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    The EU Clinical Trials Register currently displays   43858   clinical trials with a EudraCT protocol, of which   7284   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

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    Summary
    EudraCT Number:2021-000043-49
    Sponsor's Protocol Code Number:LOXO-BTK-20022
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-10-12
    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
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2021-000043-49
    A.3Full title of the trial
    A Phase 3 Open-Label, Randomized Study of Fixed Duration Pirtobrutinib (LOXO-305) plus Venetoclax and Rituximab versus Venetoclax and Rituximab in Previously Treated Chronic Lymphocytic Leukemia/Small
    Lymphocytic Lymphoma (BRUIN-CLL-322)
    Studio di fase 3, in aperto, randomizzato, di durata fissa per valutare pirtobrutinib (LOXO-305) in aggiunta a venetoclax e rituximab rispetto a venetoclax e rituximab in pazienti affetti da leucemia linfocitica cronica/linfoma linfocitico a piccole cellule precedentemente trattati (BRUIN-CLL-322)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 3 Trial of Fixed Duration Pirtobrutinib (LOXO-305) plus Venetoclax and Rituximab versus Venetoclax and Rituximab in Previously Treated CLL/SLL
    Uno studio di fase 3 a durata fissa con Pirtobrutinib (LOXO-305) più Venetoclax e Rituximab rispetto a Venetoclax e Rituximab nella LLC / SLL precedentemente trattata
    A.3.2Name or abbreviated title of the trial where available
    LOXO-BTK-20022
    LOXO-BTK-20022
    A.4.1Sponsor's protocol code numberLOXO-BTK-20022
    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 SponsorLOXO ONCOLOGY INCORPORATED
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportLoxo Oncology Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationIQVIA RDS GmbH
    B.5.2Functional name of contact pointMedical and Scientific Services
    B.5.3 Address:
    B.5.3.1Street AddressUnterschweinstiege 2-14.
    B.5.3.2Town/ cityFrankfurt am Main
    B.5.3.3Post code60549
    B.5.3.4CountryGermany
    B.5.6E-mailmarialeticia.solari@iqvia.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePirtobrutinib
    D.3.2Product code [LOXO-305]
    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 INNPirtobrutinib
    D.3.9.1CAS number 2101700-15-4
    D.3.9.2Current sponsor codeLOXO-305
    D.3.9.4EV Substance CodeSUB215610
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 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.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 No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePirtobrutinib
    D.3.2Product code [LOXO-305]
    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 INNPirtobrutinib
    D.3.9.1CAS number 2101700-15-4
    D.3.9.2Current sponsor codeLOXO-305
    D.3.9.4EV Substance CodeSUB215610
    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 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.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Venclyxto
    D.2.1.1.2Name of the Marketing Authorisation holderAbbVie Deutschland GmbH
    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 nameVenclyxto
    D.3.2Product code [venclyxto]
    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 INNVenetoclax
    D.3.9.1CAS number 1257044-40-8
    D.3.9.2Current sponsor codePR7
    D.3.9.4EV Substance CodeSUB176260
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 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.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePirtobrutinib
    D.3.2Product code [LOXO-305]
    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 INNPirtobrutinib
    D.3.9.1CAS number 2101700-15-4
    D.3.9.2Current sponsor codeLOXO-305
    D.3.9.4EV Substance CodeSUB215610
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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 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.IMP: 5
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name MabThera
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Pharma (Switzerland)
    D.2.1.2Country which granted the Marketing AuthorisationSwitzerland
    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 nameRituximab
    D.3.2Product code [na]
    D.3.4Pharmaceutical form Concentrate for solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRITUXIMAB
    D.3.9.1CAS number 174722-31-7
    D.3.9.2Current sponsor codena
    D.3.9.4EV Substance CodeSUB12570MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    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.IMP: 6
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Venclyxto
    D.2.1.1.2Name of the Marketing Authorisation holderAbbVie Deutschland GmbH
    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 nameVenclyxto
    D.3.2Product code [na]
    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 INNVenetoclax
    D.3.9.1CAS number 1257044-40-8
    D.3.9.2Current sponsor codena
    D.3.9.4EV Substance CodeSUB176260
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    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 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.IMP: 7
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name MabThera
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    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 nameRituximab
    D.3.2Product code [na]
    D.3.4Pharmaceutical form Concentrate for solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRITUXIMAB
    D.3.9.1CAS number 174722-31-7
    D.3.9.2Current sponsor codena
    D.3.9.4EV Substance CodeSUB12570MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    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
    Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
    leucemia linfocitica cronica/linfoma linfocitico a piccole cellule
    E.1.1.1Medical condition in easily understood language
    Chronic lymphocytic leukaemia/Small Lymphocytic Lymphoma is a typeof cancer that affects the white blood cells and tends to progress slowly over many years.
