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    Summary
    EudraCT Number:2021-001572-42
    Sponsor's Protocol Code Number:FCN-159-002
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:
    Date on which this record was first entered in the EudraCT database:2022-03-29
    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 number2021-001572-42
    A.3Full title of the trial
    A multi-center, open-label, single-arm Phase I dose-escalation and Phase II dose-expansion study to evaluate the safety, tolerability, PK characteristics and anti-tumor activity of FCN-159 in adult and pediatric participants with neurofibromatosis type 1
    Studio multicentrico, in aperto, a braccio singolo, di Fase I con incremento della dose, e di Fase II con espansione della dose, volto a valutare la sicurezza, la tollerabilità, le caratteristiche di farmacocinetica e l’attività antitumorale di FCN-159 in pazienti adulti e pediatrici affetti da neurofibromatosi di tipo 1
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase I/II study of FCN-159 in adults and children with neurofibromatosis type 1
    Studio di Fase I/II su FCN-159 in adulti e bambini con Neurofibromatosi di tipo 1
    A.3.2Name or abbreviated title of the trial where available
    .
    .
    A.4.1Sponsor's protocol code numberFCN-159-002
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT04954001
    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 SponsorShanghai Fosun Pharmaceutical Industrial Development Co. Ltd.
    B.1.3.4CountryChina
    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 supportShanghai Fosun Pharmaceutical Industrial Development Co., Ltd.
    B.4.2CountryChina
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPPD
    B.5.2Functional name of contact pointProject Management
    B.5.3 Address:
    B.5.3.1Street AddressBuilding 2/1 M. Grinchenka Street, Business Park 'Protasov', 2nd Floor
    B.5.3.2Town/ cityKyiv
    B.5.3.3Post code03038
    B.5.3.4CountryUkraine
    B.5.4Telephone number+380674135535
    B.5.6E-maildmytro.kim@ppd.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 name.
    D.3.2Product code [FCN-159]
    D.3.4Pharmaceutical form 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 INNFCN-159
    D.3.9.2Current sponsor codeFCN-159
    D.3.9.4EV Substance CodeSUB233407
    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 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
    Participants diagnosed with Neurofibromatosis NF1-related plexiform neurofibromas (PN) and symptomatic with requirement of systematic therapy per investigator's judgment. A PN is defined as a neurofibroma that has grown along the length of a nerve and may involve multiple fascicles and branches. A spinal PN involves two or more levels with connection between the levels or extending laterally along the nerve.
    Partecipanti a cui sono stati diagnosticati neurofibromi plessiformi (PN) correlati a neurofibromatosi NF1 e con sintomi che necessitano di una terapia sistematica a giudizio dello sperimentatore. Un PN è un neurofibroma che si sviluppa lungo un nervo e può coinvolgere più fasci e rami nervosi. Un PN spinale coinvolge due o più livelli, collegati tra loro o può estendersi lateralmente lungo il nervo.
    E.1.1.1Medical condition in easily understood language
    NF-1 is a genetic disorder, which causes tumors to grow along the nervous system anywhere on the body.
    NF-1 è una malattia genetica che causa lo sviluppo di tumori lungo tutto il sistema nervoso e colpisce qualsiasi parte del corpo.
    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 10029270
    E.1.2Term Neurofibromatosis, type 1 (von Recklinghausen's disease)
    E.1.2System Organ Class 100000004850
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase I:
    -To evaluate the safety and tolerability of FCN-159 administered PO daily.
    -To determine the maximum tolerated dose (MTD) and recommended Phase II dose (RP2D).

    Phase II:
    -To assess the efficacy of FCN-159 per REiNS criteria.
    Fase I:
    - Valutare la sicurezza e la tollerabilità di FCN-159 somministrato per via orale ogni giorno.
    - Determinare la dose massima tollerata (MTD) e la dose raccomandata per la Fase II (RP2D).
    Fase II:
    - Valutare l'efficacia di FCN-159 in base ai criteri REiNS.
    E.2.2Secondary objectives of the trial
    Phase I:
    -To assess the preliminary efficacy of FCN-159 per REiNS criteria.
    -To determine the pharmacokinetic (PK) characteristics and pharmacodynamics (PD) of FCN-159 treatment.
    -To evaluate clinical response to FCN-159 in terms of pain, quality of life, disfigurement, and function as compared to baseline in participants with NF1-related PN.

