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    Summary
    EudraCT Number:2020-005639-65
    Sponsor's Protocol Code Number:GEICAM/2017-01_IBCSG62-20_BIG18-04
    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:2021-06-30
    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 number2020-005639-65
    A.3Full title of the trial
    A randomized phase III trial of trastuzumab + ALpelisib +/- fulvestrant versus trastuzumab + chemotherapy in patients with PIK3CA mutated previously treated HER2+ Advanced BrEasT cancer. “ALPHABET Study”
    Ensayo aleatorizado de fase III de trastuzumab + ALpelisib +/- fulvestrant frente a trastuzumab + quimioterapia en pacientes con cáncer de mama avanzado HER2+ con mutación de PIK3CA previamente tratadas. “Estudio ALPHABET”
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A phase III trial of trastuzumab + ALpelisib +/- fulvestrant versus trastuzumab + chemotherapy in patients with PIK3CA mutated previously treated HER2+ Advanced BrEasT cancer. “ALPHABET Study”
    Ensayo fase III de trastuzumab + ALpelisib con o sin fulvestrant frente a trastuzumab + quimioterapia en pacientes con cáncer de mama avanzado HER2+ con mutación de PIK3CA y tratados previamente. “Estudio ALPHABET”
    A.3.2Name or abbreviated title of the trial where available
    ALPHABET
    ALPHABET
    A.4.1Sponsor's protocol code numberGEICAM/2017-01_IBCSG62-20_BIG18-04
    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 SponsorGEICAM (Fundación Grupo Español de Investigación en Cáncer de Mama)
    B.1.3.4CountrySpain
    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 supportNovartis Pharma AG
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGEICAM (Fundación Grupo Español de Investigación en Cáncer de Mama)
    B.5.2Functional name of contact pointClinical Operations Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenida de los Pirineos nº 7, 1ª Planta, oficina 1-14
    B.5.3.2Town/ citySan Sebastián de los Reyes (Madrid)
    B.5.3.3Post code28703
    B.5.3.4CountrySpain
    B.5.4Telephone number34916592870
    B.5.5Fax number34916510406
    B.5.6E-mailgeicam@geicam.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.2.5The 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 nameAlpelisib
    D.3.2Product code BYL719
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNALPELISIB
    D.3.9.1CAS number 1217486-61-7
    D.3.9.2Current sponsor codeBYL719
    D.3.9.3Other descriptive nameAlpelisib
    D.3.9.4EV Substance CodeSUB180707
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The 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 nameAlpelisib
    D.3.2Product code BYL719
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNALPELISIB
    D.3.9.1CAS number 1217486-61-7
    D.3.9.2Current sponsor codeBYL719
    D.3.9.3Other descriptive nameAlpelisib
    D.3.9.4EV Substance CodeSUB180707
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    PIK3CA mutated HER2+ advanced or relapsed breast cancer (BC) previously treated with trastuzumab and trastuzumab emtansine (T-DM1)
    Cáncer de mama (CM) avanzado o recidivante HER2+ con mutación de PIK3CA
    previamente tratado con trastuzumab y trastuzumab emtansina (T-DM1)
    E.1.1.1Medical condition in easily understood language
    PIK3CA mutated and HER2 positive metastatic breast cancer (ABC), previously treated with trastuzumab T-DM1
    Cáncer de mama metastásico (CMA) HER2 positivo y con mutación de PIK3CA
    previamente tratado con trastuzumab y T-DM1
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027475
    E.1.2Term Metastatic breast cancer
    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 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
    -To determine whether the PI3K inhibitor alpelisib + trastuzumab improve efficacy, as measured by PFS, compared to trastuzumab + chemotherapy of physician's choice (vinorelbine, capecitabine or eribulin) in previously treated HER2+/HR- PIK3CA mutated advanced breast cancer patients.