    La/il leucemia linfatica cronica/linfoma linfocitico a piccole cellule è un tipo di tumore che colpisce i globuli bianchi e tende a progredire lentamente nell’arco di molti anni.
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10008976
    E.1.2Term Chronic lymphocytic leukemia
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10008976
    E.1.2Term Chronic lymphocytic leukemia
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate PFS of pirtobrutinib plus venetoclax and rituximab (Arm A) compared to venetoclax and rituximab (Arm B)
    Valutare la PFS di pirtobrutinib più venetoclax e rituximab (Braccio A) rispetto a venetoclax e rituximab (Braccio B)
    E.2.2Secondary objectives of the trial
    To evaluate the effectiveness of Arm A compared to Arm B based on overall response rate (ORR) and time to event(s) outcomes
    To evaluate the safety and tolerability of each treatment arm
    To evaluate the effectiveness of Arm A compared to Arm B in patientreported disease-related symptoms and physical functioning
    Valutare l’efficacia del Braccio A rispetto al Braccio B in base al tasso di risposta complessiva (ORR) e ai tempi del manifestarsi del/degli evento/i
    Valutare la sicurezza e la tollerabilità di ciascun braccio di trattamento
    Valutare l’efficacia del Braccio A rispetto al Braccio B rispetto ai sintomi correlati alla malattia riferiti dal paziente e alla funzionalità fisica
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Age 18 and older at time of enrollment.
    Type of Patient and Disease Characteristics
    2. Confirmed diagnosis by redacted local laboratory report of CLL/SLL as defined by International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2018 criteria including the following:
    a) B-cells coexpressing the surface antigen CD5 together with at least one B-cell antigen (CD19, CD20, CD23) and either ¿ or ¿ light-chain restricted (for CLL/SLL patients).
    b) = 5 × 109 B lymphocytes/L (5000/µL) in the peripheral blood (for CLL patients).
    c) Prolymphocytes may comprise = 55% of blood lymphocytes (for CLL patients).
    3. A requirement for therapy consistent with iwCLL 2018 criteria for initiation of therapy such that at least 1 of the following should be met:
    a) Evidence of progressive marrow failure as manifested by the development of, or worsening of, anemia (such as hemoglobin < 10 g/dL) and/or thrombocytopenia (such as platelets = 100 × 109/L).
    b) Massive (i.e., spleen edge = 6 cm below the left costal margin) or c) Massive nodes (i.e., = 10 cm in longest diameter) or progressive or symptomatic lymphadenopathy.
    d) Progressive lymphocytosis with an increase of > 50% over a 2-month period, or lymphocyte doubling time < 6 months. Factors contributing to lymphocytosis other than CLL/SLL (e.g., infections, steroid administration) should be excluded.
    e) Autoimmune complications including anemia or thrombocytopenia poorly responsive to corticosteroids.
    f) Symptomatic or functional extranodal involvement (e.g., skin, kidney, lung, spine).
    g) Disease-related symptoms (also known as B-symptoms) as defined by any of the following:
    i. Unintentional weight loss = 10% within the previous 6 months.
    ii. Significant fatigue (i.e., Eastern Cooperative Oncology Group performance status [ECOG PS] 2 or worse; cannot work or unable to perform usual activities).
    iii. Fevers = 100.5°F or 38.0°C for 2 or more weeks without evidence of infection.
    iv. Night sweats for = 1 month without evidence of infection.
