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    Summary
    EudraCT Number:2021-000203-20
    Sponsor's Protocol Code Number:MCLA-129-CL01
    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:2021-06-23
    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 number2021-000203-20
    A.3Full title of the trial
    Phase 1/2 dose escalation and expansion study evaluating MCLA-129, a human anti-EGFR and anti-c-MET bispecific antibody, in patients with advanced NSCLC and other solid tumors
    Estudio en fase I/II de aumento escalonado y ampliación de la dosis para evaluar MCLA-129, un anticuerpo biespecífico humano anti-EGFR y anti-c-MET, en pacientes con CPNM avanzado y otros tumores sólidos
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 1/2 study of MCLA-129 in patients with NSCLC and other solid tumors
    Estudio en fase I/II de MCLA-129 en pacientes con CPNM avanzado y otros tumores sólidos
    A.4.1Sponsor's protocol code numberMCLA-129-CL01
    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 SponsorMerus N.V.
    B.1.3.4CountryNetherlands
    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 supportMerus N.V.
    B.4.2CountryNetherlands
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerus N.V
    B.5.2Functional name of contact pointMCLA-129-CL01 Project Manager
    B.5.3 Address:
    B.5.3.1Street AddressYalelaan 62
    B.5.3.2Town/ cityUtrecht
    B.5.3.3Post code3584 CM
    B.5.3.4CountryNetherlands
    B.5.4Telephone number+31611 28 87 94
    B.5.6E-mailE.Wasserman@merus.nl
    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.3.2Product code MCLA-129
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMCLA-129
    D.3.9.2Current sponsor codeMCLA-129
    D.3.9.3Other descriptive nameMCLA-129
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    advanced NSCLC and other solid tumors
    CPNM avanzado y otros tumores sólidos
    E.1.1.1Medical condition in easily understood language
    advanced NSCLC and other solid tumors
    CPNM avanzado y otros tumores sólidos
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung 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 21.0
    E.1.2Level LLT
    E.1.2Classification code 10049280
    E.1.2Term Solid tumour
    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
    Phase 1
    Primary Objective
    • To determine the maximum tolerated dose (MTD) and/or recommended phase 2 dose (RP2D) of single-agent MCLA-129 in patients with NSCLC, GC/GEJ adenocarcinoma, HNSCC or ESCC, with disease progression after prior therapy for advanced/metastatic disease.

    Phase 2
    Primary Objective
    • To evaluate the ORR in molecularly defined populations of advanced/metastatic solid tumors including NSCLC, GC/GEJ adenocarcinoma, and other selected solid tumors selected according to their molecular profile.
    Fase I
    Objetivo principal
    • Establecer la dosis máxima tolerable (DMT) o la dosis recomendada para la fase II (DRF2) de MCLA-129 en monoterapia en pacientes con CPNM, adenocarcinoma CE/UGE, CECC o CEE, con progresión de la enfermedad después de un tratamiento previo para la enfermedad avanzada/metastásica.

    Fase II
    Objetivo principal
    • Evaluar la TRG en poblaciones molecularmente definidas de tumores sólidos avanzados/metastásicos, como CPNM, adenocarcinoma CE/UGE y otros tumores sólidos seleccionados según su perfil molecular.
    E.2.2Secondary objectives of the trial
    Phase 1
    Secondary Objectives
    • To evaluate preliminary antitumor activity in terms of best overall response (BOR), overall response rate (ORR), disease control rate (DCR), and duration of response (DoR).
    • To evaluate progression-free survival (PFS) and overall survival (OS).
    • To characterize the pharmacokinetics (PK) of MCLA-129 including development of a population PK model.
    • To assess changes in cytokines following administration of MCLA-129.
    • To assess the immunogenicity of MCLA-129.

    Phase 2
    Secondary Objectives
    • To evaluate preliminary antitumor activity in terms of BOR, DCR, and DoR.
    • To evaluate PFS and OS.
    • To characterize the safety and tolerability of MCLA-129 at the RP2D.
