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    Summary
    EudraCT Number:2020-005114-18
    Sponsor's Protocol Code Number:MK1308A-008
    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:2021-07-05
    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 number2020-005114-18
    A.3Full title of the trial
    A Phase 2, Multicenter, Multi Arm, Study to Evaluate Pembrolizumab (MK-
    3475) or MK-1308A (Co-formulated quavonlimab (MK-1308)/pembrolizumab) in Participants with Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient (dMMR) Stage IV Colorectal Cancer: (MK-1308A-008)
    Estudio de fase 2, multicéntrico y de varios grupos para evaluar pembrolizumab (MK-3475) o MK-1308A (coformulación de quavonlimab (MK-1308)/ pembrolizumab) en participantes con cáncer colorrectal en estadio IV con inestabilidad de microsatélites alta (MSI-H) o con defectos en la reparación de los errores de emparejamiento (dMMR): (MK-1308A-008)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 2 Basket study of Pembrolizumab or MK1308A in mCRC
    Estudio de fase 2, de varios grupos, para evaluar Pembrolizumab o MK-1308A en pacientes con cáncer colorrectal metastásico
    A.4.1Sponsor's protocol code numberMK1308A-008
    A.5.4Other Identifiers
    Name:INDNumber:151343
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España S.A.
    B.5.2Functional name of contact pointInvestigación Clínica
    B.5.3 Address:
    B.5.3.1Street AddressC/ Josefa Valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28037
    B.5.3.4CountrySpain
    B.5.4Telephone number+34913210600
    B.5.5Fax number+34913210590
    B.5.6E-mailensayos_clinicos@merck.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameMK-1308A (Coformulated MK 1308/MK 3475)
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNquavonlimab
    D.3.9.2Current sponsor codeMK-1308
    D.3.9.3Other descriptive nameMK-1308
    D.3.9.4EV Substance CodeSUB191936
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1.43
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number22.86
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA® (Pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.2Product code MK-3475
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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
    Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient
    (dMMR) Stage IV Colorectal Cancer
    Cáncer colorrectal en estadio IV con inestabilidad de microsatélites alta (MSI-H) o con defectos en la reparación de los errores de emparejamiento (dMMR)
    E.1.1.1Medical condition in easily understood language
    Colorectal Cancer
    Cáncer colorrectal
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10010035
    E.1.2Term Colorectal cancer stage IV
    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 20.1
    E.1.2Level LLT
    E.1.2Classification code 10079619
    E.1.2Term MSI-high
    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
    1. Objective (Cohort A): To compare MK-1308A and pembrolizumab with respect to Objective Response Rate per RECIST 1.1 as assessed by Blinded Independent Central Review
    2. Objective (Cohorts B and C): To evaluate the efficacy of MK-1308A with respect to Objective Response Rate per RECIST 1.1 as assessed by Blinded Independent Central Review
    1. Objetivo (cohorte A): Comparar MK-1308A y pembrolizumab en cuanto a la tasa de respuestas objetivas conforme a los criterios RECIST 1.1, según una evaluación central independiente y con enmascaramiento.
    2. Objetivo (cohortes B y C): Determinar la eficacia de MK-1308A en cuanto a la tasa de respuestas objetivas conforme a los criterios RECIST 1.1, según una evaluación central independiente y con enmascaramiento.
    E.2.2Secondary objectives of the trial
    1. Objective (Cohort A, B and C): To evaluate Duration of Response per RECIST 1.1 as assessed by Blinded Independent Central Review
    2. Objective (Cohort A): To compare MK-1308A and pembrolizumab with respect to Progression-Free Survival per RECIST 1.1 as assessed by Blinded Independent Central Review
    3. Objective (Cohorts B and C): To evaluate the Progression-Free Survival per RECIST 1.1 as assessed by Blinded Independent Central Review
    4. Objective (Cohort A): To compare MK-1308A and pembrolizumab with respect to Overall Survival
    5. Objective (Cohorts B and C): To evaluate Overall Survival
    6. To evaluate the safety and tolerability of MK-1308A alone (Cohorts B and C) and compared to pembrolizumab (Cohort A)
    1. Objetivo (cohortes A, B y C): Determinar la duración de la respuesta conforme a los criterios RECIST 1.1, según una evaluación central independiente y con enmascaramiento.