    -To determine whether the PI3K inhibitor alpelisib + trastuzumab + fulvestrant improve efficacy, as measured by PFS, compared to trastuzumab + hemotherapy of physician's choice (vinorelbine, capecitabine or eribulin) in previously treated HER2+/HR+ PIK3CA mutated advanced breast cancer patients.
    -Determinar si el inhibidor de PI3K alpelisib + trastuzumab mejoran la eficacia, determinada mediante la SLP, en comparación con la combinación formada por trastuzumab + la quimioterapia elegida por el médico del estudio (vinorelbina,capecitabina o eribulina) en pacientes con cáncer de mama avanzado HER2+/RH- con mutación de PIK3CA previamente tratados.
    -Determinar si el inhibidor de la PI3K alpelisib + trastuzumab + fulvestrant mejoran la eficacia, determinada mediante la SLP, en comparación con la combinación formada por trastuzumab + la quimioterapia elegida por el médico del estudio (vinorelbina, capecitabina o eribulina) en pacientes con cáncer de mama avanzado HER2+/RH+ con mutación de PIK3CA previamente tratados.
    E.2.2Secondary objectives of the trial
    -To compare additional measures of efficacy between treatment arms per cohort of
    patients:
    Overall survival (OS).
    Objective response rate (ORR).
    -To compare safety and tolerability between treatment arms per cohort of patients.
    -Comparar medidas de eficacia adicionales entre los brazos de tratamiento, por cohorte de pacientes:
    Supervivencia global (SG).
    Tasa de respuestas objetivas (TRO).
    -Comparar la seguridad y la tolerabilidad entre los brazos de tratamiento, por cohorte de pacientes.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Written informed consent prior to any specific study procedures, showing patient willingness to comply with all study procedures.
    2.Documented HER2+ status based on local laboratory determination, preferably on the most recent available FFPE tumor sample, and according to American Society of Clinical Oncology (ASCO)/Collegue of American Pathologists (CAP) international guidelines valid at the time of the assay.
    3.Documented HR status based on local laboratory, preferably on the most recent available FFPE tumor sample, and according to ASCO/CAP international guidelines valid at the time of the assay. In case of discordance in HR status by different biopsies, we will consider the most recent one. HR+ will be defined as ≥1% positive cells by immunohistochemistry for Estrogen Receptor (ER) and/or Progesterone Receptor (PgR). HR- will be defined as <1% positive cells by immunohistochemistry for both ER and PgR. For the purpose of this study, patients with ER and PgR expression between 1 and 10% (considered to be HR low by the most recent ASCO/CAP guidelines) will be eligible for inclusion in the HR- cohort.
    4.Patients with a PIK3CA tumor mutation at central laboratory determination, preferably on the most recent available FFPE tumor sample.
    5.At least 1 but no more than 4 prior lines of anti-HER2 based therapy for metastatic breast cancer (MBC). Maintenance therapy will not count as an additional line of therapy.
    6.At least 1 prior line of trastuzumab in the metastatic setting, or in the (neo)adjuvant setting (provided the patient relapsed while on therapy or within 6 months after completing adjuvant trastuzumab).
    7.Previous therapy with T-DM1 is mandatory. Patients with residual disease after neoadjuvant therapy and treated with adjuvant T-DM1 will be allowed to enter the study.
    8.Female or male patient is at least 18 years of age.
    9.Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1.
    10.Patients can be either males or premenopausal/perimenopausal or postmenopausal females. In the HR+ cohort, males and females who are not post-menopausal must have been on a gonadotropin-releasing hormone (GnRH) agonist (e.g. goserelin or leuprorelin) for at least 28 days prior to starting study treatment.
    11.Measurable disease or at least one evaluable bone lesion, lytic or mixed (lytic+blastic), which has not been previously irradiated and is assessable by computer tomography (CT)/magnetic resonance imaging (MRI) in the absence of measurable disease according to RECIST 1.1 criteria.
    12.Life expectancy ≥ 12 weeks.