    • To characterize the PK of MCLA-129 including development of a population PK model.
    • To assess the immunogenicity of MCLA-129.
    Fase I
    Objetivos secundarios
    • Evaluar la actividad antitumoral preliminar en términos de mejor respuesta global (MRG), tasa de respuesta global (TRG), tasa de control de la enfermedad (TCE) y duración de la respuesta (DdR).
    • Evaluar la supervivencia sin progresión (SSP) y la supervivencia global (SG).
    • Caracterizar la farmacocinética (FC) de MCLA-129, incluido el desarrollo de un modelo FC poblacional.
    • Evaluar los cambios producidos en las citocinas después de la administración de MCLA-129.
    • Evaluar la inmunogenicidad de MCLA-129.

    Fase II
    Objetivos secundarios
    • Evaluar la actividad antitumoral preliminar en términos de MRG, TCE y DdR.
    • Evaluar la SSP y la SG.
    • Caracterizar la seguridad y la tolerabilidad de MCLA-129 a la DRF2.
    • Caracterizar la FC de MCLA-129, incluido el desarrollo de un modelo FC poblacional.
    • Evaluar la inmunogenicidad de MCLA-129.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Signed informed consent before initiation of any study procedures.
    2. Age ≥ 18 years at signature of informed consent.
    3. Histologically or cytologically confirmed solid tumors with evidence of metastatic or locally advanced unresected disease that is incurable:
    • Dose Escalation Part - Patients who have failed prior standard first-line treatment. Patients must have progressed on or be intolerant to therapies that are known to provide clinical benefit. There is no limit to the number of prior treatment regimens. Patients must have:
    - Non-small cell lung cancer (NSCLC) harboring activating EGFR mutations including tyrosine kinase inhibitor (TKI) sensitizing mutations (e.g., 19del and L858R), and/or approved TKI-resistance mutations (e.g., acquired TKI-resistance mutations, i.e., T790M, C797S, L792, L798I, exon 20 insertion), or any activating c-MET mutation/amplification (e.g., high-level c-MET amplification [MET/CEP7 > 5 or cfDNA ≥ 2 copies], or c-MET exon 14 skipping mutation).
    - Gastric/gastroesophageal junction (GC/GEJ) adenocarcinoma harboring an EGFR amplification (EGFR/CEP7 ≥2 or cfDNA ≥ 8 copies) or c-MET amplification (MET/CEP7 > 5 or cfDNA ≥ 2 copies).
    - Head and neck squamous cell cancer (HNSCC) or esophageal squamous cell cancer (ESCC).
    *NOTE: Patient identification will be based on previous treatment history with EGFR tyrosine kinase inhibitors and on local tests performed in CLIA-certified laboratories.
    • Cohort Expansion Part - Patients who have failed prior standard first-line treatment. Patients must have progressed on or be intolerant to therapies that are known to provide clinical benefit. There is no limit to the number of prior treatment regimens. Patients must have:
    - Cohort A: NSCLC harboring EGFR exon 20 insertions. Patients who have received a prior EGFR TKI or who are TKI-naïve are eligible.
    - Cohort B: NSCLC harboring acquired EGFR C797S TKI resistance.
    - Cohort C: NSCLC harboring a c-MET amplification (c-MET/CEP7 > 5 copies or cfDNA ≥ 2 copies).
    - Cohort D: GC/GEJ adenocarcinoma or other selected solid tumors harboring an EGFR amplification (EGFR/CEP7 ≥ 2 or cfDNA ≥ 8 copies) or c-MET amplification (MET/CEP7 > 5 copies or cfDNA ≥ 2 copies).
    *NOTE: Patient identification will be based on local tests performed in CLIA-certified laboratories or on commercial diagnostics (e.g., FoundationOne). Genetic aberrations in EGFR or c-MET will be retrospectively confirmed by central testing using a validated assay.
