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    Summary
    EudraCT Number:2021-002555-10
    Sponsor's Protocol Code Number:DS1062-A-U304
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-03-02
    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 number2021-002555-10
    A.3Full title of the trial
    A Randomized, Open-label, Phase 3 Trial of Dato-DXd Plus Pembrolizumab vs Pembrolizumab Alone in Treatment-naïve Subjects with Advanced or Metastatic PD-L1 High (TPS =50%) Non-small Cell Lung Cancer Without Actionable Genomic Alterations (Tropion-Lung08)
    Sperimentazione di fase 3, randomizzata, in aperto su Dato-DXd più pembrolizumab rispetto a pembrolizumab in monoterapia in soggetti naïve al trattamento con carcinoma polmonare non a piccole cellule avanzato o metastatico che esprime alti livelli di PD-L1 (TPS =50%) senza alterazioni genomiche “actionable” (Tropion-Lung08)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of DS-1062a with or without Pembrolizumab in Advanced or Metastatic Non-small Cell Lung Cancer without Actionable Genomic Alterations
    Dato-DXd più pembrolizumab rispetto a pembrolizumab in monoterapia nel trattamento di prima linea di soggetti con NSCLC avanzato o metastatico senza alterazioni genomiche “actionable”
    A.3.2Name or abbreviated title of the trial where available
    Tropion-Lung08
    Tropion-Lung08
    A.4.1Sponsor's protocol code numberDS1062-A-U304
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN00000000
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT00000000
    A.5.4Other Identifiers
    Name:IND NUMBERNumber:136626
    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 SponsorDAIICHI SANKYO 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 supportDaiichi Sankyo, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationDaiichi Sankyo , Inc.
    B.5.2Functional name of contact pointClinical Trial Information Contact
    B.5.3 Address:
    B.5.3.1Street Address211 Mt. Airy Road
    B.5.3.2Town/ cityBasking Ridge
    B.5.3.3Post codeNJ 07920
    B.5.3.4CountryUnited States
    B.5.4Telephone number+19089926400
    B.5.5Fax number+19089926400
    B.5.6E-maileu_cta@dsi.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameKEITRUDA
    D.3.2Product code [MK-3475]
    D.3.4Pharmaceutical form Concentrate for 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 INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDatopotamab deruxtecan (Dato- DXd)
    D.3.2Product code [DS-1062a]
    D.3.4Pharmaceutical form Powder for concentrate for 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 INNDatopotamab deruxtecan (Dato-DXd)
    D.3.9.1CAS number 2238831-60-0
    D.3.9.2Current sponsor codeDS-1062a
    D.3.9.3Other descriptive nameDato-DXd
    D.3.9.4EV Substance CodeSUB213761
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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 or Metastatic Non-small Cell Lung Cancer (NSCLC)
    carcinoma polmonare non a piccole cellule avanzato o metastatico (NSCLC)
    E.1.1.1Medical condition in easily understood language
    Lung Cancer
    carcinoma polmonare
    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 compare the efficacy of Dato-DXd in combination with
    pembrolizumab versus pembrolizumab alone, as measured by
    progression-free survival (PFS) by blinded independent central review
    (BICR).
    - To compare the efficacy of Dato-DXd in combination with
    pembrolizumab versus pembrolizumab alone, as measured by overall
    survival (OS).
    -Confrontare l’efficacia di Dato-DXd in combinazione con pembrolizumab rispetto a pembrolizumab in monoterapia, misurata in base alla sopravvivenza libera da progressione (PFS) mediante revisione centrale indipendente in cieco (BICR)
    - Confrontare l’efficacia di Dato-DXd in combinazione con pembrolizumab rispetto a pembrolizumab in monoterapia, misurata in base alla sopravvivenza complessiva (OS)
    E.2.2Secondary objectives of the trial
    - To evaluate the efficacy of Dato-DXd in combination with
    pembrolizumab versus pembrolizumab alone, as measured by objective
    response rate (ORR) by BICR.
    - To further evaluate the efficacy of Dato- DXd in combination with
    pembrolizumab versus pembrolizumab alone.