    4. Known 17p deletion status as indicated in Section 1.2.2.
    5. Previously treated with at least one line of therapy that may include a covalent BTK inhibitor (patients may be eligible if they have previously received a covalent BTK inhibitor or if they have not previously received a covalent BTK inhibitor). There is no limit on prior number of lines of therapy.
    6. Eastern Cooperative Oncology Group (ECOG) 0-2.
    7. Must have adequate organ function, as defined in the protocol. These values must be met during the Screening Period as well as pre-dose on C1D1 (see table).
    8. Patients who have received investigational agents, anticancer treatment and/or radiotherapy are required the have the following washout periods prior to planned C1D1:
    a) Targeted agents: 5 half-lives or 14 days, whichever is shorter
    b) Cytotoxic chemotherapy: 28 days
    c) Therapeutic monoclonal antibodies: 28 days
    d) Palliative limited field radiation: 7 days
    e) Broad field radiation (= 30% of bone marrow or whole brain radiotherapy): 28 days
    9. Prior treatment related AEs must have recovered to Grade = 1 or pretreatment baseline with the exception of alopecia
    Contraception
    10. Willingness of men and women of childbearing potential (WOCBP), and their partners, to both observe highly effective birth control methods as outlined in Section 10.2 (Appendix 2; and below) for the duration of treatment and for 6 months following the last dose of study treatment or 12 months after the last dose of rituximab, whichever is later.
    .
    1. Età pari o superiore a 18 anni al momento dell’arruolamento.
    Tipo di paziente e caratteristiche della malattia
    2. Diagnosi confermata in base al referto redatto dal laboratorio locale sulla LLC/SLL in base ai criteri definiti dall’International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2018, tra i quali figurano:
    a) Le cellule B che rivelano la presenza dell'antigene di superficie CD5, insieme ad almeno un antigene delle cellule B (CD19, CD20, CD23) e limitazione della catena leggera ¿ o ¿ (per i pazienti con LLC/SLL).
    b) = 5 × 109 linfociti B/l (5000/µl) nel sangue periferico (per i pazienti con LLC).
    c) I prolinfociti possono costituire =55% dei linfociti ematici (per pazienti con LLC).
    3. Un requisito della terapia che rispecchi i criteri iwCLL 2018 per l’avvio della terapia, in modo tale da soddisfare almeno 1 dei seguenti:
    a) Evidenza di insufficienza midollare progressiva manifestata dallo sviluppo o dal peggioramento dell’anemia (come emoglobina <10 g/dl) e/o trombocitopenia (come piastrine =100 × 109/l).
    b) Massiva (ovvero, bordo della milza =6 cm al di sotto del margine costale sinistro) o c) Noduli massivi (ovvero, =10 cm nel diametro più lungo) o linfoadenopatia progressiva o sintomatica.
    d) Linfocitosi progressiva con un aumento >50% per un periodo di 2 mesi, oppure tempo di raddoppio dei linfociti <6 mesi. I fattori che contribuiscono alla linfocitosi diversa dalla LLC/SLL (ad es., infezioni, somministrazione di steroidi) devono essere esclusi.
    e) Complicanze autoimmuni, tra cui anemia o trombocitopenia con scarsa risposta ai corticosteroidi.
    f) Coinvolgimento extranodale sintomatico o funzionale (per es. pelle, reni, polmone, colonna vertebrale).
    g) Sintomi correlati alla malattia (noti anche come sintomi B), vale a dire uno qualsiasi dei seguenti:
    i. Perdita di peso involontaria =10% nei 6 mesi precedenti.
    ii. Affaticamento significativo (ovvero, stato di validità pari a 2 o peggiore, secondo l’Eastern Cooperative Oncology Group [ECOG PS]; non è in grado di lavorare o di svolgere le normali attività).
    iii. Temperatura =100,5 °F o 38,0 °C per 2 o più settimane senza evidenza di infezione.
    iv. Sudorazioni notturne per = 1 mese senza evidenza di infezione.
