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    Summary
    EudraCT Number:2020-004241-36
    Sponsor's Protocol Code Number:ML42502
    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:2021-02-01
    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 number2020-004241-36
    A.3Full title of the trial
    TIME AND MOTION STUDY OF A SUBCUTANEOUS FIXED-DOSE COMBINATION OF PERTUZUMAB AND TRASTUZUMAB FOR THE TREATMENT OF PATIENTS WITH HER2-POSITIVE EARLY BREAST CANCER.
    ESTUDIO CLINICO DE DETERMINACION DE TIEMPOS Y DESPLAZAMIENTOS DE LA COMBINACION DE UNA DOSIS FIJA SUBCUTÁNEA DE PERTUZUMAB Y TRASTUZUMAB PARA EL TRATAMIENTO DE PACIENTES CON CÁNCER DE MAMA PRECOZ HER2 POSITIVO
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    STUDY OF A SUBCUTANEOUS FIXED-DOSE COMBINATION OF PERTUZUMAB AND TRASTUZUMAB FOR THE TREATMENT OF PATIENTS WITH HER2-POSITIVE EARLY BREAST CANCER
    ESTUDIO CLINICO DE LA COMBINACION DE UNA DOSIS FIJA SUBCUTÁNEA DE PERTUZUMAB Y TRASTUZUMAB PARA EL TRATAMIENTO DE PACIENTES CON CÁNCER DE MAMA PRECOZ HER2 POSITIVO
    A.4.1Sponsor's protocol code numberML42502
    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 SponsorRoche Farma 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 supportRoche Farma S.A
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationRoche Farma S.A.
    B.5.2Functional name of contact pointHead of Spain
    B.5.3 Address:
    B.5.3.1Street AddressC/Ribera del Lora 50
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28042
    B.5.3.4CountrySpain
    B.5.4Telephone number+34913248735
    B.5.5Fax number+34913248196
    B.5.6E-mailspain.start_up_unit@roche.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 nameFixed dose combination of pertuzumab and trastuzumab
    D.3.2Product code RO7198574
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPertuzumab
    D.3.9.2Current sponsor codeRO7198574
    D.3.9.3Other descriptive namePertuzumab SC as part of the fixed dose combination with Trastuzumab
    D.3.9.4EV Substance CodeSUB191357
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number80
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTrastuzumab
    D.3.9.2Current sponsor codeRO7198574
    D.3.9.3Other descriptive nameTrastuzumab SC as part of fixed dose combination with Pertuzumab
    D.3.9.4EV Substance CodeSUB191357
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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 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.2.1.1.1Trade name Perjeta
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Ltd
    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 namePertuzumab
    D.3.2Product code RO4368451
    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 INNPertuzumab
    D.3.9.1CAS number R04368451
    D.3.9.2Current sponsor codePertuzumab IV
    D.3.9.3Other descriptive namePERJETA
    D.3.9.4EV Substance CodeSUB191250
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    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 Yes
    D.3.11.13.1Other medicinal product typehumanised IgG1 monoclonal antibody
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Herceptin
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Ltd
    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 nameTrastuzumab
    D.3.2Product code RO0452317
    D.3.4Pharmaceutical form Powder for concentrate and solution 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 INNTrastuzumab
    D.3.9.1CAS number RO0452317
    D.3.9.3Other descriptive nameHERCEPTIN IV
    D.3.9.4EV Substance CodeSUB191251
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    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: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Herceptin
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Ltd.