    - To evaluate the patient-reported outcomes (PROs) of Dato-DXd in
    combination with pembrolizumab and of pembrolizumab alone.
    - To further evaluate the safety of Dato- DXd in combination with
    pembrolizumab.
    - To assess the immunogenicity of Dato-DXd in combination with
    pembrolizumab.
    -Valutare l’efficacia di Dato-DXd in combinazione con pembrolizumab rispetto a pembrolizumab in monoterapia, misurata in base al tasso di risposta obiettiva (ORR) valutato mediante BICR
    - Valutare ulteriormente l’efficacia di Dato-DXd in combinazione con pembrolizumab rispetto a pembrolizumab in monoterapia
    - Valutare gli esiti riferiti dal paziente (PRO) di Dato-DXd in combinazione con pembrolizumab e di pembrolizumab in monoterapia
    - Valutare ulteriormente la sicurezza di Dato-DXd in combinazione con pembrolizumab
    - Valutare l’immunogenicità di Dato-DXd in combinazione con pembrolizumab
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Sign and date the Tissue Screening and Main ICFs, prior to start any procedures.
    2. Adults =18 years
    3. Histologically documented NSCLC that meets all of the following
    criteria:
    a. Stage IIIB or IIIC disease and not candidates for surgical resection or
    definitive chemoradiation, or Stage IV NSCLC disease at the time of
    randomization (based on the American Joint Committee on Cancer,
    Eighth Edition).
    b. Documented negative test results for EGFR, ALK, and ROS1 actionable
    genomic alterations based on analysis of tumor tissue. If test results for
    EGFR, ALK, and ROS1 are not available, subjects are required to undergo
    testing performed locally for these genomic alterations.
    c. No known actionable genomic alterations in NTRK, BRAF, RET, MET, or
    other actionable driver kinases with locally approved therapies. (Testing for genomic alterations besides EGFR, ALK, and ROS1 is not required
    prior to enrollment.)
    4. Has provided a formalin-fixed tumor tissue sample
    for the measurement of TROP2 protein expression and for the assessment of other exploratory biomarkers. This tissue requirement is in addition to the tissue required for PD-L1 testing for tissue screening purposes.
    5. Tumor has high PD-L1 expression (TPS =50%) as determined by PDL1 IHC 22C3 pharmDx assay by central testing (minimum of 6 slides).
    6. Has an adequate treatment washout period before Cycle 1 Day 1 as
    defined in protocol Section 5.1.
    7. Measurable disease based on local imaging assessment using RECIST
    Version 1.1.
    8. Has left ventricular ejection fraction (LVEF) =50% by either an
    echocardiogram (ECHO) or multigated acquisition scan (MUGA) within 28 days before randomization.
    9. ECOG PS of 0 or 1 at screening.
    10. Has a life expectancy of at least 3 months.11. Adequate bone marrow function within 7 days before randomization
    as defined in protocol Section 5.1.
    12. If the subject is a female of childbearing potential, she must not be pregnant, breastfeeding or intend to become pregnant during the study;
    she must also have a negative serum pregnancy test at screening and
    must be willing to use highly effective birth control (as detailed in
    protocol Section 10.3.4) or avoid heterosexual intercourse upon
    randomization, during the Treatment Period, for 7 months following the last dose of Dato-DXd, and for 4 months following the last dose of
    pembrolizumab, whichever occurs later. A female is considered of
    childbearing potential following menarche and until becoming
    postmenopausal (no menstrual period for a minimum of 12 months)
    unless permanently sterile (undergone a hysterectomy, bilateral
    salpingectomy, or bilateral oophorectomy).
    13. If male, the subject must be surgically sterile or willing to use highly effective birth control or avoid heterosexual intercourse upon
    enrollment, during the Treatment Period, and for 4 months following the last dose of study drug. last dose of study drug.
    14. Male subjects must not freeze or donate sperm starting at screening and throughout the study period, and at least 4 months after the last dose of study drug.
