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    Summary
    EudraCT Number:2020-005429-10
    Sponsor's Protocol Code Number:EORTC-1926-BTG
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2022-05-19
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2020-005429-10
    A.3Full title of the trial
    Romiplostim for thrombocytopenia induced by lomustine at first progression of MGMT promoter-methylated glioblastoma: a randomized phase II open label multicenter study
    Romiplostim per la trombocitopenia indotta da lomustina alla prima progressione del glioblastoma con metilazione del promotore di MGMT: uno studio multicentrico di fase II, in aperto, randomizzato
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Romiplostim for thrombocytopenia induced by lomustine at first progression of MGMT promoter-methylated glioblastoma: a randomized phase II open label multicenter study
    Romiplostim per bassi livelli piastrinici dovuti a chemioterapia con lomustina in pazienti con prima recidiva (ricrescita) del tumore al cervello di tipo glioblastoma MGMT metilato
    A.3.2Name or abbreviated title of the trial where available
    RIGOLETTO
    RIGOLETTO
    A.4.1Sponsor's protocol code numberEORTC-1926-BTG
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04933942
    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 SponsorEORTC AISBL/IVZW
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportEuropean Organisation for Research and Treatment of Cancer (EORTC)
    B.4.2CountryBelgium
    B.4.1Name of organisation providing supportAmgen Europe B.V.
    B.4.2CountryNetherlands
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEORTC
    B.5.2Functional name of contact pointRegulatory Affairs Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenue E. Mounierlaan 83/11
    B.5.3.2Town/ cityBrussels
    B.5.3.3Post code1200
    B.5.3.4CountryBelgium
    B.5.4Telephone number+3227741066
    B.5.5Fax number+3227727063
    B.5.6E-mailregulatory@eortc.org
    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 Yes
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameromiplostim
    D.3.2Product code [NA]
    D.3.4Pharmaceutical form Powder for 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 INNRomiplostim
    D.3.9.1CAS number 267639-76-9
    D.3.9.2Current sponsor codeNA
    D.3.9.4EV Substance CodeSUB27756
    D.3.10 Strength
    D.3.10.1Concentration unit µg microgram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    thrombocytopenia caused by chemotherapy drug lomustine
    trombocitopenia causata da chemioterapia con lomustina
    E.1.1.1Medical condition in easily understood language
    Low platelets due to bone marrow suppression caused by chemotherapy drug lomustine
    livello basso di piastrine causata dalla terapia con lomustina
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Confronto della sopravvivenza libera da progressione (PFS) condotto dallo sperimentatore principale locale tra:
    • pazienti trattati con lomustina in monoterapia alla prima progressione nel gruppo di controllo (Braccio A= pazienti trattati con lomustina e miglior standard di cura solo per trombocitopenia)
    • pazienti trattati con lomustina e sottoposti a profilassi secondaria della trombocitopenia indotta da lomustina mediante romiplostim, in aggiunta al miglior standard di cura per la trombocitopenia, nel gruppo sperimentale (Braccio B)
    comparazione della sopravvivenza libera da progressione tra:
    - pazienti trattati con la lomustina alla prima progressione e che ricevono la terapia standard per la trombocitopenia (gruppo di controllo)
    - pazienti trattati con la lomustina alla prima progressione e che ricevono una profilassi secondaria per la trobmocitopenia indotta dalla lomustina con rimoplostim in aggiunta alla terapia standard per la trombocitopenia (gruppo sperimentale)
    E.2.2Secondary objectives of the trial
    • To assess overall survival
    • To compare PFS by central review according to RANO criteria
    • To assess response by local investigator and by central review in patients with measurable disease
    • To determine the exposure to lomustine for both arms, romiplostim in arm B, platelet values, platelet transfusions
    • To assess health-related quality of life
    • To investigate treatment safety
    • To perform health care resource use analysis (including platelet transfusions and days of hospitalization)
    • Valutazione della sopravvivenza complessiva (OS) tra i 2 bracci
    • Confronto della PFS in base ad una revisione centrale
    • Valutazione della risposta in pazienti con malattia misurabile in entrambi i bracci
    • Determinazione dell’esposizione alla lomustina in entrambi i bracci e al romiplostim solo nel braccio sperimentale, dei valori piastrinici e delle trasfusioni
    • Valutazione della qualità della vita correlata alla salute
    • Indagine sulla sicurezza del trattamento
    • Analisi dell’uso delle risorse sanitarie (comprese le trasfusioni di piastrine e i giorni di ricovero).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    • Age 18 years or more on day of signing informed consent
    • Karnofsky Performance Score (KPS) of 60-100
    • Life expectancy > 8 weeks
    • Stable or decreasing dose of steroids for at least 1 week prior to enrolment
    • Glioblastoma, isocitrate dehydrogenase (IDH1) R132H wild-type, per cIMPACT NOW recommendations (Brat et al., 2018; Brat et al., 2020)
    • MGMT promoter methylation determined by methylation-specific PCR or pyrosequencing or methylation profiling per local assessment
    • Treatment with lomustine alone for first progression after any treatment comprising intent to treat with standard TMZ /RT -> TMZ for newly diagnosed disease, with at least one dose of maintenance TMZ received. Hypofractionated regimens of RT are allowed.