    4. Availability of archival or a fresh tumor tissue sample.
    5. Measurable disease as defined by RECIST version 1.1 by radiologic methods.
    6. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
    7. Life expectancy ≥ 12 weeks, as per Investigator.
    8. Adequate organ function:
    • Absolute neutrophil count (ANC) ≥1.5 X 109/L
    • Hemoglobin ≥9 g/dL
    • Platelets ≥100 x 109/L
    • Corrected total serum calcium within normal ranges
    • Serum magnesium within normal ranges (or corrected with supplements)
    • Alanine aminotransferase (ALT), aspartate aminotransferase (AST) ≤3 x upper limit of normal (ULN) and total bilirubin ≤1.5 x ULN (patients with Gilbert’s syndrome are eligible if conjugated bilirubin value is within normal limits); in cases of liver involvement, ALT/AST ≤5 x ULN and total bilirubin ≤2 x ULN will be allowed
    • Serum creatinine ≤1.5 x ULN or creatinine clearance ≥50 mL/min calculated according to the Cockroft and Gault formula or MDRD formula for patients aged >65 years
    • Serum albumin >3.3 g/dL
    1. Formulario de consentimiento informado firmado antes de iniciar cualquier procedimiento del estudio.
    2. Edad ≥18 años en el momento de firmar el formulario de consentimiento informado.
    3. Tumores sólidos confirmados histológica o citológicamente con indicios de metástasis o de enfermedad localmente avanzada no resecada que sea incurable:
    • Parte de escalada de dosis: pacientes en los que ha fracasado el tratamiento de primera línea estándar anterior. Los pacientes deben haber experimentado progresión durante el tratamiento o ser intolerantes a los tratamientos que se sepa que proporcionan un beneficio clínico. No hay límite en cuanto al número de pautas de tratamiento previas. Los pacientes deben tener:
    - Cáncer de pulmón no microcítico (CPNM) con mutaciones activadoras en EGFR, lo que incluye mutaciones sensibilizantes a los inhibidores de la tirosina cinasa (TKI) (p. ej., 19del y L858R) o mutaciones de resistencia a los TKI aprobados (p. ej., mutaciones de resistencia a los TKI adquiridas, es decir, T790M, C797S, L792, L798I, inserción en el exón 20), o cualquier mutación/amplificación activadora en c-MET (p. ej., amplificación de alto nivel de c-MET
    [MET/CEP7 >5 o ADNlc ≥2 copias], o mutación por omisión del exón 14 de c-MET).
    - Adenocarcinoma de estómago/de la unión gastroesofágica (CE/UGE) con amplificación en EGFR (EGFR/CEP7 ≥2 o ADNlc ≥8 copias) o amplificación en c-MET (MET/CEP7 > 5 o ADNlc ≥2 copias).
    - Carcinoma epidermoide de cabeza y cuello (CECC) o carcinoma epidermoide de esófago (CEE).
    *NOTA: La identificación de los pacientes se basará en los antecedentes de tratamiento previo con inhibidores de la tirosina cinasa del EGFR y en las pruebas locales realizadas en laboratorios con la certificación CLIA.
    • Parte de ampliación de cohortes: pacientes en los que ha fracasado el tratamiento de primera línea estándar anterior. Los pacientes deben haber experimentado progresión durante el tratamiento o ser intolerantes a los tratamientos que se sepa que proporcionan un beneficio clínico. No hay límite en cuanto al número de pautas de tratamiento previas. Los pacientes deben tener:
    - Cohorte A: CPNM con inserciones en el exón 20 de EGFR. Serán aptos los pacientes que hayan recibido un TKI del EGFR previo o que no hayan recibido anteriormente ningún TKI.
    - Cohorte B: CPNM con resistencia adquirida a los TKI de EGFR C797S.
    - Cohorte C: CPNM con amplificación en c-MET (c-MET/CEP7 >5 copias o ADNlc ≥2 copias).
    - Cohorte D: adenocarcinoma CE/UGE u otros tumores sólidos seleccionados con amplificación en EGFR (EGFR/CEP7 ≥2 o ADNlc ≥8 copias) o amplificación en c-MET (MET/CEP7 >5 copias o ADNlc ≥2 copias).
