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    Summary
    EudraCT Number:2021-002561-18
    Sponsor's Protocol Code Number:GEICAM/2020-08
    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:2022-10-07
    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 number2021-002561-18
    A.3Full title of the trial
    Single arm phase II study of the efficacy and safety of the combination of Trastuzumab plus TUCAtinib plus viNorelbine in patients with HER2-positive non-resectable locally advanced or metastatic breast cancer “TrasTUCAN Study”
    Estudio fase 2 de un solo brazo sobre la eficacia y la seguridad de la combinación de trastuzumab, TUCAtinib y viNorelbina en pacientes con cáncer de mama localmente avanzado no resecable o metastásico HER2-positivo «Estudio TrasTUCAN
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Single arm phase II study of the efficacy and safety of the combination of Trastuzumab plus TUCAtinib plus viNorelbine in patients with HER2-positive non-resectable locally advanced or metastatic breast cancer “TrasTUCAN Study”
    Estudio fase 2 de un solo brazo sobre la eficacia y la seguridad de la combinación de trastuzumab, TUCAtinib y viNorelbina en pacientes con cáncer de mama localmente avanzado no resecable o metastásico HER2-positivo «Estudio TrasTUCAN
    A.3.2Name or abbreviated title of the trial where available
    TrasTUCAN
    TrasTUCAN
    A.4.1Sponsor's protocol code numberGEICAM/2020-08
    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 SponsorGEICAM (Fundación Grupo Español de Investigación en Cáncer de Mama)
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportSEAGEN Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGEICAM (Fundación Grupo Español de Investigación en Cáncer de Mama)
    B.5.2Functional name of contact pointClinical Operations Department
    B.5.3 Address:
    B.5.3.1Street AddressAvenida de los Pirineos nº7, 1ª planta, oficina 1-14
    B.5.3.2Town/ citySan Sebastián De Los Reyes (Madrid)
    B.5.3.3Post code28703
    B.5.3.4CountrySpain
    B.5.4Telephone number+34916592870
    B.5.5Fax number+34916510406
    B.5.6E-mailgeicam@geicam.org
    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 Yes
    D.2.1.1.1Trade name TUKYSA
    D.2.1.1.2Name of the Marketing Authorisation holderSEAGEN B.V.
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTucatinib
    D.3.9.1CAS number 937263-43-9
    D.3.9.4EV Substance CodeSUB177913
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 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 Yes
    D.2.1.1.1Trade name TUKYSA
    D.2.1.1.2Name of the Marketing Authorisation holderSEAGEN B.V.
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTucatinib
    D.3.9.1CAS number 937263-43-9
    D.3.9.4EV Substance CodeSUB177913
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    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
    Non-resectable locally advanced or metastatic HER2-positive breast cancer.
    Cáncer de mama irresecable localmente avanzado o metastásico HER2-positivo.
    E.1.1.1Medical condition in easily understood language
    Non-resectable locally advanced or metastatic HER2-positive breast cancer.
    Cáncer de mama irresecable localmente avanzado o metastásico HER2-positivo.
    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 10027475
    E.1.2Term Metastatic breast cancer
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy of the combination of tucatinib plus vinorelbine plus trastuzumab
    Evaluar la eficacia de la combinación de tucatinib más vinorelbina más trastuzumab
    E.2.2Secondary objectives of the trial
    - To evaluate other efficacy objectives in all patients.
    - To evaluate other efficacy objectives in patients with brain metastatasis at baseline.
    - To evaluate the safety of the combination of tucatinib plus vinorelbine plus trastuzumab.
    - To evaluate the tolerability of the combination of tucatinib plus vinorelbine plus trastuzumab.
    - To evaluate the effect on the Quality of life (QoL) of the combination of tucatinib plus vinorelbine plus trastuzumab, as measured by the EORTC QLQ-C30.
    -Evaluar otros objetivos de eficacia en la totalidad de los pacientes.
    -Evaluar otros objetivos de eficacia en los pacientes con metástasis cerebrales en la situación basal.
    -Evaluar la seguridad de la combinación de tucatinib más vinorelbina más trastuzumab.
    -Evaluar la tolerabilidad de la combinación de tucatinib más vinorelbina más trastuzumab.
    -Evaluar el efecto sobre la calidad de vida (CdV) de la combinación de tucatinib, vinorelbina y trastuzumab, empleando el cuestionario EORTC QLQ-C30.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1 Written and signed informed consent obtained prior to any study-specific procedure. 2 Male or female patients at least 18 years of age.