    • Clinically relevant thrombocytopenia defined as thrombocytopenia requiring dose delay of lomustine for at least one week (more than 7 days) (for any grade of toxicity) or requiring a dose reduction of lomustine because of grade 3 or 4 thrombocytopenia.
    • Diagnosis of first recurrence according to RANO criteria (Wen et al., 2010) more than 3 months after the end of radiotherapy for first-line treatment
    • Patients may have been operated for recurrence.
    • For non-operated patients: recurrent disease must correspond to at least one bi-dimensionally measurable contrast-enhancing lesion with clearly defined margins by MRI scan, with minimal diameters of 10 mm (10x10 mm), visible on 2 or more axial slices 5 mm apart (measurable disease according to RANO criteria)[20]. The MRI can be used for enrolment if dated within 6 weeks prior to enrolment.
    • In case of clinical deterioration or increase of steroids since the last MRI, a new MRI should be done prior to enrolment and should be dated within 6 weeks prior to enrolment.
    • Capacity for adequate fluid and oral intake
    • Adequate bone marrow (except for platelet count, which can be <100 000 x 109/L at enrolment), renal and hepatic function within 7 days before enrolment:
    • Haemoglobin = 8 g/dl
    • Leukocytes count NOT requiring CGSF per local SOC
    • Total bilirubin = 1.5 ULN
    • alanine aminotransferase (SGPT), aspartate aminotransferase (SGOT), alkaline phosphatase (ALP) = 2.5 × ULN
    • Serum creatinine < 1.5 x ULN or creatinine clearance (CrCl) > 30 mL/min (using the Cockcroft-Gault formula)
    • Women of childbearing potential (WOCBP) must have a negative urine or serum pregnancy test within 7 days prior to enrolment.
    • Patients of childbearing / reproductive potential must agree to use adequate birth control measures, as defined by the investigator, during the study treatment period and for at least 6 months after the last study treatment, due to mutagenic effect of lomustine. A highly effective method of birth control is defined as those which result in low failure rate (i.e. less than 1% per year) when used consistently and correctly. (see Appendix F).
    • Patients must also agree not to donate sperm during the study and for 6 months after receiving the last dose of study treatment due to mutagenic effect of lomustine.
    • Women who are breast feeding must agree to discontinue nursing prior to the first dose of study treatment and until 6 months after the last study treatment.
    • Ability to understand the requirements of the study, provide written informed consent and authorization of use and disclosure of protected health information, and agree to abide by the study restrictions and return for the required assessments
    • Before patient enrolment, written informed consent must be given according to ICH/GCP, and national/local regulations.
    • Età pari o superiore a 18 anni nel giorno della firma del consenso informato
    • Punteggio della scala di Karnofsky (KPS) di 60-100
    • Aspettativa di vita > 8 settimane
    • Dose stabile o decrescente di steroidi per almeno 1 settimana prima dell’arruolamento
    • Glioblastoma con isocitrato deidrogenasi (IDH1) R132H wild-type, secondo le raccomandazioni cIMPACT NOW (Brat et al., 2018; Brat et al., 2020)
    • Metilazione del promotore di MGMT determinata mediante PCR metilazione-specifica o pirosequenziamento o definizione dei profili di metilazione per valutazione locale
    • Trattamento con lomustina in monoterapia per la prima progressione dopo qualsiasi trattamento comprendente intent-to-treat con TMZ/RT ¿TMZ standard per glioblastoma di nuova diagnosi, con almeno una dose di TMZ di mantenimento ricevuta.
