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    Summary
    EudraCT Number:2021-000705-25
    Sponsor's Protocol Code Number:AT148002
    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:2021-09-10
    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 number2021-000705-25
    A.3Full title of the trial
    A PHASE 1/2 STUDY OF ALX148 IN COMBINATION WITH AZACITIDINE IN PATIENTS WITH HIGHER RISK MYELODYSPLASTIC SYNDROME (MDS) (ASPEN-02)
    STUDIO DI FASE 1/2 SU ALX148 IN COMBINAZIONE CON AZACITIDINA IN PAZIENTI CON SINDROME MIELODISPLASTICA (SMD) A RISCHIO PIÙ ELEVATO (ASPEN-02)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A trial in patients with with higher risk myelodysplastic syndrome looking at combining ALX148 and Azacitidine
    Sperimentazione in pazienti con sindrome mielodisplastica a rischio più elevato volta a valutare la combinazione di alx148 e azacitidina
    A.3.2Name or abbreviated title of the trial where available
    ASPEN-02
    ASPEN-02
    A.4.1Sponsor's protocol code numberAT148002
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04417517
    A.5.4Other Identifiers
    Name:US IND NumberNumber:147991
    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 SponsorALX ONCOLOGY INC
    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 supportALX Oncology Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationALX Oncology Inc.
    B.5.2Functional name of contact pointChief Medical Officer
    B.5.3 Address:
    B.5.3.1Street Address866 Malcolm Rd., Suite 100
    B.5.3.2Town/ cityBurlingame, CA
    B.5.3.3Post code94010
    B.5.3.4CountryUnited States
    B.5.4Telephone number+16504891277
    B.5.5Fax number+16504667138
    B.5.6E-mailsrandolph@alxoncology.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 nameALX148
    D.3.2Product code [ALX148]
    D.3.4Pharmaceutical form 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.3.9.1CAS number 2484949-51-9
    D.3.9.2Current sponsor codeALX148
    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 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 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.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 nameALX148
    D.3.2Product code [ALX148]
    D.3.4Pharmaceutical form 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.3.9.1CAS number 2484949-51-9
    D.3.9.2Current sponsor codeALX148
    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 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 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.IMP: 3
    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 nameALX148
    D.3.2Product code [ALX148]
    D.3.4Pharmaceutical form 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.3.9.1CAS number 2484949-51-9
    D.3.9.2Current sponsor codeALX148
    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 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 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.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 Yes
    D.2.1.1.1Trade name Azacitidine
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare S.L.U.
    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 nameAzacitidine
    D.3.2Product code [na]
    D.3.4Pharmaceutical form Powder for suspension for injection
    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.3.9.1CAS number 320-67-2
    D.3.9.2Current sponsor codeNA
    D.3.9.4EV Substance CodeSUB05624MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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.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
    Patients with higher risk myelodysplastic syndrome (MDS) who have not yet been treated for their disease
    Pazienti con Sindrome Mielodisplastica (SMD) a rischio più elevato che non sono stati ancora trattati per la loro malattia
    E.1.1.1Medical condition in easily understood language
    Myelodysplastic syndrome is a type of cancer where the blood-forming cells in the bone marrow are abnormal
    La sindrome mielodisplastica è un tipo di cancro in cui le cellule che formano il sangue nel midollo osseo sono anormali
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase 1:
    •To evaluate the safety and tolerability of ALX148 administered in combination with AZA in adult patients with relapsed/refractory MDS or previously untreated higher risk MDS as defined by IPSS-R score >3.5
