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    Summary
    EudraCT Number:2021-001557-31
    Sponsor's Protocol Code Number:ALKS4230-006
    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:2021-11-05
    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 number2021-001557-31
    A.3Full title of the trial
    A Phase 2, Open-label, Multicenter, Cohort Study of Nemvaleukin Alfa (ALKS 4230) Monotherapy Administered Subcutaneously in Patients With Advanced Cutaneous Melanoma or Intravenously in Patients With Advanced Mucosal Melanoma Who Have Previously Received Anti-PD-[L]1 Therapy - ARTISTRY-6
    Un estudio de fase II, abierto, multicéntrico y con cohortes sobre la monoterapia con nemvaleukin alfa (ALKS 4230) administrado por vía subcutánea en pacientes con melanoma cutáneo avanzado o por vía intravenosa en pacientes con melanoma mucoso avanzado que han recibido previamente un tratamiento anti-PD(L)1: ARTISTRY-6
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2, Open-label, Multicenter, Cohort Study of Nemvaleukin Alfa (ALKS 4230) Monotherapy Administered Subcutaneously in Patients With Advanced Cutaneous Melanoma or Intravenously in Patients With Advanced Mucosal Melanoma Who Have Previously Received Anti-PD-[L]1 Therapy - ARTISTRY-6
    Un estudio de fase II, abierto, multicéntrico y con cohortes sobre la monoterapia con nemvaleukin alfa (ALKS 4230) administrado por vía subcutánea en pacientes con melanoma cutáneo avanzado o por vía intravenosa en pacientes con melanoma mucoso avanzado que han recibido previamente un tratamiento anti-PD(L)1: ARTISTRY-6
    A.3.2Name or abbreviated title of the trial where available
    ARTISTRY-6
    ARTISTRY-6
    A.4.1Sponsor's protocol code numberALKS4230-006
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04830124
    A.5.4Other Identifiers
    Name:IND Number:Number:128159
    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 SponsorAlkermes, 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 supportAlkermes, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAlkermes, Inc.
    B.5.2Functional name of contact pointJames Corkery
    B.5.3 Address:
    B.5.3.1Street Address852 Winter Street
    B.5.3.2Town/ cityWaltham
    B.5.3.3Post codeMA 02451
    B.5.3.4CountryUnited States
    B.5.4Telephone number781-296-8638
    B.5.6E-mailJames.Corkery@alkermes.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 nameNemvaleukin Alfa (Formulation 2)
    D.3.2Product code ALKS 4230; RDB-1450
    D.3.4Pharmaceutical form Lyophilisate and solvent for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    Subcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNemvaleukin alfa
    D.3.9.1CAS number 2315268-27-8
    D.3.9.2Current sponsor codeALKS 4230
    D.3.9.3Other descriptive nameNA
    D.3.9.4EV Substance CodeSUB199780
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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.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 nameNemvaleukin Alfa (Formulation 2)
    D.3.2Product code ALKS 4230; RDB-1450
    D.3.4Pharmaceutical form Lyophilisate and solvent for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    Subcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNemvaleukin alfa
    D.3.9.1CAS number 2315268-27-8
    D.3.9.2Current sponsor codeALKS 4230
    D.3.9.3Other descriptive nameNA
    D.3.9.4EV Substance CodeSUB199780
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    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 cutaneous melanoma and Advanced mucosal melanoma
    Melanoma cutáneo avanzado y melanoma mucoso avanzado
    E.1.1.1Medical condition in easily understood language
    Cancer
    Cáncer
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027481
    E.1.2Term Metastatic melanoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the antitumor activity of nemvaleukin by centralized reviewers’ assessment of ORR separately for patients with:
    - Advanced cutaneous melanoma (Cohort 1)
    - Advanced mucosal melanoma (Cohort 2)
    Evaluar la actividad antitumoral de nemvaleukin mediante la valoración centralizada de los revisores de la tasa de respuesta global (TRG) por separado en pacientes con:
    ‒ melanoma cutáneo avanzado (cohorte 1)
    ‒ melanoma mucoso avanzado (cohorte 2)
    E.2.2Secondary objectives of the trial
    • To evaluate the antitumor activity of nemvaleukin (other than by centrally-assessed ORR) separately for patients with:
    - Advanced cutaneous melanoma (Cohort 1)
    - Advanced mucosal melanoma (Cohort 2)

    • To evaluate the safety and tolerability of nemvaleukin separately for patients with:
    - Advanced cutaneous melanoma (Cohort 1)
    - Advanced mucosal melanoma (Cohort 2)
    • Evaluar la actividad antitumoral de nemvaleukin (aparte de la TRG evaluada centralmente) por separado en pacientes con:
    ‒ melanoma cutáneo avanzado (cohorte 1)
    ‒ melanoma mucoso avanzado (cohorte 2)
    • Evaluar la seguridad y la tolerabilidad de nemvaleukin por separado en pacientes con:
    ‒ melanoma cutáneo avanzado (cohorte 1)
    ‒ melanoma mucoso avanzado (cohorte 2)
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patient is >=18 years of age.