    • Trombocitopenia clinicamente rilevante definita come trombocitopenia che richiede un ritardo della dose di lomustina per almeno una settimana (più di 7 giorni) (per qualsiasi grado di tossicità) o che richiede una riduzione della dose di lomustina a causa di trombocitopenia di grado 3 o 4
    • Diagnosi di prima progressione secondo i criteri RANO (Wen et al., 2010) a più di 3 mesi dopo la fine della radioterapia per il trattamento di prima linea
    • I pazienti possono essere stati operati per recidiva.
    • Per i pazienti non operati: la recidiva deve corrispondere ad almeno una lesione misurabile bidimensionalmente mediante mezzo di contrasto con margini chiaramente definiti mediante risonanza magnetica, diametri minimi di 10 mm (10x10 mm), visibile su 2 o più sezioni assiali distanti 5 mm (malattia misurabile secondo i criteri RANO).
    • In caso di deterioramento clinico o aumento degli steroidi dall’ultima risonanza magnetica, deve essere eseguita una nuova risonanza magnetica prima dell’arruolamento e datata entro le 6 settimane precedenti.
    • I pazienti con diagnosi di tromboembolia venosa o eventi trombotici negli ultimi 3 mesi possono essere arruolati se sono stati in regime stabile di anticoagulanti per almeno 14 giorni.
    • Capacità di un’adeguata assunzione di liquidi e per via orale
    • Midollo osseo adeguato (ad eccezione della conta piastrinica, che può essere < 100x109/L all’arruolamento), funzionalità renale ed epatica entro i 7 giorni precedenti l’arruolamento
    • Emoglobina = 8 g/dl
    • Conta dei leucociti che NON richiede CGSF secondo lo standard di cura locale
    • Bilirubina totale = 1,5 ULN
    • Alanina aminotransferasi (ALT), aspartato aminotransferasi (AST), fosfatasi alcalina (ALP) = 2,5 × ULN
    • Creatinina sierica < 1,5 x ULN o clearance della creatinina (CrCl) > 30 mL/min (usando la formula di Cockcroft-Gault)
    • Le donne in età fertile (WOCBP) devono avere un test di gravidanza delle urine o sierologico negativo entro i 7 giorni precedenti l’arruolamento.
    • I pazienti in età fertile/con potenziale riproduttivo devono accettare di utilizzare misure contraccettive adeguate, come definito dallo sperimentatore, durante il periodo di trattamento in studio e per almeno 6 mesi dopo l’ultimo trattamento dello studio. Con metodo di controllo delle nascite altamente efficace si intende un metodo che risulta in un basso tasso di fallimento (ovvero meno dell’1% all’anno) se usato in modo costante e corretto
    • I pazienti devono inoltre accettare di non donare sperma durante lo studio e per 6 mesi dopo aver ricevuto l’ultima dose del trattamento dello studio
    • Le donne che allattano al seno devono accettare di interrompere l’allattamento prima della prima dose del trattamento dello studio e fino a 6 mesi dopo l’ultimo trattamento dello studio
    • Capacità di comprendere i requisiti dello studio, concedere consenso informato scritto e autorizzazione all’uso e alla divulgazione di informazioni sanitarie protette e accettare di rispettare le restrizioni dello studio e restituire le valutazioni richieste
    • Prima dell’arruolamento del paziente, deve essere concesso il consenso informato scritto secondo ICH/GCP e le normative nazionali/locali
    E.4Principal exclusion criteria
    • Radiotherapy or stereotactic radiosurgery for the treatment of first recurrence prior to enrolment in this study
    • Known further progression after initiation of lomustine at the time of enrolment. Any suspicion of progression should be explored by a new MRI prior to enrolment
    • Prior exposure to romiplostim or other TPO mimetics
    • Contraindications for MRI, including intolerance of gadolinium as a contrast agent
    • Known coagulation disease or known haematological disease even if resolved.
    • Known hypercoagulative state (e.g., factor V Leiden, protein C deficiency, III deficiency, protein S deficiency, antiphospholipid antibody syndrome)
    • Other haematological toxicity (anaemia, neutropenia) requiring erythropoietin or GCSF.
