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    Summary
    EudraCT Number:2021-001309-60
    Sponsor's Protocol Code Number:MK4280A-007
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2021-07-20
    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 number2021-001309-60
    A.3Full title of the trial
    A Phase 3 study of MK-4280A (coformulated favezelimab [MK-4280] plus
    pembrolizumab [MK-3475]) Versus Standard of Care in Previously Treated Metastatic PD-L1 positive Colorectal Cancer
    Estudio de fase 3 de MK-4280A (favezelimab [MK-4280] en coformulación con pembrolizumab [MK-3475]) en comparación con el tratamiento de referencia en participantes con cáncer colorrectal metastásico positivo para PD-L1 tratados previamente.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    MK-4280A Versus Standard of Care in Previously Treated Metastatic PD-L1 positive Colorectal Cancer
    MK-4280A en comparación con el tratamiento de referencia en pacientes con Cancer Colorrectal metastásico positivo para PD-L1 tratados previamente
    A.4.1Sponsor's protocol code numberMK4280A-007
    A.5.4Other Identifiers
    Name:INDNumber:147726
    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 SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., 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 supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España SA
    B.5.2Functional name of contact pointInvestigación clínica
    B.5.3 Address:
    B.5.3.1Street AddressCalle Josefa valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491321 06 00
    B.5.5Fax number+34918321 05 90
    B.5.6E-mailensayos_clinicos@merck.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 namefavezelimab / pembrolizumab
    D.3.2Product code MK-4280A
    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 INNFavezelimab
    D.3.9.2Current sponsor codeMK-4280
    D.3.9.3Other descriptive nameAnti-LAG-3 antibody
    D.3.9.4EV Substance CodeSUB191937
    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.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    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) Yes
    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 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 Stivarga 40 mg film-coated tablets
    D.2.1.1.2Name of the Marketing Authorisation holderBayer AG
    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.3.4Pharmaceutical 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 INNREGORAFENIB
    D.3.9.1CAS number 755037-03-7
    D.3.9.3Other descriptive nameREGORAFENIB
    D.3.9.4EV Substance CodeSUB73090
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 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 Lonsurf 15 mg/6.14 mg film-coated tablets
    D.2.1.1.2Name of the Marketing Authorisation holderLes Laboratoires Servier
    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 nameTRIFLURIDINE / TIPIRACIL
    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 INNTRIFLURIDINE
    D.3.9.3Other descriptive nameTRIFLURIDINE
    D.3.9.4EV Substance CodeSUB11291MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTIPIRACIL
    D.3.9.3Other descriptive nameTIPIRACIL
    D.3.9.4EV Substance CodeSUB174128
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6.14
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    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 Lonsurf 20 mg/8.19 mg film-coated tablets
    D.2.1.1.2Name of the Marketing Authorisation holderLes Laboratoires Servier
    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 nameTRIFLURIDINE / TIPIRACIL
    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 INNTRIFLURIDINE
    D.3.9.3Other descriptive nameTRIFLURIDINE
    D.3.9.4EV Substance CodeSUB11291MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTIPIRACIL
    D.3.9.3Other descriptive nameTIPIRACIL
    D.3.9.4EV Substance CodeSUB174128
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number8.19
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Metastatic Colorectal Cancer
    cáncer colorrectal metastásico
    E.1.1.1Medical condition in easily understood language
    Metastatic Colorectal Cancer
    cáncer colorrectal metastásico
    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 10052362
    E.1.2Term Metastatic colorectal cancer
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To compare MK-4280A to standard of care (regorafenib or TAS-102) with respect to overall survival.
    1.Comparar MK-4280A con el tratamiento de referencia (regorafenib o TAS-102) en cuanto a la supervivencia global.
    E.2.2Secondary objectives of the trial
    1. To compare MK-4280A to standard of care with respect to progression free survival per RECIST 1.1 as assessed BICR.
    2. To compare MK-4280A to standard of care with respect to objective response rate per RECIST 1.1 as assessed by BICR.
    3. To assess the efficacy of MK-4280A and standard of care with respect to duration of response per RECIST 1.1 by BICR.
    4. To determine the safety and tolerability of MK-4280A and standard of care.
    5. To compare the change from baseline in global health status/QoL, physical functioning, appetite loss and bloating for MK-4280A versus standard of care.