    2. Objetivo (cohorte A): Comparar MK-1308A y pembrolizumab en cuanto a la supervivencia sin progresión conforme a los criterios RECIST 1.1, según una evaluación central independiente y con enmascaramiento.
    3. Objetivo (cohortes B y C): Determinar la supervivencia sin progresión conforme a los criterios RECIST 1.1, según una evaluación central independiente y con enmascaramiento.
    4. Objetivo (cohorte A): Comparar MK-1308A y pembrolizumab en cuanto a la supervivencia global.
    5.Objetivo (cohortes B y C): Determinar la supervivencia global.
    6. Determinar la seguridad y la tolerabilidad de MK-1308A en monoterapia (cohortes B y C) y en comparación con pembrolizumab (cohorte A).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Has a histologically confirmed diagnosis of Stage IV CRC adenocarcinoma (as defined by AJCC version 8).
    2. Has locally confirmed dMMR/MSI-H.
    Cohort A:
    3. Has been previously treated for their disease and radiographically progressed per RECIST 1.1 on or after or could not tolerate standard treatment, which must include ALL of the following agents if approved and locally available in the country where the participant is randomized:
    a) Fluoropyrimidine, irinotecan and oxaliplatin.
    b) With or without an anti-VEGF monoclonal antibody (eg, bevacizumab)
    c) At least one of the anti-EGFR monoclonal antibodies (cetuximab or panitumumab) for RAS WT participants with left-sided tumors.
    4. Must not have had prior exposure to PD-1 or PD-L1 therapies as treatment for this disease.
    Cohort B:
    5. Has untreated Stage IV dMMR/MSI-H CRC with no prior chemotherapy or immunotherapy for this disease.
    Cohort C:
    6. Has radiographically progressed on-treatment with an anti-PD-1 mAb administered either as monotherapy or in combination with other therapies. PD-1 treatment progression is defined by meeting all of the following criteria:
    a. Has received at least 2 doses of an approved anti-PD-1 mAb.
    b. Has shown disease progression after anti-PD-1 as defined by RECIST 1.1. The initial evidence of disease progression is to be confirmed by a second assessment no less than 4 weeks from the date of the first documented disease progression, in the absence of rapid symptom progression or clinical deterioration.
    c. Has documented progressive disease within 12 weeks from the last dose of anti-PD-1 mAb.
    ◦ Progressive disease is determined according to RECIST 1.1.
    ◦ This determination is made by the investigator. Once disease progression is confirmed, the initial date of disease progression documentation will be considered the date of disease progression.
    7. Has had 0 to 1 prior systemic fluoropyrimidine based chemotherapy regimens.
    8. Must not have been treated in Cohort A.
    9. Is male or female and at least 18 years of age at the time of providing documented informed consent.
    10. Has a life expectancy of at least 3 months.
    11. Has ECOG Performance Status of 0 to 1 at screening and within 3 days before Cycle 1 Day 1.
    12. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    • Is not a WOCBP
    OR
    • Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis), during the intervention period and for at least 120 days after the last dose of study intervention. The investigator should evaluate the potential for contraceptive method failure in relationship to the first dose of study intervention.
    A WOCBP must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 24 hours for a urine test and 72 hours for a serum test before the first dose of study intervention.
    If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
    The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
    Contraceptive use by women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
    13. The participant (or legally acceptable representative) has provided documented informed consent/assent for the study. The participant may also provide consent/assent for FBR. However, the participant may participate in the study without participating in FBR.
    14. Have measurable disease per RECIST 1.1 as assessed by BICR. Lesions situated in a previously irradiated area are considered measurable if progression has been shown in such lesions.
    15. Submit an archival or newly obtained tumor tissue sample that has not been previously irradiated; FFPE blocks are preferred to slides. If a sufficient specimen does not exist, the participant must be willing to undergo a core or excisional biopsy during screening.
    Newly obtained biopsies are preferred to archived tissue. For Cohort A, samples may predate chemotherapy. For Cohort B, the specimen may predate adjuvant chemotherapy (this cohort will have had no therapy for metastatic disease). For Cohort C, samples may have been taken prior to PD-1 therapy if taken within 3 months of allocation (i.e. primarily refractory disease); otherwise, a fresh biopsy will be required.
    16. Have adequate organ function. Specimens must be collected within 7 days before the start of study intervention.
    1.Diagnóstico confirmado histológicamente de CCR (adenocarcinoma) estadio 4 (según def. del AJCC, V.8).
    2.Tener dMMR / MSI-H confirmado local.