    • New or uncontrolled venous thromboembolism or thrombotic events within 3 months prior to enrolment. Patients diagnosed with a venous thromboembolism or thrombotic events within the last 3 months can be enrolled if they have been on a stable regimen of anticoagulation for at least 14 days
    • Clinically significant cardiac comorbidities, including: history of arterial thrombotic events (eg, myocardial ischemia, transient ischemic attack, or stroke) within 6 months prior to enrolment, any history of active congestive heart failure (NYHA class II to IV), symptomatic ischaemia including known myocardial infarction, uncontrolled cardiac arrythmias, clinically significant ECG abnormalities, including screening ECG with QTc interval > 470 msec in women, >450 msec in men, known pericardial disorder .
    • Evidence of active infection within 2 weeks prior to enrolment
    • Known hypersensitivity to any E-coli derived product
    • Known hypersensitivity to the active substances or to any of the excipients of the study drugs,
    • History or present acute lymphoblastic leukaemia, acute myeloid leukaemia, any myeloid malignancy, myelodysplastic syndrome, myeloproliferative disease, multiple myeloma
    • Live attenuated vaccine within 3 months of lomustine initiation.
    • Known coeliac disease or wheat allergy
    • Concurrent severe or uncontrolled medical disease (e.g., active systemic infection, diabetes, hypertension, coronary artery disease) that, in the opinion of the Investigator, would compromise the safety of the patient or compromise the ability of the patient to complete the study
    • Known human immunodeficiency virus infection or acquired immune deficiency syndrome
    • Known chronic active HBV or HCV
    • Previous other malignancies, except for any previous malignancy which was treated with curative intent more than 2 years prior to enrolment, and except for adequately controlled limited basal cell carcinoma of the skin, adequately treated and without evidence of disease non-melanoma of the skin, squamous carcinoma of the skin and carcinoma in situ of the cervix, adequately treated breast ductal carcinoma in situ without evidence of disease, prostatic intraepithelial neoplasia without evidence of prostate cancer, low risk prostate cancer (cT1-2a N0 and Gleason score = 6 and PSA < 10 ng/mL), either totally resected or irradiated with curative intent (with PSA of less than or equal to 0.1 ng/mL) or under active surveillance as per ESMO guidelines
    • Pregnant women
    • Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
    • Radioterapia o radiochirurgia stereotassica per il trattamento della prima progressione prima dell’arruolamento in questo studio
    • Ulteriore progressione nota dopo l’inizio della lomustina al momento dell’arruolamento. Qualsiasi sospetto di progressione deve essere approfondito mediante nuova risonanza magnetica prima dell’arruolamento
    • Precedente esposizione a romiplostim o ad altri trombopoietino-mimetici (TPO)
    • Altra tossicità ematologica (anemia, neutropenia) che richiede eritropoietina o GCSF
    • Controindicazioni alla risonanza magnetica, inclusa l’intolleranza al gadolinio come mezzo di contrasto
    • Malattia della coagulazione nota o malattia ematologica nota anche se risolta.
    • Stato ipercoagulativo noto (ad es., fattore V Leiden, deficit di ATIII, deficit di proteina C, deficit di proteina S, sindrome da anticorpi antifosfolipidi)
    • Comorbidità cardiache clinicamente significative, tra cui: storia di eventi trombotici arteriosi (ad es., ischemia miocardica, attacco ischemico transitorio o ictus) nei 6 mesi precedenti lo screening, qualsiasi storia di insufficienza cardiaca congestizia attiva (classe NYHA da II a IV), ischemia sintomatica, compreso infarto del miocardio, aritmie cardiache non controllate, anomalie sull’ECG clinicamente significative, incluso ECG di screening con intervallo QTc > 470 ms nelle donne, > 450 ms negli uomini, patologia pericardica nota.
    • Leucemia linfoblastica acuta passata o presente, leucemia mieloide acuta, qualsiasi neoplasia mieloide, sindrome mielodisplastica, malattia mieloproliferativa, mieloma multiplo
    • Evidenza di infezione attiva entro le 2 settimane precedenti l’arruolamento
    • Ipersensibilità nota a qualsiasi prodotto derivato da E-coli
    • Ipersensibilità nota ai principi attivi o a uno qualsiasi degli eccipienti dei farmaci in studio
    • Qualsiasi vaccino vivo attenuato, come il vaccino contro la febbre gialla, nei 3 mesi precedenti l’inizio della terapia con lomustina.