    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 nameTrastuzumab
    D.3.2Product code RO0452317
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTrastuzumab
    D.3.9.2Current sponsor codeRO0452317
    D.3.9.3Other descriptive nameTrastuzumab SC
    D.3.9.4EV Substance CodeSUB191252
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number120
    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 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 Yes
    D.3.11.13.1Other medicinal product typehumanised IgG1 monoclonal antibody
    D.IMP: 5
    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 nameFixed dose combination of pertuzumab and trastuzumab RO7198574
    D.3.2Product code RO7198574
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPertuzumab
    D.3.9.2Current sponsor codeRO7198574
    D.3.9.3Other descriptive namePertuzumab SC as part of fixed dose combination with Trastuzumab
    D.3.9.4EV Substance CodeSUB191357
    D.3.10 Strength
    D.3.10.1Concentration unit mEq/ml milliequivalent(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTrastuzumab
    D.3.9.2Current sponsor codeRO7198574
    D.3.9.3Other descriptive nameTrastuzumab SC as part of fixed dose combination with Pertuzumab
    D.3.9.4EV Substance CodeSUB191357
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    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 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 Yes
    D.3.11.13.1Other medicinal product typeA fixed dose combination product of 2 humanised IgG1 monoclonal antibodies (pertuzumab and trastuzumab)
    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
    EARLY BREAST CANCER
    Cáncer de mama temprano
    E.1.1.1Medical condition in easily understood language
    Breast cancer is a type of cancer that forms in the cells of the breast
    El cáncer de mama es un tipo de cáncer que se forma en las células de las mamas
    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 10065430
    E.1.2Term HER2 positive 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
    - Quantify HCP time savings for PH FDC SC vs Perjeta IV + Herceptin
    IV and Perjeta IV + Herceptin SC in the treatment of HER2-positive
    EBC patients.

    - Quantify patient time savings for PH FDC SC vs Perjeta IV +
    Herceptin IV and Perjeta IV + Herceptin SC.
    - Cuantificar el ahorro de tiempo para los PS con el uso de la CDF SC PH comparado con pertuzumab IV + trastuzumab IV y pertuzumab IV + trastuzumab SC para el tratamiento de pacientes con CMP HER2 positivo.
    - Cuantificar el ahorro de tiempo para los pacientes con el uso de la CDF SC PH comparado con pertuzumab IV +
    trastuzumab IV y pertuzumab IV + Herceptin SC.
    E.2.2Secondary objectives of the trial
    •Quantify total patient time spent in hospital for the different administration routes.

    •Quantify resource utilization reduction in terms of consumables related to the different administration routes.

    •To describe the safety and tolerability of PH FDC SC, P IV +
    H IV and P IV + H SC over the entire adjuvant treatment period.
    - Cuantificar el tiempo total que pasa el paciente en el hospital, para las diferentes vías de administración.
    - Cuantificar la reducción de la utilización de recursos en términos de
    los consumibles, y fármaco desperdiciado ,relacionados con las
    diferentes vías de administración
    - Describir la seguridad y tolerabilidad de la CDF SC PH, P IV + H IV y P IV + H SC durante el período de tratamiento adyuvante completo
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Signed Informed Consent Form
    2.Age ≥ 18 years at time of signing Informed Consent Form
    3.Ability to comply with the study protocol, in the investigator’s judgment
    4.Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1
    5.Female and male patients with locally advanced, inflammatory, or early-stage, unilateral, and histologically confirmed node positive invasive breast cancer with initial diagnosis TNM staging any T (except T0) plus N+ and M0.
    6.Completed neoadjuvant treatment with pertuzumab and trastuzumab in combination with chemotherapy according to routine clinical practice, and have undergone surgery.
    7.Confirmed tpCR (total pathologic complete response), defined as eradication of invasive disease in the breast and axilla (i.e., ypT0/is ypN0), according to local pathologist assessment
    8.HER2-positive breast cancer confirmed by a local laboratory prior to study enrollment. HER2-positive status will be determined based on pretreatment breast biopsy material and defined as 3+ by IHC and/or positive by HER2 amplification by in situ hybridization (ISH) with a ratio of ≥ 2 for the number of HER2 gene copies to the number of signals for chromosome 17 copies.
    9.Hormone receptor positive or negative for the primary tumor.
    10.Baseline LVEF ≥ 55% measured by echocardiogram (ECHO) or multiple-gated acquisition scan (MUGA)
    11.For women of childbearing potential (WOCBP) who are sexually active: agreement to remain abstinent (refrain from heterosexual intercourse) or use one highly effective non-hormonal contraceptive method with a failure rate of < 1% per year, or two effective non-hormonal contraceptive methods during the treatment period and for 7 months after the last dose of HER2-targeted therapy, and agreement to refrain from donating eggs during this same period. A woman is considered to be of childbearing potential if she is postmenarchal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus). Examples of highly effective non-hormonal contraceptive methods with a failure rate of < 1% per year include bilateral tubal ligation, male sterilization (with appropriate post-vasectomy documentation of the absence of sperm in the ejaculate). The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception.