    6. To compare the time to deterioration in global health status/QoL, physical functioning, appetite loss and bloating for MK-4280A versus standard of care.
    1.Comparar MK-4280A con el tratamiento de referencia en cuanto a la supervivencia sin progresión conforme a los criterios RECIST 1.1, evaluada mediante una ECIE.
    2.Comparar MK-4280A con el tratamiento de referencia en cuanto a la tasa de respuestas objetivas conforme a los criterios RECIST 1.1, evaluada mediante una ECIE.
    3.Evaluar la eficacia de MK-4280A y el tratamiento de referencia en cuanto a la duración de la respuesta conforme a los criterios RECIST 1.1, según una ECIE.
    4.Determinar la seguridad y la tolerabilidad de MK-4280A y el tratamiento de referencia.
    5.Comparar la variación con respecto al momento basal del estado de salud general/calidad de vida, el funcionamiento físico, la pérdida de apetito y el meteorismo con MK-4280A frente al tratamiento habitual.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. The participant must have histologically confirmed colorectal adenocarcinoma that is metastatic and unresectable (Stage IV as defined by AJCC eighth edition) [National Comprehensive Cancer Network 2018]
    2. Have measurable disease per RECIST 1.1 as assessed by the local site investigator. Lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions.
    3. Has been previously treated for their disease and radiographically progressed on or after or could not tolerate standard treatment, which must include ALL of the following agents if approved and locally available in the country where the participant is randomized:
    a. Fluoropyrimidine, irinotecan and oxaliplatin.
    b. With or without an anti-VEGF monoclonal antibody (eg, bevacizumab)
    c. At least one of the anti-EGFR monoclonal antibodies (cetuximab or panitumumab) for Ras WT participants with left-sided tumors.
    d. Participants with BRAF v600E mutations must have been treated with a RAF inhibitor. Participants with BRAF mutations that are not v600E are not required to have received RAF inhibitor therapy.
    4. Submit an archival (≤ 5 years) or newly obtained tumor tissue sample or newly obtained tumor tissue sample that has not been previously irradiated, to enable central laboratory testing of PD-L1 and MMR status. FFPE blocks are preferred to slides.
    5. Have an ECOG PS of 0 to 1 within 10 days prior to first dose of study intervention.
    6. Have a life expectancy of at least 3 months, based on the investigator assessment.
    7. Have the ability to swallow and retain oral medication and not have any clinically significant gastrointestinal abnormalities that might alter absorption.
    8. Have adequate organ function as defined in the study protocol. Specimens must be collected within 10 days prior to the start of study intervention.
    9. Is male or female, ≥18 years of age at the time of obtaining the informed consent.
    10. Male participants are eligible to participate if they agree to the following during the intervention period and for at least the time needed to eliminate each study intervention after the last dose of study intervention. The length of time required to continue contraception for each study intervention is as follows: TAS-102 (90 days) and regorafenib (90 days). No contraception requirements are needed for males receiving MK-4280A.
    • Refrain from donating sperm
    PLUS either:
    • Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis) and agree to remain abstinent
    OR
    • Must agree to use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause). Agree to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a WOCBP who is not currently pregnant.
    • Contraceptive use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
    Female Participants
    • Is not a WOCBP
    OR
    • Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis), as described in the protocol during the intervention period and for at least the time needed to eliminate each study intervention after the last dose of study intervention and agrees not to donate eggs (ova, oocytes) to others or freeze/store for her own use for the purpose of reproduction during this period. The length of time required to continue contraception for each study intervention is as follows: MK-4280A (120 days), TAS-102 (180 days), and regorafenib (180 days). The investigator should evaluate the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention.
    A WOCBP must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 24 or 72 hours, respectively, before the first dose of study intervention.
    - The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
    - Contraceptive use by women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
    11. The participant (or legally acceptable representative) has provided documented informed consent/assent for the study. The participant may also provide consent/assent for FBR. However, the participant may participate in the study without participating in FBR.
    1. El participante debe tener un adenocarcinoma colorrectal confirmado histológicamente que sea metastásico e irresecable (estadio IV según la definición de la octava edición del AJCC).