    Phase II:
    -To evaluate the safety and tolerability of FCN-159 administered PO daily in continuous 28-day cycles.
    -To evaluate clinical response to FCN-159 in terms of pain, quality of life, disfigurement, and function as compared to baseline in participants with NF1-related PN.
    -To evaluate the population PK characteristics of FCN-159.
    -To evaluate dose intensity of FCN-159 administered to in participants with NF1-related PN.
    Fase I:
    - Valutare l'efficacia preliminare di FCN-159 in base ai criteri REiNS.
    - Determinare le caratteristiche di farmacocinetica (PK) e la farmacodinamica (PD) del trattamento con FCN-159.
    - Valutare la risposta clinica a FCN-159 in termini di dolore, qualità della vita, deturpazione e funzione rispetto al basale nei partecipanti con PN correlati a NF1.

    Fase II:
    - Valutare la sicurezza e la tollerabilità di FCN-159 somministrato per via orale ogni giorno in cicli continui di 28 giorni.
    - Valutare la risposta clinica a FCN-159 in termini di dolore, qualità della vita, deturpazione e funzione rispetto al basale nei partecipanti con PN correlati a NF1.
    - Valutare le caratteristiche PK di FCN-159 nella popolazione.
    - Valutare l'intensità della dose di FCN-159 somministrata ai partecipanti con PN correlati a NF1.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Phase I/II
    1. Cohort 2: 2-18 years of age (inclusive) and able to swallow whole tablet.
    2.Participants must be diagnosed with NF1-related plexiform
    neurofibromas (PN) and symptomatic with requirement of systematic
    therapy per investigator's judgment. A PN is defined as a neurofibroma
    that has grown along the length of a nerve and may involve multiple
    fascicles and branches. A spinal PN involves two or more levels with
    connection between the levels or extending laterally along the nerve.
    Diagnosis of neurofibromatosis type 1 (NF1) is based on meeting at least
    1 of the following 2 diagnostic criteria:
    1)Genetic testing confirmation: i.e., positive for NF1 germline mutation
    per CLIA-certified laboratory (or equivalent) testing. - OR -
    2)Clinical and imaging confirmation: Meets at least 2 of the following 7
    NF1 diagnostic criteria according to the clinical NIH consensus criteria:
    a.= 6 cafe-au-lait macules (>0.5 cm in prepubertal participants and >
    1.5 cm in post-pubertal participants);
    b.Axillary freckling or freckling in inguinal regions;
    c.=2 neurofibromas of any type, or = 1 plexiform neurofibroma;
    d.An optic pathway glioma;
    e.=2 Lisch nodules (iris hamartomas);
    f.A distinctive bony lesion such as dysplasia of the sphenoid bone or
    dysplasia or thinning of long bone cortex);
    g.First-degree relative with NF1.
    3. Participants should meet one of the following criteria
    a. Must be judged by the investigator to be inoperable for complete
    resection without causing substantial damage, or unsuitable for surgery
    with high surgical risks or participant refuses surgery,
    b.The participants who have previously received surgical treatment, if
    the PN resection is incomplete, the postoperative residual exceeds 15%
    of the primary lesion, or relapse after surgery, and the lesions of at least
    3 cm are measured in one dimension, are eligible for enrollment. At least
    a 28-day interval is required between surgery and the first dose of FCN159.
    4. Participants must have a measurable lesion, defined as at least 3 cm
    in length in at least one dimension, amenable to MRI for efficacy
    assessment.
    5. Participants (>16 years of age) : Karnofsky performance level of
    =70%; Participants (=16years of age): Lansky performance score = 70%,
    see Appendix 15.
    6. Coagulation function: International normalized ratio (INR) and
    activated partial thromboplastin time (APTT) = 1.5ULN.
    7. Participants or their legal guardians (if the participant is <18 years
    old) are able to understand and voluntarily sign a written informed
    consent
    form.
    8. For participants of childbearing potential: during treatment and for at
    least 90 days after the last dose, participants must agree to
    use a highly effective method of contraception which is defined as
    combined hormonal contraception, progesterone-only hormonal
    contraception associated with inhibition of ovulation, intrauterine
    device, intrauterine system, bilateral tubal occlusion, vasectomised