    12.For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom in combination with a spermicidal foam, gel, film, cream, or suppository, and agreement to refrain from donating sperm, as defined below: With female partners of childbearing potential or pregnant female partners, men must remain abstinent or use a condom with a spermicidal product during the treatment period and for 7 months after the last dose of HER2-targeted therapy to avoid exposing the embryo. Men must refrain from donating sperm during this same period. The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception.
    13.A negative serum pregnancy test must be available prior to randomization for WOCBP (premenopausal women and women < 12 months after the onset of menopause), unless they have undergone surgical sterilization (removal of ovaries and/or uterus).
    14.No major surgical procedure unrelated to breast cancer within 28 days prior to randomization or anticipation of the need for major surgery during the course of study treatment.
    1. Firmar el formulario de consentimiento informado
    2. 2. Tener ≥ 18 años en el momento de firmar el formulario de consentimiento informado
    3. Capacidad para cumplir los requisitos del protocolo del estudio, de acuerdo con el criterio del investigador
    4. Estado funcional del Eastern Cooperative Oncology Group (ECOG) ≤ 1
    5. Pacientes de ambos sexos con cáncer de mama unilateral invasivo, localmente avanzado, inflamatorio o en estadio precoz, con ganglios positivos, confirmado histológicamente, cuyo diagnóstico inicial sea cualquier T (excepto T0) más N+ y M0
    6. Haber completado el tratamiento neoadyuvante con pertuzumab y trastuzumab en combinación con quimioterapia de acuerdo con la práctica clínica habitual, y haber sido sometidos a cirugía para su cáncer de mama
    7. RpCt (respuesta patológica completa total) confirmada, definida como erradicación de la enfermedad invasiva en la mama y axila (es decir, ypT0/is ypN0), de acuerdo con la evaluación del patólogo local
    8. Cáncer de mama HER2 positivo confirmado por un laboratorio local antes de la inclusión en el estudio. La
    positividad del estado de HER2 se determinará basándose en el análisis de la muestra de la biopsia de mamarealizado antes del tratamiento y se define por una puntuación 3+ en inmunohistoquímica (IHC) y/o amplificación de HER2 en hibridación in situ (ISH) con una relación ≥ 2 entre el número de copias del gen HER2 y el de señales del cromosoma 17.
    9. Determinación local del Status del receptor hormonal del tumor primario.
    10. FEVI basal ≥ 55% determinada mediante ecocardiograma (ECO) o angiografía isotópica (MUGA)
    11. Las mujeres potencialmente fértiles (MPF) que sean sexualmente activas deben comprometerse a practicar la abstinencia sexual (abstenerse de mantener relaciones heterosexuales) o a usar un método anticonceptivo no hormonal muy eficaz que tenga una tasa de fallos anual < 1% o dos métodos anticonceptivos no hormonales
    eficaces, durante el período de tratamiento y hasta 7 meses después de la administración de la última dosis de la terapia dirigida a HER2, así como comprometerse a no donar óvulos durante este mismo período. Se considera que una mujer es potencialmente fértil si es postmenárquica, no se encuentra en fase postmenopáusica
    (amenorrea durante ≥ 12 meses consecutivos sin una causa identificada, más que la menopausia) y no está esterilizada quirúrgicamente (extirpación de ovarios y/o útero). Ejemplos de métodos anticonceptivos no hormonales muy eficaces con una tasa de fallos anual < 1% incluyen la ligadura de trompas bilateral, la
    esterilización masculina (con documentación apropiada tras la vasectomía que confirme la ausencia de esperma en el eyaculado). La fiabilidad de la abstinencia sexual se debe valorar en relación con la duración del estudio clínico y con el estilo de vida preferido y habitual de la paciente. La abstinencia periódica (p. ej. métodos de calendario, control de la ovulación, sintotérmico o cálculo del período postovulatorio) y la retirada no son métodos anticonceptivos aceptables
    12. Los varones deben comprometerse a practicar la abstinencia sexual (abstenerse de mantener relaciones heterosexuales) o a usar preservativos conjuntamente con espuma, gel, película, crema u óvulos espermicidas, así como a no donar semen, según se especifica a continuación: los varones con pareja femenina potencialmente
    fértil o embarazada deben practicar la abstinencia sexual o usar preservativos junto con un producto espermicida durante el período de tratamiento y hasta 7 meses después de la administración de la última dosis de la terapia dirigida a HER2, para evitar la exposición del embrión. Los varones deben abstenerse de donar
    semen durante este mismo período. La fiabilidad de la abstinencia sexual se debe valorar en relación con la duración del estudio clínico y con el estilo de vida preferido y habitual del paciente. La abstinencia periódica (p. ej. métodos de calendario, control de la ovulación, sintotérmico o cálculo del período postovulatorio) y la
    retirada no son métodos anticonceptivos aceptables.