    2. Patient or patient’s legal representative is willing and able to provide written informed consent.
    3. Patient is willing and able to comply with scheduled visits, treatment schedule, laboratory tests, and other requirements of the study.
    4. The patient must have one of the following tumor types:
    • Cohort 1 (advanced cutaneous melanoma cohort): Patient has unresectable and/or metastatic cutaneous melanoma. No more than 5 patients with acral melanoma may enroll in this cohort.
    • Cohort 2 (advanced mucosal melanoma cohort): Patient has unresectable and/or metastatic mucosal melanoma.
    5. The patient must have received previous treatment as follows:
    a. Patient has received anti-PD-[L]1 therapy with or without anti-CTLA-4 therapy, and no more than one other prior regimen of systemic anti-neoplastic therapy (eg, targeted therapy, chemotherapy). Previous adjuvant and/or neoadjuvant therapy counts as one prior regimen.
    b. Patients have experienced objective response (PR or CR; by RECIST 1.1 or iRECIST) or SD (by RECIST 1.1 or iRECIST) as BOR to anti-PD-[L]1 therapy. Patients with confirmed progressive disease (by RECIST 1.1 or iRECIST) as best response may be included, if they received anti-PD-[L]1 therapy for a minimum of 12 weeks (eg, 4 doses of pembrolizumab q3w).
    c. Patients with BRAF mutations may or may not have received prior targeted therapy.
    6. A patient who has received prior treatment with talimogene laherparepvec (TVEC) is allowed to enroll provided that last exposure to TVEC was >=28 days prior to first exposure to nemvaleukin and that all ISRs to TVEC have resolved. TVEC shall not be considered a prior regimen of systemic anti-neoplastic therapy, nor shall it be considered a systemic immunomodulatory agent.
    7. Patient has at least one measurable lesion that qualifies as a target lesion based on RECIST 1.1. Tumor lesions situated in a previously irradiated area, or in an area subjected to other loco-regional therapy, are not considered measurable unless there has been demonstrated progression in the lesion.
    8. Patient is willing to undergo a pretreatment tumor biopsy or provide qualifying archival tumor tissue. To qualify, archival tissue must have been sampled after last exposure to any systemic anti-neoplastic agent (including TVEC). Patients unable to undergo a biopsy may be enrolled if risk/benefit ratio of biopsy is considered unfavorable and/or when a biopsy would likely lead to significant delays in care. This decision must be accompanied by supporting documentation from the Investigator and performed in consultation with Medical Monitor. All pretreatment tissue must have been collected no more than 120 days prior to screening.
    9. Patient has recovered from the effects of any previous chemotherapy, immunotherapy, other prior systemic anticancer therapy, radiotherapy, and/or surgery (ie, residual toxicity no worse than Grade 1 [Grade 2 treatment-associated peripheral neuropathy and/or any grade of alopecia are acceptable assuming all other inclusion criteria are met]).