    4. Stato della delezione 17p noto, come indicato nella Sezione 1.2.2.
    5. Trattato in precedenza con almeno una linea di terapia che potrebbe includere un inibitore covalente della BTK (i pazienti potrebbero essere idonei se hanno ricevuto in precedenza un inibitore covalente della BTK o se non hanno ricevuto in precedenza un inibitore covalente della BTK). Non vi è alcun limite al numero di linee di terapia precedenti.
    6. Eastern Cooperative Oncology Group (ECOG) 0-2.
    7. Deve avere un'adeguata funzionalità degli organi, come si precisa nel protocollo. Questi valori devono essere soddisfatti durante il periodo di screening, nonché nel pre-dose al C1G1 (vedere tabella).
    8. I pazienti che hanno ricevuto agenti sperimentali, trattamenti antitumorali e/o radioterapia devono sottoporsi ai seguenti periodi di washout prima del C1G1 programmato:
    a) Agenti mirati: 5 emivite o 14 giorni, a seconda di quale sia più breve
    b) Chemioterapia citotossica: 28 giorni
    c) Anticorpi monoclonali terapeutici: 28 giorni
    d) Radioterapia a campo limitato e palliativa: 7 giorni
    e) Radioterapia a campo esteso (=30% del midollo osseo oppure radioterapia dell’intero cervello): 28 giorni
    9. Gli EA precedenti correlati al trattamento devono essersi risolti a un Grado =1 o al basale del pretrattamento, ad eccezione dell’alopecia
    Contraccezione
    10. Consenso di uomini e donne in età fertile (WOCBP) e relative compagni/e a usare metodi di controllo delle nascite altamente efficaci, come indicato nella Sezione 10.2 (Appendice 2; e qui di seguito) per la durata del trattamento e per 6 mesi dopo l’ultima dose di trattamento dello studio o 12 mesi dopo l’ultima dose di rituximab, a seconda di quale evento si verifichi per ultimo.
    E.4Principal exclusion criteria
    Exclusion criteria
    1. Known or suspected Richter's Transformation to diffuse large B-cell lymphoma (DLBCL), prolymphocytic leukemia, or Hodgkin lymphoma at any time preceding enrollment.
    2. Known or suspected history of central nervous system (CNS) involvement by CLL/SLL.
    3. History of Grade =2 arrhythmia on prior covalent BTK inhibitor.
    4. Patients who experienced a major bleeding event on a prior BTK inhibitor.
    NOTE: Major bleeding is defined as bleeding having one or more of the following features: life-threatening bleeding with signs or symptoms of hemodynamic compromise; bleeding associated with a decrease in the hemoglobin level of at least 2 g/dL; or bleeding in a critical area or organ (e.g., retroperitoneal, intraarticular, pericardial, epidural, or intracranial bleeding or intramuscular bleeding with compartment syndrome).
    5. Active second malignancy. Patients with treated second malignancy who are in remission with life expectancy > 2 years and with documented Sponsor approval are eligible. Examples include:
    a) Adequately treated non-melanomatous skin cancer or lentigo maligna melanoma without current evidence of disease.
    b) Adequately treated cervical carcinoma in situ without current evidence of disease.
    c) Localized (e.g., lymph node negative) breast cancer treated with curative intent with no evidence of active disease present for more than 3 years and receiving adjuvant hormonal therapy.
    d) Localized prostate cancer undergoing active surveillance.
    e) History of treated and cured Hodgkin's disease or NHL < 5 years from diagnosis.
    6. Major surgery within 4 weeks of planned start of study therapy.
    7. A significant history of renal, neurologic, psychiatric, endocrine, metabolic or immunologic, that, in the opinion of the Investigator, would adversely affect the patient's participation in this study or interpretation of study outcomes.