    15. Female subjects must not donate, or retrieve for their own use, ova from the time of screening and throughout the study treatment period,
    and for at least 7 months after the last dose of Dato-DXd, or for at least 4 months after the last dose of pembrolizumab, whichever occurs later.
    16. Is willing and able to comply with scheduled visits, drug
    administration plan, laboratory tests, other study procedures, and study restrictions
    1. Firmare e datare ICF per screening tissutale e ICF principale prima di iniziare qualsiasi procedura
    2. Essere adulti di età =18 anni.
    3. Presentare NSCLC istologicamente documentato che soddisfi tutti i seguenti criteri:
    a. Malattia in stadio IIIB o IIIC e non candidato a resezione chirurgica o chemioradioterapia definitiva, o NSCLC in stadio IV al momento della randomizzazione (in base all’American Joint Committee on Cancer, Eighth Edition).
    b. Risultati di test negativi documentati per alterazioni genomiche “actionable” EGFR, ALK e ROS1 in base all’analisi del tessuto tumorale. Se i risultati dei test per EGFR, ALK e ROS1 non sono disponibili, i soggetti devono sottoporsi a test eseguiti localmente per queste alterazioni genomiche.
    c. Nessuna alterazione genomica “actionable” nota di NTRK, BRAF, RET, MET o altre chinasi driver “actionable” con terapie approvate localmente (prima dell’arruolamento non è necessario eseguire test per le alterazioni genomiche oltre a EGFR, ALK e ROS1).
    4. Aver fornito un campione di tessuto tumorale fissato in formalina per la misurazione dell’espressione della proteina TROP2 e per la valutazione di altri biomarcatori esplorativi. Questo requisito di tessuto è in aggiunta al tessuto necessario per l’analisi di PD-L1 ai fini dello screening tissutale.
    5. Il tumore esprime alti livelli di PD-L1 (TPS =50%) come determinato dal test PD-L1 IHC 22C3 pharmDx mediante test centrale (minimo 6 vetrini).
    6. Avere un adeguato periodo di washout dal trattamento prima del Giorno 1 del Ciclo 1, come definito nella sezione n5.1 del protocollo
    7. Malattia misurabile in base alla valutazione di diagnostica per immagini locale utilizzando i criteri RECIST versione 1.1.
    8. Presentare frazione di eiezione ventricolare sinistra (LVEF) =50% nei 28 giorni precedenti alla randomizzazione per ecocardiogramma (ECO) o scansione con acquisizione a gate multipli (MUGA).
    9. Stato della prestazione (PS) ECOG di 0 o 1 allo screening.
    10. Avere un’aspettativa di vita pari almeno a 3 mesi.
    11. Adeguata funzionalità del midollo osseo nei 7 giorni precedenti alla randomizzazione, definita come:
    12. Se il soggetto è donna in età fertile, non deve essere incinta, allattare o avere intenzione di rimanere incinta durante lo studio;
    deve inoltre avere un test di gravidanza negativo al momento dello screening ed essere disposta a utilizzare un controllo delle nascite altamente efficace (come specificato nel protocollo Sezione 10.3.4) o evitare rapporti eterosessuali al momento della randomizzazione, durante il periodo di trattamento, per 7 mesi dopo l'ultima dose di Dato-DXd e per 4 mesi dopo l'ultima dose di pembrolizumab, qualunque sia la data successiva. Una donna è considerata
    potenziale di gravidanza dopo il menarca e fino a quando non diventa
    postmenopausa (nessun periodo mestruale per un minimo di 12 mesi) a meno che non sia sterile (sottoposta a isterectomia, salpingectomia bilaterale salpingectomia o ooforectomia bilaterale).
    13. Se maschio, il soggetto deve essere chirurgicamente sterile o disposto a usare un controllo delle nascite altamente efficace o evitare rapporti eterosessuali al momento dell'arruolamento
    all'arruolamento, durante il periodo di trattamento e per 4 mesi dopo l'ultima dose del farmaco in studio.
    14. I soggetti di sesso maschile non devono congelare o donare lo sperma dallo screening e per tutto il periodo di studio, e almeno 4 mesi dopo l'ultima dose del farmaco in studio.