    *NOTA: La identificación de los pacientes se basará en las pruebas locales realizadas en laboratorios con la certificación CLIA o en métodos de diagnóstico comerciales (p. ej., FoundationOne). Las aberraciones genéticas en EGFR o en c-MET se confirmarán de forma retrospectiva mediante pruebas centrales con un análisis validado.
    4. Disponibilidad de una muestra de tejido tumoral de archivo o en fresco.
    5. Enfermedad medible según la definición de los Criterios de evaluación de la respuesta en tumores sólidos (RECIST), versión 1.1, mediante métodos radiológicos.
    6. Estado funcional de 0 o 1 según el Grupo Oncológico Cooperativo del Este (ECOG).
    7. Esperanza de vida ≥12 semanas, según el investigador.
    8. Función orgánica adecuada:
    • Recuento absoluto de neutrófilos (RAN) ≥1,5 × 109/l.
    • Hemoglobina ≥9 g/dl.
    • Plaquetas ≥100 x 109/l.
    • Calcio en suero total corregido dentro de los límites normales.
    • Magnesio en suero dentro de los límites normales (o corregido con suplementos).
    • Alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) ≤3 veces el límite superior de la normalidad (LSN) y bilirrubina total ≤1,5 x LSN (los pacientes con síndrome de Gilbert serán aptos si el valor de bilirrubina conjugada se encuentra dentro de los límites normales); en caso de afectación hepática, se permitirán ALT/AST ≤5 x LSN y bilirrubina total ≤2 x LSN.
    • Creatinina sérica ≤1,5 x LSN o aclaramiento de creatinina ≥50 ml/min calculado de acuerdo con la fórmula de Cockcroft y Gault o la fórmula de la modificación de la dieta en enfermedad renal (MDER) para los pacientes >65 años de edad.
    • Albúmina en suero >3,3 g/dl.
    E.4Principal exclusion criteria
    1. Central nervous system metastases that are untreated or symptomatic, or require radiation, surgery, or continued steroid therapy (> 10 mg prednisone or equivalent) to control symptoms within 14 days of study entry.
    2. Known leptomeningeal involvement.
    3. Participation in another clinical study or treatment with any investigational drug within 4 weeks prior to study entry.
    4. Prior treatment with a bispecific EGFR-c-MET antibody.
    5. Systemic anticancer therapy or immunotherapy within 4 weeks or 5 half-lives, whichever is shorter, of the first dose of study drug. For cytotoxic agents that have major delayed toxicity (e.g., mitomycin C, nitrosoureas), a washout period of 6 weeks is required. Note: For agents with long half-lives, enrollment before the fifth half-life requires Sponsor approval.
    6. Major surgery or radiotherapy within 3 weeks of the first dose of study drug. Patients who received prior radiotherapy to ≥25% of bone marrow at any time are not eligible.
    7. Persistent grade >1 clinically significant toxicities related to prior antineoplastic therapies (except for alopecia); stable sensory neuropathy ≤ grade 2 NCI-CTCAE v5.0 and hypothyroidism ≤ grade 2 which is stable on hormone replacement are allowed.
    8. History of hypersensitivity reaction or any toxicity attributed to human proteins or any of the excipients that warranted permanent cessation of these agents.
    9. History of clinically significant cardiovascular disease including, but not limited to:
    • Diagnosis of deep vein thrombosis or pulmonary embolism within 1 month prior to first dose of study drug, or any of the following within 6 months prior to the first dose of study drug: myocardial infarction, unstable angina, stroke, transient ischemic attack, coronary/peripheral artery bypass graft, or any acute coronary syndrome.
    • Prolonged QT interval > 480 msec or clinically significant cardiac arrythmia or electrophysiologic disease (i.e., placement of implantable cardioverter defibrillator or atrial fibrillation with uncontrolled rate). Patients with cardiac pacemakers who are clinically stable are eligible.
    • Uncontrolled (persistent) arterial hypertension: systolic blood pressure > 180 mm Hg and/or diastolic blood pressure > 100 mm Hg.