    •To identify the RP2D of ALX148 in combination with AZA
    Phase 2:
    •To assess the effect of ALX148 administered at the RP2D (60 mg/kg Q4W) determined in Phase 1 in combination with AZA versus AZA alone on the investigator-assessed complete response rate (CRR) per IWG 2006 criteria in adult patients with previously-untreated higher risk MDS (IPSS-R score >3.5)
    Fase 1:
    • Valutare la sicurezza e la tollerabilità di ALX148 somministrato in combinazione con AZA in pazienti adulti con SMD recidivante/refrattaria o SMD a rischio più elevato precedentemente non trattata, come definito da un punteggio IPSS-R >3,5
    • Identificare la RP2D di ALX148 in combinazione con AZA
    Fase 2:
    • Valutare l’effetto di ALX148 somministrato alla RP2D (60 mg/kg Q4W) determinata nella Fase 1 (Sezione 1.2.5) in combinazione con AZA rispetto ad AZA in monoterapia sul tasso di risposta completa (CRR) valutato dallo sperimentatore secondo i criteri IWG 2006 in pazienti adulti con SMD a rischio più elevato precedentemente non trattata (punteggio IPSS-R >3,5)
    E.2.2Secondary objectives of the trial
    Phase 1:
    •To evaluate the overall safety profile of ALX148 in combination with AZA
    •To characterize the safety profile of the MTD or RP2D of ALX148 in combination with AZA
    •To characterize the single and multiple-dose PK of ALX148 in combination with AZA
    •To evaluate the immunogenicity of ALX148
    •To document any evidence of antitumor activity
    Phase 2:
    •To assess the effect of ALX148 RP2D (60 mg/kg Q4W) in combination with AZA versus AZA alone on the CRR per IWG 2006 criteria as determined by independent central review in adult patients with previously-untreated higher risk MDS (IPSS-R score >3.5)
    •To assess secondary measures of efficacy for ALX148 administered in combination with AZA versus AZA alone
    •To assess the safety and tolerability of ALX148 administered in combination with AZA versus AZA alone
    •To assess if ALX148 in combination with AZA improves global health status/quality of life versus AZA alone based on patient reported outcome (PRO) assessment
    Fase 1:
    • Valutare il profilo di sicurezza complessivo di ALX148 in combinazione con AZA
    • Caratterizzare il profilo di sicurezza della massima dose tollerata (MTD) o RP2D di ALX148 in combinazione con AZA
    • Caratterizzare la farmacocinetica (PK) a dose singola e multipla di ALX148 in combinazione con AZA
    • Valutare l’immunogenicità di ALX148
    • Documentare qualsiasi evidenza di attività antitumorale
    Fase 2:
    • Valutare effetto di ALX148 somministrato alla RP2D (60 mg/kg Q4W) determinata nella Fase 1 in combinazione con AZA rispetto ad AZA in monoterapia sul tasso di risposta completa (CRR) secondo i criteri IWG 2006...
    • Valutare misure secondarie di efficacia per ALX148 somministrato in combinazione con AZA rispetto ad AZA in monoterapia
    • Valutare sicurezza e tollerabilità di ALX148...
    • Valutare se ALX148 in combinazione con AZA migliora lo stato di salute globale/la qualità della vita (GHS/QoL) rispetto ad AZA in monoterapia in base alla valutazione di PRO
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Phase 1: Adult patients with documented diagnosis of relapsed/refractory MDS or higher risk MDS (IPSS-R score >3.5) that is previously untreated. For patients with relapsed/refractory MDS, prior exposure to hypomethylating agents is allowed. Patients with previously untreated disease must have had no prior exposure to hypomethylating agents or cytotoxic chemotherapy (prior use of single agent lenalidomide for low or intermediate-1 risk MDS with deletion 5q abnormality is allowed) for the treatment of MDS and be appropriate candidates for single-agent AZA.
    Phase 2: Adult patients with documented diagnosis of higher risk MDS (IPSS-R score >3.5) who have had no prior exposure to hypomethylating agents or cytotoxic chemotherapy (prior use of single agent lenalidomide for low or intermediate-1 risk MDS with deletion 5q abnormality is allowed) for the treatment of MDS, and are considered appropriate candidates for single-agent AZA.
    2. Phase 2 only: Bone marrow with >5% to <20% myeloblasts.
    3. Adequate Renal Function with estimated creatinine clearance <=30 mL/min as calculated using the method standard for the institution.
