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    Summary
    EudraCT Number:2021-001825-33
    Sponsor's Protocol Code Number:61186372NSC3002
    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:2021-08-27
    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 number2021-001825-33
    A.3Full title of the trial
    A Phase 3, Open-Label, Randomized Study of Amivantamab and Lazertinib in Combination with Platinum-Based Chemotherapy Compared with Platinum-Based Chemotherapy in Patients with EGFR-Mutated Locally Advanced or Metastatic Non-Small Cell Lung Cancer After Osimertinib Failure
    Estudio en fase III abierto y aleatorizado del tratamiento combinado de amivantamab y lazertinib con quimioterapia basada en platino en comparación con quimioterapia basada en platino en pacientes con cáncer de pulmón no microcítico con mutación del EGFR localmente avanzado o metastásico tras el fracaso de osimertinib
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Clinical Study of Amivantamab and Lazertinib in Combination with Platinum-Based Chemotherapy Compared with Platinum-Based Chemotherapy in Patients with EGFR-Mutated Locally Advanced or Metastatic Non-Small Cell Lung Cancer After Osimertinib Failure
    Un estudio clínico de Amivantamab y Lazertinib en combinación con quimioterapia basada en platino en comparación con quimioterapia basada en platino en
    pacientes con cáncer de pulmón no microcítico con mutación del EGFR localmente avanzado o metastásico tras el fracaso de osimertinib
    A.3.2Name or abbreviated title of the trial where available
    MARIPOSA-2
    MARIPOSA-2
    A.4.1Sponsor's protocol code number61186372NSC3002
    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 SponsorJanssen-Cilag International NV
    B.1.3.4CountryBelgium
    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 supportJanssen Research and Development
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationJanssen-Cilag International NV
    B.5.2Functional name of contact pointGlobal Clinical Operations Spain
    B.5.3 Address:
    B.5.3.1Street AddressPaseo de las Doce Estrellas, 5-7
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28042
    B.5.3.4CountrySpain
    B.5.4Telephone number+34672 601 075
    B.5.5Fax number+3491 7228628
    B.5.6E-mailjmedina9@its.jnj.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 nameAmivantamab
    D.3.2Product code JNJ-61186372
    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 INNAmivantamab
    D.3.9.1CAS number 2171511-58-1
    D.3.9.2Current sponsor codeJNJ-61186372
    D.3.9.3Other descriptive nameCNTO 4424
    D.3.9.4EV Substance CodeSUB193051
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    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 nameLazertinib
    D.3.2Product code JNJ-73841937/YH-25448
    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 INNLazertinib
    D.3.9.2Current sponsor codeJNJ-73841937/YH-25448
    D.3.9.3Other descriptive nameLazertinib mesylate monohydrate
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number80
    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
    Locally Advanced or Metastatic Non-Small Cell Lung Cancer
    Cáncer de pulmón no microcítico con mutación del EGFR localmente avanzado o metastásico
    E.1.1.1Medical condition in easily understood language
    A specific type of lung cancer called "Non-Small Cell Lung Cancer"
    Un tipo específico de cáncer de pulmón llamado "cáncer de pulmón no microcítico"
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To assess the efficacy of lazertinib, amivantamab, carboplatin, and pemetrexed ( LACP), compared with carboplatin and pemetrexed (CP), in participants with locally advanced or metastatic epidermal growth factor receptor (EGFR) Exon 19del or Exon 21 L858R substitution NSCLC
    Evaluar la eficacia de lazertinib, amivantamab, carboplatino y pemetrexed (LACP), en comparación con carboplatino y pemetrexed (CP), en pacientes con CPNM localmente avanzado o metastásico con deleción del exón 19 o sustitución del exón 21 L858R del EGFR
    E.2.2Secondary objectives of the trial
    The secondary objectives are:
    1. To further assess the clinical benefit of LACP vs CP
    2. To assess the safety of LACP vs CP
    3. To assess the relationship between pharmacokinetics or immunogenicity and selected endpoints (including but not limited to efficacy, safety, and/or patient-reported outcomes)
    4. To assess health-related quality of life and disease-related symptoms in participants treated with LACP vs CP
    5.To describe the contribution of lazertinib to the efficacy of LACP (vs ACP)
    Los objetivos secundarios son:
    1. Para evaluar más a fondo el beneficio clínico de LACP frente a CP
    2. Evaluar la seguridad de LACP frente a CP
    3. Evaluar la relación entre la farmacocinética o inmunogenicidad y criterios de valoración seleccionados (incluidos, entre otros, la eficacia, la seguridad y / o los resultados informados por el paciente)
    4. Evaluar la calidad de vida relacionada con la salud y los síntomas relacionados con la enfermedad en participantes tratados con LACP versus CP
    5.Describir la contribución de lazertinib a la eficacia de LACP (frente a ACP)
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Each potential participant must satisfy all of the following criteria to be enrolled in the study:
    1. At least 18 years of age (or the legal age of consent in the jurisdiction in which the study is taking place).
    2. Participant must have histologically or cytologically confirmed, locally advanced or metastatic, non-squamous NSCLC, characterized at or after the time of locally advanced metastatic disease diagnosis by either EGFR Exon 19del or Exon 21 L858R mutation, by an FDA-approved or other validated test of either ctDNA or tumor tissue in a CLIA certified laboratory (sites in the US) or an accredited local laboratory (sites outside of the US). A de-identified copy of the initial test report documenting the EGFR mutation must be included in the participant records and must be submitted to the sponsor during the Screening Phase. If provision of this report is not permitted by the site or local policies, then sponsor-approved equivalent documentation must be provided.
    3. Participant must have progressed on or after osimertinib monotherapy as the most recent line of treatment. Osimertinib must have been administered as either the first line treatment for locally advanced or metastatic disease or in the second line setting after prior treatment with first- or second-generation EGFR TKI.
    Participants who received either neoadjuvant and/or adjuvant treatment are eligible if progression to locally advanced or metastatic disease occurred at least 12 months after the last dose of such therapy and then the participant progressed on or after osimertinib in the locally advanced or metastatic setting.
    Treatment with osimertinib must be discontinued at least 8 days (4 half-lives) prior to randomization (ie, last dose no later than Day -8).
    4. Participant must have at least 1 measurable lesion, according to RECIST v1.1, that has not been previously irradiated. Measurable lesions should not have been biopsied during screening, but if only 1 non-irradiated measurable lesion exists, it may undergo the optional diagnostic biopsy and be acceptable as a target lesion, provided the baseline tumor assessment scans are performed at least 14 days after the biopsy.
    5. A participant with definitively, locally treated brain metastases must be clinically stable and asymptomatic, with or without low-dose corticosteroid treatment (≤10 mg prednisone or equivalent), for at least 14 days prior to randomization.
    6. Participant must have Eastern Cooperative Oncology Group (ECOG) status of 0 or 1.
    7. Participant must have adequate organ and bone marrow function as follows, without history of red blood cell transfusion or platelet transfusion within 7 days prior to the date of the laboratory test:
    • Hemoglobin ≥10 g/dL
    • Absolute neutrophil count ≥1.5109/L, without use of G-CSF within 10 days prior to the date of the test
    • Platelets ≥100109/L
    • ALT and AST ≤3×upper limit of normal (ULN)
    • Total bilirubin ≤1.5ULN if no liver metastasis, or ≤3×ULN in the presence of liver metastasis (participants with Gilbert’s syndrome can enroll if conjugated bilirubin is within normal limits)
    • Creatinine clearance >50 mL/min as measured or calculated by Cockcroft-Gault formula
    8. Any toxicities from prior systemic anticancer therapy must have resolved to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 5.0 Grade 1 or baseline level (except for alopecia [any grade], Grade ≤2 peripheral neuropathy, or Grade <2 hypothyroidism stable on hormone replacement).
    9. Participant must sign an ICF indicating that the participant understands the purpose of, and procedures required for, the study and is willing to participate in the study.