    2. Presencia de enfermedad mensurable conforme a los criterios RECIST, versión 1.1, según la evaluación del IP del centro. Las lesiones ubicadas en una zona previamente irradiada se considerarán mensurables siempre que se haya constatado progresión en éstas.
    3. Tratamiento (Tto) previo por la enfermedad y progresión radiográfica durante o después del tto de referencia o intolerancia al mismo, que deberá incluir TODOS los fármacos siguientes si están aprobados y disponibles localmente en el país en el que se aleatorice al participante:
    a. Fluoropirimidina, irinotecán y oxaliplatino.
    b. Con o sin un anticuerpo monoclonal anti-VEGF.
    c. Al menos 1 de los anticuerpos monoclonales anti-EGFR en los participantes con RAS natural y tumores del lado izquierdo.
    d. Los participantes con mutaciones BRAF V600E deberán haber recibido Tto. con un inhibidor de RAF. No es necesario que los participantes con mutaciones de BRAF que no sean V600E hayan recibido Tto. con inhibidores de RAF.
    4. Envío de una muestra de tejido tumoral de archivo (≤5 años) o recién obtenida o una muestra de tejido tumoral recién obtenida que no haya sido irradiada previamente para permitir el análisis del estado de PD-L1 y REE en el laboratorio central.
    5. EF del ECOG de 0 o 1 en los 10 días previos a la 1ªde la intervención del estudio.
    6. Esperanza de vida mínima de 3 meses, según la evaluación del IP.
    7. Capacidad de tragar y retener medicación oral y ausencia de anomalías digestivas clínicamente significativas que puedan alterar la absorción.
    8. Presencia de 1 función orgánica adecuada, como se define en el protocolo. Las muestras se obtendrán en los 10 días previos al comienzo de la intervención del estudio.
    9. Participante de cualquier sexo con una edad mínima de 18 años en el momento de obtener el CI
    10. En el estudio podrán participar varones que se comprometan a todo lo siguiente durante el período de intervención y durante, como mínimo, el tiempo necesario para eliminar cada intervención del estudio después de recibir la última dosis de esta. El tiempo que tendrá que mantenerse la anticoncepción con cada intervención del estudio es el siguiente: TAS-102 y regorafenib (90 d). No se necesitan requisitos de anticoncepción para los varones tratados con MK-4280A.
    •Abstenerse de donar semen.
    MÁS:
    • Abstenerse de mantener relaciones heterosexuales, como modo de vida habitual y preferido (abstinencia a largo plazo y persistente), y compromiso de mantener dicha abstinencia.
    O
    • Comprometerse a utilizar métodos anticonceptivos, a menos que se confirme la presencia de azoospermia.
    • Comprometerse a utilizar preservativo masculino más uso por parte de la pareja de un método anticonceptivo adicional cuando mantengan relaciones sexuales con penetración vaginal con mujeres en edad fértil que no estén embarazadas.
    • El uso de anticonceptivos por los varones deberá cumplir la normativa local.
    Mujeres participantes
    • No es una mujer en edad fértil.
    O
    • Es una MEF y utiliza un método anticonceptivo muy eficaz, con baja dependencia de la usuaria, o practica la abstinencia de relaciones heterosexuales como modo de vida preferido y habitual (abstinencia a largo plazo y persistente), según se describe en el protocolo, durante el período de intervención y durante, como mínimo, el tiempo necesario para eliminar cada intervención del estudio después de recibir la última dosis de la misma y se compromete a no donar óvulos a otras personas ni congelarlos/conservarlos para su propio uso con fines de reproducción durante este período. El tiempo que tendrá que mantenerse la anticoncepción con cada intervención del estudio es el siguiente: MK-4280A (120 días), TAS-102 (180 d) y regorafenib (180 d). El IP deberá evaluar la posibilidad de fracaso del método anticonceptivo en relación con la 1ªde la intervención del estudio.
    •Las mujeres en edad fértil deberán dar negativo en una prueba de embarazo de alta sensibilidad realizada en las 24 o 72h. previas, respectivamente, a la 1ªde la intervención del estudio.