    13. Se debe disponer de una prueba de embarazo en suero con resultado negativo antes de la aleatorización en las
    MPF (mujeres premenopáusicas y aquellas en las que hayan transcurrido < 12 meses desde el comienzo de la
    menopausia), a menos que estén esterilizadas quirúrgicamente (extirpación de ovarios y/o útero).
    14. No haber sido sometidos a un procedimiento de cirugía mayor no relacionado con el cáncer de mama en los 28 días previos a la aleatorización ni requerir previsiblemente un procedimiento de este tipo en el transcurso del tratamiento del estudio.
    E.4Principal exclusion criteria
    1. Stage IV (metastatic) breast cancer
    2. Any amount of residual disease in both breast and residual nodes, other than ypT0/is ypN0,
    will not be allowed to enter the study
    3. Neoadjuvant treatment with trastuzumab alone
    4. Already started systemic treatment for their breast cancer in the adjuvant setting
    5. Need for chemotherapy during the adjuvant setting
    6. Patients with a history of concurrent or previously treated non-breast malignancies except for appropriately treated 1) non-melanoma skin cancer and/or 2) in situ carcinomas, including cervix, colon, and skin
    7. A patient with previous invasive non-breast cancer is eligible provided he/she has been disease free for more than 5 years.
    8. Patients who have a past history of ductal carcinoma in situ (DCIS), infiltrative ductal carcinoma (IDC), lobular carcinoma in situ (LCIS) or infiltrative lobular carcinoma (ILC) if they have received any systemic therapy for its treatment or radiation therapy to the ipsilateral breast
    9. Patients with bilateral breast cancer
    10. Patients who have undergone an excisional biopsy of primary tumor and/or axillary lymph nodes
    11. Axillary lymph node dissection (ALND) prior to initiation of neoadjuvant therapy
    12. Patients with clinically negative axilla (by physical examination and radiographic imaging) may undergo a core or needle biopsy procedure prior to neoadjuvant systemic therapy if in keeping with local practice
    13. Sentinel lymph node biopsy (SLNB) prior to neoadjuvant therapy
    14. Treatment with any investigational drug within 28 days prior to randomization
    15. Serious cardiac illness or medical conditions including, but not confined to, the following:
    - History of NCI CTCAE (v5) Grade ≥ 3 symptomatic congestive heart failure (CHF) or New York Heart Association (NYHA) Class ≥ II
    - High-risk uncontrolled arrhythmias (i.e., atrial tachycardia with a heart rate ≥ 100/min at rest, significant ventricular arrhythmia [ventricular tachycardia], or higher-grade atrioventricular [AV]-block, such as second degree AV-block Type 2 [Mobitz 2] or third-degree AV-block)
    -Serious cardiac arrhythmia not controlled by adequate medication, severe conduction abnormality
    - Angina pectoris requiring anti-anginal medication
    - Clinically significant valvular heart disease
    - Evidence of transmural infarction on ECG
    - Evidence of myocardial infarction within 12 months prior to starting neoadjuvant treatment
    - Poorly controlled hypertension (e.g., systolic > 180 mm Hg or diastolic > 100 mmHg)
    16. History of ventricular dysrhythmias or risk factors for ventricular dysrhythmias, such as structural heart disease (e.g., severe LVSD, left ventricular hypertrophy), coronary heart disease (symptomatic or with ischemia demonstrated by diagnostic testing), clinically significant electrolyte abnormalities (e.g., hypokalemia, hypomagnesemia, hypocalcemia),
    or family history of sudden unexplained death or long QT syndrome
    17. Inadequate bone marrow function, defined as:
    - Absolute neutrophil count < 1.5 x 109/L
    - Platelet count < 100 x 109/L
    - Hemoglobin < 9 g/dL
    18. Impaired liver function, defined as:
    - Serum (total) bilirubin > 1.25 x upper limit of normal (ULN). In case of Gilbert’s syndrome: a total bilirubin of 2 x ULN is permitted.
    - Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) > 1.25 x ULN Albumin < 25 g/L
    19. Inadequate renal function with serum creatinine > 1.5 x ULN
    20. Current severe, uncontrolled systemic disease that may interfere with planned treatment
    (e.g., clinically significant cardiovascular, pulmonary, or metabolic disease; wound-healing disorders)
    21. Pregnant or breastfeeding, or intending to become pregnant during the study or within 7 months after the last dose of HER2-targeted therapy
    22. Women of childbearing potential must have a negative serum pregnancy test result within 7 days prior to initiation of study drug.
    23. Any serious medical condition or abnormality in clinical laboratory tests that, in the investigator’s judgment, precludes the patient’s safe participation in and completion of the study
    24. Known active liver disease, for example, active viral hepatitis infection (i.e., hepatitis B or hepatitis C), autoimmune hepatic disorders, or sclerosing cholangitis
    25. Concurrent, serious, uncontrolled infections, or known infection with HIV
    26. Known hypersensitivity to study drugs, excipients, and/or murine proteins
    27. Current chronic daily treatment with corticosteroids (dose > 10 mg methylprednisolone or equivalent excluding inhaled steroids)
    28. History of other malignancy within 5 years prior to screening, except for appropriately treated carcinoma in situ of the cervix, colon, skin, and/or non melanoma skin carcinoma
    1. Cáncer de mama en estadio IV (metastásico)
    2. No permitida inclusión de pts que presenten cualquier cantidad de enfermedad residual tanto en mama como en ganglios residuales, que no sea ypT0/ ypN0
    3. Tto neoadyuvante con trastuzumab solo
    4. Pts que ya hayan comenzado tto sistémico para cancer de mama en entorno adyuvante
    5. Quimioterapia durante período de tto adyuvante
    6. Pts con antecedentes de neoplasias malignas no de mama concurrentes o tratadas previamente, except. las siguientes si han sido tratadas adecuadamente 1) cáncer de piel no melanoma y/o 2) carcinomas in situ, incluyendo de cérvix, colon y piel