    10. A woman of childbearing potential must have a negative serum pregnancy test at screening and within 72 hours of the first dose of study treatment and must agree to further serum or urine pregnancy tests during the study.
    11. A woman must be either of the following:
    a. Not of childbearing potential; or
    b. Of childbearing potential and
    • practicing true abstinence during the entire period of the study, including up to 6 months after the last dose of study treatment is given; or
    • have a sole partner who is vasectomized; or
    • practicing at least 1 highly effective user independent method of contraception.
    Participant must agree to continue contraception throughout the study and through 6 months after the last dose of study treatment.
    12. A woman must agree not to donate eggs (ova, oocytes) for the purposes of assisted reproduction during the study and for 6 months after receiving the last dose of study treatment.

    Please refer to pages 32- 34 of the protocol for full inclusion criteria.
    Todos los posibles pacientes deberán cumplir los criterios siguientes para participar en el estudio:
    1. Tener al menos 18 años de edad.
    2. El paciente debe padecer CPCNP no escamoso localmente avanzado o metastásico confirmado histológicamente o citológicamente, caracterizado en el momento del diagnóstico de enfermedad metastásica localmente avanzada o después del mismo por una mutación EGFR Exon 19del o Exon 21 L858R, por una mutación aprobada por la FDA u otra prueba validada de ADNct o tejido tumoral en un laboratorio certificado por CLIA (centros en EE. UU.) o un laboratorio local acreditado (centros fuera de los EE. UU.). Se debe incluir una copia anónima del informe de prueba inicial que documente la mutación de EGFR en los registros del participante y se debe enviar al patrocinador durante la Fase de selección. Si el sitio o las políticas locales no permiten la provisión de este informe, se debe proporcionar documentación equivalente aprobada por el patrocinador.
    3. El paciente debe haber progresado durante o después de la monoterapia con osimertinib como la línea de tratamiento más reciente. Osimertinib debe haberse administrado como tratamiento de primera línea para la enfermedad localmente avanzada o metastásica o en el entorno de segunda línea después de un tratamiento previo con EGFR TKI de primera o segunda generación.
    Los pacientes que recibieron tratamiento neoadyuvante y / o adyuvante son elegibles si la progresión a enfermedad localmente avanzada o metastásica ocurrió al menos 12 meses después de la última dosis de dicha terapia y luego el participante progresó con osimertinib o después en el entorno localmente avanzado o metastásico.
    El tratamiento con osimertinib debe suspenderse al menos 8 días (4 vidas medias) antes de la aleatorización (es decir, la última dosis no más tarde del día -8).
    4. El paciente debe tener al menos 1 lesión medible, según RECIST v1.1, que no haya sido irradiada previamente. Las lesiones medibles no deben haber sido biopsiadas durante el cribado, pero si solo existe una lesión medible no irradiada, se puede someter a la biopsia de diagnóstico opcional y ser aceptable como lesión diana, siempre que las exploraciones de evaluación del tumor de referencia se realicen al menos 14 días después de la biopsia.
    5. Un paciente con metástasis cerebrales tratadas localmente definitivamente debe estar clínicamente estable y asintomático, con o sin tratamiento con corticosteroides en dosis bajas (≤10 mg de prednisona o equivalente), durante al menos 14 días antes de la aleatorización.
    6. El paciente debe tener el estado 0 o 1 del Eastern Cooperative Oncology Group (ECOG).
    7. Tener una función adecuada de los órganos y la médula ósea, sin tener antecedentes de transfusión de glóbulos rojos o transfusión de plaquetas en los 7 días anteriores a la fecha del análisis de laboratorio:
    • Hemoglobina ≥10 g / dL
    • Recuento absoluto de neutrófilos ≥1,5x109 / L, sin el uso de G-CSF dentro de los 10 días anteriores a la fecha de la prueba
    • Plaquetas ≥100x109 / L
    • ALT y AST ≤3 × límite superior de lo normal (LSN)
    • Bilirrubina total ≤1.5xULN si no hay metástasis hepática, o ≤3 × LSN en presencia de metástasis hepática (los participantes con síndrome de Gilbert pueden inscribirse si la bilirrubina conjugada está dentro de los límites normales)
    • Aclaramiento de creatinina> 50 ml / min medido o calculado con la fórmula de Cockcroft-Gault
    8. Cualquier toxicidad de la terapia anticancerosa sistémica previa debe haberse resuelto según los Criterios de terminología común para eventos adversos del Instituto Nacional del Cáncer (NCI CTCAE) Versión 5.0 Grado 1 o nivel inicial (excepto para alopecia [cualquier grado], neuropatía periférica grado ≤2 o <2 hipotiroidismo estable con reemplazo hormonal).