    • Congestive heart failure defined as New York Heart Association class III-IV or hospitalization for CHF within 6 months of the first dose of study drug.
    • Clinically significant pericardial effusion.
    • Myocarditis.
    10. History of interstitial lung disease including drug-induced interstitial lung disease, radiation pneumonitis that requires treatment with prolonged steroids or other immune suppressive agents within 1 year.
    11. Previous or concurrent malignancy, excluding non-basal cell carcinomas of skin or carcinoma in situ of the uterine cervix, unless the tumor was treated with curative or palliative intent and in the opinion of the Investigator, with Sponsor agreement, the previous or concurrent malignancy condition does not affect the assessment of safety and efficacy of the study drug.
    12. Current dyspnea at rest of any origin, or other diseases requiring continuous oxygen therapy.
    13. Current serious illness or medical conditions including, but not limited to uncontrolled active infection, clinically significant pulmonary, metabolic or psychiatric disorders.
    14. Active Hepatitis B infection (HBsAg positive) without receiving antiviral treatment. Note: Patients with active hepatitis B must receive antiviral treatment with lamivudine, tenofovir, entecavir, or other antiviral agents, starting at least ≥ 7 days before the initiation of the study treatment. Patients with antecedents of Hepatitis B (anti-HBc positive, HbsAg and HBV-DNA negative) are eligible.
    15. Positive test for Hepatitis C ribonucleic acid (HCV RNA); Note: Patients in whom HCV infection resolved spontaneously (positive HCV antibodies without detectable HCV-RNA) or those who achieved a sustained virological response after antiviral treatment and show absence of detectable HCV RNA ≥ 6 months (with the use of IFN-free regimens) or ≥ 12 months (with the use of IFN-based regimens) after cessation of antiviral treatment are eligible.
    16. Known history of HIV (HIV 1/2 antibodies). HIV testing is not required unless mandated by local health authority or regulations.
    17. Sexually active male and female patients of childbearing potential must agree to use one of the following highly effective methods of birth control during the entire duration of the study and for 6 months after final administration of MCLA-129:
    • combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal)
    • progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable)
    • intrauterine device (IUD)
    • intrauterine hormone-releasing system (IUS)
    • bilateral tubal occlusion
    • vasectomized partner
    • sexual abstinence
    1. Metástasis en el SNC no tratadas o sintomáticas, o que requieran radioterapia, cirugía o tto continuado con corticoesteroides (>10mg de prednisona o equivalente) para controlar los síntomas en el plazo de 14D antes de la entrada en el estudio.
    2. Afectación leptomeníngea conocida.
    3. Participación en otro estudio clínico o tto con cualquier fármaco en investigación dentro en el plazo de 4S antes de la entrada en el estudio.
    4. Tto previo con un anticuerpo biespecífico contra EGFR-c-MET.
    5. Inmunoterapia o tto antineoplásico sistémico en el plazo de 4S o 5 semividas, lo que sea más corto, de la 1a dosis de MCLA-129. En el caso de los agentes citotóxicos que presenten toxicidad impte retardada (p. ej., mitomicina C, nitrosoureas), se requiere un periodo de reposo farmacológico de 6S. Nota: En otros fármacos con semividas prolongadas, la inclusión antes de la quinta semivida requiere la aprobación del promotor.
    6. Cirugía mayor o radioterapia en el plazo de 3S antes de la 1a dosis de MCLA-129. No serán aptos los ptes que hayan recibido radioterapia previa en ≥25 % de la médula ósea en algún momento.
    7. Toxicidades persistentes de grado >1 de imp clínica relacionadas con ttos antineoplásicos previos (excepto alopecia); se permiten la neuropatía sensitiva estable de grado ≤2 según los criterios terminológicos comunes para AAs (CTCAE) v5.0 del NCI estadounidense y el hipotiroidismo de grado ≤2 que permanezca estable con tto de reposición hormonal.