    8. History of allogeneic or autologous SCT or CAR-T therapy within the past 60 days.
    9. Active uncontrolled auto-immune cytopenia (e.g., autoimmune hemolytic anemia [AIHA], idiopathic thrombocytopenic purpura [ITP]) not on a stable regimen and dose for at least 4 weeks prior to study enrollment.
    10. Significant cardiovascular disease, defined as any of the following:
    a) Unstable angina or acute coronary syndrome within the past 2 months
    b) History of myocardial infarction within 3 months prior to planned start of study treatment
    c) Documented left ventricular ejection fraction (LVEF) by any method of = 40% in the 12 months prior to planned start of study treatment
    d) = Grade 3 New York Heart Association (NYHA) functional classification system of heart failure, uncontrolled or symptomatic arrhythmias
    11. Prolongation of the QT interval corrected (QTc) for heart rate using Fredericia's Formula (QTcF) > 470 msec on at least 2 of 3 consecutive electrocardiograms (ECGs), and mean QTcF > 470 msec on all 3 ECGs, during Screening.
    a) QTcF is calculated using Fredericia's Formula (QTcF = QT/(RR^0.33)
    b) Correction of suspected drug-induced QTcF prolongation or prolongation due to electrolyte abnormalities can be attempted at the Investigator's discretion, and only if clinically safe to do so with either discontinuation of the offending drug or switch to another drug not known to be associated with QTcF prolongation or electrolyte supplementation.
    c) Correction of QTc for underlying bundle branch block (BBB) permissible.
    1. Nota o sospetta trasformazione di Richter in linfoma diffuso a grandi cellule B (diffuse large B-cell lymphoma, DLBCL), leucemia prolinfocitica oppure linfoma di Hodgkin in qualsiasi momento precedente l’arruolamento.
    2. Anamnesi nota o sospetta di coinvolgimento del sistema nervoso centrale (SNC) da parte di LLC/LLPC.
    3. Anamnesi di aritmia di grado =2 su precedente inibitore covalente della BTK.
    4. Pazienti che hanno manifestato un evento emorragico grave con un precedente inibitore della BTK.
    ATTENZIONE: Si definisce emorragia grave un’emorragia che presenta una o diverse delle seguenti caratteristiche: sanguinamento potenzialmente letale con segni o sintomi di compromissione emodinamica; emorragia associata a una diminuzione del livello dell’emoglobina di almeno 2 g/dl; o sanguinamento in un’area critica o di un organo (ad es. emorragia retroperitoneale, intrarticolare, pericardica, epidurale o intracranica o emorragia intramuscolare con sindrome compartimentale).
    5. Secondo tumore maligno attivo. Sono idonei i pazienti con un secondo tumore maligno trattato che siano in remissione, con aspettativa di vita >2 anni e con approvazione documentata dello sponsor. Alcuni esempi:
    a) Tumore cutaneo diverso dal melanoma o lentigo maligna adeguatamente trattati, senza evidenza di malattia in corso.
    b) Carcinoma cervicale in situ adeguatamente trattato, senza evidenza di malattia in corso.
    c) Carcinoma mammario localizzato (ad es., linfonodo negativo) trattato con intento curativo, con nessuna evidenza di malattia attiva presente da oltre 3 anni e in trattamento con terapia ormonale adiuvante.
    d) Tumore alla prostata localizzato sottoposto a sorveglianza attiva.
    e) Anamnesi di malattia di Hodgkin trattata e curata o di LNH <5 anni dalla diagnosi.
    6. Intervento chirurgico serio nelle 4 settimane precedenti l’inizio previsto della terapia dello studio.
    7. Anamnesi significativa nefrologica, neurologica, psichiatrica, endocrina, metabolica o immunologica, che, a giudizio dello sperimentatore, influirebbe negativamente sulla partecipazione del paziente a questo studio o sull’interpretazione degli esiti dello studio.