    15. I soggetti di sesso femminile non devono donare, o recuperare per uso personale, ovuli dal momento dello screening e per tutto il periodo di trattamento dello studio,
    e per almeno 7 mesi dopo l'ultima dose di Dato-DXd, o per almeno 4 mesi dopo l'ultima dose di pembrolizumab, a seconda di quale evento si verifichi dopo.
    16. È disposto e in grado di rispettare le visite programmate, il piano di piano di somministrazione del farmaco, test di laboratorio, altre procedure di studio e restrizioni dello studio
    E.4Principal exclusion criteria
    1 Prior systemic treatment for advanced or metastatic NSCLC.
    2. Prior treatment with any of the following, including in
    the adjuvant/neoadjuvant setting:
    a. Any agent, including an antibody-drug conjugate, containing a
    chemotherapeutic agent targeting topoisomerase I.
    b. TROP2-targeted therapy.
    c. Any anti-programmed death receptor-1 (PD-1), anti-PD-L1, or anti-
    PD-ligand 2 (L2) agent or with an agent directed to another stimulatory
    or co-inhibitory T-cell receptor (eg, CTLA-4, OX40, CD137).
    d. Any other immune checkpoint inhibitors.
    Subjects who received adjuvant or neoadjuvant therapy OTHER than
    those listed above, are eligible if the adjuvant/neoadjuvant therapy was completed at least 6 months prior to the diagnosis of
    advanced/metastatic disease.
    3. Has spinal cord compression or active and untreated central nervous system (CNS) metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are radiologically stable (ie, without evidence of progression) for at least
    4 weeks by repeat imaging (note: repeat imaging should be performed during study screening), clinically stable, and without requirement of steroid treatment for at least 7 days before the first dose of study drug.
    4. Has received prior radiotherapy =4 weeks of start of study
    intervention or more than 30Gy to the lung within 6 months of Cycle 1 Day 1. Subjects must have recovered from all radiation related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 2- week washout is permitted for palliative radiation (=2 weeks of radiotherapy) to non-CNS disease.
    5. History of another primary malignancy (beyond NSCLC) except for:
    - Malignancy treated with curative intent and with no known active
    disease =3 years before the first dose of study treatment and of low
    potential risk for recurrence
    - Adequately treated non-melanoma skin cancer or lentigo malignancy without evidence of disease
    - Adequately treated carcinoma in situ without evidence of disease
    - Participants with a history of prostate cancer (tumor/node/metastasis
    stage) of Stage =T2cN0M0 without biochemical recurrence or
    progression and who in the opinion of the Investigator are not deemed to require active intervention.
    6. Has a history of (non-infectious) interstitial lung disease
    (ILD)/pneumonitis that required steroids, has current ILD/pneumonitis,
    or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening.
    7. Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses including, but not limited to, any underlying pulmonary disorder (eg, pulmonary emboli diagnosed within 3 months of Cycle 1 Day 1, severe asthma, severe chronic obstructive pulmonary disease, restrictive lung disease, pleural effusion, etc.), or any autoimmune, connective tissue or inflammatory disorders with pulmonary involvement (eg, rheumatoid arthritis, Sjögren's syndrome, sarcoidosis, etc.), or prior complete pneumonectomy.
    8. Uncontrolled or significant cardiovascular disease, including:
    a. Mean QT interval corrected for heart rate using Fridericia's formula
    (QTcF) interval >470 msec regardless of sex (based on the average of
    the 12-lead electrocardiogram determination at screening).
    b. Myocardial infarction within 6 months prior to randomization.
    c. Uncontrolled angina pectoris within 6 months prior to randomization.
    d. LVEF <50% by ECHO or MUGA scan within 28 days before
    randomization.
    e. New York Heart Association Class 2 to 4 congestive heart failure (CHF) at screening. Subjects with a history of Class 2 to 4 CHF prior to
    screening, must have returned to Class 1 CHF and have LVEF =50% (byeither an ECHO or MUGA scan within 28 days before randomization) to be eligible.
    f. Uncontrolled hypertension (resting systolic blood pressure >180 mmHg or diastolic blood pressure >110 mmHg) within 28 ds beforerandomization.