    8. Antecedentes de reacción de hipersensibilidad o de cualquier toxicidad atribuida a proteínas humanas o a cualquiera de los excipientes que hayan justificado la interrupción permanente de estos fármacos.
    9. Antecedentes de enfermedad cardiovascular de importancia clínica, incluidos, entre otros:
    • Diagnóstico de trombosis venosa profunda o de embolia pulmonar en el plazo de 1M antes de la 1a dosis de MCLA-129, o cualquiera de lo sgte en el plazo de 6M antes de la 1a dosis de MCLA-129: infarto de miocardio, angina inestable, accidente cerebrovascular, accidente isquémico transitorio, injerto de derivación arterial coronaria/periférica o cualquier síndrome coronario agudo.
    • Intervalo QT prolongado >480 ms o arritmia cardiaca o enfermedad electrofisiológica de imp clínica (es decir, colocación de desfibrilador cardioversor implantable o fibrilación auricular con frecuencia no controlada). Serán aptos los ptes con marcapasos cardiacos que estén clínicamente estables.
    • Hipertensión arterial no controlada (persistente): PA sistólica >180 mmHg o PA diastólica >100 mmHg.
    • Insuficiencia cardiaca congestiva (ICC), definida como de clase III-IV según la NYHA u hospitalización por ICC en el plazo de 6M antes de la 1a dosis de MCLA-129.
    • Derrame pericárdico de imp clínica.
    • Miocarditis.
    10. Antecedentes de enfermedad pulmonar intersticial, lo que incluye enfermedad pulmonar intersticial farmacógena, neumonitis por radiación que requiera tratamiento prolongado con corticoesteroides u otros inmunodepresores en el plazo de 1A.
    11. Neoplasia maligna previa o simultánea, excepto carcinomas no basocelulares de piel o carcinoma cervicouterino in situ, a menos que el tumor se haya tratado con intención curativa o paliativa y que, en opinión del investigador, con la aprobación del promotor, la neoplasia maligna previa o simultánea no afecte a la evaluación de la seguridad y la eficacia de MCLA-129.
    12. Disnea en reposo en curso de cualquier origen u otras enfermedades que requieran oxigenoterapia continua.
    13. Enfermedad o afecciones médicas graves en curso, incluidas, entre otras, infección activa no controlada o trastornos pulmonares, metabólicos o psiquiátricos de importancia clínica.
    14. Infección activa por hepatitis B (+ para HBsAg) sin recibir tto antivírico. Nota: Los ptes con hepatitis B activa (+ para HBsAg) deben recibir tto antivírico con lamivudina, tenofovir, entecavir u otros antivíricos, empezando al menos ≥7D antes del inicio del tto del estudio. Serán aptos los ptes con antecedentes de hepatitis B (+ para anti-HBc, HbsAg y (-) para ADN del VHB).
    15. Prueba (+) para ácido ribonucleico del virus de la hepatitis C (ARN del VHC). Nota: Serán aptos los ptes en los que la infección por VHC se haya resuelto espontáneamente (anticuerpos (+) contra el VHC sin ARN del VHC detectable) o aquellos que hayan alcanzado una respuesta virológica mantenida después del tto antivírico y muestren ausencia de ARN del VHC detectable ≥6M (con pautas sin interferón [IFN]) o ≥12M (con pautas con IFN) después de interrumpir el tto antivírico.
    16. Antecedentes conocidos de VIH (anticuerpos contra el VIH 1/2). No es necesario realizar pruebas del VIH, a menos que lo exijan las normativas o las autoridades sanitarias locales.
    17. Los ptes de sexo masculino y femenino sexualmente activos en edad fértil deben aceptar el uso de 1 de los sgtes métodos anticonceptivos altamente eficaces a lo largo de todo el estudio y durante los 6M sgtes a la administración final de MCLA-129
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1
    Primary endpoint
    1. Incidence and severity of DLTs during Cycle 1.

    Phase 2
    Primary endpoint
    2. ORR per RECIST v.1.1 based on Investigator assessment
    Fase I
    Criterio de valoración principal
    1. Incidencia e intensidad de las TLD durante el ciclo 1.

    Fase II
    Criterio de valoración principal
    TRG evaluada por el investigador según los criterios RECIST v1.1.