    10. Patient who has received prior systemic anti-neoplastic agent(s) must wait at least 5 half-lives or 4 weeks (whichever is shorter) following prior therapy before enrollment into the study, or 4 weeks if the half-life of a given investigational agent is not known.
    11. Patient has an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1 within 5 days before the first dose of study drug and an estimated life expectancy of at least 3 months.
    12. Patient has adequate hematologic reserve as defined in the protocol.
    13. Patient has adequate hepatic function as evidenced by aspartate transaminase (AST) and alanine transaminase (ALT) values <=3 × the upper limit of normal (ULN) and serum total bilirubin values of <=1.5 × ULN (<=2 × ULN for patients with known Gilbert’s syndrome) for the reference laboratory measured within 7 days prior to the first dose of study drug. For patients with documented baseline liver metastasis, the following limits will apply: 5 × ULN for transaminase and 2 × ULN for bilirubin.
    14. Patient has adequate renal function as evidenced by a serum creatinine <=1.5 × the ULN for the reference laboratory or a calculated creatinine clearance of >=45 mL/min by the Cockcroft-Gault Equation measured within 7 days prior to the first dose of study drug.
    15. Patient has international normalized ratio (INR) AND/OR prothrombin time (PT) AND activated partial thromboplastin time (aPTT) <=1.5 × ULN unless the patient is receiving anticoagulant therapy, in which case INR and/or PT and aPTT must be within the desired therapeutic range of intended use for such anticoagulants.
    16. Patient agrees to abide by the contraceptive requirements as described in the protocol.
    17. Women of childbearing potential (WOCBP) must have a negative pregnancy test (serum or urine) within 3 days before the first dose of study drug.
    1.>=18 años.
    2.Paciente/representante legal dispuesto y es capaz de proporcionar el CI por escrito.
    3.Paciente está dispuesto y es capaz de cumplir con las visitas programadas, el calendario de tratamiento, las pruebas de laboratorio y otros.
    4.Paciente debe tener 1 de los siguientes tipos:
    • Cohorte1: melanoma cutáneo irresecable o metastásico. No podrán incluirse más de 5 con melanoma acro.
    • Cohorte2: melanoma mucoso irresecable o metastásico.
    5.Paciente tiene que haber recibido el siguiente tratamiento previo:
    a.Paciente ha recibido tratamiento anti-PD-(L)1 con o sin tratamiento anti-CTLA-4 y, como mucho, otra pauta previa de tratamiento antineoplásico sistémico. El tratamiento adyuvante o neoadyuvante previo cuenta como una pauta previa.
    b.Pacientes han manifestado una respuesta objetiva (respuesta parcial [RP] o RC; según RECIST 1.1 o iRECIST) o enfermedad estable (EE; según RECIST 1.1 o iRECIST) como mejor respuesta global (MRG) al tratamiento anti-PD-(L)1. Es posible incluir a pacientes con progresión de la enfermedad confirmada (por RECIST 1.1 o iRECIST) como mejor respuesta, si recibieron tratamiento anti-PD-(L)1 durante un mínimo de 12 semanas (p. ej., 4 dosis de pembrolizumab cada 3 semanas).
    c.Pacientes con mutaciones de BRAF pueden haber recibido o no tratamiento dirigido previo.
    6.Es posible incluir a pacientes que hayan recibido tratamiento previo con talimogene laherparepvec (TVEC) siempre que la última exposición a TVEC haya sido >=28 días antes de la 1a exposición a nemvaleukin y que se hayan resuelto todas las reacciones a TVEC en el lugar de la inyección. TVEC no se considerará una pauta previa de tratamiento antineoplásico sistémico, ni un fármaco inmunomodulador sistémico.
    7.Paciente tiene al menos 1 lesión medible que reúne los requisitos para considerarse 1 lesión diana según RECIST 1.1. Las lesiones tumorales situadas en una zona previamente irradiada, o en una zona sometida a otro tratamiento locorregional, no se consideran medibles a menos que se haya demostrado una progresión en la lesión.