    7. Los pts con cáncer no de mama invasivo previo son elegibles si han estado libres de enfermedad durante más de 5 años.
    8. Pts con antecedentes de CDIS, CDI, CLIS o CLI que hayan recibido cualquier tratamiento sistémico o RT en mama ipsilateral
    9. Pts con cáncer mama bilateral
    10. Pacientes sometidos a biopsia por escisión del tumor primario y/o los ganglios linfáticos axilares
    11. Pts sometidos a linfadenectomía axilar antes del inicio del tratamiento neoadyuvante
    12. Los pts con axila clínicamente negativa (deter. en la exploración física y en los estudios radiológicos) pueden ser sometidos a biopsia por punción o con aguja antes del tto sistémico neoadyuvante si esto es acorde con la práctica clínica local
    13. Biopsia ganglio centinela (BGC) antes del tto neoadyuvante
    14. Tto con fármaco en investigación en 28 días previos a la aleatorización
    15. Enferm. o trastornos cardíacos graves, incluyendo:
    -Antecedentes de ICC sintomática de grado ≥ 3 según los criterios NCI CTCAE (v5) o de clase ≥ II de acuerdo con la NYHA
    -Arritmias de alto riesgo no controladas (taquicardia auricular con frecuencia cardíaca ≥ 100/min en reposo, arritmia ventricular significativa [taquicardia ventricular] o bloqueo auriculoventricular [AV] de grado más alto, como bloqueo AV de segundo grado tipo II [Mobitz II] o de tercer grado)
    - Arritmias cardíacas graves no controladas con medicación adecuada, anomalías severas de la conducción
    - Angina de pecho que requiere medicación antianginosa
    - Enfermedad valvular clínicamente significativa
    - Evidencia infarto transmural en el ECG
    - Evidencia infarto de miocardio en los 12 meses previos al inicio del tto neoadyuvante
    - HiperT mal controlada (p. ej., sistólica > 180 mm Hg o diastólica > 100 mm Hg)
    16. Antecedentes arritmias ventriculares o factores de riesgo para su desarrollo, como enfermedad cardíaca estructural (p. ej. disfunción sistólica ventricular izquierda [DSVI] severa, hipertrofia ventricular izquierda), cardiopatía coronaria (sintomática o con isquemia demostrada en pruebas diagnósticas), alteraciones electrolíticas c.s (p. ej., hipopotasemia, hipomagnesemia, hipocalcemia) o antecedentes familiares de muerte súbita inexplicada o síndrome de QT largo
    17. Función médula ósea inadecuada, definida por:
    -Recuento absoluto de neutrófilos < 1,5 x 109/l
    - Recuento de plaquetas < 100 x 109/l
    - Hemoglobina < 9 g/dl
    18. Función hepática alterada, definida por:
    - Bilirrubina sérica (total) > 1,25 x límite superior de normalidad (LSN). En caso de síndrome de Gilbert, permitido que la concentración de bilirrubina total sea 2 x LSN.
    - Aspartato aminotransferasa (AST) y/o alanina aminotransferasa (ALT) > 1,25 x LSN
    - Albúmina < 25 g/l
    19. Función renal inadecuada con concentración de creatinina sérica > 1,5 x LSN
    20. Enferm. sistémicas graves, no controladas en la actualidad que puedan interferir en el tratamiento previsto (p. ej.enferm. cardiovasculares, pulmonares o metabólicas clínicamente significativas; alteraciones de la cicatrización de heridas)
    21. Mujeres embarazadas o en período de lactancia o que tengan intención de quedarse embarazadas durante el estudio o en los 7 meses siguientes a la administración de la última dosis de la terapia dirigida a HER2
    22. Las mujeres potencialmente fértiles deben presentar un resultado negativo en la prueba de embarazo en suero
    realizada en los 7 días previos al inicio del tratamiento con los fármacos del estudio.
    23. Cualquier trastorno grave o anomalía en los análisis clínicos que, en opinión del investigador, impida al paciente
    participar con seguridad en el estudio y completarlo
    24. Enferm. hepática activa documentada, p ej, infección activa por virus de hepatitis (es decir, hepatitis B o C), trastornos hepáticos autoinmunes o colangitis esclerosante
    25. Infecciones concurrentes graves, no controladas o infección por VIH documentada
    26. Hipersensibilidad a los fármacos del estudio, sus excip. y/o a proteínas murinas
    27. Tto crónico diario actual con corticosteroides (dosis > 10 mg de metilprednisolona o equival., excep. esteroides inhalados)
    28. Antecedentes de otras neoplasias malignas en los 5 años previos a la selección, exceptuando carcinoma in situ de cérvix, colon, piel y/o carcinoma de piel no melanoma tratados adecuadamente
    E.5 End points
    E.5.1Primary end point(s)
    - Average HCP time per patient per visit (per treatment
    cycle), measured for cycles 2-7 in the adjuvant setting,
    for the different administration route processes, time
    disaggregated per pre-specified task as well as per HCP
    (oncologist, nurse, pharmacist and other).



    - Average patient time per visit (per treatment cycle),
    measured for cycles 2-7 in the adjuvant setting, for the
    different administration route processes: patient chair
    time (measured as time between sitting and rising from
    infusion chair) and treatment room time (measured as
    time between entrance and exit from the treatment
    room).