    Cohorte A:
    3.Tratado previo por su enfermedad y progresión radiológica según RECIST 1.1 durante, después o intolerante al tto. estándar, que debe incluir TODOS los siguientes fármacos, si están aprobados y disponibles localmente en el país donde el participante es aleatorizado:
    a)Fluoropirimidina, irinotecán y oxaliplatino.
    b)Con o sin 1 mAb anti-VEGF (p.ej., bevacizumab)
    c)Al menos 1 de los mAb anti-EGFR (cetuximab o panitumumab) para participantes RAS WT y tumores del lado izqu.
    4.Sin exposición previa a terapias PD-1 o anti-PD-L1 como tto. de esta enfermedad.
    Cohorte B:
    5.Tener CCR estadio 4 con dMMR/MSI-H no tratado, sin quimioter. o inmunoter. previa por esta enfermedad.
    Cohorte C:
    6.Progresión radiológica durante el tto. con mAb anti-PD-1 administrado en monoter. o combinación con otras terapias. La progresión del tto. con PD-1 se define cumpliendo todos los criterios siguientes:
    a)Recibir al menos 2 dosis de mAb anti-PD-1 aprobado.
    b)Con progresión de la enfermedad tras anti-PD-1, según definido por RECIST 1.1. Los datos iniciales de progresión de la enfermedad se confirmarán en 2ª evaluación no menos de 4 semanas desde la fecha de la 1ª progresión documentada de la enfermedad, sin una progresión de los síntomas o deterioro clínico rápido.
    c)Progresión documentada de la enfermedad en 12 semanas siguientes a última dosis de mAb anti-PD-1.
    - Progresión de enfermedad determinada según RECIST 1.1.
    - Determinado por el investigador. Confirmada la progresión de la enfermedad, la fecha inicial de documentación de la progresión de la enfermedad será la fecha de progresión de la enfermedad.
    7.Recepción de 0 o 1 pauta sistémica previa de quimioter. a base de fluoropirimidinas.
    8.No tratado en la Cohorte A.
    9.Hombre o mujer y al menos 18 años al proporcionar el consentimiento informado documentado.
    10.Esperanza de vida mayor de 3 meses.
    11.ECOG de 0 a 1 en selección y dentro de los 3 días antes del C1D1.
    12.No estar embarazada o amamantando, y al menos 1 de las siguientes:
    -No es mujer en edad fértil, o
    -Es mujer en edad fértil y usa método anticonceptivo muy eficaz (índice de fallo <1% anual), o abstinencia de rel. heterosexuales como modo de vida habitual (abstinencia largo plazo y persistente), durante el período de intervención y al menos 120 días después de la última dosis de la intervención del estudio. El investigador evaluará la posibilidad de fallo del método anticonceptivo en relación con la 1ª dosis de la intervención del estudio.
    Las mujeres en edad fértil deberán dar negativo en prueba de embarazo de alta sensibilidad (orina o suero, según regulaciones locales) realizada 24 horas (orina) o 72 horas (suero) antes de la 1ª dosis de la intervención del estudio.
    Si la prueba de orina no se confirma como negativa (p.ej. resultado ambiguo), requiere una prueba de embarazo en suero. La participante será excluida si el resultado de la prueba de embarazo en suero es positivo.
    El investigador revisará el historial médico, menstrual y actividad sexual reciente para reducir riesgo de inclusión de mujer con embarazo temprano no detectado.
    El uso de anticonceptivos por las mujeres deberá cumplir con las regulaciones locales sobre métodos anticonceptivos para participantes en estudios clínicos.
    13.El participante (o su representante legal) otorga su consentimiento/asentimiento informado documentado para el estudio. También puede dar su consentimiento/asentimiento para investigaciones biomédicas futuras. Podrá participar en el estudio sin participar en investigaciones biomédicas futuras.
    14.Tener enfermedad medible por RECIST 1.1 según ECIE. Lesiones situadas en zona previamente irradiada se consideran medibles si se ha mostrado progresión en dichas lesiones.