    8.Paciente está dispuesto a someterse a 1 biopsia tumoral previa al tratamiento o a proporcionar tejido tumoral de archivo que reúna los requisitos. El tejido de archivo debe haberse recogido después de la última exposición a cualquier fármaco antineoplásico sistémico. Pacientes que no pueden someterse a una biopsia podrán incluirse si la relación riesgo/beneficio de la biopsia se considera desfavorable o si es probable que la biopsia llevase a retrasos significativos en la atención. Investigador aportará documentación justificativa de esta decisión que se tomará en consulta con el monitor médico. Todo el tejido de previo al tratamiento debe haberse recogido menos de 120 días antes.
    9.Paciente debe haberse recuperado de los efectos de cualquier quimioterapia, inmunoterapia, radioterapia, cirugía u otros tratamientos sistémicos anteriores contra el cáncer (es decir, toxicidad residual que no sea peor que el grado 1 [se aceptan la neuropatía periférica asociada al tratamiento de grado 2 o cualquier grado de alopecia si se cumplen todos los demás criterios de inclusión]).
    10.Si el paciente ha recibido fármacos antineoplásicos sistémicos anteriores, habrá que esperar al menos 5 semividas o 4 semanas (lo que sea más corto) después del tratamiento previo antes de su inclusión en el estudio, o 4 semanas si se desconoce la semivida de un determinado fármaco en investigación.
    11.Paciente tiene una puntuación en la Escala del ECOG PS de 0 o 1 en los 5 días anteriores a la 1a dosis del fármaco del estudio y una esperanza de vida estimada de al menos 3 meses.
    12.Paciente debe tener una reserva hematológica adecuada según el protocolo.
    13.Paciente debe tener una función hepática adecuada como demuestran los valores de aspartato transaminasa y alanina transaminasa <=3 × LSN y valores de bilirrubina total en suero <=1,5 × LSN (<=2 × LSN para pacientes con síndrome de Gilbert conocido) para los valores analíticos de referencia medidos 7 días antes de la 1a dosis del fármaco. En pacientes con metástasis hepáticas documentadas en el inicio, se aplicarán los siguientes límites: 5 × LSN para transaminasa y 2 × LSN para bilirrubina.
    14.Paciente debe tener una función renal adecuada como lo demuestra una creatinina en suero <=1,5 × LSN para valores analíticos de referencia o un aclaramiento de creatinina calculado >=45 ml/min según la ecuación de Cockroft-Gault medidos en el plazo de 7 días antes de la 1a dosis.
    15.Paciente tiene una INR O un TP Y un tiempo de TTPa <=1,5 × LSN, a menos que paciente esté recibiendo tratamiento anticoagulante, en cuyo caso la INR o TP y la TTPa deben estar dentro del rango terapéutico deseado de uso previsto de dichos anticoagulantes.
    16.Paciente acepta cumplir con los requisitos anticonceptivos.
    17.Mujeres en edad fértil deben contar con una prueba de embarazo negativa practicada en los 3 días previos a la administración de la 1a dosis del fármaco.
    E.4Principal exclusion criteria
    1. Patient has uveal melanoma.
    2. Patient has received prior IL-2–based or IL-15–based cytokine therapy; patient has had exposure, including intralesional, to IL-12 or analogs thereof.
    3. Patient has received radiotherapy within the last 4 weeks before start of study treatment, with the exception of limited field palliative radiotherapy to an area not inclusive of or adjacent to the target lesion(s), that has been completed at least 2 weeks before starting study treatment with no ongoing acute sequelae (eg, radiation burns).
    4. Patient requires systemic corticosteroids (>10 mg of prednisone daily, or equivalent) or patient has taken systemic corticosteroids (>10 mg of prednisone daily, or equivalent) within 14 days prior to the first dose of study drug; however, replacement doses, topical, ophthalmologic, and inhalational steroids are permitted.
    5. Patient has taken non-steroid systemic immunomodulatory agents (eg, Enbrel®, Humira®, etc) within 28 days prior to the first dose of study drug or anticipates use of these therapies during the study period.