    13.Adequate organ and marrow function defined as follows:
    -Absolute neutrophil count (ANC) ≥ 1,500/mm3 (1.5x109/L).
    -Platelets ≥ 100,000/mm3 (100x109/L).
    -Hemoglobin ≥ 9g/dL (90g/L).
    -Calcium (corrected for serum albumin) and magnesium within normal limits or ≤ grade 1.
    -Creatinine <1.5 x upper limit of normal (ULN) or creatinine Clearance ≥ 35 mL/min using Cockcroft-Gault formula (if creatinine is ≥1.5 ULN).
    -Total bilirubin < 2 x ULN (any elevated bilirubin should be asymptomatic at enrollment) except for patients with Gilbert’s syndrome who may only be included if the total bilirubin is ≤ 3.0 x ULN or direct bilirubin ≤ 1.5 x ULN.
    -Potassium within normal limits, or corrected with supplements.
    -Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3.0 x ULN. If patient has liver metastasis, AST and ALT ≤ 5.0 x ULN.
    -Fasting serum amylase ≤ 2.0 x ULN.
    -Fasting serum lipase ≤ ULN.
    -Fasting plasma glucose (FPG) < 140 mg/dL (7.7 mmol/L) and glycosylated hemoglobin (HbA1c) < 6.5%.
    14.Resolution of all acute toxic effects of prior anti-cancer therapy or surgical procedures to NCI-CTCAE version 5.0 grade ≤ 1 (except alopecia or other toxicities not considered a safety risk for the patient at investigator´s discretion).
    15.Adequate cardiac function as defined by left ventricular ejection fraction (LVEF) of ≥ 50% measured by echocardiography or multi-gated acquisition (MUGA) scans.

    “Please consult the complete criteria in the protocol”
    1.Consentimiento informado por escrito, obtenido previamente a la realización de cualquier procedimiento específico del estudio, que muestre que el paciente está de acuerdo en cumplir con todos los procedimientos del estudio.
    2.Documentación del estado del HER2+, basándose en la determinación del laboratorio local, preferiblemente en la muestra de tumor FFEP más reciente disponible, de acuerdo con las guías internacionales de la Sociedad Americana de Oncología Clínica (American Society of Clinical Oncology, ASCO)/Colegio de Anatomopatólogos Americano (College of American Pathologists, CAP) en vigor en el momento de realizar la prueba.
    3.Documentación del estado de los RHs, basándose en la determinación del laboratorio local, preferiblemente en la muestra de tumor FFEP más reciente disponible, de acuerdo con las guías internacionales de la ASCO/CAP en vigor en el momento de realizar la prueba. En caso de discordancia respecto a la situación de los RHs en las distintas biopsias, se considerará la más reciente. RH+ se definirá como ≥1% de células positivas mediante inmunohistoquímica para el receptor de estrógeno (RE) y/o el receptor de la progesterona (RPg). RH- se definirá como <1% de células positivas mediante inmunohistoquímica para el RE y el RPg. Para los fines de este estudio, los pacientes con expresión de RE y RPg entre un 1 y un 10% (considerados como con un nivel bajo de RH según las guías de la ASCO/CAP más recientes) serán elegibles para su inclusión en la cohorte RH-.
    4.Pacientes con una mutación de PIK3CA tumoral en la determinación del laboratorio central, preferentemente en la muestra de tumor FFEP más reciente disponible.
    5.Al menos una pero, no más de cuatro líneas previas, de terapia basada en agentes anti-HER2 para el cáncer de mama metastásico (CMM). La terapia de mantenimiento no contará como una línea de tratamiento adicional.
    6.Al menos una línea previa de trastuzumab en el entorno metastásico o (neo)adyuvante (a condición de que el paciente hubiese presentado la recidiva mientras se encontraba en tratamiento o dentro de los 6 meses posteriores a la finalización de la terapia adyuvante con trastuzumab).