    15.Envío de muestra de tejido tumoral de archivo o recién obtenida que no haya sido irradiada previamente; se prefieren los bloques FFIP a las extensiones de tejido. Si no hay muestra suficiente, el participante debe estar dispuesto a someterse a una biopsia con aguja gruesa o por escisión durante la selección. Se prefiere una biopsia reciente a tejidos de archivo. En la cohorte A, las muestras pueden ser anteriores a la quimioter. En la cohorte B, la muestra puede ser anterior a la quimioter. adyuvante (esta cohorte no habrá recibido tto. para la metástasis). En la Cohorte C, las muestras podrán haberse obtenido antes del tto. anti-PD-1 si se tomaron en los 3 meses previos a la asignación (es decir, enfermedad con resistencia primaria); de lo contrario, se requerirá nueva biopsia.
    16.Tener funcionamiento adecuado de los órganos. Las muestras se obtendrán en los 7 días antes del inicio de la intervención del estudio.
    E.4Principal exclusion criteria
    1. Has received prior therapy with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX-40, CD137, PD-L1).
    2. Has received prior systemic anticancer therapy including investigational agents within 4 weeks before the first dose of study intervention.
    3. If the participant had a surgery and they have not recovered adequately from the procedure and/or any complications from the surgery before starting study intervention.
    4. Has received prior radiotherapy within 2 weeks of start of study intervention. 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 (≤2 weeks of radiotherapy) to non-CNS disease.
    5. Has received a live or live-attenuated vaccine within 30 days before the first dose of study intervention.
    6. Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks before the first dose of study intervention.
    7. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study medication.
    8. Has a known additional malignancy that is progressing or has required active treatment within the past 2 years.
    9. Has known active CNS metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable, (ie, without evidence of progression) for at least 4 weeks by repeat imaging, clinically stable and without requirement of steroid treatment for at least 14 days before the first dose of study intervention.
    10. Has severe hypersensitivity (≥Grade 3) to pembrolizumab, quavonlimab and/or any of their excipients.
    11. Has an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs).
    Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed.
    Exception: Participants with a history of inflammatory bowel disease (eg, Crohn’s disease or ulcerative colitis) may not participate, regardless of treatment history.
    12. Has a history of (noninfectious) pneumonitis that required steroids or has current pneumonitis.
    13. Has an active infection requiring systemic therapy (eg, tuberculosis, known viral or bacterial infections, etc.).
    14. Has a known history of HIV infection.
    15. Has known active Hepatitis B (defined as HBsAg positive and/or detectable HBV DNA) or active Hepatitis C virus (defined as HCV RNA [qualitative] is detected or anti-HCV Ab positive) infection.
    16. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.
    17. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study.
    18. Is pregnant, or breastfeeding, or expecting to conceive children within the projected duration of the study, starting with the Screening Visit through 120 days after the last dose of study intervention.
    19. Has had an allogenic tissue/solid organ transplant.
    1. Recepción de tratamiento previo con un fármaco dirigido contra otro receptor estimulador o coinhibidor de los linfocitos T (por ejemplo, CTLA-4, OX-40, CD137 o PD-L1).
    2. Recepción de un tratamiento antineoplásico sistémico previo, incluidos fármacos en investigación, en las cuatro semanas previas a la primera dosis de la intervención del estudio.
    3. Si el participante se ha sometido a una intervención de cirugía mayor, deberá haberse recuperado debidamente del procedimiento y/o las complicaciones de la misma antes de iniciar la intervención del estudio.
    4. Recepción de radioterapia en las dos semanas previas al comienzo de la intervención del estudio. Los participantes deberán haberse recuperado de toda la toxicidad relacionada con la radioterapia, no precisar corticoides y no haber sufrido neumonitis por radiación. Se permite un reposo farmacológico de una semana en caso de radioterapia paliativa (≤ 2 semanas de radioterapia) por enfermedad que no afecta al sistema nervioso central (SNC).
    5. Recepción de una vacuna atenuada con microorganismos vivos en los 30 días previos a la administración de la primera dosis de la intervención del estudio.
    6. Participación activa o pasada en un estudio de un fármaco en investigación o uso de un dispositivo en investigación en las cuatro semanas previas a la administración de la primera dosis de la intervención del estudio.
    7. Diagnóstico de inmunodeficiencia o recepción de tratamiento sistémico crónico con esteroides (en dosis superiores a 10 mg diarios de prednisona o equivalente) o cualquier otra forma de tratamiento inmunodepresor en los siete días previos a la primera dosis de la intervención del estudio.
    8. Presencia de otra neoplasia maligna conocida que está en progresión o que ha necesitado tratamiento activo en los últimos dos años.