    • Celiachia nota o allergia al grano
    • Malattia medica concomitante grave o non controllata (ad es. infezione sistemica attiva, diabete, ipertensione, malattia coronarica) che, a parere dello sperimentatore, comprometterebbe la sicurezza del paziente o la sua capacità di completare lo studio
    • Infezione da virus dell’immunodeficienza umana o sindrome da immunodeficienza acquisita nota
    • HBV o HCV cronico attivo noto entro i 4 mesi precedenti l’arruolamento
    • Altri tumori maligni precedenti, ad eccezione di eventuali tumori maligni precedenti trattati con intento curativo oltre 2 anni prima dell’arruolamento, e ad eccezione del carcinoma a cellule basali della pelle limitato adeguatamente controllato, adeguatamente trattato e senza evidenza di malattia della pelle non melanoma, carcinoma squamoso della pelle e carcinoma in situ della cervice, carcinoma duttale della mammella in situ adeguatamente trattato senza evidenza di malattia, neoplasia prostatica intraepiteliale senza evidenza di cancro alla prostata. Carcinoma prostatico a basso rischio (cT1-2a N0 e punteggio di Gleason = 6 e PSA < 10 ng/mL), sia totalmente resecato sia irradiato con intento curativo (con PSA inferiore o uguale a 0,1 ng/mL) o sotto sorveglianza attiva come secondo le linee guida ESMO
    • Donne in stato di gravidanza
    • Qualsiasi condizione psicologica, familiare, sociologica o geografica che possa potenzialmente ostacolare il rispetto del protocollo di studio e del programma di follow-up; tali condizioni devono essere discusse con il paziente prima della registrazione nella sperimentazione
    E.5 End points
    E.5.1Primary end point(s)
    Progression-free survival (PFS) as assessed by local investigator according to RANO criteria (measured from the date of enrolment.)
    PFS valutata dallo sperimentatore locale secondo i criteri RANO (misurata dalla data di arruolamento).
    E.5.1.1Timepoint(s) of evaluation of this end point
    until disease progression
    fino a progressione della malattia
    E.5.2Secondary end point(s)
    PFS by central review according to RANO criteria (measured from the date of enrolment).; Response by local investigator and by central review according to RANO criteria (objective response (PR+CR) rate, complete response rate and duration of objective and complete response (for non-surgical patients or patients with surgery for recurrence but measurable disease thereafter).; Parameters of drug delivery for lomustine in both arms and romiplostim in arm B, platelet values, platelet transfusions; Total number of lomustine cycles prior and after enrolment, reason for discontinuation (haematological toxicities, in particular thrombocytopenia, non-haematological toxicities, progression, toxicity, patient or investigator decision, other reasons,....).; Reason for lomustine dose delays, dose reductions and discontinuations in both groups (progression, toxicity including thrombocytopenia, other haematological toxicity, non-haematological toxicities, and other causes of discontinuation); HRQoL measured by EORTC QLQ-C30 and QLQ-BN20 including one additional item from EORTC Symptom Based Questionnaire (Q940: have you bruised easily?); Frequency of worst Adverse Events (AEs) or Laboratory Event grades according to CTCAE v5.0, notably platelet values and thrombocytopenia related adverse events in both arms; Health care resource use measured by the number of platelet transfusions, number of days of hospitalization and causes of hospitalization (any cause and specifically for thrombocytopenia), stays at hospital (including admission at the emergency room).; Overall survival (measured from the date of enrolment)
    PFS valutata secondo una revisione centrale in base ai criteri RANO (misurata dalla data di arruolamento); Risposta al trattamento valutata secondo lo sperimentatore locale e una revisione centrale in base ai criteri RANO (tasso di risposta obiettiva (PR+CR), tasso di risposta completa e durata della risposta obiettiva e completa per pazienti non chirurgici o pazienti con intervento chirurgico per recidiva ma malattia successivamente misurabile); Parametri di somministrazione del farmaco (lomustina per entrambi i bracci, romiplostim nel Braccio B), valori piastrinici, trasfusioni piastriniche; Numero totale di cicli di lomustina prima e dopo l’arruolamento, motivo dell’interruzione (tossicità ematologiche, in particolare trombocitopenia, tossicità non ematologiche, progressione, tossicità, decisione del paziente o dello sperimentatore, altri motivi...); Motivo del ritardo della dose di lomustina, riduzione della dose e interruzione in entrambi i gruppi: progressione, tossicità inclusa tossicità piastrinica, altre tossicità ematologiche, tossicità non ematologiche