    partner or abstinence during treatment and for at least 90 days after the

    last dose. Male participants must agree to avoid sperm donation for at

    least 90 days after the last dose.

    9. Willing to avoid excessive sun exposure and use adequate amounts of sunscreen if sun exposure is anticipated.
    Phase I (in addition to the common ones):
    Refer to the Protocol
    Phase II (in addition to the common ones):
    1.Participants had adequate organ and bone marrow function:
    - Absolute neutrophil count = 1.0 × 109/L;
    - Hemoglobin = 9 g/dL (without red blood cell transfusion within 14days);
    - Platelets = 75 × 109/L (without platelet transfusion within 14 days);
    - Serum total bilirubin = 1.5 × upper limit normal (ULN) for age, = 3.0 ×ULN in participants with Gilbert's syndrome;
    - Aspartate aminotransferase (AST), alanine aminotransferase (ALT) =2.5 × ULN;
    - Albumin = 3 g/dL;
    - Creatinine < 1.5 × ULN (serum based on age) or a clearance or radioisotope GFR = 50ml/min/1.73 m2
    Fase I/Fase II:
    1. Coorte1: età >18 e =70. Coorte2:tra 2 e 18 anni (inclusi) e capacità di deglutire la compressa intera.
    2. Ai partecipanti devono essere stati diagnosticati dei neurofibromi plessiformi (PN) correlati a NF1 e sintomi che necessitano di una terapia sistematica secondo il giudizio del PI. PN è un neurofibroma che si è sviluppato lungo un nervo e che può coinvolgere vari fasci e rami nervosi. Un PN spinale coinvolge 2 o più livelli collegati tra loro o estendersi lateralmente lungo il nervo.
    La diagnosi di NF1 si basa sul soddisfacimento di almeno 1 dei seguenti criteri diagnostici:
    1)Conferma mediante test genetico: ovvero, positività per la mutazione germinale di NF1 in base al test eseguito da un laboratorio con certificazione CLIA (o equivalente).
    O
    2) Conferma clinica e di diagnostica per immagini: soddisfacimento di almeno2 dei 7criteri diagnostici per la NF1 in base al consenso dell’NIH:
    a.=6 macule cafe-au-lait (>0,5 cm prepuberale e >1,5 cm post-puberale);
    b.freckling ascellare o inguinale;
    c.=2 neurofibromi di qualsiasi tipo o =1 PN;
    d.glioma del pathway ottico;
    e.=2 noduli di Lisch;
    f. lesione ossea distintiva, come displasia dell’osso sfenoide o displasia o assottigliamento della corteccia di un osso lungo);
    g. parente di1° grado con NF1.
    3. I partecipanti devono soddisfare1dei seguenti criteri
    a. giudicati da PI come inoperabili per una resezione completa che non causi danni sostanziali, o inadatti a intervento chirurgico a fronte di elevati rischi chirurgici o se il partecipante rifiuta l’intervento,
    b. idonei i partecipanti che hanno precedentemente ricevuto un trattamento chirurgico, laddove la resezione della PN sia incompleta, che presentano un residuo postoperatorio > 15% della lesione primaria o recidiva dopo l’intervento chirurgico e le cui lesioni misurano almeno 3cm in1 dimensione. Tra l’intervento chirurgico e la 1a dose di FCN-159 è necessario un intervallo di almeno 28giorni.
    4. I partecipanti devono presentare una lesione misurabile, definita come una lesione di almeno 3cm in almeno una dimensione, che può essere sottoposta a RM per la valutazione dell’efficacia.
    5. Partecipanti (>16anni): livello prestazionale di Karnofsky=70%; partecipanti (=16anni): punteggio prestazionale di Lansky =70%, vedi App 15.
    6. Funzione di coagulazione: Rapporto normalizzato internazionale (INR) e valori del tempo di aPTT=1,5 volte il limite superiore della norma.
    7. I partecipanti o i loro tutori legali (se il partecipante ha < 18 anni) sono in grado di comprendere e firmare volontariamente un modulo di consenso informato scritto.
    8. Per i partecipanti in età fertile: durante il trattamento e per almeno 90giorni dopo l’ultima dose, i partecipanti devono acconsentire a utilizzare un metodo contraccettivo altamente efficace, definito come contraccezione ormonale combinata, ormonale solo a base di progesterone associata a inibizione dell’ovulazione, dispositivo intrauterino, sistema intrauterino, occlusione tubarica bilaterale, partner vasectomizzato o astinenza durante il trattamento e per almeno 90giorni dopo l’ultima dose. I partecipanti di sesso maschile devono acconsentire a evitare la donazione di sperma per almeno90giorni dopo l’ultima dose.