    9. Clinically significant corneal disease.
    Full list: see Protocol Section 5.2.
    stica per immagini deve essere eseguita durante lo screening dello studio), clinicamente stabili e senza necessità di trattamento steroideo per almeno 7 giorni prima della prima dose del farmaco dello studio
    4. Aver ricevuto una precedente radioterapia =4 settimane dall’inizio del trattamento dello studio o più di 30Gy al polmone entro 6 mesi dal Giorno 1 del Ciclo 1. I soggetti devono essersi ristabiliti da tutte le tossicità correlate alle radiazioni, non devono necessitare di corticosteroidi e non devono presentare infiammazione polmonare da radiazioni. È consentito un washout di 2 settimane per la radioterapia palliativa (=2 settimane di radioterapia) per la malattia non a carico del SNC.
    5. Anamnesi di un altro tumore maligno primario (oltre a NSCLC), fatta eccezione per:
    • Tumore maligno trattato con intento curativo e senza malattia attiva nota =3 anni prima della prima dose del trattamento dello studio e con basso rischio potenziale di recidiva
    • Tumore della pelle non melanoma o lentigo maligna adeguatamente trattati senza evidenza di malattia
    • Carcinoma in situ adeguatamente trattato senza evidenza di malattia
    • Partecipanti con anamnesi di tumore della prostata (stadio del tumore/nodo/metastasi) allo stadio =T2cN0M0 senza recidiva o progressione biochimica e che, a giudizio dello sperimentatore, non si ritiene che richiedano un intervento attivo.
    6. Presentare un’anamnesi di malattia polmonare interstiziale (ILD)/infiammazione polmonare (non infettiva) che abbia richiesto un trattamento con steroidi, ILD/infiammazione polmonare in atto o sospetto di ILD/infiammazione polmonare non escludibile dagli esami di diagnostica per immagini eseguiti allo screening.
    7. Compromissione polmonare clinicamente grave derivante da malattie polmonari intercorrenti, tra cui ma non solo, qualsiasi disturbo polmonare sottostante (per es., emboli polmonari diagnosticati entro 3 mesi dal Giorno 1 del Ciclo 1, asma grave, malattia polmonare ostruttiva cronica grave, malattia polmonare restrittiva, versamento pleurico, ecc.) o qualsiasi malattia autoimmune, tessuto connettivo o disturbi infiammatori con coinvolgimento polmonare (per es., artrite reumatoide, sindrome di Sjögren, sarcoidosi, ecc.) o precedente pneumonectomia completa.
    8. Malattia cardiovascolare significativa o non controllata, tra cui:
    a. Intervallo QT medio corretto per la frequenza cardiaca utilizzando la formula di Fridericia (QTcF) >470 msec indipendentemente dal sesso (in base alla media della determinazione dell’elettrocardiogramma a 12 derivazioni allo screening).
    b. Infarto miocardico nei 6 mesi precedenti alla randomizzazione.
    c. Angina pectoris non controllata nei 6 mesi precedenti alla randomizzazione.
    d. LVEF <50% mediante ECO o scansione MUGA nei 28 giorni precedenti alla randomizzazione.
    e. Insufficienza cardiaca congestizia (ICC) di Classe da 2 a 4 secondo la New York Heart Association allo screening. Per essere eleggibili, i soggetti con anamnesi di ICC di classe da 2 a 4 prima dello screening devono essere tornati a ICC di classe 1 e presentare una LVEF =50% (mediante una scansione ECO o MUGA entro 28 giorni prima della randomizzazione).
    f. Ipertensione non controllata (pressione sanguigna sistolica a riposo >180 mmHg o pressione sanguigna diastolica >110 mmHg) nei 28 giorni precedenti alla randomizzazione.
    9. Malattia corneale clinicamente significativa.
    Per l'elenco completo dei principali criteri di esclusione consultare il Protocollo dello studio clinico, sezione 5.2.