    6. Patient has undergone prior solid organ and/or non-autologous hematopoietic stem cell or bone marrow transplant.
    7. Patient has received a live or live-attenuated vaccine(s) within 30 days prior to the first dose of study treatment. Note: COVID-19 vaccine is allowed (see Section 8.4.2 for further details).
    8. Patient has received more than 3 doses of therapeutic systemic broad-spectrum antibiotics within 4 days prior to the first dose of study drug. Antibiotics given for peri-procedural prophylaxis or given presumptively for a limited time (eg, until infection was ruled out), as well as topical or intra-ocular antibiotics, shall not be exclusionary.
    9. Patient has had any active infection and/or a fever >=38.5°C (>=101°F) within 3 days prior to the first dose of study drug.
    10. Patient has active autoimmune disease(s) requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease that has required chronic or frequent systemic steroids. Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is allowed.
    11. Patient has underlying chronic lung disease, chronic obstructive pulmonary disease, metastatic lung disease, pleural effusions or other lung disorders (eg, pulmonary embolism) with a baseline room air oxygen saturation of <92% at screening, and/or dyspnea (>=Grade 3), which requires oxygen therapy.
    12. Patient has any other concurrent uncontrolled illness, including mental illness or substance use, which may interfere with the ability of the patient to cooperate and participate in the study. Other examples of such conditions would include unstable, poorly controlled, or severe hypertension; clinically significant pericardial effusion; New York Heart Association Class III or Class IV congestive heart failure (see Appendix 1); high risk cardiovascular disease, defined as unstable angina, myocardial infarction, or cerebrovascular accident within 6 months of first dose; uncontrolled diabetes mellitus that has required 2 or more hospitalizations in the last year and/or emergent management within the last 6 months; severe peripheral vascular disease; or recent serious trauma.
    13. Patient has had an active second malignancy within the previous 2 years. This criterion does not apply to patients with adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, prostate cancer of highest Gleason score ≤6 with undetectable prostate-specific antigen over the previous 12 months, urothelial carcinoma in situ, or ductal carcinoma in situ of the breast that has undergone full surgical resection.
    14. Patient is currently pregnant, breastfeeding, or is planning to become pregnant or to begin breastfeeding during the study period or within 30 days after last study drug administration.

    Please refer to protocol for the full list of exclusion criteria.
    1.Paciente tiene un melanoma uveal.
    2.Paciente ha recibido tratamiento previo con citocinas basado en la IL-2 o la IL-15; el paciente ha estado expuesto, incluido de forma intralesional, a la IL-12 o a sus análogos.
    3.Paciente ha recibido radioterapia en las últimas 4 semanas antes del inicio del tratamiento del estudio, con la salvedad de radioterapia paliativa de campo limitado en una zona que no incluya la(s) lesión(es) objetivo o que sea adyacente a ellas, que se haya completado al menos 2 semanas antes de iniciar el tratamiento del estudio sin que haya secuelas agudas en curso (p. ej., quemaduras por radiación).
    4.Paciente precisa corticoesteroides sistémicos (>10 mg de prednisona al día, o equivalente) o el paciente ha tomado corticoesteroides sistémicos (>10 mg de prednisona al día, o equivalente) en los 14 días anteriores a la primera dosis del fármaco del estudio; sin embargo, se permiten dosis de sustitución, esteroides tópicos, oftalmológicos e inhalados.
    5.Paciente ha tomado fármacos inmunomoduladores sistémicos no esteroideos (p. ej., Enbrel®, Humira®, etc) en los 28 días anteriores a la primera dosis del fármaco del estudio o prevé el uso de estos tratamientos durante el período del estudio.
    6.Paciente se ha sometido a un trasplante previo de víscera maciza o de células madre hematopoyéticas no autólogas o de médula ósea.
    7.Paciente ha recibido vacuna(s) viva(s) o atenuada(s) en los 30 días anteriores a la primera dosis del tratamiento del estudio. Nota: se permite la vacuna contra la COVID-19.