    9. Disponibilità a evitare un’eccessiva esposizione al sole e utilizzare adeguate quantità di crema solare se è prevista l’esposizione al sole.
    Per Fase I (in aggiunta a quelli comuni):
    Far riferimento al Protocollo
    Per Fase II (in aggiunta a quelli comuni)
    1. I partecipanti presentavano un’adeguata funzione d’organo e del midollo osseo:
    - conta assoluta dei neutrofili=1,0×109/l;
    - emoglobina=9g/dl(senza trasfusione di globuli rossi entro 14 giorni);
    - piastrine=75×109/l(senza trasfusione piastrinica entro 14 giorni);
    - bilirubina totale sierica=1,5×ULN per l’età, =3.0×ULN in partecipanti con sindrome di Gilbert;
    - AST e ALT =2,5xULN;
    - albumina=3g/dl;
    - creatinina<1,5×ULN(sierica in base all’età) o clearance o GFR con radioisotopo = 50ml/min/1.73m2.
    E.4Principal exclusion criteria
    1.Participants who have previously received one of the following:
    a)Chemotherapy for NF1within 3months of enrollment. Ongoing side effects of that treatment>Grade1 (except alopecia).
    b) Drug or biologic therapy(including investigational agents) for NF1within3weeks or at least5 half-lives of starting FCN-159, whichever is shorter (such as:tipifarnib,pirfenidone, Peg-Interferon, sorafenib or other VEGFR inhibitors).
    c)Strong CYP3A4, CYP2C8 and CYP2C9 inhibitors or inducers (moderate inducers for CYP2C8 and CYP2C9) within 14 days before treatment of the study drug, except for topical skin use.
    d)Use of growth factors to increase the number or function of platelets or white blood cells within7 days before administration of FCN-159.
    e)Radiotherapy, surgery or immunotherapy within 4 weeks before
    administration of FCN-159.
    f)Participation in other interventional clinical trials within 4 weeks
    before administration of FCN-159.
    g)Prior treatment with selumetinib or any other MEK 1/2 inhibitors
    (specific for phase2 part).
    2.Participants with malignant tumors associated with NF1 requiring chemotherapy, radiotherapy, or surgery, such as intermediate- to highgrade optic gliomas or malignant peripheral nerve sheath tumors.
    3. Participants have other malignant tumor history or with other malignant
    tumors simultaneously (excluding cured non-melanoma skin basal cell
    carcinoma, breast carcinoma in situ or cervix cancer in situ, and other
    malignant tumors without disease evidence for the past 5years);
    4. Participants who are unable to undergo MRI examination and/or for
    whom MRI examination is contraindicated (e.g., due to prostheses,
    orthotics or dental appliances or due to interference with volumetric analysis of target PN on MRI).
    5.Uncontrolled hypertension (despite medical therapy); Adult participants: defined as systolic or diastolic blood pressures > 140/90mmHg on repeat examination with existing anti-hypertension therapy. Pediatric participants: Blood pressure (BP) greater than or equal to the 95th percentile for age, height, and gender (measured as described in App 16).
    6. Participants with dysphagia, active digestive diseases, malabsorption syndrome, or other conditions that might affect the absorption of the study drug.
    7.Previous RVO, RPED, glaucoma or other significant abnormality in ophthalmic examination.
    8.Interstitial pneumonia, including existing clinically significant radiation pneumonitis.
    9.Cardiac dysfunction or concomitant diseases meeting any one of the following conditions will be excluded:
    a)Three 12-lead electrocardiogram (ECG) measurements performed at the study site during the screening period for which the mean value of three measurements was calculated according to the QTcF formula using the instrument, with QTcF >470 ms (women) and >450 ms (men); Participants with risk factors for QTcF prolongation, such as uncorrectable hypokalemia, hereditary long QT syndrome; or receiving drugs that prolong QTcF interval (mainly class Ia, Ic, III antiarrhythmic drugs). Drugs with potential to prolong QTcF interval, See Appendix 17.
    b) NYHA Class=3 congestive heart failure;
    c)Clinically significant arrhythmia, including but not limited to complete left bundle branch block, second degree atrioventricular block;