    •El IP es responsable de revisar los antecedentes médicos, los antecedentes menstruales y la actividad sexual reciente para reducir el riesgo de incluir a una mujer con un embarazo de poco tiempo no detectado.
    •El uso de anticonceptivos por las mujeres deberá cumplir la normativa local sobre métodos anticonceptivos para participantes en estudios clínicos
    11. El participante (o su representante legal) otorga su consentimiento o asentimiento informado documentado para el estudio. El participante también podrá otorgar su consentimiento para investigaciones biomédicas futuras. Podrá participar en el estudio principal sin necesidad de hacerlo en las investigaciones biomédicas futuras.
    E.4Principal exclusion criteria
    1. Has previously been found to have dMMR/MSI-H tumor status determined by either IHC or PCR.
    2. Has known active CNS metastases and/or carcinomatous meningitis or leptomeningeal disease. Participants with previously treated brain metastases may participate provided they are radiologically stable, ie, without evidence of progression for at least 28 days by repeat imaging (note that the repeat imaging should be performed during study screening), clinically stable and without requirement of steroid intervention for at least 14 days prior to first dose of study intervention.
    3. Has a history of acute or chronic pancreatitis.
    4. Has neuromuscular disorders associated with an elevated creatine kinase (eg, inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy).
    5. A WOCBP who has a positive urine/serum pregnancy test within 24/72 hours prior to the first dose of study intervention. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
    6. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD-L2 agent, anti-LAG-3 antibody, with a TKI (eg, lenvatinib) other than RAF inhibitors (if appropriate), or with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX-40, CD137).
    7. Has previously received regorafenib or TAS-102.
    8. Has received prior systemic anticancer therapy including investigational agents within 28 days before randomization.
    9. Has received prior radiotherapy within 2 weeks of start of study intervention. Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤2 weeks of radiotherapy) to non-CNS disease.
    10. Has received a live or live-attenuated vaccine within 30 days before the first dose of study intervention. Administration of killed vaccines are allowed.
    11. Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 28 days before the first dose of study intervention.
    12. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 10 days prior the first dose of study medication.
    13. Has a known additional malignancy that is progressing or has required active treatment within the past 3 years.
    14. Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients.
    15. Has an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed.
    16. Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
    17. Has an active infection requiring systemic therapy (eg, tuberculosis, known viral or bacterial infections, etc.).
    18. Has a known history of HIV infection. No HIV testing is required unless mandated by local health authority.
    19. Has a known history of Hepatitis B (defined as HBsAg reactive) or known active Hepatitis C virus (defined as HCV RNA [qualitative] is detected) infection.
    20. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.
    21. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study.
    22. Has had an allogenic tissue/solid organ transplant.
    1. Se ha constatado previamente un estado tumoral de dREE/IMS-A determinado mediante IHQ o PCR.
    2. Presencia de metástasis activas conocidas en el SNC y/o meningitis carcinomatosa o enfermedad leptomeníngea. Los participantes con metástasis cerebrales tratadas anteriormente podrán participar siempre que se encuentren radiológicamente estables, es decir, sin signos de progresión durante al menos 28 días en estudios de imagen repetidos (hay que señalar que durante la selección para el estudio deberán realizarse nuevos estudios de imagen), clínicamente estables y sin necesidad de tratamiento con esteroides durante al menos 14 días antes de la primera dosis de la intervención del estudio.
    3. Antecedentes de pancreatitis aguda o crónica
    4. Presencia trastornos neuromusculares asociados a una elevación de la creatina cinasa (por ejemplo, miopatías inflamatorias, distrofia muscular, esclerosis lateral amiotrófica o atrofia muscular espinal).
    5. Mujer en edad fértil que da positivo en una prueba de embarazo en orina o suero realizada en las 24 o 72 horas previas a la primera dosis de la intervención del estudio. Cuando el resultado de la prueba en orina sea positivo o no pueda confirmarse que es negativo, será necesario hacer una prueba de embarazo en suero.
    6. Recepción de tratamiento previo con un fármaco anti-PD-1, anti-PD-L1 o anti-PD-L2, anticuerpo anti-LAG-3, con un ITC (por ejemplo, lenvatinib) distinto de inhibidores de RAF (si procede) o con un fármaco dirigido contra otro receptor de los linfocitos T estimulador o coinhibidor (por ejemplo, CTLA-4, OX-40 o CD137).