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Cycle 1
    2. Along the study phase 2
    1. Ciclo 1
    2. A lo largo de la fase 2 del estudio
    E.5.2Secondary end point(s)
    Phase 1
    Secondary endpoints
    1. Safety: Incidence, severity and relationship of AEs and SAEs; incidence,
    severity and changes in laboratory values; measures and changes in ECG and vital signs.
    2. Tolerability: Discontinuations due to AEs, dose modifications due to AEs.
    3. Efficacy: BOR, ORR, DCR, DoR, PFS and OS, per RECIST v1.1 based on Investigator assessment.
    4. Pharmacokinetics: MCLA-129 concentration CEOI, Cmax, C0h and PK
    parameters including AUC, CL, Vss, tmax and t1/2 and to develop a population PK model.
    5. Immunogenicity: Incidence and serum titers of antidrug antibodies against MCLA-129.
    6. Cytokines: Change from baseline in systemic cytokines.

    Exploratory endpoints
    7. Biomarkers: Change from baseline in biomarkers, and correlative analyses of biomarkers with antitumor response.

    Phase 2
    Secondary endpoints
    8. Efficacy: BOR, DCR, DoR, PFS and OS, per RECIST v1.1 based on Investigator assessment.
    9. Safety: Incidence, severity and relationship of AEs and SAEs; incidence, severity and changes in laboratory values; measures and changes in ECG and vital signs.
    10. Tolerability: Discontinuations due to AEs, dose modifications due to AEs.
    11. Pharmacokinetics: MCLA-129 concentration CEOI, Cmax, C0h, and PK parameters including AUC, CL, Vss, tmax and t1/2 and to develop a population PK model.
    12. Immunogenicity: Incidence and serum titers of antidrug antibodies against MCLA-129.

    Exploratory:
    13. Biomarkers: Change from baseline in biomarkers, and correlative analyses of biomarkers with antitumor response.
    Fase I
    Criterios de valoración secundarios
    1. Seguridad: incidencia, intensidad y relación de los AA y los AAG; incidencia, intensidad y cambios en los valores analíticos; medidas y cambios en el electrocardiograma (ECG) y en las constantes vitales.
    2. Tolerabilidad: interrupciones por AA, modificaciones de la dosis por AA.
    3. Eficacia: MRG, TRG, TCE, DdR, SSP y SG evaluadas por el investigador según los criterios RECIST v1.1.
    4. Farmacocinética: concentración de MCLA-129 CFDI, Cmáx, C0h y parámetros FC, como ABC, acl., Vee, tmáx y t1/2, y
    para desarrollar un modelo FC poblacional.
    5. Inmunogenicidad: incidencia y títulos séricos de anticuerpos antifármaco contra MCLA-129.
    6. Citocinas: cambio con respecto al inicio en las citocinas sistémicas.

    Criterios de valoración exploratorios
    7. Biomarcadores: cambio con respecto al inicio en los biomarcadores y análisis de correlación de los biomarcadores con respuesta antitumoral.

    Fase II
    Criterios de valoración secundarios
    8. Eficacia: MRG, TCE, DdR, SSP y SG evaluadas por el investigador según los criterios RECIST v1.1.
    9. Seguridad: incidencia, intensidad y relación de los AA y los AAG; incidencia, intensidad y cambios en los valores analíticos; medidas y cambios en el ECG y en las constantes vitales.
    10. Tolerabilidad: interrupciones por AA, modificaciones de la dosis por AA.
    11. Farmacocinética: concentración de MCLA-129 CFDI, Cmáx, C0h y parámetros FC, como ABC, acl., Vee, tmáx y t1/2, y
    para desarrollar un modelo FC poblacional.