e altre cause di interruzione; Qualità della vita correlata alla salute (HRQoL) misurata con i questionari EORTC QLQ-C30 e QLQ-BN20 e un elemento aggiuntivo dal Questionario Basato sui Sintomi dell’EORTC (Q940: ha notato la comparsa di lividi con facilità?); Frequenza dei peggiori Eventi Avversi (AE) o gradi degli Eventi di Laboratorio secondo CTCAE v5.0, in particolare valori piastrinici ed eventi avversi correlati alla trombocitopenia in entrambi i bracci; Utilizzo delle risorse sanitarie misurato dal numero di trasfusioni di piastrine, numero di giorni di ricovero e cause di ricovero (qualsiasi causa e in particolare per eventi avversi trombocitopenici o correlati alla trombocitopenia), permanenze ospedaliere (compresa la permanenza al pronto soccorso); OS (misurata dalla data di arruolamento)
    E.5.2.1Timepoint(s) of evaluation of this end point
    until disease progression; NA; - within 2 days of randomization
    - Arm A: weekly assessments
    - Arm B: weekly visits, at EOT visit.; - within 2 days of randomization
    - Arm A: 6 weekly visits
    - Arm B: 6 weekly visits, at EoT visit; - within 2 days of randomization
    - within 2 days of randomization
    - Arm A: weekly
    - Arm B: weekly, at EoT visit; - before randomization: within 14 days
    - Arm A: 6 weekly visits
    - Arm B: 6 weekly visits
    - follow up: every 12 weeks +/- 2 days for a maximum of 2 years; - Arm A: weekly assessments
    - Arm B: weekly visits, at EOT visit
    - follow-up: until stabilization or resolution; - Arm A: 6 weekly visits, day 1
    - Arm B: 6 weekly visits, day 1, at EoT visit; every 12 weeks +/- 2 weeks (until death or lost to follow-up) after EOT visit.
    a progressione avvenuta; NA; - nelle 2 settimane dalla randomizzazione
    - braccio A: settimanale
    - braccio B: settimanale, visita EOT; - nelle 2 settimane dalla randomizzazione
    - braccio A: visita della 6° settimana
    - braccio B: visita della 6° settimana, visita EOT; - entro 2 giorni dalla randomizzazione
    - nelle 2 settimane dalla randomizzazione
    - braccio A: settimanalmente
    - braccio B: settimanalmente, visita EOT; - prima della randomizzazione: entro 14 giorni
    - braccio A: visita della 6° settimana
    - braccio B: visita della 6° settimana
    - visite di controllo: ogni 12 settimane +/- 2 giorni per un massimo di 2 anni; - braccio A: settimanalmente
    - braccio B: settimanalmente, visita EOT
    - follow-up: fino a stabilizzazione o risoluzione; - braccio A: ogni 6 settimane, giorni 1
    - braccio B: og
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis Yes
    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 Yes
    E.6.13.1Other scope of the trial description
    quality of life; health economics
    qualità della vita; economia sanitaria
    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) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    standard di cura
    standard of care
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA52
    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 Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Austria
    France
    Netherlands
    Spain
    Switzerland
    Germany
    Italy
    Belgium
    United Kingdom
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    End of study occurs when all of the following criteria have been satisfied:

    1. Thirty days after all patients have stopped protocol treatment
    2. The trial is mature for the analysis of the primary endpoint as defined in the protocol
    3. The database has been fully cleaned and locked for this analysis
    la conclusione della sperimentazione si verifica quando tutti i seguenti criteri sono soddisfatti::
    1. 30 giorni dopo tutti i pazienti hanno finito il trattamento secondo il protocollo
    2. la sperimentazione è matura per l'analisi dell'endpoint primario come definito nel protocollo
    3. il database è stato completamente pulito e chiuso per l'analisi
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days14
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months5
    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: 67
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 33
    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 state19
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 89
    F.4.2.2In the whole clinical trial 100
    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)
    At the discretion of the treating physician.
    A discrezione del medico curante.
    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 Decision2022-07-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-21
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2022-12-19
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