Clinical Trials Register

Summary
EudraCT Number:	2020-005197-10
Sponsor's Protocol Code Number:	VT3996-202
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:	2022-05-12
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

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A. Protocol Information

A.1

Member State Concerned

Spain - AEMPS

A.2

EudraCT number

2020-005197-10

A.3

Full title of the trial

An Open-Label, Phase 2 Trial of Nanatinostat in Combination with Valganciclovir in Patients with Epstein-Barr Virus-Positive (EBV+) Relapsed/Refractory Lymphomas (NAVAL-1)

Ensayo abierto de fase II de Nanatinostat en combinación con Valganciclovir en pacientes con Linfomas Recidivantes/Resistentes positivos para el Virus de Epstein-Barr (VEB+) (NAVAL-1)

A.3.1

Title of the trial for lay people, in easily understood, i.e. non-technical, language

Nanatinostat and Valganciclovir in R/R EBV+ Lymphoma (“NAVAL-1”)

Nanatinostat y Valganciclovir en Linfoma R/R VEB +

A.3.2

Name or abbreviated title of the trial where available

NAVAL-1

A.4.1

Sponsor's protocol code number

VT3996-202

A.7

Trial is part of a Paediatric Investigation Plan

A.8

EMA Decision number of Paediatric Investigation Plan

B. Sponsor Information
B.Sponsor: 1
B.1.1	Name of Sponsor	Viracta Therapeutics, Inc.
B.1.3.4	Country	United States
B.3.1 and B.3.2	Status of the sponsor	Commercial
B.4 Source(s) of Monetary or Material Support for the clinical trial:
B.4.1	Name of organisation providing support	Viracta Therapeutics, Inc.
B.4.2	Country	United States
B.5 Contact point designated by the sponsor for further information on the trial
B.5.1	Name of organisation	Viracta Therapeutics, Inc.
B.5.2	Functional name of contact point	Clinical Trial Information Desk
B.5.3	Address:
B.5.3.1	Street Address	2533 S. Coast Hwy 101, Suite 210
B.5.3.2	Town/ city	Cardiff
B.5.3.3	Post code	CA 92007
B.5.3.4	Country	United States
B.5.6	E-mail	clinicaltrials@viracta.com