    7.Es obligatorio haber recibido tratamiento previo con T-DM1. Los pacientes con enfermedad residual tras la terapia neoadyuvante que hayan sido tratados con T-DM1 adyuvante podrán participar en el estudio.
    8.Mujeres y varones de al menos 18 años de edad.
    9.Pacientes con un estado funcional ECOG (Eastern Cooperative Oncology Group) de 0-1.
    10.Los pacientes podrán ser varones o mujeres premenopáusicas/perimenopáusicas o posmenopáusicas. En la cohorte con RH+, tanto los varones como las mujeres que no sean posmenopáusicas deberán haber recibido un agonista de la hormona liberadora de gonadotropina (GnRH) (p. ej., goserelina o leuprorelina) durante un mínimo de 28 días antes de iniciar el tratamiento del estudio.
    11.Enfermedad medible según la versión 1.1. de los criterios RECIST o, en ausencia de enfermedad medible, al menos una lesión ósea evaluable, lítica o mixta (lítica + blástica) que no se haya irradiado previamente y sea evaluable mediante tomografía computarizada (TAC)/resonancia magnética nuclear (RMN).
    12.Esperanza de vida ≥ 12 semanas.
    13.Pacientes con función orgánica y de la médula ósea adecuadas, definidas tal como sigue:
    -Recuento absoluto de neutrófilos (RAN) ≥ 1,500/mm3 (1,5x109/l).
    -Plaquetas ≥ 100.000/mm3 (100x109/l).
    -Hemoglobina ≥ 9 g/dl (90 g/l).
    -Calcio (corregido teniendo en cuenta la albúmina sérica) y magnesio dentro de los límites normales o ≤ grado 1.
    -Creatinina <1,5 x límite superior de la normalidad (LSN) o aclaramiento de creatinina ≥ 35 ml/min, utilizando la fórmula de Cockcroft-Gault (si la creatinina es ≥1,5 LSN).
    -Bilirrubina total < 2 x LSN (cualquier nivel elevado de bilirrubina deberá ser asintomático en el momento de la inclusión), a excepción de los pacientes con síndrome de Gilbert, que podrán incluirse solo si la bilirrubina total es ≤ 3,0 x LSN o la bilirrubina directa es ≤ 1,5 x LSN.
    -Potasio dentro de los límites de normalidad, o bien corregido mediante suplementos.
    -Aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) ≤ 3,0 x LSN. Si el paciente presenta metástasis hepáticas, la AST y la ALT deberán ser ≤ 5,0 x LSN.
    -Amilasa sérica en ayunas ≤ 2,0 x LSN.
    -Lipasa sérica en ayunas ≤ LSN.
    -Glucosa plasmática en ayunas (GPA) < 140 mg/dl (7,7 mmol/l) y hemoglobina glicosilada (HbA1c) < 6,5%.
    14.Resolución de todos los efectos tóxicos agudos de los tratamientos antineoplásicos o procedimientos quirúrgicos previos hasta un grado ≤ 1 de la versión 5.0 de los NCI-CTCAE (a excepción de la alopecia y otras toxicidades no consideradas como riesgo de seguridad para el paciente, a criterio del investigador).
    15.Función cardíaca adecuada, definida por una fracción de eyección del ventrículo izquierdo (FEVI) ≥ 50%, determinada mediante ecocardiografía o ventriculografía isotópica (MUGA).

    Consultar protocolo
    E.4Principal exclusion criteria
    1.Have received more than 4 previous lines of anti-HER2 based therapy for MBC, or prior fulvestrant.
    2.Symptomatic visceral disease or any disease burden that makes the patient ineligible for experimental therapy per the investigator’s best judgment.
    3.Symptomatic central nervous system (CNS) metastases. However, patients with CNS metastases who have been adequately treated, are asymptomatic and do not require corticosteroid or anti-epileptic medication are eligible.