    4. Adequate Liver Function, including:
    a. Total serum bilirubin <=1.5 x ULN (<=3.0 x ULN if the patient has documented Gilbert syndrome);
    b. Aspartate and alanine transaminase (AST and ALT) <=3.0 x ULN; <=5.0 x ULN if due to leukemic organ involvement;
    c. Alkaline phosphatase <=2.5 x ULN; (<=5.0 x ULN if bone or liver metastasis).
    5. WBC < 20,000/µL. Administration of hydroxyurea for WBC control is permitted during the screening period up to and including treatment day -1 of the study (ie, one day prior to starting study treatment).
    6. QTcF interval of <=480 msec (Based upon mean value from triplicate ECGs).
    7. Age >=18 years because MDS is extremely rare in the pediatric (<18 yrs) population.
    8. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) must be 0, 1 or 2.
    9. For Phase 1 only: resolved acute effects of any prior therapy to baseline severity or Grade <=1 NCI CTCAE v.5.0 except for AEs not constituting a safety risk by Investigator judgment.
    10. Serum pregnancy test (for females of childbearing potential) negative at screening.
    11. Male and female patients of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 120 days after the last dose of assigned treatment. A patient is of childbearing potential if, in the opinion of the Investigator, he/she is biologically capable of having children and is sexually active.
    12. Evidence of a personally signed and dated informed consent document indicating that the patient (or legal representative) has been informed of all pertinent aspects of the study before any study-specific activity is performed.
    13. Patients who are willing and able to comply with scheduled visits, treatment plans, laboratory, tests and other procedures.
    1. Fase 1: pazienti adulti con diagnosi documentata di SMD recidivante/refrattaria o SMD a rischio più elevato (punteggio IPSSR >3,5) precedentemente non trattata. Per i pazienti con SMD recidivante/refrattaria, è consentita la precedente esposizione ad agenti ipometilanti. I pazienti con malattia precedentemente non trattata non devono aver avuto alcuna precedente esposizione ad agenti ipometilanti o chemioterapia citotossica (è consentito l’uso pregresso di lenalidomide come agente singolo per SMD a basso rischio o a rischio intermedio-1 con delezione 5q) per il trattamento della SMD e devono essere candidati idonei per l’AZA come agente singolo.
    Fase 2: pazienti adulti con diagnosi documentata di SMD a rischio più elevato (punteggio IPSS-R >3,5) che non hanno avuto alcuna precedente esposizione ad agenti ipometilanti o chemioterapia citotossica (è consentito l’uso precedente di lenalidomide come agente singolo per SMD a rischio basso o intermedio-1 con delezione 5q) per il trattamento della SMD e sono considerati candidati idonei per l’AZA come agente singolo.
    2. Solo per la Fase 2: midollo osseo con mieloblasti da >5% a <20%.
    3. Adeguata funzione renale con clearance della creatinina stimata <=30 ml/min calcolata utilizzando il metodo standard per l’istituto.
    4. Funzione epatica adeguata, tra cui:
    a. Bilirubina sierica totale <=1,5 volte il limite superiore di normalità (ULN) (<=3,0 volte l’ULN se il paziente presenta sindrome di Gilbert documentata).
    b. Aspartato-transaminasi e alanina-transaminasi (AST e ALT) <=3,0 volte l’ULN; <=5,0 volte l’ULN se dovute a coinvolgimento di altri organi nel processo leucemico.
    c. Fosfatasi alcalina <=2,5 volte l’ULN (<=5,0 volte l’ULN in caso di metastasi ossee o epatiche)
    5. Conta dei globuli bianchi <20.000/µl. La somministrazione di idrossiurea per il controllo dei globuli bianchi è consentita durante il periodo di screening fino al giorno di trattamento -1 dello studio incluso (ovvero, un giorno prima dell’inizio del trattamento dello studio).