    8.Paciente ha recibido más de 3 dosis de antibióticos sistémicos de amplio espectro en los 14 días anteriores a la primera dosis del fármaco del estudio. Los antibióticos administrados como profilaxis periprocedimiento o administrados presuntamente durante un tiempo limitado (p. ej., hasta que se descarte una infección), así como los antibióticos tópicos o intraoculares, no serán excluyentes.
    9.Paciente ha tenido alguna infección activa o fiebre >=38,5 °C (>=101 °F) en los 3 días anteriores a la primera dosis del fármaco del estudio.
    10.Paciente ha tenido enfermedad(es) autoinmunitaria(s) activa(s) que requiere(n) tratamiento sistémico en los últimos 3 meses o tiene antecedentes documentados de enfermedad autoinmunitaria clínicamente grave que ha precisado esteroides sistémicos crónicos o frecuentes. Se permite tratamiento sustitutivo (p. ej., tiroxina, insulina o tratamiento sustitutivo fisiológico con corticosteroides para la insuficiencia suprarrenal o hipofisaria).
    11.Paciente tiene una enfermedad pulmonar crónica subyacente, una enfermedad pulmonar obstructiva crónica, una enfermedad pulmonar metastásica, derrames pleurales u otros trastornos pulmonares (p. ej., embolia pulmonar) con una saturación de oxígeno en aire ambiente inicial <92 % en el cribado, o disnea (>=grado 3), que requiere oxigenoterapia.
    12.Paciente tiene cualquier otra enfermedad concurrente no controlada, lo que incluye enfermedades mentales o uso de sustancias ilícitas, que puede interferir con la capacidad del paciente de cooperar y participar en el estudio. Otros ejemplos de estas afecciones serían hipertensión inestable, mal controlada o grave; derrame pericárdico clínicamente significativo; insuficiencia cardíaca congestiva de clase III o clase IV de la New York Heart Association; enfermedad cardiovascular de alto riesgo, definida como angina inestable, infarto de miocardio o accidente cerebrovascular en los 6 meses anteriores a la primera dosis; diabetes mellitus no controlada que haya precisado 2 o más hospitalizaciones en el último año o un tratamiento de urgencia en los últimos 6 meses; enfermedad vascular periférica grave;
    o un traumatismo grave reciente.
    13.Paciente ha tenido una segunda neoplasia activa en los 2 años anteriores. Este criterio no se aplica a los pacientes con carcinoma basocelular o carcinoma epidermoide adecuadamente tratado, carcinoma in situ del cuello uterino, cáncer de próstata con una puntuación de Gleason <=6 con antígeno específico de la próstata no detectable durante los 12 meses anteriores, carcinoma urotelial in situ o carcinoma de mama ductal in situ que se ha sometido a resección quirúrgica completa.
    14.La paciente está actualmente embarazada, amamantando, o tiene previsto quedar embarazada o comenzar a amamantar durante el período del estudio o en los 30 días posteriores a la última administración del fármaco del estudio.

    Refiérase al protocolo para la lista completa de criterios.
    E.5 End points
    E.5.1Primary end point(s)
    Centrally-assessed overall response rate (ORR) based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
    Tasa de respuesta global (TRG) evaluada centralmente conforme a los Criterios de evaluación de la respuesta en tumores sólidos (RECIST) 1.1
    E.5.1.1Timepoint(s) of evaluation of this end point
    As per RECIST 1.1 Criteria.
    Cohort 1: Following baseline assessment, tumor assessment is to be performed every 6 weeks (i.e., on even-numbered cycles) for the first year and then every 12 weeks thereafter.
    Cohort 2: Following baseline assessment, tumor assessment is to be performed anytime after dosing on C3D5 but prior to dosing on C4D1 (8 weeks), then every 6 weeks for the remainder of the first year, and then every 12 weeks thereafter.
    Cohort 1 and 2: A confirmatory scan for the first demonstration of a partial response (PR) or better should be performed at no sooner than 4 weeks and no later than 6 weeks.