    4.Presence of leptomeningeal carcinomatosis.
    5.Invasive malignancy at the time of enrollment or previous diagnosis of a completely removed malignancy within 3 years prior to randomization except for adequately treated (including complete surgical removal) of International Federation of Gynecology and Obstetrics (FIGO) stage I grade 1 endometrial cancer, basal or squamous cell carcinoma of the skin, thyroid cancer limited to thyroid gland, in situ carcinoma of the cervix, and grade 1-2 early stage bladder cancer defined as T1 or less, without nodal involvement (N0).
    6.Patients with an established diagnosis of diabetes mellitus type I or not controlled type II (FPG ≥ 140 mg/dL [7.7 mmol/L] or HbA1c ≥ 6.5%), or history of gestational diabetes (as per ACOG guidelines) or documented steroid-induced diabetes mellitus.
    7.Prior treatment with any mTOR, AKT or PI3K inhibitor.
    8.Patients treated within the last 7 days prior to treatment initiation with:
    -Drugs that are strong inducers of CYP3A4.
    -Drugs that are inhibitors of BCRP (Breast Cancer Resistance Protein).
    9.Patients who received before randomization:
    -Any investigational agent within 4 weeks.
    -Chemotherapy within a period of time that is shorter than the cycle duration used for that treatment (e.g. < 3 weeks for fluorouracil, doxorubicine, epirubicine or < 1 week for weekly chemotherapy).
    -Biologic therapy (e.g., antibodies): up to 4 weeks prior to starting study treatment.
    -Endocrine therapy: tamoxifen or aromatase inhibitor (AI) within 2 weeks prior to starting study treatment.
    -Corticosteroids within 2 weeks prior to starting study treatment.
    -Radiotherapy within 2 weeks prior to starting study treatment. Patients who received prior radiotherapy to >25% of bone marrow are not eligible regardless of when it was administered.
    -Major surgery or other anti-cancer therapy not previously specified within 4 weeks prior to starting study treatment.
    10.Patient has clinically significant, uncontrolled heart disease and/or recent cardiac events.
    11.Bleeding diathesis (i.e., disseminated intravascular coagulation [DIC], clotting factor deficiency) or long-term (> 6 months) anticoagulant therapy, other than antiplatelet therapy and low dose coumarin derivatives, provided that the International Normalised Ratio (INR) is less than 1.5.
    12.History of clinically significant bowel disease including abdominal fistula, or gastrointestinal perforation.
    13.Difficulties to swallow tablets, malabsorption syndrome disease significantly affecting gastrointestinal function, resection of the stomach or small bowel, or active inflammatory bowel disease (e.g., ulcerative diseases).
    14.Known hypersensitivity to trastuzumab, alpelisib or fulvestrant or any of their excipients. If known hypersensitivity to all three cytostatics (vinorelbine, capecitabine and eribulin), the patient will not be eligible.
    15.Known positive serology for Human Immunodeficiency Virus (HIV), or active infection for hepatitis B or hepatitis C.
    16.Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
    21.Patient is nursing (lactating) or is pregnant as confirmed by a positive serum human Chorionic Gonadotropin (hCG) test prior to initiating study treatment.

    “Please consult the complete criteria in the protocol”
    1.Haber recibido más de cuatro líneas previas de terapia basada en agentes anti-HER2 para el CMM, o fulvestrant previo.
    2.Enfermedad visceral sintomática o cualquier carga de la enfermedad que haga que el paciente no resulte elegible para recibir el tratamiento experimental, según el criterio del investigador.
    3.Metástasis sintomáticas en el sistema nervioso central (SNC). No obstante, los pacientes con metástasis en el SNC que hayan sido tratados adecuadamente, permanezcan asintomáticos y no requieran tratamiento con corticoides o antiepilépticos, serán elegibles para el estudio.
    4.Presencia de carcinomatosis leptomeníngea.