    E.5 End points
    E.5.1Primary end point(s)
    -Progression-free survival (PFS) is defined as the time from
    randomization to the first documented radiographic disease progression
    or death due to any cause, whichever occurs first.
    -Overall survival (OS) is defined as the time from randomization to death
    due to any cause.
    -La sopravvivenza libera da progressione (PFS) è definita come il tempo dalla
    randomizzazione alla prima progressione radiografica documentata della malattia
    o alla morte per qualsiasi causa, a seconda di quale si verifichi per prima.
    -La sopravvivenza complessiva (OS) è definita come il tempo dalla randomizzazione alla morte
    per qualsiasi causa.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Subjects will undergo radiographic assessment of tumor response based
    on Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1
    every 9 weeks (±7 days) for the first 2 years and then every 12 weeks
    (±7 days) thereafter, from randomization until radiological disease
    progression as determined by BICR, death, lost to follow-up, or
    withdrawal of consent, regardless of discontinuing study treatment or
    starting a new anticancer therapy (tumor assessment is not restricted to
    the Treatment Period).
    I soggetti saranno sottoposti alla valutazione radiografica della risposta tumorale basata
    sui criteri di valutazione della risposta nei tumori solidi (RECIST), versione 1.1
    ogni 9 settimane (±7 giorni) per i primi 2 anni e poi ogni 12 settimane
    (±7 giorni) in seguito, dalla randomizzazione fino alla progressione radiologica della
    progressione radiologica della malattia determinata dal BICR, morte, perdita del follow-up o
    ritiro del consenso, indipendentemente dall'interruzione del trattamento dello studio o
    iniziare una nuova terapia antitumorale (la valutazione del tumore non è limitata al
    al periodo di trattamento).

    Tradotto con www.DeepL.com/Translator (versione gratuita)
    E.5.2Secondary end point(s)
    1. Efficacy:
    - Objective response rate (ORR) is defined as the proportion of subjects
    who achieved a best overall response (BOR) of confirmed complete
    response (CR) or confirmed partial response (PR).
    - PFS is defined as the time from randomization to the first documented
    radiographic disease progression or death due to any cause, whichever
    occurs first.
    - PFS2 is defined as the time from date of randomization to the first
    documented disease progression on next-line therapy or death due to
    any cause, whichever occurs first.
    - ORR is defined as the proportion of subjects who achieved a BOR of
    confirmed CR or confirmed PR.
    - Duration of response (DoR) is defined as the time from the date of the
    first documentation of objective response (confirmed CR or confirmed
    PR) to the date of the first radiographic disease progression or death
    due to any cause, whichever occurs first.
    - Time to response (TTR) is defined as the time from randomization to
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    the date of the first documentation of objective response (confirmed CR
    or confirmed PR) in responding subjects.
    -Disease control rate (DCR) is defined as the proportion of subjects who
    achieved a BOR of confirmed CR, confirmed PR, or stable disease (SD).; 2. Patient-reported outcomes (PROs):
    - Time to deterioration (TTD) is defined as the time from randomization
    to first onset of a =10-point increase in cough, chest pain, or dyspnea,
    confirmed by a second adjacent =10- point increase from randomization
    in the same symptom, or confirmed by death within 21 days of a =10-
    point increase from randomization.; 3. Safety:
    - Treatment-emergent adverse events (TEAEs), serious adverse events
    (SAEs), adverse events of special interest (AESIs), Eastern Cooperative
    Oncology Group performance status (ECOG PS), vital sign
    measurements, standard clinical laboratory parameters (hematology,
    clinical chemistry, and urinalysis), electrocardiogram parameters,
    echocardiogram (ECHO)/multigated acquisition (MUGA) scan findings,
    and ophthalmologic findings. AEs will be coded by the most recent
    version of the Medical Dictionary for Regulatory Activities (MedDRA) and
    both AEs and laboratory test results will be graded by the National
    Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE)
    Version 5.0; 4. Immunogenicity:
    - Anti-drug antibody (ADA) prevalence: the proportion of subjects who
    are ADA-positive at any point in time (at baseline or post-baseline) ADA
    incidence: the proportion of subjects having a treatment-emergent ADA
    Titer and neutralizing antibodies will be determined when the ADA is
    positive.