    9. El paciente debe firmar un ICF indicando que comprende el objetivo y los procedimientos necesarios para el estudio y está dispuesto a participar en el estudio.
    10. Las pacientes con capacidad de tener hijos deben presentar una prueba de embarazo en suero u orina negativa en la selección y en las 72 horas anteriores a la administración de la primera dosis del tratamiento del estudio y debe aceptar a realizarse más pruebas de embarazo en suero u orina durante el estudio.
    11. Las participantes deben:
    a. No tener capacidad de tener hijos, o
    b. Tener capacidad de tener hijos y
    • practicar la verdadera abstinencia durante todo el periodo del estudio, incluso hasta 6 meses después de la última dosis del tratamiento del estudio;
    • tener una única pareja que se haya sometido a una vasectomía; o
    • usar al menos 1 método anticonceptivo independiente de la paciente de alta eficacia.
    Las pacientes deben comprometerse a no donar óvulos (ovocitos) con fines de reproducción asistida durante el estudio y durante 6 meses después de recibir la última dosis del tratamiento del estudio.


    Consulte las páginas 32 a 34 del protocolo para conocer los criterios de inclusión completos
    E.4Principal exclusion criteria
    Any potential participant who meets any of the following criteria will be excluded from participating in the study:
    1. Participant has an uncontrolled illness, including but not limited to:
    • Uncontrolled diabetes
    • Ongoing or active infection (includes infection requiring treatment with antimicrobial therapy [participants will be required to complete antibiotics at least 1 week prior to starting study treatment] or diagnosed or suspected viral infection), except as allowed by Exclusion Criterion 17 for HIV
    • Active bleeding diathesis
    • Impaired oxygenation requiring continuous oxygen supplementation
    • Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product, or previous significant bowel resection that would preclude adequate absorption of study treatment
    • Psychiatric illness or any other circumstances (including social circumstances) that would limit compliance with study requirements
    • Any ophthalmologic condition that is clinically unstable
    2. Participant received prior systemic anticancer therapy in the locally advanced or metastatic setting, or in the adjuvant setting, for the same nonsquamous NSCLC intended for treatment now, except as allowed by Inclusion Criterion 3.
    3. Participant received radiotherapy for palliative treatment of NSCLC less than 14 days prior to randomization.
    4. Participant has active brain metastases not definitively treated with local therapy.
    5. Participant previously enrolled in the Sponsor’s study 73841937NSC3003 (NCT04487080).
    6. Participant has leptomeningeal disease, or participant has spinal cord compression not definitively treated with surgery or radiation.
    7. Participant has known small cell transformation.
    8. Participant has uncontrolled tumor-related pain. Symptomatic lesions amenable to palliative radiotherapy (eg, bone metastases, or metastases causing nerve impingement) should be treated at least 14 days prior to randomization.
    9. Participant has a medical history of ILD, including drug induced ILD or radiation pneumonitis.
    10. Participant has a history of hypersensitivity to carboplatin or pemetrexed, or to any excipient of carboplatin, pemetrexed, amivantamab, or lazertinib.