    En función del criterio RECIST 1.1
    Cohorte 1: Siguiendo la evaluación inicial, la evaluación del tumor debe hacerse cada 6 semanas (por ej. en ciclos pares) el primer año y cada 12 semanas después.
    Cohorte 2: Siguiendo la evaluación inicial, la evaluación del tumor debe hacerse en cualquier momento después de la dosis en C3D5 pero antes de la dosis en C4D1 (8 semanas), cada 6 semanas después para los restantes del primer año y después cada 12 semanas.
    Cohorte 1 y Cohorte 2: Un escáner de confirmación para la primera manifestación de una respuesta parcial (RP) o mejor debe ser realizado no antes de 4 semanas y no después de 6 semanas.
    E.5.2Secondary end point(s)
    Key Secondary Endpoints:
    - Centrally-assessed duration of response (DOR), progression-free survival (PFS), and disease control rate (DCR), and time to response (TTR) based on RECIST 1.1.
    - Safety and tolerability will be assessed on the basis of treatment-emergent adverse events (TEAEs), vital signs and weight, electrocardiograms (ECGs), and clinical laboratory parameters.

    Other Secondary Endpoints:
    - Investigator-assessed ORR, DOR, PFS, DCR, and TTR based on RECIST 1.1
    - Investigator-assessed immune ORR (iORR), immune DOR (iDOR), immune PFS (iPFS), immune DCR(iDCR), and immune TTR (iTTR) based on Immune RECIST (iRECIST)
    Criterios de valoración secundarios clave:
    • Duración de la respuesta (DR), supervivencia sin progresión (SSP), tasa de control de la enfermedad (TCE) y tiempo de respuesta (TR) evaluados centralmente según RECIST 1.1
    • La seguridad y la tolerabilidad se evaluarán en función de los acontecimientos adversos durante el tratamiento (AADT), las constantes vitales y el peso, los electrocardiogramas (ECG) y los parámetros analíticos clínicos
    Otros criterios de valoración secundarios:
    • TRG, DR, SSP, TCE y TR evaluados por el investigador según RECIST 1.1
    • TRG inmunitaria (TRGi), DR inmunitaria (DRi), SSP inmunitaria (SSPi), TCE inmunitaria (TCEi) y TR inmunitario (TRi) evaluados por el investigador según RECIST inmunitarios (iRECIST)
    E.5.2.1Timepoint(s) of evaluation of this end point
    As described in Schedule of assessments in the protocol.
    Descritos en el calendario de evalauciones del protocolo.
    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 Yes
    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
    Immunogenicity, Tolerability, Health-related quality of life (HRQoL)
    Inmunogenicidad, tolerabilidad, calidad de vida relacionada con la salud (HRQoL)
    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) 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.8.3 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 EEA9
    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
    Hong Kong
    Korea, Republic of
    Taiwan
    United States
    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
    Patients will be considered to have completed the study if they are followed until end of the survival period.
    The end of the study will be the last patient’s last visit (or, if applicable, the last phone call with the Investigator during the follow-up period) as indicated in the Schedules of Assessments.
    Se considerará que les pacientes han completado el estudio si han continuado hasta el fin del periodo de supervivencia.
    El fin del estudio será la última visita del último paciente (o, si procede, la última llamada con el investigador durante el periodo de seguimiento) como se describe en el calendario de evaluaciones.
    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 days
    E.8.9.2In all countries concerned by the trial years4
    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: 60
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 50
    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 state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 20
    F.4.2.2In the whole clinical trial 110
    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)
    After the ET/EOT Visit, patients will be followed for PFS (assuming no new anticancer treatment has been initiated and OS. The PFS and 2-year OS periods begin on the date of each respective patient’s first dose of ALKS 4230.
    Después de la visita de fin del estudio, se hará seguimiento de los pacientes para PFS (asmiendo que no se ha iniciado ningún tratamiento anticáncer y OS. PFS y OS 2-años periodo empieza en la fecha de la primera dosis de ALKS 4230 de cada paciente.
    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 Decision2022-01-31
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-01-19
    P. End of Trial
    P.End of Trial StatusOngoing
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