    1. Efficacia:
    - Il tasso di risposta obiettiva (ORR) è definito come la proporzione di soggetti
    che hanno ottenuto una migliore risposta complessiva (BOR) di risposta completa confermata
    risposta completa (CR) o una risposta parziale confermata (PR).
    - La PFS è definita come il tempo trascorso dalla randomizzazione al primo documentato
    progressione radiografica della malattia o al decesso per qualsiasi causa, a seconda di quale
    si verifichi per primo.
    - La PFS2 è definita come il tempo trascorso dalla data di randomizzazione alla prima
    progressione documentata della malattia con la terapia successiva o il decesso per qualsiasi causa, a seconda di quale delle due condizioni si verifichi per prima.
    qualsiasi causa, a seconda di quale si verifichi per prima.
    - ORR è definito come la proporzione di soggetti che hanno raggiunto un BOR di
    CR confermato o PR confermato.
    - La durata della risposta (DoR) è definita come il tempo trascorso dalla data della
    prima documentazione di risposta obiettiva (CR confermata o PR confermata) alla data della prima
    PR) alla data della prima progressione radiografica della malattia o del decesso
    per qualsiasi causa, a seconda di quale si verifichi per prima.
    - Il tempo di risposta (TTR) è definito come il tempo dalla randomizzazione alla
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    alla data della prima documentazione della risposta obiettiva (CR confermata o PR confermata) nei soggetti che rispondono.
    o PR confermata) nei soggetti rispondenti.
    -Il tasso di controllo della malattia (DCR) è definito come la proporzione di soggetti che
    hanno raggiunto un BOR di CR confermato, PR confermato o malattia stabile (SD).

    Tradotto con www.DeepL.com/Translator (versione gratuita); 2. Esiti riferiti dai pazienti (PROs):
    - Il tempo di deterioramento (TTD) è definito come il tempo dalla randomizzazione
    alla prima comparsa di un aumento =10 punti di tosse, dolore toracico o dispnea,
    confermato da un secondo aumento adiacente di =10 punti dalla randomizzazione
    nello stesso sintomo, o confermato dalla morte entro 21 giorni da un aumento di =10 punti dalla randomizzazione.
    punto di aumento dalla randomizzazione.; 3. Sicurezza:
    - Eventi avversi emergenti dal trattamento (TEAEs), eventi avversi gravi
    (SAEs), eventi avversi di particolare interesse (AESIs), Eastern Cooperative
    Oncology Group performance status (ECOG PS), segni vitali
    misurazioni dei segni vitali, parametri clinici di laboratorio standard (ematologia,
    chimica clinica e analisi delle urine), parametri dell'elettrocardiogramma,
    risultati dell'ecocardiogramma (ECHO)/scansione ad acquisizione multipla (MUGA),
    e risultati oftalmologici. Gli AE saranno codificati dalla più recente
    versione del Medical Dictionary for Regulatory Activities (MedDRA) e
    sia gli AE che i risultati dei test di laboratorio saranno classificati in base al National
    Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE)
    Versione 5.0; 4. Immunogenicità:
    - Prevalenza di anticorpi antidroga (ADA): la proporzione di soggetti che
    sono ADA-positivi in qualsiasi momento (al baseline o post-baseline) ADA
    incidenza: la proporzione di soggetti che hanno un'ADA emergente dal trattamento
    Il titolo e gli anticorpi neutralizzanti saranno determinati quando l'ADA è
    positivo.
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Efficacy: Please refer time point of evaluation for Primary end point.; 2. PROs: From randomization until EOT.; 3. Safety: After the subject signs the Tissue Screening ICF and up to 90
    (+7) days after the last dose of study drug (or 30 [+7] days following
    cessation of study treatment if the subject initiates new anticancer
    therapy, whichever is earlier).; 4. For subjects receiving Dato-DXd: C1 – Day 1 (within 8h before
    infusion), C2 – Day 1 (within 8h before infusion), C4, C6, C8, and then
    every 4 cycles (ie, C12, C16 and so on) until EOT
    For subjects receiving pembrolizumab: C1 – Day 1 (within 8h before
    infusion), C2 – Day 1 (within 8h before infusion), and then every 2
    cycles (ie, C4, C6) until C8 or pembrolizumab discontinuation, whichever
    occurs first.