    11. Participant has an active malignancy (ie, progressing or requiring treatment change in the last 24 months) other than the disease being treated under study. Exceptions include participants who have undergone curative therapy and have no evidence of disease recurrence since completion of that therapy, and those with local cancers that have been apparently cured such as:
    a. Non-muscle invasive bladder cancer (NMIBC) treated within the last 24 months that is considered completely cured.
    b. Skin cancer (non-melanoma or melanoma) treated within the last 24 months that is considered completely cured.
    c. Non-invasive cervical cancer treated within the last 24 months that is considered completely cured.
    d. Localized prostate cancer (N0M0):
    • with a Gleason score of 6, treated within the last 24 months or untreated and under surveillance,
    • with a Gleason score of 3+4 that has been treated more than 6 months prior to full study screening and considered to have a very low risk of recurrence,
    • or history of localized prostate cancer and receiving androgen deprivation therapy and considered to have a very low risk of recurrence.
    e. Breast cancer:
    • lobular carcinoma in situ or ductal carcinoma in situ that is considered completely cured, or history of localized breast cancer and receiving antihormonal agents and considered to have a very low risk of recurrence.
    f. Other malignancy that is considered cured with minimal risk of recurrence.
    12. Participant has any contraindication to treatment with pemetrexed or carboplatin or participant has a history of hypersensitivity to, or cannot take, vitamin B12 or folic acid.
    13. Participant has a history of clinically significant cardiovascular disease including, but not limited to the following:
    • Diagnosis of deep vein thrombosis or pulmonary embolism within 4 weeks prior to randomization, or any of the following within 24 weeks prior to randomization: myocardial infarction, unstable angina, stroke, transient ischemic attack, coronary/peripheral artery bypass graft, or acute coronary syndrome.

    Please refer to pages 36- 38 of the protocol for full exclusion criteria.
    No podrán participar en el estudio los posibles pacientes que cumplan alguno de los siguientes criterios:
    1. El paciene tiene una enfermedad no controlada, que incluye, entre otros:
    • Diabetes no controlada
    • Infección en curso o activa (incluye infección que requiere tratamiento con terapia antimicrobiana [los participantes deberán completar los antibióticos al menos 1 semana antes de comenzar el tratamiento del estudio] o una infección viral diagnosticada o sospechada), excepto según lo permitido por el Criterio de exclusión 17 para el VIH
    • Diátesis hemorrágica activa
    • Oxigenación deteriorada que requiere suplementación continua de oxígeno
    • Náuseas y vómitos refractarios, enfermedades gastrointestinales crónicas, incapacidad para tragar el producto formulado o resección intestinal significativa previa que impediría la absorción adecuada del tratamiento del estudio
    • Enfermedad psiquiátrica o cualquier otra circunstancia (incluidas las circunstancias sociales) que limitarían el cumplimiento de los requisitos del estudio.
    • Cualquier afección oftalmológica que sea clínicamente inestable.
    2. Haber recibido tratamiento antineoplásico sistémico previo para tratar una enfermedad localmente avanzada o metastásica, o en el entorno adyuvante, para el mismo NSCLC no escamoso que se pretende tratar ahora, excepto según lo permitido por el Criterio de inclusión 3.
    3. Haber recibido radioterapia para el tratamiento paliativo del NSCLC menos de 14 días antes de la aleatorización.
    4. Tener metástasis cerebrales activas no tratadas definitivamente con terapia local.
    5. Haber estado inscrito previamente en el estudio del patrocinador 73841937NSC3003 (NCT04487080).
    6. Tener la enfermedad leptomeníngea o compresión de la médula espinal que no se trató definitivamente con cirugía o radiación.
    7. Tener conocimiento sobre la transformación de células pequeñas.
    8. Tener dolor no controlado relacionado con el tumor. Las lesiones sintomáticas susceptibles de recibir radioterapia paliativa (p. Ej., Metástasis óseas o metástasis que provocan pinzamiento nervioso) deben tratarse al menos 14 días antes de la aleatorización.
    9. Tener antecedentes médicos de Enfermedad Pulmonar Intersticial (EPI), incluida EPI inducida por fármacos o neumonitis por radiación.
    10. Tener antecedentes de hipersensibilidad al carboplatino o pemetrexed, o a cualquier excipiente de carboplatino, pemetrexed, amivantamab o lazertinib.