D. IMP Identification
D.IMP: 1
D.1.2 and D.1.3	IMP Role	Test
D.2	Status of the IMP to be used in the clinical trial
D.2.1	IMP to be used in the trial has a marketing authorisation	No
D.2.5	The IMP has been designated in this indication as an orphan drug in the Community	No
D.2.5.1	Orphan drug designation number
D.3 Description of the IMP
D.3.1	Product name	Nanatinostat
D.3.2	Product code	VRx-3996
D.3.4	Pharmaceutical form	Film-coated tablet
D.3.4.1	Specific paediatric formulation	No
D.3.7	Routes of administration for this IMP	Oral use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8	INN - Proposed INN	Nanatinostat
D.3.9.1	CAS number	1256448-47-1
D.3.9.2	Current sponsor code	VRx-3996
D.3.10	Strength
D.3.10.1	Concentration unit	mg milligram(s)
D.3.10.2	Concentration type	equal
D.3.10.3	Concentration number	10
D.3.11 The IMP contains an:
D.3.11.1	Active substance of chemical origin	Yes
D.3.11.2	Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP)	No
	The IMP is a:
D.3.11.3	Advanced Therapy IMP (ATIMP)	No
D.3.11.3.1	Somatic cell therapy medicinal product	No
D.3.11.3.2	Gene therapy medical product	No
D.3.11.3.3	Tissue Engineered Product	No
D.3.11.3.4	Combination ATIMP (i.e. one involving a medical device)	No
D.3.11.3.5	Committee on Advanced therapies (CAT) has issued a classification for this product	No
D.3.11.4	Combination product that includes a device, but does not involve an Advanced Therapy	No
D.3.11.5	Radiopharmaceutical medicinal product	No
D.3.11.6	Immunological medicinal product (such as vaccine, allergen, immune serum)	No
D.3.11.7	Plasma derived medicinal product	No
D.3.11.8	Extractive medicinal product	No
D.3.11.9	Recombinant medicinal product	No
D.3.11.10	Medicinal product containing genetically modified organisms	No
D.3.11.11	Herbal medicinal product	No
D.3.11.12	Homeopathic medicinal product	No
D.3.11.13	Another type of medicinal product	No
D.IMP: 2
D.1.2 and D.1.3	IMP Role	Test
D.2	Status of the IMP to be used in the clinical trial
D.2.1	IMP to be used in the trial has a marketing authorisation	Yes
D.2.5	The IMP has been designated in this indication as an orphan drug in the Community	No
D.2.5.1	Orphan drug designation number
D.3 Description of the IMP
D.3.1	Product name	Valganciclovir
D.3.4	Pharmaceutical form	Film-coated tablet
D.3.4.1	Specific paediatric formulation	No
D.3.7	Routes of administration for this IMP	Oral use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8	INN - Proposed INN	VALGANCICLOVIR
D.3.9.1	CAS number	175865-60-8
D.3.9.4	EV Substance Code	SUB00007MIG
D.3.10	Strength
D.3.10.1	Concentration unit	mg milligram(s)
D.3.10.2	Concentration type	equal
D.3.10.3	Concentration number	450
D.3.11 The IMP contains an:
D.3.11.1	Active substance of chemical origin	Yes
D.3.11.2	Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP)	No
	The IMP is a:
D.3.11.3	Advanced Therapy IMP (ATIMP)	No
D.3.11.3.1	Somatic cell therapy medicinal product	No
D.3.11.3.2	Gene therapy medical product	No
D.3.11.3.3	Tissue Engineered Product	No
D.3.11.3.4	Combination ATIMP (i.e. one involving a medical device)	No
D.3.11.3.5	Committee on Advanced therapies (CAT) has issued a classification for this product	No
D.3.11.4	Combination product that includes a device, but does not involve an Advanced Therapy	No
D.3.11.5	Radiopharmaceutical medicinal product	No
D.3.11.6	Immunological medicinal product (such as vaccine, allergen, immune serum)	No
D.3.11.7	Plasma derived medicinal product	No
D.3.11.8	Extractive medicinal product	No
D.3.11.9	Recombinant medicinal product	No
D.3.11.10	Medicinal product containing genetically modified organisms	No
D.3.11.11	Herbal medicinal product	No
D.3.11.12	Homeopathic medicinal product	No
D.3.11.13	Another type of medicinal product	No
D.IMP: 3
D.1.2 and D.1.3	IMP Role	Test
D.2	Status of the IMP to be used in the clinical trial
D.2.1	IMP to be used in the trial has a marketing authorisation	Yes
D.2.5	The IMP has been designated in this indication as an orphan drug in the Community	No
D.2.5.1	Orphan drug designation number
D.3 Description of the IMP
D.3.1	Product name	ganciclovir
D.3.4	Pharmaceutical form	Powder for concentrate for solution for infusion
D.3.4.1	Specific paediatric formulation	No
D.3.7	Routes of administration for this IMP	Intravenous use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8	INN - Proposed INN	GANCICLOVIR SODIUM
D.3.9.1	CAS number	107910-75-8
D.3.9.4	EV Substance Code	SUB02312MIG
D.3.10	Strength
D.3.10.1	Concentration unit	mg milligram(s)
D.3.10.2	Concentration type	equal
D.3.10.3	Concentration number	500
D.3.11 The IMP contains an:
D.3.11.1	Active substance of chemical origin	Yes
D.3.11.2	Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP)	No
	The IMP is a:
D.3.11.3	Advanced Therapy IMP (ATIMP)	No
D.3.11.3.1	Somatic cell therapy medicinal product	No
D.3.11.3.2	Gene therapy medical product	No
D.3.11.3.3	Tissue Engineered Product	No
D.3.11.3.4	Combination ATIMP (i.e. one involving a medical device)	No
D.3.11.3.5	Committee on Advanced therapies (CAT) has issued a classification for this product	No
D.3.11.4	Combination product that includes a device, but does not involve an Advanced Therapy	No
D.3.11.5	Radiopharmaceutical medicinal product	No
D.3.11.6	Immunological medicinal product (such as vaccine, allergen, immune serum)	No
D.3.11.7	Plasma derived medicinal product	No
D.3.11.8	Extractive medicinal product	No
D.3.11.9	Recombinant medicinal product	No
D.3.11.10	Medicinal product containing genetically modified organisms	No
D.3.11.11	Herbal medicinal product	No
D.3.11.12	Homeopathic medicinal product	No
D.3.11.13	Another 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.1.1