    7. Recepción previa de regorafenib o TAS-102.
    8. Recepción de un tratamiento antineoplásico sistémico previo, incluidos fármacos en investigación, en los 28 días anteriores a la aleatorización.
    9. Haber recibido radioterapia en las dos semanas previas al comienzo de la intervención del estudio. Los participantes deberán haberse recuperado de toda toxicidad relacionada con la radioterapia, no precisar corticoides y no haber sufrido neumonitis por radiación. Se permite un reposo farmacológico de una semana en caso de radioterapia paliativa (≤2 semanas de radioterapia) por enfermedad que no afecta al SNC.
    10. Recepción de una vacuna de microorganismos vivos o vivos atenuados en los 30 días previos a la primera dosis de la intervención del estudio. Se permite la administración de vacunas inactivadas.
    11. Participación activa o pasada en un estudio de un fármaco en investigación o uso de un dispositivo en investigación en los 28 días previos a la administración de la primera dosis de la intervención del estudio.
    12. Diagnóstico de inmunodeficiencia o recepción de tratamiento sistémico crónico con esteroides (en dosis superiores a 10 mg diarios de prednisona o equivalente) o cualquier otra forma de tratamiento inmunodepresor en los 10 días previos a la primera dosis de la medicación del estudio.
    13. Presencia de otra neoplasia maligna conocida que esté en progresión o que haya precisado tratamiento activo en los últimos 3 años.
    14. Presencia de hipersensibilidad grave (grado ≥3) a pembrolizumab y/o a cualquiera de sus excipientes.
    15. Presencia de una enfermedad autoinmunitaria activa que haya precisado tratamiento sistémico (es decir, fármacos modificadores de la enfermedad, corticosteroides o inmunodepresores) en los dos últimos años. El tratamiento de reposición (por ejemplo, tiroxina, insulina o corticoides en dosis fisiológicas por insuficiencia suprarrenal o hipofisaria) no se considera una forma de tratamiento sistémico y se permitirá su uso.
    16. Antecedentes de neumonitis (no infecciosa)/neumopatía intersticial que precisó corticoides o presencia de una neumonitis/neumopatía intersticial.
    17. Presencia de una infección activa con necesidad de tratamiento sistémico (por ejemplo, tuberculosis, infecciones víricas o bacterianas conocidas, etc.).
    18. Antecedentes de infección por el virus de la inmunodeficiencia humana (VIH). No será necesario realizar pruebas de VIH a menos que lo exijan las autoridades sanitarias locales.
    19. Antecedentes de infección por el virus de la hepatitis B (reactividad del antígeno de superficie del virus de la hepatitis B [HBsAg]) o de infección activa por el virus de la hepatitis C (definida como detección de ARN del virus de la hepatitis C [VHC] [cualitativo]).
    20. Antecedentes o datos presentes de cualquier proceso, tratamiento o anomalía analítica que, en opinión del investigador responsable del tratamiento, podría confundir los resultados del estudio, dificultar la participación durante la totalidad del estudio o motivar que la participación no sea lo más conveniente para el posible participante.
    21. Presencia de un trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante para colaborar en el cumplimiento de los requisitos del estudio.
    22. Recepción de un alotrasplante de órgano sólido o tejidos
    E.5 End points
    E.5.1Primary end point(s)
    1. Overall Survival (OS)
    1.Supervivencia Global (SG)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 26 months
    1.Hasta aproximadamente 26 meses
    E.5.2Secondary end point(s)
    1. Progression-Free Survival (PFS) according per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by Blinded Independent Central Review (BICR)
    2. Objective Response Rate (ORR) per RECIST 1.1 as Assessed by BICR
    3. Duration of Response (DOR) per RECIST 1.1 as Assessed by BICR
    4. Number of Participants Who Experience at least One Adverse Event (AE)
    5. Number of Participants Who Discontinue Study Treatment Due to an AE
    6. Change from Baseline in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) Global Health Status (Item 29) and Quality of Life (Item 30) Combined Score
    7. Change from Baseline in EORTC QLQ-C30 Physical Functioning (Items 1-5) Score
    8. Change from Baseline in EORTC QLQ-C30 Appetite Loss (Item 13) Score
    9. Change from Baseline in EORTC Quality of Life Questionnaire-Colorectal Cancer-Specific 29 Items (QLQ-CR29) Bloating (Item 37) Score
    10. Time to Deterioration (TTD) in EORTC QLQ-C30 Global Health Status (Item 29) and Quality of Life (Item 30) Combined Score
    11. TTD in EORTC QLQ-C30 Physical Functioning (Items 1-5) Combined Score
    12. TTD in in EORTC QLQ-C30 Appetite Loss (Item 13) Score
    13. TTD in EORTC Quality of Life Questionnaire-Colorectal Cancer-Specific 29 Items (QLQ-CR29) Bloating (Item 37) Score
    1.Supervivencia sin progresión según los criterios de evaluación de respuesta en tumores sólidos versión 1.1 (RECIST 1.1) evaluada mediante una ECIE.