    11. Tener una neoplasia maligna activa (es decir, que progresa o requiere un cambio de tratamiento en los últimos 24 meses) que no es la enfermedad que se está tratando en estudio. Las excepciones incluyen a los participantes que se han sometido a una terapia curativa y no tienen evidencia de recurrencia de la enfermedad desde la finalización de esa terapia, y aquellos con cánceres locales que aparentemente se han curado, como:
    a. Cáncer de vejiga no invasivo muscularmente (NMIBC) tratado en los últimos 24 meses que se considera completamente curado.
    b. Cáncer de piel (no melanoma o melanoma) tratado en los últimos 24 meses que se considera completamente curado.
    c. Cáncer de cuello uterino no invasivo tratado en los últimos 24 meses que se considera completamente curado.
    d. Cáncer de próstata localizado (N0M0):
    • con una puntuación de Gleason de 6, tratados en los últimos 24 meses o sin tratamiento y bajo vigilancia,
    • con una puntuación de Gleason de 3 + 4 que ha sido tratada más de 6 meses antes de la selección completa del estudio y se considera que tiene un riesgo muy bajo de recurrencia,
    • o antecedentes de cáncer de próstata localizado y que reciben terapia de privación de andrógenos y se considera que tienen un riesgo muy bajo de recurrencia.
    e. Cáncer de mama:
    • carcinoma lobulillar in situ o carcinoma ductal in situ que se considera completamente curado, o antecedentes de cáncer de mama localizado y que recibe agentes antihormonales y se considera que tiene un riesgo muy bajo de recurrencia.
    f. Otra malignidad que se considera curada con un riesgo mínimo de recurrencia.
    12. Tener alguna contraindicación para el tratamiento con pemetrexed o carboplatino o tener antecedentes de hipersensibilidad a, o no puede tomar, vitamina B12 o ácido fólico.
    13. Tener antecedentes de enfermedad cardiovascular clínicamente significativa que incluye, entre otros, los siguientes:
    • Diagnóstico de trombosis venosa profunda o embolia pulmonar dentro de las 4 semanas previas a la aleatorización, o cualquiera de los siguientes dentro de las 24 semanas previas a la aleatorización: infarto de miocardio, angina inestable, accidente cerebrovascular, ataque isquémico transitorio, injerto de derivación de arteria coronaria / periférica o coronario agudo. síndrome.

    Consulte las páginas 36 a 38 del protocolo para conocer los criterios de exclusión completos.
    E.5 End points
    E.5.1Primary end point(s)
    Progression-free survival (PFS) using RECIST v1.1 guidelines, as assessed by blinded independent central review (BICR)
    Supervivencia libre de progresión (SLP) según las directrices RECIST v1.1, evaluada por una revisión central independiente cegada (BICR)
    E.5.1.1Timepoint(s) of evaluation of this end point
    The time from randomization until the date of objective disease progression or death, whichever comes first, based on BICR using RECIST v1.1.
    El tiempo transcurrido desde la aleatorización hasta la fecha de progresión objetiva de la enfermedad o la muerte, lo que ocurra primero, basado en la BICR utilizando RECIST v1.1.