Medical condition(s) being investigated

Epstein-Barr Virus-Positive (EBV+) Relapsed/Refractory Lymphomas

Linfomas Recidivantes/Resistentes positivos para el Virus de Epstein-Barr (VEB+)

E.1.1.1

Medical condition in easily understood language

Epstein-Barr Virus-Positive (EBV+) Relapsed/Refractory Lymphomas

Linfomas Recidivantes/Resistentes positivos para el Virus de Epstein-Barr (VEB+)

E.1.1.2

Therapeutic area

Diseases [C] - Cancer [C04]

MedDRA Classification

E.1.2 Medical condition or disease under investigation

E.1.2	Version	21.0
E.1.2	Level	PT
E.1.2	Classification code	10071441
E.1.2	Term	Epstein-Barr virus associated lymphoma
E.1.2	System Organ Class	10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)

E.1.3

Condition being studied is a rare disease

E.2 Objective of the trial

E.2.1

Main objective of the trial

To evaluate the anti-tumor activity of the combination treatment of nanatinostat (Nstat) with valganciclovir (VGCV) based on objective tumor response rates

Evaluar la actividad antitumoral del tratamiento combinado de nanatinostat (Nstat) con valganciclovir (VGCV) basado en las tasas de respuesta tumoral objetiva.

E.2.2

Secondary objectives of the trial

To determine the duration of tumor control
To determine survival outcomes
To describe the safety profile of the combination treatment of Nstat with VGCV
To generate pharmacokinetic (PK) data

+ Determinar la duración del control tumoral.
+ Determinar los resultados de supervivencia.
+ Describir el perfil de seguridad del tratamiento combinado de Nstat con VGCV.
+ Generar datos de farmacocinética (FC)

E.2.3

Trial contains a sub-study

E.3

Principal inclusion criteria

1. Adult patients age ≥18 years at the time of informed consent.
2. EBV+ relapsed/refractory lymphoma following 2 or more prior systemic therapies
3. EBV+ DLBCL, NOS: Must have received at least one course of an anti-CD20 immunotherapy, and at least one course of anthracycline-based
chemotherapy
4. PTLD: Must have received immunotherapy with an anti-CD20 agent.
5. Hodgkin lymphoma: Must have received at least one course of antracycline-based chemotherapy. Patients with classical Hodgkin
lymphoma should have failed or be ineligible for an anti-PD-1 agent and CD30-directed therapy.
6. For extranodal NK/T-cell lymphoma patients only: Relapsed/refractory disease following 1 or more prior systemic therapies. Patients must have failed an a sparaginase-containing regimen.
7. No available therapies in the opinion of the investigator.
8. Not eligible for high-dose chemotherapy with allogeneic/autologous stem cell transplantation or CAR-T Therapy.
9. Measurable disease per Lugano 2007.
10. ECOG performance status 0, 1, 2.
11. Adequate bone marrow function.

1.Pacientes adultos de ≥18 años en el momento del consentimiento informado.
2. Linfoma recidivante/resistente VEB+ después de 2 o más tratamientos sistémicos previos
con confirmación histológica
3. En el caso del LDLBG sin especificar VEB+: deben haber recibido al menos un ciclo de inmunoterapia anti-CD20, y al menos un ciclo de quimioterapia basada en antraciclinas.
4. TLPT: los pacientes deben haber recibido inmunoterapia con un fármaco anti-CD20.
5. Linfoma de Hodgkin: deben haber recibido al menos un ciclo de quimioterapia basada en antraciclinas. Los pacientes con linfoma de Hodgkin clásico deben haber fracasado o no ser aptos para recibir un fármaco anti-PD-1 ni tratamiento dirigido a CD30.
6. Solo para pacientes con linfoma extraganglionar de linfocitos NK/T: enfermedad recidivante/resistente tras 1 o más tratamientos sistémicos previos. Los pacientes debían haber fracasado con una pauta posológica que contuviera asparaginasa.
7. No hay tratamientos estándar disponibles en opinión del investigador.
8. No ser apto para quimioterapia en dosis altas con trasplante alogénico/autólogo de células madre o tratamiento CAR-T en el momento de la entrada en el estudio.
9. Enfermedad medible por Lugano 2007.
10. Estado funcional del Grupo Oncológico Cooperativo de la Costa Este (ECOG) de 0, 1 o 2
11. Función de la médula ósea adecuada