    2.Tasa de respuestas objetivas conforme a los criterios RECIST 1.1, evaluada mediante una ECIE.
    3.duración de la respuesta conforme a los criterios RECIST 1.1, según una ECIE.
    4.Número de participantes que experimentan al menos un acontecimiento adverso (AE).
    5.Número de participantes que discontinúan el tratamiento del estudio por un AE.
    6.Cambios con respecto al momento basal de la puntuación combinada del estado de salud general/calidad de vida (apartados 29 y 30 del cuestionario QLQ-C30 de la EORTC)
    7.Cambios con respecto al momento basal del funcionamiento físico (apartados 1-5 del cuestionario QLQ-C30 de la EORTC)
    8.Cambios con respecto al momento basal de la pérdida de apetito (apartado 13 del cuestionario QLQ-C30 de la EORTC)
    9.Cambios con respecto al momento basal sobre el meteorismo (apartado 37 del cuestionario QLQ-CR29 de la EORTC).
    10.Tiempo hasta el deterioro (TTD) de la puntuación combinada del estado de salud general/calidad de vida (apartados 29 y 30 del cuestionario QLQ-C30 de la EORTC)
    11.TTD del funcionamiento físico (apartados 1-5 del cuestionario QLQ-C30 de la EORTC)
    12.TTD de la pérdida de apetito (apartado 13 del cuestionario QLQ-C30 de la EORTC)
    13.TTD sobre el meteorismo (apartado 37 del cuestionario QLQ-CR29 de la EORTC).
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 19 months
    2. Up to approximately 19 months
    3. Up to approximately 19 months
    4. Up to approximately 27 months
    5. Up to approximately 24 months
    6. Baseline and up to approximately 24 months
    7. Baseline and up to approximately 24 months
    8. Baseline and up to approximately 24 months
    9. Baseline and up to approximately 24 months
    10. Baseline and up to approximately 24 months
    11. Baseline and up to approximately 24 months
    12. Baseline and up to approximately 24 months
    13. Baseline and up to approximately 24 months
    1.Hasta aproximadamente 19 meses
    2.Hasta aproximadamente 19 meses
    3.Hasta aproximadamente 19 meses
    4.Hasta aproximadamente 27 meses
    5.Hasta aproximadamente 24 meses
    6. Momento basal y hasta aproximadamente 24 meses
    7. Momento basal y hasta aproximadamente 24 meses
    8. Momento basal y hasta aproximadamente 24 meses
    9. Momento basal y hasta aproximadamente 24 meses
    10. Momento basal y hasta aproximadamente 24 meses
    11. Momento basal y hasta aproximadamente 24 meses
    12. Momento basal y hasta aproximadamente 24 meses
    13. Momento basal y hasta aproximadamente 24 meses
    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 Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarkers
    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 No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA33
    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
    Australia
    Canada
    Chile
    China
    Israel
    Japan
    Korea, Republic of
    Russian Federation
    South Africa
    Taiwan
    Turkey
    Ukraine
    United States
    France
    Germany
    Italy
    Spain
    United Kingdom
    Czechia
    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 years3
    E.8.9.1In the Member State concerned months3
    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: 216
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 216
    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 state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 133
    F.4.2.2In the whole clinical trial 432
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-10-08
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-07-23
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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