    - Tiempo medio dedicado por los PS a cada paciente por visita
    (por ciclo de tratamiento), determinado durante los ciclos 2-
    7 en el entorno adyuvante, para los procesos empleados
    para las diferentes vías de administración; tiempo
    desglosado por tarea preespecificada, así como por PS
    (oncólogo, enfermero, farmacéutico u otros
    - Tiempo medio del paciente por visita (por ciclo de
    tratamiento), determinado durante los ciclos 2-7 en el
    entorno adyuvante, para los procesos empleados para las
    diferentes vías de administración: tiempo de permanencia
    del paciente en el sillón (medido como el tiempo desde que
    se sienta hasta que se levanta del sillón de infusión) y en la
    sala de tratamiento (medido como el tiempo desde que
    entra hasta que sale de la sala).
    E.5.1.1Timepoint(s) of evaluation of this end point
    At each site visit and for the entire duration of the study
    En cada visita al centro y durante la duración completa del estudio
    E.5.2Secondary end point(s)
    - Average patient hospital time per visit (per treatment
    cycle), measured for cycles 2-7 in the adjuvant setting,
    for the different administration route processes
    measured as time between first entry and last exit from
    the hospital.
    - Average quantity for each consumable used per patient
    visit (per treatment cycle), measured for cycles 2-7 in the
    adjuvant setting, per pre-specified task for the different
    administration route processes. Milligrams wasted from
    partly-used vials per patient visit (per treatment cycle),
    measured for cycles 2-7 in the adjuvant setting


    - Incidence, nature and severity of all AEs, ≥ Grade 3
    AEs, serious adverse events (SAEs) and cardiac AEs
    (including left ventricular ejection fraction [LVEF] events).
    Incidence of premature withdrawal from study treatment.
    Targeted vital signs and physical findings. Targeted
    clinical laboratory test results.
    - Tiempo medio del paciente en el hospital por visita (por ciclo
    de tratamiento), determinado durante los ciclos 2-7 en el
    entorno adyuvante, para los procesos empleados para las
    diferentes vías de administración, medido como el tiempo
    transcurrido desde la primera entrada y la última salida del
    hospital.
    - Cantidad media de cada consumible utilizado por visita del
    paciente (por ciclo de tratamiento), determinada durante
    los ciclos 2-7 en el entorno adyuvante, por tarea
    preespecificada para los procesos empleados para las
    diferentes vías de administración. Miligramos
    desperdiciados de viales utilizados parcialmente en cada
    visita del paciente (debido a ciclo de tratamiento) medido
    durante los ciclos 2-7 en el entorno adyuvante
    - Incidencia, tipo e intensidad de todos los acontecimientos
    adversos (AA), AA de grado ≥ 3, acontecimientos adversos
    graves (AAG) y AA cardíacos (incluyendo eventos
    relacionados con la fracción de eyección del ventrículo
    izquierdo [FEVI]). Incidencia de retiradas prematuras del
    tratamiento del estudio. Constantes vitales y hallazgos de la
    exploración física específicos. Resultados de los análisis
    clínicos específicos.
    E.5.2.1Timepoint(s) of evaluation of this end point
    At each site visit and for the entire duration of the study
    En cada visita al centro y durante la duración completa del estudio
    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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others 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) No
    E.7.4Therapeutic use (Phase IV) Yes
    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 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.8.3 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 concerned9
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    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
    The end of this study is defined as the last patient last visit which will occur approximately 3 years after the last patient is randomized or the date at which the last data point required for the final statistical analysis or safety follow-up is received from the last patient, whichever occurs later. In addition, the Sponsor may decide to terminate the study at any time
    La terminación de este estudio se define como la fecha en la que el ultimo paciente tenga la última visita, lo que ocurrirá aproximadamente 3 años después de que el último paciente sea aleatorizado o la fecha en el que se recoja el último
    dato de un paciente necesario para el análisis estadístico final o seguimiento del ultimo paciente, lo que ocurra antes.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 33
    F.1.3Elderly (>=65 years) No
    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 No
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state33
    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)
    None
    Ninguno
    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 Decision2021-03-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-01-21
    P. End of Trial
    P.End of Trial StatusOngoing
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