    8. Anamnesi di terapia SCT o CAR-T allogenica o autologa negli ultimi 60 giorni.
    9. Citopenia autoimmune attiva non controllata (ad es., anemia emolitica autoimmune [AIHA], porpora trombocitopenica idiopatica [ITP]) non con un regime e una dose stabili per almeno 4 settimane prima dell’arruolamento nello studio.
    10. Malattia cardiovascolare significativa, che si definisce come una qualsiasi delle seguenti:
    a) Angina instabile o sindrome coronarica acuta negli ultimi 2 mesi
    b) Anamnesi di infarto miocardico nei 3 mesi precedenti l’inizio previsto del trattamento dello studio
    c) Frazione di eiezione del ventricolo sinistro (FEVS), documentata mediante qualsiasi metodo, =40% nei 12 mesi precedenti l’inizio previsto del trattamento dello studio
    d) Insufficienza cardiaca di grado =3 del sistema di classificazione funzionale della New York Heart Association (NYHA), aritmie non controllate o sintomatiche
    11. Prolungamento dell’intervallo QT corretto (QTc) per la frequenza cardiaca utilizzando la formula di Fredericia (QTcF) >470 ms in almeno 2 elettrocardiogrammi (ECG) consecutivi su 3 e QTcF medio >470 ms in tutti e 3 gli ECG, durante lo screening.
    a) Il QTcF viene calcolato utilizzando la formula di Fredericia (QTcF = QT/(RR^0,33)
    b) Una correzione di sospetto prolungamento del QTcF indotto da farmaco o prolungamento dovuto ad anomalie elettrolitiche può essere tentata a discrezione dello sperimentatore e solo se ciò è sicuro dal punto di vista clinico, o con l’interruzione del farmaco in questione, con il passaggio a un altro farmaco non noto per essere associato a prolungamento del QTcF o con integrazione di elettroliti.
    c) Correzione del QTc per il blocco di branca sottostante (BBB) consentito.
    E.5 End points
    E.5.1Primary end point(s)
    PFS per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria 2018, assessed by Independent Review Committee (IRC)
    PFS secondo i criteri 2018 del workshop internazionale sulla leucemia linfatica cronica (iwCLL), valutati dal Comitato di revisione indipendente (IRC)
    E.5.1.1Timepoint(s) of evaluation of this end point
    The time from the date of randomization until disease progression or death from any cause, whichever occurs first.
    Il tempo trascorso dalla data della randomizzazione fino alla progressione della malattia o al decesso per qualsiasi causa, a seconda di quale evento si verifichi per primo.
    E.5.2Secondary end point(s)
    • Assessed by Investigator:
    - Progression free survival (PFS)
    - Overall survival (OS)
    - Time to next treatment (TTNT), defined as time from the date of randomization to the date of the next non-protocol-specified therapy for CLL/SLL (Section 9.4.4 for full definition).
    - Event free survival (EFS) defined as the time from date of randomization to the date of disease progression (PD) or start of new treatment for CLL/SLL or discontinuation from trial due to toxicity or death, whichever occurs first.
    • Assessed by Investigator and IRC:
    - ORR
    • Including but not limited to SAEs, AEs, deaths and clinical laboratory abnormalities per National Cancer Institute Common Terminology Criteria in Adverse Events version 5.0 (NCI CTCAE v5.0)
    • Time to worsening (TTW) of CLL/SLL-related symptoms
    • TTW of physical functioning
    • Valutati dallo sperimentatore:
    - Sopravvivenza libera da progressione (PFS)
    - Sopravvivenza complessiva (OS)
    - Tempo al trattamento successivo (TTNT), che si definisce come il tempo trascorso dalla data della randomizzazione fino alla data della successiva terapia non specificata dal protocollo per LLC/SLL (per la definizione completa vedere la Sezione 9.4.4).