    6. Intervallo QTcF <=480 msec (basato sui valori medi di ECG in triplicato).
    7. Età >=18 anni perché la SMD è estremamente rara nella popolazione pediatrica (<18 anni).
    8. Lo stato di validità (PS) secondo l’Eastern Cooperative Oncology Group (ECOG [Gruppo cooperativo orientale di oncologia]) deve essere pari a 0, 1 o 2.
    9. Solo per la Fase 1: effetti acuti di qualsiasi precedente terapia risolti alla gravità basale o al Grado <=1 NCI CTCAE v.5.0 ad eccezione degli EA che non costituiscono un rischio per la sicurezza secondo il giudizio dello sperimentatore.
    10. Test di gravidanza sul siero (per donne in età fertile) negativo allo screening.
    11. I pazienti di sesso maschile e femminile in età fertile devono accettare di utilizzare un metodo contraccettivo altamente efficace per tutta la durata dello studio e per almeno 120 giorni dopo l’ultima dose del trattamento assegnato. Un paziente è in età fertile se, a giudizio dello sperimentatore, è biologicamente in grado di concepire ed è sessualmente attivo.
    12. Evidenza di un documento di consenso informato personalmente firmato e datato indicante che il paziente (o un rappresentante legale) è stato informato di tutti gli aspetti pertinenti dello studio prima di eseguire qualsiasi attività specifica dello studio.
    13. Pazienti disposti e in grado di attenersi alle visite programmate, ai piani di trattamento, alle analisi di laboratorio e alle altre procedure.
    E.4Principal exclusion criteria
    1. Patients with a history of autoimmune hemolytic anemia, autoimmune thrombocytopenia, or hemolytic transfusion reaction secondary to an acquired allo-antibody.
    2. Previous allogeneic hematopoietic stem cell transplant (allo-HSCT) for MDS or AML. If allo-HSCT was performed for another disease, patient must be at least a year post-HSCT, off all treatment for graft-versus-host disease (GVHD), and without any active GVHD.
    3. Prior treatment with any anti-CD47 or anti-SIRPa agent.
    4. Phase 1 only: prior cytotoxic chemotherapy, CAR-T, or other cellular or experimental therapy within 4 weeks of starting study treatment. If any of these therapies (except hydroxyurea up to day -1 of study) was given within 4 weeks, patient may be included if at least 4 times the elimination half-life of the drug has passed.
    Phase 2 only: prior treatment with any hypomethylating agents or cytotoxic chemotherapy for MDS (except hydroxyurea up to day -1 of study and lenalidomide for low or intermediate-1 risk MDS with deletion 5q abnormality).
    5. Phase 2 only: Patients with MPN/MDS overlap syndromes, including CMML.
    6. Prior treatment with myeloid growth factors and erythropoiesis stimulating agents (ESAs) must be discontinued a minimum of 4-5 half-lives prior to initiation of study treatment.
    7. Patients with intolerance to or who have had a severe allergic or anaphylactic reaction to antibodies or infused therapeutic proteins or patients who have had a severe allergic or anaphylactic reaction to any of the substances included in the study drug (including excipients).
    8. Any experimental antibodies or live vaccines in the last 28 days prior to the first dose of study drug. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster, yellow fever, rabies, Bacillus Calmette–Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed.
    9. Known active viral infections, including hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) related illness, or known active infection with SARS-CoV-2 (testing to be performed per local criteria).
    10. Any of the following in the previous 6 months: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, NYHA Class II or greater congestive heart failure, uncontrolled hypertension, cerebrovascular accident, transient ischemic attack, deep venous thrombosis (except for thrombi considered device-associated and not clinically significant), arterial thrombosis, symptomatic pulmonary embolism, or any other significant thromboembolism. Any major surgery, within 28 days prior to enrollment.
    11. Current active treatment in another interventional therapeutic clinical study.
    12. Prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, prostate/breast/other cancer under control with hormone therapy alone, or other cancer from which the subject has been disease free for at least 2 years and felt to be at low risk for recurrence by the treating physician.