    12. Inmunogenicidad: incidencia y títulos séricos de anticuerpos antifármaco contra MCLA-129.

    Exploratorios:
    13. Biomarcadores: cambio con respecto al inicio en los biomarcadores y análisis de correlación de los biomarcadores con respuesta antitumoral.
    E.5.2.1Timepoint(s) of evaluation of this end point
    1,2.Along phase1
    3.Every 8 wks after start treatment until progression
    4.Cycle 1:Day1,4,8,15,22. Cycle 2:Day1&15. Cycle 3:Day1, then every 4 cycles after Day1
    5.Day1 Cycles1,2,3 then every 4 cycles & EoT visit
    6.Cycle1 only, on Day1 pre-dose, 2,4&22 h post-end of infusion (EOI) and Day15, pre-dose, 2&4 h post-EOI
    7.Cycle1:Pre-dose Day1,EOI,22 h post- EOI; Any time on Days4 or 5 & 8; pre-dose and EOI, Day15; Day22 Cycle2:pre-dose & EOI on Days1&15
    8.Every 8 wks after start treatment until progression
    9,10.Along phase2
    11.Cycles1,2,3 then every 4 cycles
    12.Day1 Cycles 1,2,3 then every 4 cycles
    13.ctDNA:Pre-dose Day 1 Cycle 1. Plasma & Serum PD: Cycle 1: Pre-dose Day 1,EOI,22 h post-EOI; any time on Days 4 or 5,&8; pre-dose & EOI Day 15; Day 22. Cycle 2: pre-dose & EOI on Day 1 & 15
    1,2. A lo largo de la fase I
    3. Cada 8S después del inicio del tto hasta progresión
    4. C1: D1,D4,D8,D15,D22. C2: D1yD5. C3: D1, después cada 4 ciclos después de D1
    5.D1 C1,C2,C3 después cada 4 ciclos y visita FdE
    6.C1 sólo,D1 pre-dosis, D2,D4y22h post-fin de la infusion (FdI)y D15, pre-dosis,D2y4h postFdI
    7.C1:pre-dosis D1,FdI,22h post-FdI;En cualquier momento en D4 o D5yD8;pre-dosis y FdI,D15;D22 C2:pre-dosis y FdI en D18 y D15
    8. Cada 8S después del inicio del tto hasta progresión
    9,10. A lo largo de la Fase II
    11.C1, C2, C3 y después cada 4 ciclos
    12. D1 C1, C2, C3 y luego cada 4 ciclos
    13.ctDNA:Pre-dosis D1 C1. Plasma y suero PD:C1: Pre-dosis D1,FdI,22h post-FdI; en cualquier momento en D4 o D5 y D8; pre-dosis y FdI D15; D22. C2: pre-dose y FdI en D1 y D15
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans Yes
    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 No
    E.8.1.1Randomised No
    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) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA12
    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
    Korea, Republic of
    Singapore
    United States
    Belgium
    France
    Netherlands
    Spain
    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
    The study will be closed after the last patient on study has been followed-up for 12 months or initiates a new anticancer treatment, whichever occurs first.
    El estudio será cerrado después de que el último paciente del estudio haya estado en seguimiento durante 12 meses o inicie un nuevo tratamiento contra el cáncer, lo que ocurra primero.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    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 years3
    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: 72
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 108
    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 state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 101
    F.4.2.2In the whole clinical trial 180
    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)
    In the event of premature discontinuation of the trial for patients who have proven clinical benefit with MCLA-129, the Sponsor will provide MCLA-129 on a case-by-case basis outside the context of the study. Continued evidence of clinical benefit will need to be provided by the Investigator every 3 months to ensure continued provision of study drug.
    En caso de interrupción prematura del estudio, para los pacientes que hayan mostrado beneficio clínico con MCLA-129 el promotor proveerá MCLA-129 caso por caso fuera del contexto del estudio. El investigador deberá proporcionar pruebas de continuidad del beneficio clínico cada 3 meses para garantizar la continuación del suministro del fármaco del estudio.
    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 Decision2021-09-15
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-09-10
    P. End of Trial
    P.End of Trial StatusOngoing
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