    - Sopravvivenza libera da eventi (EFS), che si definisce come il tempo trascorso dalla data della randomizzazione fino alla data di progressione della malattia (PD), dell’inizio di un nuovo trattamento per LLC/SLL, di interruzione della sperimentazione a causa di tossicità o del decesso, a seconda di quale evento si verifichi per primo.
    • Valutati dallo sperimentatore e dall’IRC:
    - ORR
    • Compresi, ma non limitati a SAE, EA, decessi e anomalie cliniche di laboratorio secondo i Criteri terminologici comuni per gli eventi avversi del National Cancer Institute versione 5.0 (NCI CTCAE v5.0)
    • Tempo al peggioramento (TTW) dei sintomi correlati alla LLC/LL
    • TTW di funzionalità fisica
    E.5.2.1Timepoint(s) of evaluation of this end point
    PFS - The time from the date of randomization until disease progression or death from any cause
    ORR - The number of patients who achieve a best overall response (BOR) of CR, CRi, nPR, or partial remission (PR) divided by the total number of patients randomized to each treatment arm.
    OS- The time from randomization until death from any cause.
    TTNT - Time from the date of randomization to the date of the initiation of the next non-protocol-specified therapy for CLL/SLL or death from any cause
    EFS - The time from date of randomization to the date of disease progression or start of new treatment for CLL/SLL or withdrawal from study due to toxicity or death
    PFS: il tempo trascorso dalla data della randomizzazione fino alla progressione della malattia o al decesso per qualsiasi causa
    ORR: il numero di pazienti che raggiungono una migliore risposta complessiva (BOR) di CR, CRi, nPR o remissione parziale (PR) diviso il numero totale di pazienti randomizzati a ciascun braccio di trattamento.
    OS: tempo trascorso dalla randomizzazione fino al decesso per qualsiasi causa.
    TTNT: tempo trascorso dalla data della randomizzazione fino alla data dell’inizio della successiva terapia non specificata dal protocollo per LLC/SLL o al decesso per qualsiasi causa
    EFS: - il tempo trascorso dalla data della randomizzazione fino alla data di progressione della malattia, all’inizio di un nuovo trattamento per LLC/SLL
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) 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 No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) 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 concerned10
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA56
    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
    Australia
    Canada
    China
    Israel
    Japan
    Korea, Democratic People's Republic of
    Russian Federation
    Singapore
    Taiwan
    United States
    Belgium
    Denmark
    France
    Germany
    Hungary
    Ireland
    Italy
    Netherlands
    Norway
    Poland
    Slovakia
    Spain
    Sweden
    Switzerland
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study is defined as the date of the last visit of the last participant in the study or last scheduled procedure shown in the Schedule of Assessments (SoA) for the last participant in the trial globally, which is estimated at approximately 60 months from the first patient randomized to allow approximately 17 months recruitment and 43 months of follow-up (i.e., at least 3.5 years follow up for all enrolled patients).
    La fine dello studio si definisce come la data dell’ultima visita dell’ultimo partecipante allo studio o dell’ultima procedura programmata indicata nel Programma delle valutazioni (SoA) per l’ultimo partecipante alla sperimentazione a livello mondiale, stimata a circa 60 mesi dal primo paziente randomizzato per consentire un arruolamento di circa 17 mesi e 43 mesi di follow-up (ovvero, almeno 3,5 anni di follow-up per tutti i pazienti arruolati).
    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 months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 180
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 420
    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 state38
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 226
    F.4.2.2In the whole clinical trial 600
    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)
    Arms A and B are time-limited regimens and treatment is considered complete when patients complete treatment cycles. The Sponsor reserves the right to discontinue the study for clinical or administrative reasons at any time.
    I Bracci A e B sono regimi a tempo limitato e il trattamento è considerato completo quando i pazienti completano i cicli di trattamento. Lo sponsor si riserva il diritto di interrompere lo studio per motivi clinici o amministrativi in qualsiasi momento.
    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 Decision2021-09-01
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-09-29
    P. End of Trial
    P.End of Trial StatusOngoing
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