E.4

Principal exclusion criteria

1. Presence or history of central nervous system (CNS) involvement by lymphoma.
2. Systemic anticancer therapy or CAR within 21 days.
3. Antibody (anticancer) agents within 28 days.
4. Less than 60 days from prior autologous hematopoietic stem cell or solid organ transplant.
5. Less than 90 days from prior allogeneic transplant.
6. Daily corticosteroids (≥20 mg of prednisone or equivalent) within week prior to Cycle 1 Day 1.
7. Inability to take oral medication, malabsorption syndrome or any other gastrointestinal condition (nausea, diarrhea, vomiting) that may impact the absorption of nanatinostat and valganciclovir.
8. Active infection requiring systemic therapy (Excluding viral upper respiratory tract infections

1. Presencia o antecedentes de afectación del sistema nervioso central (SNC) a causa del linfoma.
2. Tratamiento antineoplásico sistémico o CAR-T en los 21 días previos.
3. Anticuerpos (antineoplásicos) en los 28 días previos.
4. Han transcurrido menos de 60 días después de un trasplante autólogo de células madre hematopoyéticas o de órgano sólido.
5. Han transcurrido menos de 90 días desde el trasplante alogénico previo.
6. Recibir corticoesteroides (20 mg/día de prednisona o equivalente) durante la última semana antes del día 1 del ciclo 1.
7. Incapacidad para tomar medicación por vía oral, síndrome de malabsorción o cualquier otra afección gastrointestinal (náuseas, diarrea, vómitos) que pueda afectar a la absorción de nanatinostat y valganciclovir.
8. Infección activa que requiera tratamiento sistémico (se excluyen las infecciones víricas de las vías respiratorias altas).

E.5 End points

E.5.1

Primary end point(s)

Objective response rate (ORR) as assessed by an Independent Review Committee (IRC) per the 2007 International Working Group (IWG) criteria.

Tasa de respuesta objetiva (TRO) evaluada por un Comité de Revisión Independiente (CRI), según los criterios del Grupo de Trabajo Internacional de 2007 (International Working Group, IWG)

E.5.1.1

Timepoint(s) of evaluation of this end point

The primary efficacy endpoint is ORR assessed by an IRC every 8 weeks until 24 weeks, and then every 12 weeks for the remainder of the study.

La variable principal de eficacia es la TRO evaluada por un CRI cada 8 semanas hasta la semana 24, y después cada 12 semanas durante el resto del estudio

E.5.2

Secondary end point(s)

• Duration of response (DOR)
• Time to next anti-lymphoma treatment
• Progression-free survival
• Time to progression
• Overall survival (OS)
• Pharmacokinetic (PK) parameters (eg, time to maximum plasma concentration [tmax], maximum plasma concentration [Cmax], area
under the plasma concentration-time curve [AUC]).

+ Duración de la respuesta (DR)
+ Tiempo transcurrido hasta el siguiente tratamiento contra el linfoma
+ Supervivencia sin progresión.
+ Tiempo hasta la progresión.
+ Supervivencia global (SG).
+ Parámetros farmacocinéticos (p. ej., tiempo hasta la concentración plasmática máxima [tmáx.], concentración plasmática máxima [Cmáx.], área bajo la curva de concentración plasmática frente al tiempo [ABC]).

E.5.2.1

Timepoint(s) of evaluation of this end point

Overall survival,Time to next anti-lymphoma treatment, Duration of response, Progression free survival

Supervivencia global, Tiempo transcurrido hasta el siguiente tratamiento contra el linfoma, Duración de la respuesta, Supervivencia sin progresión

E.6 and E.7 Scope of the trial

E.6

Scope of the trial

E.6.1

Diagnosis

E.6.2

Prophylaxis

E.6.3

Therapy

Yes

E.6.4

Safety

Yes

E.6.5

Efficacy

Yes

E.6.6

Pharmacokinetic

Yes

E.6.7

Pharmacodynamic

E.6.8

Bioequivalence

E.6.9

Dose response

E.6.10

Pharmacogenetic

E.6.11

Pharmacogenomic

E.6.12

Pharmacoeconomic

E.6.13

Others

E.7

Trial type and phase

E.7.1

Human pharmacology (Phase I)

E.7.1.1

First administration to humans

E.7.1.2

Bioequivalence study

E.7.1.3

Other

E.7.1.3.1

Other trial type description

E.7.2

Therapeutic exploratory (Phase II)

Yes

E.7.3

Therapeutic confirmatory (Phase III)

E.7.4

Therapeutic use (Phase IV)