    5.Neoplasias malignas invasivas en el momento de la inclusión o diagnóstico previo de neoplasia maligna resecada por completo dentro de los 3 años previos a la aleatorización, a excepción del cáncer de endometrio de grado 1 en estadio I de la Federación internacional de ginecología y obstetricia (International Federation of Gynecology and Obstetrics, FIGO) tratado adecuadamente (lo que incluye la extirpación quirúrgica completa), el carcinoma escamoso cutáneo, el cáncer de tiroides limitado a la glándula tiroides, el carcinoma in situ del cuello uterino y el cáncer de vejiga urinaria en estadio inicial de grado 1-2, definido como T1 o inferior y sin afectación ganglionar (N0).
    6.Pacientes con un diagnóstico establecido de diabetes mellitus tipo 1, o de diabetes tipo 2 no controlada (GPA ≥ 140 mg/dl [7,7 mmol/l] o HbA1c ≥ 6,5%), antecedentes de diabetes gestacional (según las guías de la ACOG) o diabetes mellitus inducida por corticoides documentada.
    7.Tratamiento previo con cualquier inhibidor de mTOR, AKT o PI3K.
    8.Pacientes tratados dentro de los 7 días previos al inicio del tratamiento del estudio con:
    -Fármacos inductores potentes del CYP3A4.
    -Fármacos inhibidores de la BCRP (proteína de resistencia del cáncer de mama).
    9.Pacientes que han recibido, antes de la aleatorización:
    -Cualquier agente en investigación dentro de las 4 semanas anteriores.
    -Quimioterapia dentro de un período de tiempo inferior a la duración del ciclo usada para ese tratamiento (p. ej., < 3 semanas para fluorouracilo, doxorubicina, epirubicina o < 1 semana para la quimioterapia semanal).
    -Terapias biológicas (p. ej., anticuerpos): recibidas hasta 4 semanas antes de iniciar el tratamiento del estudio.
    -Terapias endocrinas: tamoxifeno o inhibidores de la aromatasa (IA), recibidas dentro de las 2 semanas previas al inicio del tratamiento del estudio.
    -Corticoides: recibidos dentro de las 2 semanas previas al inicio del tratamiento del estudio.
    -Radioterapia dentro de las 2 semanas previas al inicio del tratamiento del estudio. Los pacientes que hayan recibido radioterapia previa en >25% de la médula ósea no serán elegibles, independientemente de cuándo se haya administrado.
    -Cirugía mayor u otros tratamientos antineoplásicos no especificados previamente dentro de las 4 semanas previas al inicio del tratamiento del estudio.
    10.Pacientes con cardiopatías no controladas clínicamente significativas y/o acontecimientos cardíacos recientes.
    11.Diátesis hemorrágicas (coagulación intravascular diseminada [CID], deficiencia de factores de la coagulación) o tratamiento anticoagulante a largo plazo (>6 meses), exceptuando la terapia antiagregante plaquetaria y las dosis bajas de derivados cumarínicos, siempre que el INR sea inferior a 1,5.
    12.Antecedentes de enfermedades intestinales clínicamente significativas, incluidas las fístulas abdominales y las perforaciones gastrointestinales.
    13.Dificultades para tragar comprimidos, síndrome de malabsorción que afecte a la función gastrointestinal de manera significativa, resección del estómago o del intestino delgado o enfermedad inflamatoria intestinal activa (p. ej., enfermedades ulcerativas).
    14.Hipersensibilidad conocida al trastuzumab, alpelisib o fulvestrant o a cualquiera de sus excipientes. Si existe hipersensibilidad conocida a los tres citostáticos (vinorelbina, capecitabina y eribulina), el paciente no será elegible para participar en el estudio.
    15.Serología positiva para el virus de la inmunodeficiencia humana (VIH) o infección activa por el virus de la hepatitis B o C.