    1. Efficacia: Si prega di fare riferimento al momento della valutazione per end point finale primario.; 2. PROs: dalla randomizzazione fino a EOT.; 3. Sicurezza: Dopo che il soggetto ha firmato l'ICF per lo screening dei tessuti e fino a 90
    (+7) giorni dopo l'ultima dose del farmaco in studio (o 30 [+7] giorni dopo
    cessazione del trattamento dello studio se il soggetto inizia una nuova terapia antitumorale
    terapia antitumorale, a seconda di quale evento si verifichi per primo).; 4. Per i soggetti che ricevono Dato-DXd: C1 - Giorno 1 (entro 8 ore prima
    infusione), C2 - Giorno 1 (entro 8h prima dell'infusione), C4, C6, C8, e poi
    ogni 4 cicli (cioè, C12, C16 e così via) fino all'EOT
    Per i soggetti che ricevono pembrolizumab: C1 - Giorno 1 (entro 8 ore prima
    infusione), C2 - Giorno 1 (entro 8h
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Patient-reported outcomes (PROs), Immunogenicity, Biomarkers
    Risultati riferiti dai pazienti (PROs), Immunogenicità, Biomarcator
    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 No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Datopotamab deruxtecan (Dato-DXd) in combinazione con pembrolizumab vs pembrolizumab da solo
    Datopotamab deruxtecan (Dato-DXd) in combination with pembrolizumab versus pembrolizumab alone
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA62
    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
    Argentina
    Australia
    Brazil
    Canada
    Chile
    China
    Hong Kong
    Japan
    Korea, Republic of
    Mexico
    Russian Federation
    Taiwan
    Thailand
    Turkey
    Ukraine
    United States
    Belgium
    Czechia
    France
    Germany
    Greece
    Italy
    Netherlands
    Poland
    Portugal
    Romania
    Spain
    Switzerland
    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
    Overall EOS will occur after all subjects have discontinued the study or
    have died; or an alternative study becomes available for subjects
    continuing to derive benefit from treatment with pembrolizumab
    and/or Dato-DXd where the drug is offered to these subjects; or the
    study is discontinued by the Sponsor for other reasons. A final analysis
    may be conducted at the overall EOS.
    The subject's EOS is the date of their last study visit/contact.
    L'EOS globale si verificherà dopo che tutti i soggetti hanno interrotto lo studio o sono deceduti; oppure si rende disponibile uno studio alternativo per i soggetti che continuano a trarre beneficio dal trattamento con pembrolizumab e/o Dato-DXd in cui il farmaco viene offerto a questi soggetti;
    o lo studio viene interrotto dallo sponsor per altri motivi.
    Un'analisi finale può essere condotta all'EOS complessiva.
    L'EOS del soggetto è la data della sua ultima visita/contatto dello studio.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years6
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years6
    E.8.9.2In all countries concerned by the trial months2
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 370
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 370
    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 state42
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 190
    F.4.2.2In the whole clinical trial 740
    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)
    Overall EOS will occur after all subjects have discontinued the study or
    have died; or an alternative study becomes available for subjects
    continuing to derive benefit from treatment with pembrolizumab
    and/or Dato-DXd where the drug is offered to these subjects; or the
    study is discontinued by the Sponsor for other reasons.
    L'EOS globale si verificherà dopo che tutti i soggetti hanno interrotto lo studio o
    sono deceduti; oppure si rende disponibile uno studio alternativo per i soggetti
    che continuano a trarre beneficio dal trattamento con pembrolizumab
    e/o Dato-DXd in cui il farmaco viene offerto a questi soggetti; o lo
    lo studio viene interrotto dallo Sponsor per altri motivi.
    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 Decision2022-05-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-05-31
    P. End of Trial
    P.End of Trial StatusOngoing
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