    13. Has an active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs)....
    14. Other severe acute or chronic medical or psychiatric condition, including uncontrolled systemic infection, recent (within the past year) or active suicidal ideation or behavior, or laboratory abnormality that may increase the risk associated with study participation or investigational product administration...
    15. Males and females of childbearing potential...
    16. Patients who are pregnant or breastfeeding.
    1. Anamnesi di anemia emolitica autoimmune, trombocitopenia autoimmune o reazione da trasfusione emolitica secondaria a un allo-anticorpo acquisito.
    2. Precedente trapianto allogenico di cellule staminali ematopoietiche (allo-HSCT) per SMD o LMA. Se l’allo-HSCT è stato eseguito per un’altra malattia, deve essere trascorso almeno un anno post-HSCT, il paziente deve avere interrotto tutti i trattamenti per la malattia del trapianto contro l’ospite (GVHD) e non deve avere alcuna GVHD attiva.
    3. Precedente trattamento con qualsiasi anti-CD47 o agente anti-SIRPa
    4. Solo per la Fase 1: precedente chemioterapia citotossica, CAR-T o altra terapia cellulare o sperimentale entro 4 settimane dall’inizio del trattamento dello studio. Se una qualsiasi di queste terapie (ad eccezione dell’idrossiurea fino al giorno -1 dello studio) è stata somministrata entro 4 settimane, il paziente può essere incluso se è trascorsa almeno 4 volte l’emivita di eliminazione del farmaco.
    Solo per la Fase 2: precedente trattamento con qualsiasi agente ipometilante o chemioterapia citotossica per SMD (eccetto idrossiurea fino al giorno -1 dello studio e lenalidomide per SMD a rischio basso o intermedio-1 con delezione 5q).
    5. Solo per la Fase 2: pazienti con sindromi da sovrapposizione di NMP/SMD, incluso la leucemia cronica mielomonocitica (CMML).
    6. Il precedente trattamento con fattori di crescita mieloidi e agenti stimolanti l’eritropoiesi (ESA) deve essere interrotto almeno 4-5 emivite prima dell’inizio del trattamento dello studio.
    7. Pazienti con intolleranza o che hanno manifestato una grave reazione allergica o anafilattica agli anticorpi o alle proteine terapeutiche infuse o pazienti che hanno manifestato una grave reazione allergica o anafilattica a una qualsiasi delle sostanze incluse nel farmaco dello studio (compresi gli eccipienti).
    8. Qualsiasi anticorpo sperimentale o vaccino vivo negli ultimi 28 giorni precedenti la prima dose del farmaco dello studio. Esempi di vaccini vivi includono, a titolo meramente esemplificativo: vaccino per morbillo, parotite, rosolia, varicella/zoster, febbre gialla, rabbia, bacillo di Calmette–Guérin (BCG) e tifo. I vaccini antinfluenzali stagionali somministrati tramite iniezione generalmente sono vaccini con virus ucciso e dunque sono consentiti;
    tuttavia, i vaccini antinfluenzali intranasali (ad es. FluMist®) sono vaccini vivi attenuati e non sono consentiti.
    9. Infezioni virali attive note, tra cui epatite B (HBV), epatite C (HCV), virus dell’immunodeficienza umana (HIV), malattia correlata alla sindrome da immunodeficienza acquisita (AIDS) o infezione attiva nota da SARS-CoV-2 (test da eseguire in base ai criteri locali).
    10. Uno qualsiasi dei seguenti nei 6 mesi precedenti: infarto miocardico, angina grave/instabile, innesto di bypass aortocoronarico/periferico, scompenso cardiaco congestizio di classe II o superiore secondo la New York Heart Association (NYHA), ipertensione non controllata, accidente cerebrovascolare, attacco ischemico transitorio, trombosi venosa profonda (ad eccezione...), trombosi arteriosa, embolia polmonare sintomatica o qualsiasi altra tromboembolia significativa..