    16.Otro trastorno médico o psiquiátrico, agudo o crónico, o alteración de laboratorio importante que pueda incrementar el riesgo asociado a la participación en el estudio o a la administración del tratamiento del estudio, o que pueda interferir con la interpretación de los resultados del estudio y que, según el criterio del investigador, haga que el paciente no sea adecuado para su inclusión en el estudio.
    21.Pacientes en período de lactancia materna o gestantes, cuyo embarazo se haya confirmado mediante un resultado positivo de la prueba de la gonadotropina coriónica humana (hCG) antes de iniciar el tratamiento del estudio.

    “Consultar criterios completos en protocolo”
    E.5 End points
    E.5.1Primary end point(s)
    PFS: Time from randomization to objective disease progression based on the investigator’s assessment according to the response evaluation criteria for solid tumors (RECIST) version 1.1., or death from any cause.
    SLP: Tiempo transcurrido desde la aleatorización hasta la progresión objetiva de la enfermedad, basada en la evaluación del investigador y de acuerdo con los criterios de evaluación de la respuesta de los tumores sólidos (RECIST), versión 1.1., o la muerte por cualquier causa.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Two interim analyses and the primary analysis based on the primary endpoint of PFS will be conducted.
    A first interim analysis will be conducted at approximately 25% information (approximately 30 PFS events).
    A second interim analysis for inefficacy monitoring will be conducted at approximately 50% (approximately 60 PFS events).
    The interim analyses are expected to occur before completion of enrollment.
    The primary analysis of targeted PFS events is estimated at 44 months since first patients randomized.
    Se realizarán dos análisis intermedios y el análisis principal basado en el criterio de valoración principal de la SLP.
    El primer análisis intermedio se realizará cuando se disponga de aproximadamente un 25% de la información (30 eventos de SLP).
    El segundo análisis intermedio se realizará cuando se disponga de aproximadamente un 50% de la información (60 eventos de SLP).
    Los análisis intermedios se espera que sucedan antes de completar el periodo de reclutamiento.
    El análisis principal de los eventos de SLP se estima realizar a los 44 meses de la inclusión del primer paciente.
    E.5.2Secondary end point(s)
    -OS: time from randomization to death from any cause.
    -OR: complete or partial response as best overall response based on the investigator’s assessment according to RECIST version 1.1.
    -Safety and tolerability: adverse events (AEs) grades will be defined by the National Cancer Institute common terminology criteria for adverse events (NCI-CTCAE) version 5.0. AE terms will be coded according to the MedDRA dictionary.
    -SG: tiempo desde la aleatorización hasta la muerte por cualquier causa.
    -RO: respuesta completa o parcial, alcanzada como mejor respuesta y basada en la evaluación del investigador, según los criterios RECIST, versión 1.1.
    -Seguridad y tolerabilidad: El grado de los acontecimientos adversos (AA) se definirá según la versión 5.0 de los Criterios terminológicos comunes para los acontecimientos adversos del Instituto Nacional del Cáncer de los EE. UU. (National Cancer Institute Common Terminology Criteria for Adverse Events, NCI CTCAE). Los términos de los AA se codificarán de acuerdo con el diccionario MedDRA.
    E.5.2.1Timepoint(s) of evaluation of this end point
    The data cut-off date for the final analysis will occur approximately 12-15 months after the primary analysis, estimated to be approximately 59 months from the inclusion of the first patient, in order to estimate OS.
    La fecha de corte para el análisis final se espera que suceda aproximadamente a los 12-15 meses después del análisis principal, estimado que sea aproximadamente a los 59 meses de la inclusión del primer paciente, según la estimación de la SG.
    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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    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) Yes
    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 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 concerned32
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA106
    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
    Switzerland
    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
    última visita del último paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years5
    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: 300
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 300
    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 state150
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 288
    F.4.2.2In the whole clinical trial 300
    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 Decision2021-05-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-03-26
    P. End of Trial
    P.End of Trial StatusOngoing
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