    Please refer to the Protocol for the other Exclusion criteria
    1. Partecipanti che hanno precedentemente ricevuto uno dei seguenti:
    a) chemioterapia per NF1 entro 3 mesi dall’arruolamento. Effetti collaterali in corso di quel trattamento di Grado > 1 (eccetto alopecia);
    b) trattamento con qualsiasi farmaco o terapia biologica (compresi gli agenti sperimentali) per NF1 entro 3 settimane o almeno 5 emivite dall’inizio di FCN-159, a seconda di quale evento sia più breve (come tipifarnib, pirfenidone, Peg-interferone, sorafenib o altri inibitori di VEGFR)
    c) forti inibitori o induttori di CYP3A4 e CYP2C8 e CYP2C9 (induttori moderati di CYP2C8 e CYP2C9) nei 14 giorni precedenti il trattamento con il farmacosperimentale, eccetto per uso cutaneo topico.
    d) uso di fattori di crescita per aumentare il numero o la funzione delle piastrine o dei globuli bianchi nei 7 giorni precedenti la somministrazione di FCN-159.
    e) radioterapia, intervento chirurgico o immunoterapia nelle 4 settimane precedenti la somministrazione di FCN-159.
    f) partecipazione ad altre sperimentazioni cliniche interventistiche nelle 4 settimane precedenti la somministrazione di FCN-159.
    g) precedente trattamento con selumetinib o qualsiasi altro inibitore di MEK 1/2 (specifico per la parte di fase 2).
    2. Partecipanti con tumori maligni associati a NF1 che necessitano dichemioterapia, radioterapia o intervento chirurgico, come gliomi ottici di grado da intermedio a elevato o tumori maligni delle guaine di nervi periferici.
    3. Partecipanti con altra anamnesi di tumore maligno o con altri tumori maligni contemporaneamente (esclusi carcinoma cutaneo basocellulare non melanomatoso curato, carcinoma mammario in situ o carcinoma in situ del collo dell’uteroe altri tumori maligni senza evidenza di malattia negli ultimi 5 anni);
    4. Partecipanti che non sono in grado di sottoporsi a un esame RM e/o per i quali l’esame RM è controindicato (per es., a causa di protesi, ortesi o dispositivi dentali o a causa di interferenza con l’analisi volumetrica dell’NP target alla RM).
    5. Ipertensione incontrollata (nonostante la terapia farmacologica); Partecipanti adulti: definita come pressione sanguigna sistolica o diastolica > 140/90 mmHg all’esame ripetuto con terapia antipertensiva esistente. Partecipanti pediatrici: pressione arteriosa (PA) superiore o uguale a 95° percentile per età, altezza e sesso (misurata come descritto in Appendice 16).
    6. Partecipanti affetti da disfagia, malattie digestive attive, sindrome da malassorbimento o altre condizioni che potrebbero influenzare l’assorbimento del farmaco sperimentale.
    7. Precedente o attuale occlusione venosa retinica (Retinic Vein Occlusion, [RVO]), distacchi epiteliali del pigmento retinico (RPED), glaucoma o altra anomalia significativa all’esame oftalmico.
    8. Polmonite interstiziale, inclusa polmonite da radiazioni clinicamente significativa esistente.
    9. Saranno escluse disfunzione cardiaca o malattie concomitanti che soddisfano una qualsiasi delle seguenti condizioni:
    a) tre misurazioni dell’elettrocardiogramma (ECG) a 12 derivazioni eseguite presso il centro dello studio durante il periodo di screening, per cui il valore medio delle tre misurazioni è stato calcolato in base alla formula QTcF utilizzando lo strumento, con QTcF >470 millisecondi (per le donne) e >450 millisecondi (per gli uomini); partecipanti affetti da fattori di rischio per il prolungamento dell’intervallo QTcF, come ipokaliemia non correggibile, sindrome ereditaria del QT lungo, o che ricevono farmaci che prolungano l’intervallo QTcF (principalmente farmaci antiaritmici di classe Ia, Ic, III). Farmaci potenzialmente in grado di prolungare l’intervallo QTcF; vedere Appendice 17.
    b) insufficienza cardiaca di classe = 3 secondo la New York Heart Association (NYHA);
    c) aritmia clinicamente significativa, inclusi, ma senza limitazione, blocco di branca sinistra completo, blocco atrioventricolare di secondo grado;
    Si faccia riferimenbto al protocollo per gli altri criteri di esclusione
    E.5 End points
    E.5.1Primary end point(s)
    Phase I
    -Safety dose-limiting toxicity (DLT) incidence rate.
    -MTD and RP2D.