    11. Attuale trattamento attivo in un altro studio clinico interventistico terapeutico.
    12. Precedente neoplasia maligna, ad eccezione di carcinoma cutaneo basocellulare o squamocellulare adeguatamente trattato, carcinoma cervicale in situ, carcinoma della prostata/tumore alla mammella/altro tumore sotto controllo con la sola terapia ormonale o altro tumore ..
    13. Malattia autoimmune attiva che ha richiesto un trattamento sistemico negli ultimi 2 anni....
    14. Altre condizioni gravi, acute o croniche cliniche o psichiatriche, tra cui infezione sistemica incontrollata, ideazione o comportamento suicidario recente (nell’ultimo anno), o anomalie...
    15. Soggetti di sesso maschile e femminile in età fertile ...
    16. Pazienti in gravidanza o che allattano al seno.
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1:
    •First Cycle DLTs using CTCAE v5.0
    Phase 2:
    •The primary endpoint of the Phase 2 part of the study is complete response rate (CRR), assessed by investigator using IWG 2006 response criteria for MDS, defined as a best response of CR, with the final analysis to be performed after the last patient has completed 6 cycles of treatment or is considered evaluable for response.
    Fase 1:
    • Tossicità dose limitante (DLT) del primo ciclo utilizzando i Criteri terminologici comuni per gli eventi avversi (CTCAE) v5.0
    Fase 2:
    • Tasso di risposta completa (CRR) valutato dallo sperimentatore (utilizzando i criteri di risposta IWG 2006 per la SMD)
    E.5.1.1Timepoint(s) of evaluation of this end point
    In the Phase 1 portion of the study, the sample size is not based on formal statistical considerations. Rather, it is based on a desire to obtain sufficient safety, tolerability, PK, PD and preliminary efficacy information while exposing as few patients as possible to the investigational treatments.
    In Phase 2, the final analysis to be performed after the last patient has completed 6 cycles of treatment or is considered evaluable for response.
    Nella fase 1 dello studio, la dimensione del campione non si basa su considerazioni statistiche formali. Piuttosto, si basa sul desiderio di ottenere sufficienti informazioni su sicurezza, tollerabilità, farmacocinetica, PD e efficacia preliminare esponendo il minor numero possibile di pazienti ai trattamenti sperimentali.
    Nella Fase 2, l'analisi finale da eseguire dopo che l'ultimo paziente ha completato 6 cicli di trattamento o è considerata valutabile per la risposta.
    E.5.2Secondary end point(s)
    Both Phase 1 and 2
    •Incidence of marrow CR, objective response rate (ORR), CRR (Phase 1 only), hematologic improvement (HI) in erythrocytes (E), platelets (P), and neutrophils (N), red blood cell (RBC) and platelet (PLT) transfusion independence, frequency and level of measurable residual disease (MRD)
    •Duration of response (DOR), event-free survival (EFS), progression-free survival (PFS), overall survival (OS), time to progression (TTP).
    •Percentage of patients able to proceed to allogeneic hematopoietic stem cell transplant (allo-HSCT).
    •Changes in global health status/quality of life (GHS/QoL) status based on patient reported outcome (PRO) assessment (Phase 2 only).
    •Adverse Events as characterized by type, frequency, severity (as graded by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v. 5.0), timing, seriousness, and relationship to study therapy;
    •Laboratory abnormalities as characterized by type, frequency, severity (as graded by NCI CTCAE v. 5.0) and timing;
    •Pharmacokinetic parameters of ALX148 such as Cmax, Tmax, AUC, CL, and t1/2 as data permit;
    •Immunogenicity; Human serum ADA (anti ALX148 antibody) samples will be analyzed for the presence or absence of anti ALX148 antibodies.