    9. Metástasis activas en el SNC y/o meningitis carcinomatosa conocidas. Podrán participar pacientes con metástasis cerebrales tratadas previamente, siempre que se encuentren radiológicamente estables (es decir, sin signos de progresión) durante al menos cuatro semanas según estudios de imagen repetidos, estén clínicamente estables y no tengan necesidad de tratamiento con esteroides durante al menos 14 días antes de la primera dosis de la intervención del estudio.
    10. Presencia de hipersensibilidad grave (grado ≥ 3) a pembrolizumab, quavonlimab y/o a cualquiera de sus excipientes.
    11. Presencia de una enfermedad autoinmunitaria activa que haya precisado tratamiento sistémico (es decir, fármacos modificadores de la enfermedad, corticoides o inmunodepresores) en los dos últimos años. El tratamiento de reposición (por ejemplo, tiroxina, insulina o corticoides en dosis fisiológicas por insuficiencia suprarrenal o hipofisaria) no se considera una forma de tratamiento sistémico y se permitirá su uso.
    Excepción: No podrán participar pacientes con antecedentes de enfermedad inflamatoria intestinal (por ejemplo, enfermedad de Crohn o colitis ulcerosa), con independencia de los antecedentes de tratamiento.
    12. Antecedentes de neumonitis (no infecciosa) que haya precisado la administración de esteroides o presencia de una neumonitis activa.
    13. Presencia de una infección activa con necesidad de tratamiento sistémico (por ejemplo, tuberculosis, infecciones víricas o bacterianas conocidas, etc.).
    14. Antecedentes de infección por el virus de la inmunodeficiencia humana (VIH).
    15. Infección activa conocida por el virus de la hepatitis B (definida como HBsAg positivo o ADN del VHB detectable) o el virus de la hepatitis C (definida como detección de ARN del VHC [cualitativo] o positividad de anticuerpos anti-VHC).
    16. Antecedentes o datos presentes de cualquier proceso, tratamiento o anomalía analítica que, en opinión del investigador responsable del tratamiento, podría confundir los resultados del estudio, dificultar la participación durante la totalidad del estudio o motivar que la participación no sea lo más conveniente para el posible participante.
    17. Presencia de un trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante para colaborar en el cumplimiento de los requisitos del estudio.
    18. Embarazo, período de lactancia o intención de concebir durante el período previsto del estudio, desde la visita de selección hasta 120 días después de la última dosis de la intervención del estudio.
    19. Recepción de un alotrasplante de órgano sólido o tejidos.
    E.5 End points
    E.5.1Primary end point(s)
    1. Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by Blinded Independent Central Review (BICR)
    1. Tasa de respuesta objetiva (TRO) según los criterios de evaluación de respuesta en tumores sólidos versión 1.1 (RECIST 1.1) según una evaluación central independiente y con enmascaramiento (ECIE).
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 39 months
    1. Hasta aproximadamente 39 meses
    E.5.2Secondary end point(s)
    1. Duration of Response (DOR) per RECIST 1.1 as assessed by BICR
    2. Progression-Free Survival (PFS) per RECIST 1.1 as assessed by BICR
    3. Overall Survival (OS)
    4. Number of participants who experienced an Adverse Event (AE)
    5. Number of participants discontinuing study treatment due to an AE
    1. Duración de la respuesta (DR) por RECIST 1.1 según una ECIE
    2. Supervivencia sin progresión (SSP) por RECIST 1.1 según una ECIE
    3. Supervivencia global (SG)
    4. Número de participantes que experimentaron un evento adverso (EA)
    5. Número de participantes que interrumpieron el tratamiento del estudio debido a un EA
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 39 months
    2. Up to approximately 39 months
    3. Up to approximately 39 months
    4. Up to approximately 27 months
    5. Up to approximately 24 months
    1. Hasta aproximadamente 39 meses
    2. Hasta aproximadamente 39 meses
    3. Hasta aproximadamente 39 meses
    4. Hasta aproximadamente 27 meses
    5. Hasta aproximadamente 24 meses
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) 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 Yes
    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 Yes
    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) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    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 EEA29
    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
    Canada
    Korea, Republic of
    Russian Federation
    Turkey
    United States
    Belgium
    France
    Germany
    Italy
    Poland
    Spain
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    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 months3
    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 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: 120
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 120
    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 state34
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 150
    F.4.2.2In the whole clinical trial 240
    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 Decision2021-06-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-05-14
    P. End of Trial
    P.End of Trial StatusOngoing
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