    Phase II
    -Objective response rate (ORR) by BIRC assessment
    Fase I
    -Sicurezza: tasso di incidenza di tossicità limitanti la dose (Dose-Limiting Toxicity, [DLT]).
    -MTD e RP2D.

    Fase II
    -Tasso di risposta obiettiva (ORR) in base alla valutazione del BIRC
    E.5.1.1Timepoint(s) of evaluation of this end point
    Phase I
    DLT assessment is conducted throughout the continuous administration period on C1D1, C1D2, C1D8, C1D15 and C1D28.
    MTD is defined as the highest dose level with a DLT incidence rate of less than, or equal to, 33% (0/3 or 1/6). Dose escalation will continue until MTD is reached. Once MTD has been reached, the RP2D will be defined after review of the data from the Phase I stage

    Phase II
    BIRC assessment will be conducted 12 months after the first dose of the last enrolled participant, and at the end of the study
    Fase I
    La valutazione delle DLT viene effettuata per tutto il periodo di somministrazione continuato di C1G1, C1G2, C1G8, C1G15 e C1G28.
    MTD è definito come il livello di dosaggio massimo con un tasso di incidenza di DLT inferiore o uguale a 33% (0/3 or 1/6). L’incremento della dose proseguirà fino al raggiungimento dell’MTD. Una volta raggiunto l’MTD si definirà il RP2D una volta rivisti i dati della Fase I

    Fase II
    La valutazione del BIRC sarà effettuata 12 mesi dopo la prima dose somministrata all’ultimo partecipante arruolato e alla fine dello studio
    E.5.2Secondary end point(s)
    Phase I:
    Other safety:
    The type and frequency of adverse events (AE) occurring during
    treatment will be evaluated for toxicity grade according to the National
    Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE) version
    5.0;
    - Treatment-Emergent Serious Adverse Events (SAE), and toxic
    reactions
    leading to permanent
    discontinuation;
    - The frequency and causes of death events within 30 days after last

    administration;
    - Laboratory safety test results

    - Changes in vital
    signs
    Changes in NF1-related
    symptoms.
    Efficacy: objective response rate (ORR) by investigator /BIRC