    Entrambe le Fasi 1 e 2:
    • Incidenza di CR midollare, tasso di risposta obiettiva (ORR), CRR (solo Fase 1), miglioramento ematologico (HI) di eritrociti (E), piastrine (P), neutrofili (N),indipendenza trasfusionale di globuli rossi (RBC) e piastrine (PLT), frequenza e livello di malattia residua misurabile (MRD)
    • Durata della risposta (DOR), sopravvivenza libera da eventi (EFS), sopravvivenza libera da progressione (PFS), sopravvivenza complessiva (OS), tempo alla progressione (TTP).
    • Percentuale di pazienti in grado di procedere al trapianto allogenico di cellule staminali ematopoietiche (allo-HSCT).
    • Variazioni nello stato di salute globale/stato di qualità della vita (GHS/QoL) in base alla valutazione degli esiti riferiti dal paziente (PRO) (solo Fase 2).
    • Eventi avversi caratterizzati per tipo, frequenza, gravità [secondo la classificazione dei Criteri terminologici comuni per gli eventi avversi del National Cancer Institute (NCI CTCAE v. 5.0)], tempistica, serietà e relazione con la terapia dello studio.
    • Anomalie di laboratorio caratterizzate per tipo, frequenza, gravità (secondo la classificazione NCI CTCAE v. 5.0) e tempistica.
    • Parametri farmacocinetici di ALX148 come Cmax, Tmax, area sotto la curva (AUC), clearance plasmatica (CL) e emivita plasmatica di eliminazione (t1/2) come consentito dai dati.
    • Immunogenicità. I campioni di siero umano per gli ADA (anticorpi anti-ALX148) saranno analizzati per la presenza o l’assenza di anticorpi anti-ALX148.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Duration of response (DOR) is measured from the time measurement criteria are first met for CR, PR, mCR, CyR, or HI, until the first date that progressive disease (PD) is documented. Duration of CR is also measured from the time measurement criteria are first met for CR only, until the first date that progressive disease (PD) is documented. Patients who do not have any documentation of progression will be censored at their last tumor assessment. DOR will be evaluated in the responders population.
    Time to progression (TTP) is measured from start of treatment until progressive disease (PD) is documented. Patients who do not have any documentation of progression will be censored at their last tumor assessment.

    La durata della risposta viene misurata dal momento in cui i criteri di misurazione vengono soddisfatti per la prima volta per CR, PR, mCR, CyR o HI, fino alla prima data in cui viene documentata la malattia progressiva (PD). La durata della CR viene misurata anche dal momento in cui i criteri di misurazione sono soddisfatti per la prima volta solo per CR, fino alla prima data in cui viene documentata la PD. I pazienti che non hanno alcuna documentazione sulla progressione saranno censurati all'ultima valutazione del tumore. Il DOR sarà valutato nella popolazione dei responder.
    Il TTP viene misurato dall'inizio del trattamento fino alla documentazione della PD. I pazienti che non hanno alcuna documentazione della progressione saranno censurati all'ultima valutazione del tumore.
    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 Yes
    E.6.13.1Other scope of the trial description
    Tolerability; Immunogenicity; Pharmacodynamic for CD47 occupancy
    tollerabilità; immunogenicità; Farmacodinamica per occupazione CD47
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    US only: Dose Exploration and Selection of the ALX148 Recommended Phase 2 Dose and Schedule (RP2D)
    Solo USA: esplorazione della dose e selezione della dose e del programma consigliati per la fase 2 d
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group 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 concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA23
    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
    Korea, Republic of
    United States
    Belgium
    France
    Germany
    Italy
    Spain
    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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months6
    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: 77
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 78
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Subjects with no physical capacity to consent for themselves having an officially assigned legal representative authorised to consent on behalf/for the patient.
    Soggetti privi della capacità fisica di acconsentire per se stessi che hanno un rappresentante legale ufficialmente assegnato autorizzato a prestare il consenso per conto del paziente.
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 65
    F.4.2.2In the whole clinical trial 155
    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)
    Usual care
    Cure abituali
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-03-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-02-21
    P. End of Trial
    P.End of Trial StatusOngoing
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