E.8 Design of the trial

E.8.1

Controlled

E.8.1.1

Randomised

E.8.1.2

Open

Yes

E.8.1.3

Single blind

E.8.1.4

Double blind

E.8.1.5

Parallel group

E.8.1.6

Cross over

E.8.1.7

Other

Yes

E.8.1.7.1

Other trial design description

Estudio con diseño en cesta

basket design study

E.8.2

Comparator of controlled trial

E.8.2.1

Other medicinal product(s)

E.8.2.2

Placebo

E.8.2.3

Other

E.8.2.4

Number of treatment arms in the trial

E.8.3

The trial involves single site in the Member State concerned

E.8.4

The trial involves multiple sites in the Member State concerned

Yes

E.8.4.1

Number of sites anticipated in Member State concerned

E.8.5

The trial involves multiple Member States

Yes

E.8.5.1

Number of sites anticipated in the EEA

E.8.6 Trial involving sites outside the EEA

E.8.6.1

Trial being conducted both within and outside the EEA

Yes

E.8.6.2

Trial being conducted completely outside of the EEA

E.8.6.3

If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned

Australia

Canada

Korea, Republic of

Singapore

Taiwan

United States

France

Spain

Germany

Italy

United Kingdom

E.8.7

Trial has a data monitoring committee

E.8.8

Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial

The end of the study occurs when all patients have either progressed, discontinued, died, become lost to follow-up, or have maintained a CR, PR, or SD for at least 3 years, or when the trial is terminated by the Sponsor.

El final del estudio tiene lugar cuando todos los pacientes hayan sufrido progresión, discontinuado, fallecido, pasen a perderse para el seguimiento, o hayan mantenido una RC, RP o EE durante al menos 3 años, o cuando el promotor decida darlo por terminado

E.8.9 Initial estimate of the duration of the trial

E.8.9.1

In the Member State concerned years

E.8.9.1

In the Member State concerned months

E.8.9.1

In the Member State concerned days

E.8.9.2

In all countries concerned by the trial years

E.8.9.2

In all countries concerned by the trial months

E.8.9.2

In all countries concerned by the trial days

F. Population of Trial Subjects

F.1 Age Range

F.1.1

Trial has subjects under 18

F.1.1.1

In Utero

F.1.1.2

Preterm newborn infants (up to gestational age < 37 weeks)

F.1.1.3

Newborns (0-27 days)

F.1.1.4

Infants and toddlers (28 days-23 months)

F.1.1.5

Children (2-11years)

F.1.1.6

Adolescents (12-17 years)

F.1.2

Adults (18-64 years)

Yes

F.1.2.1

Number of subjects for this age range:

112

F.1.3

Elderly (>=65 years)

Yes

F.1.3.1

Number of subjects for this age range:

F.2 Gender

F.2.1

Female

Yes

F.2.2

Male

Yes

F.3 Group of trial subjects

F.3.1

Healthy volunteers

F.3.2

Patients

Yes

F.3.3

Specific vulnerable populations

Yes

F.3.3.1

Women of childbearing potential not using contraception

F.3.3.2

Women of child-bearing potential using contraception

Yes

F.3.3.3

Pregnant women

F.3.3.4

Nursing women

F.3.3.5

Emergency situation

F.3.3.6

Subjects incapable of giving consent personally

F.3.3.7

Others

F.4 Planned number of subjects to be included

F.4.1

In the member state

F.4.2

For a multinational trial

F.4.2.1

In the EEA

F.4.2.2

In the whole clinical trial

150

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)

Patients continuing to derive benefit from study treatment in the opinion of the Investigator at the end of the study may be able to continue receiving study drugs on an individual basis (eg, by separate protocol or post-trial access plan) with Sponsor approval.

Los pacientes que continúen beneficiándose del tratamiento del estudio en opinión del Investigador al final del estudio pueden continuar recibiendo los medicamentos del estudio de forma individual (p. ej., mediante un protocolo distinto o un plan de acceso posterior al ensayo) con la aprobación del Promotor.

G. Investigator Networks to be involved in the Trial

N. Review by the Competent Authority or Ethics Committee in the country concerned

Competent Authority Decision

Authorised

Date of Competent Authority Decision

2022-07-27

Ethics Committee Opinion of the trial application

Favourable

Ethics Committee Opinion: Reason(s) for unfavourable opinion

Date of Ethics Committee Opinion

2022-06-28

P. End of Trial
P.	End of Trial Status	Ongoing

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