    assessment, clinical benefit rate (CBR) per investigator/BIRC

    assessment including CR, PR, and SD lasting more than 6
    months;
    Clinical outcome variables: patient- and observer-reported outcomes
    and
    functional
    measures;
    PK
    parameters.
    PD marker: ERK phosphorylation inhibition in peripheral blood
    mononuclear cells(PBMCs), obtained pre-treatment, C1D1, C1D8, and at steady
    state on treatment with FCN-159.
    Phase II:
    Other efficacy endpoints: objective response rate (ORR); Clinical benefit
    rate (CBR), disease control rate (DCR), progression-free survival (PFS),
    time to progression (TTP), time to response (TTR), duration of response
    (DOR), 1- and 2-year PFS rate per investigator +/- BIRC assessment;
    overall survival (OS);
    Safety endpoints:
    - The type and frequency of adverse events (AE) occurring during
    treatment will be evaluated for toxicity grade according to the National
    Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE) version
    5.0;
    - Treatment-Emergent Serious Adverse Events (SAE), and toxic
    reactions
    leading to permanent
    discontinuation;
    - The frequency and causes of death events within 30 days after last

    administration;
    -Laboratory safety test results graded according to NCI-CTCAE version

    5.0;
    - Changes in vital
    signs;
    Dose
    intensity
    Changes in NF1-related
    symptoms.
    Population PK
    parameters.
    Clinical outcome variables
    Fase 1:
    Altre variabili di sicurezza:
    il tipo e la frequenza di eventi avversi (EA) che si verificano durante il trattamento saranno valutati per il grado di tossicità in base ai Criteri terminologici comuni per gli eventi avversi (Common Terminology Criteria for Adverse Events, [CTCAE]) del National Cancer Institute (NCI) versione 5.0;
    - Eventi avversi seri (SAE) emergenti dal trattamento e reazioni tossiche che portano all’interruzione permanente;
    - Frequenza e cause degli eventi di decesso entro 30 giorni dopo l’ultima somministrazione;
    - Risultati dei test di laboratorio sulla sicurezza
    - Variazioni nei segni vitali variazioni nei sintomi correlati alla NF1.
    Efficacia: tasso di risposta obiettiva (ORR) in base alla valutazione dello sperimentatore/valutazione BIRC, tasso di beneficio clinico (CBR) in base alla valutazione dello sperimentatore/valutazione BIRC, compresi CR, PR, e SD di durata superiore a 6 mesi;
    Variabili degli esiti clinici: esiti riferiti dal/dalla paziente e dall’osservatore e misure funzionali;
    Parametri PK.
    Marcatori PD: inibizione della fosforilazione di ERK nelle cellule mononucleate del sangue periferico
    (Peripheral Blood Mononuclear Cells, [PBMC]), pre-trattamento ottenuto, il Giorno 1 del Ciclo 1 (C1G1), C1G8 e allo stato di equilibrio durante il trattamento con FCN-159.

