topotecán y el irinotecán.
    7.Tratamiento previo con inhibidor de ATR
    8.Tratamiento previo o simultáneo con fármaco o intervención no permitidos:
    -Participantes que puedan haber recibido cualquiera tratamiento antineoplásicos dentro de los siguientes márgenes de tiempo desde el primer día de administración de las medicaciones del estudio: o Tratamiento con inhibidores de moléculas pequeñas (incluido tratamiento en fase de investigación clínica) en el plazo de 2 semanas o 5 semividas, el período que sea mayor/o Cualquier tipo de anticuerpo antineoplásico o conjugados de anticuerpo y fármaco en el plazo de 4 semanas/o Quimioterapia general en un plazo de 4 semanas (en un plazo de 6 semanas para nitrosoureas/ mitomicina C)/o Dosis alta de radioterapia con intención curativa en el plazo de 4 semanas. Se permite la radioterapia paliativa previa a la lesión o lesiones metastásicas, siempre que se haya completado al menos 1 semana antes del primer día de la administración de la medicación del estudio y que las toxicidades se hayan recuperado al grado ≤1./o Cualquier otro tipo de tratamiento antineoplásico, no mencionado, en 4 semanas.
    Referirse al protocolo para la lista completa.
    E.5 End points
    E.5.1Primary end point(s)
    Objective response according to RECIST 1.1 as assessed by the IRC Objective response according to RECIST 1.1 as assessed by the IRC.
    Respuesta objetiva según los criterios RECIST 1.1 evaluada por el CEI
    E.5.1.1Timepoint(s) of evaluation of this end point
    Objective response assessed by IRC during study
    Respuesta objetiva evaluada por el CEI durante el estudio
    E.5.2Secondary end point(s)
    -Duration of response according to RECIST 1.1 as assessed by the IRC.
    - Progression-free survival according to RECIST 1.1
    - Overall survival
    - Change from baseline in physical functioning measured by the EORTC QLQ-C30; cough, dyspnea, and chest pain measured by EORTC QLQ-LC13; health state as measured by VAS as a component of the EQ-5D-5L
    - Occurrence of AEs and treatment-related AEs and occurrence of clinically significant changes in vital signs,
    laboratory parameters and 12-lead ECG findings
    - Change from baseline in functioning scales and symptom scales/items measured by EORTC QLQ-C30 and EORTC QLQ-LC13
    - Time to deterioration in functioning scales and symptom scales/items
    - Concentrations of berzosertib (berzosertib metabolites) and topotecan in plasma
    - Relative changes from Baseline in ECG parameter QTc in relation to berzosertib plasma concentration
    - Association of baseline and on treatment biomarkers with response to treatment
    - Association of germline genetic polymorphisms as detected in normal blood DNA with berzosertib and
    topotecan clinical efficacy.
    - occurrence of DLTs in JPN participants.
    - - OR and DOR
    - Duración de la respuesta según los criterios RECIST 1.1 evaluada por el CEI.
    - Supervivencia sin progresión según los criterios RECIST 1.1
    - Supervivencia general
    - Cambios con respecto al estado inicial en la función física cuantificable mediante el EORTC QLQ-C30; tos, disnea y dolor torácico cuantificable mediante el EORTC QLQ-C13; estado de salud cuantificable mediante EVA como parte del EQ-5D-5L
    - Aparición de AA, también los relacionados con el tratamiento, y aparición de cambios con relevancia clínica en las constantes vitales, los parámetros analíticos y los resultados del ECG de 12 derivaciones
    - Cambio con respecto al estado inicial en las escalas de funcionamiento y las escalas/elementos de los síntomas cuantificados mediante el EORTC QLQ-C30 y el EORTC QLQ-LC13
    - Tiempo hasta el empeoramiento en las escalas de evaluación funcional y las escalas/elementos de los síntomas - Concentraciones del berzosertib (metabolitos del berzosertib) y del topotecán en plasma
    - Cambios relativos con respecto al inicio en el parámetro QTc del ECG en relación con la concentración plasmática del berzosertib
    - Asociación de los biomarcadores iniciales y del tratamiento con la respuesta al tratamiento
    - Asociación de polimorfismos genéticos de la línea germinal detectados en pruebas ADN en sangre con la eficacia clínica del berzosertib y del topotecán.
    - aparición de TLD en participantes japoneses.
    - Respuesta global y duración de la respuesta
    E.5.2.1Timepoint(s) of evaluation of this end point
    - DOR and PFS: from first documentation of objective response to PD or death, occurring within 2 scheduled tumor assessments after last evaluable assessment or first study intervention
    - OS: from first study intervention to death
    - QLQ questionnaires: throughout study
    - AEs measured during study
    . time to deterioration from first study intervention and first occurrence of worsening in HRQoL score
    - Concentrations of berzosertib and topotecan in plasma at blood test timepoint.
    - ECG par. all times after dosing with concurrent QTc and plasma concentration assessment
    - Occurence of DLTs until end of Cycle 1 in JPN
    - OR and DOR: from first documentation of objective response to PD or death, within 2 scheduled tumor assessments after last evaluable assessment or 1st intervention.
    DR y SSP desde la 1ª verificación de resp. objetiva a PE/muerte, producidas en las 2 evaluaciones tumorales programadas tras la última prueba evaluable o la 1ª intervención del estudio/SG desde la 1ª intervención del estudio hasta la muerte/Cuestionarios QLQ del estudio/AA medidos durante el estudio/Tiempo hasta el empeoramiento desde la 1ª intervención del estudio y la 1ª aparición de un empeoramiento de la puntuación de la CdVRS/Concentraciones del berzosertib y topotecán en plasma/ECG tras las administraciones con QTc simultáneo y evaluación de la concentración plasmática/Respuesta global y duración de la respuesta desde la primera verificación de respuesta objetiva hasta la PE o la muerte, en las 2 evaluaciones tumorales programadas tras la última prueba evaluable o la 1ª intervención.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    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) 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 No
    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 No
    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 trial1
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA18
    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
    China
    Japan
    United States
    Belgium
    France
    Italy
    Spain
    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
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months3
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months3
    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: 74
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 12
    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 state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 42
    F.4.2.2In the whole clinical trial 86
    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)
    After a participant has completed the study, has withdrawn consent, or has been withdrawn early, appropriate treatment will be administered, in accordance with the study site's standard of care and generally accepted medical practice and depending on the participant's individual medical needs. On withdrawal from the study, participants may receive whatever care they and their physicians agree upon.
    Después de que un participante haya completado el estudio, haya retirado el consentimiento o se haya retirado anticipadamente, se administrará el tratamiento clinico habitual del centro según las necesidades médicas individuales del participante. Al retirarse del estudio, los participantes pueden recibir el cuidado que ellos y sus médicos acuerden.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-06-17
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-04-13
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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