    E.5.2Secondary end point(s)
    1. Clinical benefits:
    • Objective response (by BICR)
    • Overall survival
    • Duration of response (by BICR)
    • Time to subsequent therapy
    • PFS after first subsequent therapy (PFS2)
    • Time to symptomatic progression
    • Intracranial PFS (by BICR)
    2. Safety: Incidence and severity of adverse events and clinical laboratory abnormalities
    3. Pharmacokinetics or immunogenicity: Serum amivantamab and plasma lazertinib concentrations, and serum anti-amivantamab antibodies
    4. HRQOL and disease related symptoms:
    • NSCLC-SAQ
    • EORTC-QLQ-C30
    • PROMIS-PF
    5. Efficacy:
    • Intracranial PFS (by BICR)
    • Objective response (by BICR)
    • Duration of response (by BICR)
    • PFS (by BICR)
    1. Beneficios clínicos:
    • Respuesta objetiva (por BICR)
    • Supervivencia global
    • Duración de la respuesta (por BICR)
    • Tiempo hasta la terapia posterior
    • SLP después de la primera terapia posterior (SLP2)
    • Tiempo hasta la progresión sintomática
    • SLP intracraneal (por BICR)
    2. Seguridad: Incidencia y gravedad de los acontecimientos adversos y de las anomalías de laboratorio clínico
    3. Farmacocinética o inmunogenicidad: Concentraciones de amivantamab en suero y de lazertinib en plasma, y anticuerpos antiamivantamab en suero
    4. CVRS y síntomas relacionados con la enfermedad:
    • NSCLC-SAQ
    • EORTC-QLQ-C30
    • PROMIS-PF
    5. Eficacia:
    • SLP intracraneal (por BICR)
    • Respuesta objetiva (por BICR)
    • Duración de la respuesta (por BICR)
    • SLP (por BICR)
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. From randomization until the date of documented progression or death due to any cause, whichever comes first.
    2. Throughout the study or as clinically indicated.
    3. Arm A- Cycle 1 Day 1 (C1D1): predose, 2 hours (h), 4h; C2D1: predose, 2h, 4h; C3D1, C5D1, C7D1, C9D1, C11D1, C13D1: predose, 30 days after last dose
    PK: Arms A and C- C1D1 & C1D2, C2D1 : predose and end of infusion; C3D1, C5D1, C7D1, C10D1, C13D1, C17D1: predose, end of infusion and 30 days after last dose
    Immunogenicity: Arms A and C- C1D1, C2D1, C3D1, C5D1, C7D1, C9D1, C11D1, C13D1: predose and 30 days after last dose
    4. C1D1, C2D1, C3D1, C4D1, C5+, EOT and follow up
    5. From randomization until the date of documented progression or death due to any cause, whichever comes first.
    1. Desde aleatorización hasta fecha de progresión doc. o la muerte por cualquier causa, lo que ocurra primero.
    2. Durante todo el estudio o según se indique clínicamente.
    3. Brazo A- C1 Día 1 (C1D1): predosis, 2 hrs (h), 4h; C2D1: predosis, 2h, 4h; C3D1, C5D1, C7D1, C9D1, C11D1, C13D1: predosis, 30 días después de la última dosis
    PK: Brazos A y C- C1D1 & C1D2, C2D1: predosis y final de la infusión; C3D1, C5D1, C7D1, C10D1, C13D1, C17D1: predosis, final de la infusión y 30 días después de la última dosis
    Inmunogenicidad: Brazos A y C- C1D1, C2D1, C3D1, C5D1, C7D1, C9D1, C11D1, C13D1: predosis y 30 días después de la última dosis
    4. C1D1, C2D1, C3D1, C4D1, C5+, EOT y seguim.
    5. Desde aleatorización hasta fecha de progresión doc. o muerte por cualquier causa, lo que ocurra primero.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Tolerability, Biomarker evaluation, Immunogenicity assessments, Quality of life
    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 Yes
    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 trial3
    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 concerned16
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA90
    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
    Brazil
    Canada
    China
    Hong Kong
    India
    Israel
    Japan
    Korea, Republic of
    Malaysia
    Mexico
    Puerto Rico
    Russian Federation
    Taiwan
    Turkey
    United States
    Belgium
    Bulgaria
    Denmark
    France
    Germany
    Hungary
    Italy
    Netherlands
    Poland
    Portugal
    Spain
    Sweden
    United Kingdom
    Czechia
    Argentina
    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
    The end of study is considered as the last scheduled study assessment shown in the Schedule of Activities for the last participant in the study.
    Se considera que el final del estudio es la última evaluación programada que aparece en el Programa de Actividades para el último participante en el estudio.


    .
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days16
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial days16
    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: 275
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 225
    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 state51
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 185
    F.4.2.2In the whole clinical trial 500
    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)
    Standard of care
    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 Decision2021-11-11
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-09-10
    P. End of Trial
    P.End of Trial StatusOngoing
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