    Fase II:
    Altri endpoint di efficacia: tasso di risposta obiettiva (ORR); tasso di beneficio clinico (CBR), tasso di controllo della malattia (Disease Control Rate, [DCR]), sopravvivenza libera da progressione (PFS), tempo alla progressione (TTP), tempo alla risposta (TTR), durata della risposta (DOR), tasso di PFS a 1 e 2 anni secondo la valutazione dello sperimentatore +/- del BIRC; e sopravvivenza complessiva (OS).
    Endpoint di sicurezza:
    - Il tipo e la frequenza di eventi avversi (EA) che si verificano durante il trattamento saranno valutati per il grado di tossicità in base ai Criteri terminologici comuni per gli eventi avversi (Common Terminology Criteria for Adverse Events, [CTCAE]) del National Cancer Institute (NCI) versione 5.0;
    - Eventi avversi seri (SAE) emergenti dal trattamento e reazioni tossiche che portano all’interruzione permanente;
    - Frequenza e cause degli eventi di decesso entro 30 giorni dopo l’ultima somministrazione;
    - Risultati degli esami di laboratorio per la sicurezza classificati in base ai criteri NCI-CTCAE versione 5.0;
    - Variazioni nei segni vitali;
    Intensità della dose
    Variazioni nei sintomi correlati alla NF1.
    Parametri PK di popolazione.
    Variabili degli esiti clinici
    E.5.2.1Timepoint(s) of evaluation of this end point
    Phase I & II
    SAEs: monitored 30 days from signing ICF until end of study treatment
    Clinical outcome variables (PhI & II) & changes in NF1-related
    symptoms (PhII): screening period; every 4 cycles for 1st 2 years &
    every 6 cycles thereafter; at end of treatment
    Phase I
    Changes in vital signs & lab safety tests: screening period; C1D1, C1D8,
    C1D15, C1D28 & CXD1; at end of treatment; at safety follow-up
    BIRC assessment: 12 months after first dose of last enrolled participant
    & at end of study
    PK/PD: C1D1, C1D2 (PK only), C1D8, C1D28 & C2D1 (PK only)
    Phase II
    Efficacy endpoints: Assessed 12 months after 1st dose of last enrolled
    participant & at end of study
    Changes in vital signs & lab safety tests: screening period; CXD1; end of
    treatment; safety follow up
    PK: CXD1
    Fase I/II
    SAE: monitorati per 30 giorni da firma ICF fino a fine del trattamento.
    Variabili esiti clinici (Fase I e II) e variazioni sintomi correlati a NF1: periodo di screening; ogni 4 cicli per i primi 2 anni e poi ogni 6 cicli; a fine trattamento.
    Fase I
    Variazioni segni vitali e test di laboratorio di sicurezza: periodo di screening; C1G1, C1G8, C1G15, C1G28 e CXG1; a fine trattamento; al follow-up
    Valutazione BIRC: 12 mesi dopo la 1a dose all’ultimo partecipante arruolato e alla fine dello studio.
    PK/PD: C1G1, C1G2 (solo PK), C1G8, C1G28 e C2G1 (solo PK)
    Fase II
    Endpoint efficacia: 12 mesi dopo la 1a dose ultimo partecipante arruolato e a fine dello studio
    Variazioni segni vitali e test di laboratorio di sicurezza: periodo di screening; CXG1; fine
    trattamento/follow-up
    PK: CXG1
    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
    Quality of life
    Qualità della vita
    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
    Phase I/II study in adult and paediatric patients with NF1. Dose escalation and dose expansion
    Studio di Fase I/II in pazienti adulti/e e pediatrici/che con NF1. Incremento della dose ed espansio
    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 No
    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 Yes
    E.8.1.7.1Other trial design description
    Incremento della dose ed espansione della dose.
    Dose escalation and dose expansion
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned 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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA14
    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
    China
    United States
    France
    Italy
    Spain
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of study is defined as 2 years after the first dose of FCN-159
    administered to the last participant enrolled on the trial or the last dose
    of FCN-159 for the last participant, whichever occurs first.
    La fine dello studio è definita come 2 anni dopo la somministrazione della prima dose di FCN-159 all’ultimo partecipante arruolato nella sperimentazione o il momento in cui l’ultima dose di FCN-159 viene somministrata all'ultimo partecipante, a seconda di quale evento si verifichi prima.
    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 months6
    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 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 Yes
    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) Yes
    F.1.1.5.1Number of subjects for this age range: 33
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 30
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 95
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 2
    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 state17
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 25
    F.4.2.2In the whole clinical trial 160
    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)
    Patients will be treated as per the investigator's judgement with the
    available standard of care. Prolongation of this study could be
    considered in future if beneficial for patients.
    I pazienti saranno trattati in base al giudizio dello sperimentatore con lo standard di cure disponibili. Se vantaggioso per i pazienti, in futuro si potrà considerare il possibile prolungamento di questo studio.
    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 Decision2022-09-08
    N.Ethics Committee Opinion of the trial applicationWithdrawn
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-01-19
    P. End of Trial
    P.End of Trial Status
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