    3 Availability of pre-treatment archival FFPE tumor tissue (preferably the most recent available), otherwise possibility to perform a biopsy, to carry out exploratory biomarker analyses. 4 Documented HER2-positive status by local laboratory determination, preferably on the most recent available FFPE tumor sample, according to the American Society of Clinical Oncology (ASCO)/Collegue of American Pathologists (CAP) international guidelines valid at the time of the assay. 5 Previous therapy with taxanes, trastuzumab and T-DM1 are mandatory. Prior treatment with pertuzumab and anti-HER2 TKI agents is allowed. 6 Measurable disease according to RECIST 1.1 criteria, defined as at least 1 extra-osseous lesion that can be accurately measured in at least 1 dimension. 7 Mandatory contrast brain MRI must be performed at baseline and patients must have at least one of the following:
    a. No evidence of brain metastases. b. Untreated brain metastases not needing immediate local therapy. c. Previously treated brain metastases:
    c-1. Brain metastases previously treated with local therapy may either be stable since treatment or may have progressed since prior local central nervous system CNS therapy, provided that there is no clinical indication for immediate re-treatment with local therapy. c-2. Subjects treated with CNS local therapy for newly identified lesions may be eligible to enroll if all of the following criteria are met: -Time since stereotactic radiosurgery (SRS) is at least 1 week prior to first dose of study treatment, time since whole brain radiation therapy (WBRT) is at least 3 weeks prior to first dose, or time since surgical resection is at least 4 weeks. - Other sites of evaluable disease are present. c-3. Relevant records of any CNS treatment must be available to allow for classification of target and non-target lesions. 8. Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1. 9 Life expectancy ≥ 12 weeks. 10 Adequate organ and marrow function defined as follows: a. Absolute Neutrophil Count (ANC) ≥ 1,500/mm3 (1.5x109/L). b. Platelet count ≥ 100,000/mm3 (100x109/L). c. Hemoglobin ≥ 9g/dL (90g/L). d. Serum creatinine ≤ 1,5x upper limit of the normal range (ULN) or estimated creatinine clearance ≥ 60 mL/min as calculated using the standard method for the institution. e. Total serum bilirubin ≤ 1,5xULN (≤ 3.0xULN if Gilbert´s disease). f. Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT ≤ 3.0xULN (≤5.0xULN if liver metastases are present). g. Alkaline phosphatase ≤ 2.5xULN (≤5.0xULN if bone or liver metastases are present). 11. Left ventricular ejection fraction (LVEF) ≥ 50% measured by multiple-gated acquisition scan (MUGA) or echocardiogram (ECHO). 12. Negative urine or serum pregnancy test for females of childbearing potential.
    1. Otorgamiento del consentimiento informado, por escrito y firmado, antes de realizar ningún procedimiento específico del estudio. 2. Varones o mujeres de 18 años de edad como mínimo. 3. Disponibilidad de tejido tumoral FFPE de archivo pre-tratamiento (preferiblemente el más reciente); en caso contrario, posibilidad de realizar una biopsia para llevar a cabo los análisis exploratorios de biomarcadores. 4. Situación de HER2-positivo documentada, basándose en la determinación del laboratorio local, preferiblemente en la muestra de tumor FFPE más reciente disponible, de acuerdo con las guías internacionales de la Sociedad Americana de Oncología Clínica (American Society of Clinical Oncology, ASCO)/Colegio de Anatomopatólogos Americano (College of American Pathologists, CAP) en vigor en el momento de realizar la determinación. 5. Es obligatorio el tratamiento previo con taxanos, trastuzumab y T-DM1. Se permite el tratamiento previo con pertuzumab y agentes TKI anti-HER2. 6. Enfermedad mensurable de acuerdo con los criterios RECIST 1.1., definida como un mínimo de una lesión extraósea que pueda medirse con precisión en como mínimo una dimensión. 7. En la situación basal será obligatorio realizar una prueba de resonancia magnética nuclear (RMN) cerebral con contraste; adicionalmente, los pacientes deberán presentar como mínimo uno de las siguientes requisitos: a. Sin evidencias de metástasis cerebrales. b. Metástasis cerebrales no tratadas que no requieran tratamiento local inmediato. c. Metástasis cerebrales tratadas previamente.
    c-1 Las metástasis cerebrales tratadas previamente con terapia local podrán haber permanecido estables desde su tratamiento o podrán haber progresado desde la terapia local previa del sistema nervioso central (SNC), a condición de que no exista ninguna indicación clínica para el retratamiento inmediato con terapia local.
    c-2 Los sujetos tratados con terapia local sobre el SNC debido a lesiones de nueva identificación podrán ser elegibles y participar en el estudio si cumplen todos los criterios siguientes:
    - Tiempo desde la radiocirugía estereotáctica (RCE) de como mínimo 1 semana previamente de la administración de la primera dosis del tratamiento del estudio, tiempo transcurrido desde la radioterapia holocraneal (WBRT) de como mínimo 3 semanas previamente a la primera dosis del tratamiento del estudio o tiempo transcurrido desde la resección quirúrgica de un mínimo de 4 semanas.
    - Existencia otras localizaciones de enfermedad evaluable.
    c-3. Debe disponerse de los registros correspondientes a todos los tratamientos del SNC, a fin de permitir la clasificación de las lesiones diana y no diana. 8. Estado funcional ECOG (Eastern Cooperative Oncology Group) ≤1. 9. Esperanza de vida ≥ 12 semanas. 10. Pacientes con función orgánica y de la médula ósea adecuadas, definidas como: a. Recuento absoluto de neutrófilos (RAN) ≥ 1.500/mm3 (1,5x109/l). b. Recuento de plaquetas ≥100.000/mm3 (100×109/l). c. Hemoglobina ≥ 9 g/dl (90 g/l). d. Creatinina sérica ≤1,5 veces el límite superior de normalidad (LSN) o aclaramiento estimado de creatinina ≥60 ml/min, calculado mediante el método habitual del centro. e. Bilirrubina total sérica ≤1,5 x LSN (≤3,0 x LSN en caso de enfermedad de Gilbert). f. Aspartato aminotransferasa (AST) y/o alanina aminotransferasa (ALT) ≤3,0 x LSN (≤5,0 x LSN en caso de presencia de metástasis hepáticas). g. Fosfatasa alcalina ≤2,5 x LSN (≤5,0 x LSN en caso de metástasis óseas o hepáticas). 11. Fracción de eyección del ventrículo izquierdo (FEVI) ≥50%, medida con ventriculografía isotópica (MUGA) o ecocardiograma (ECO). 12. Mujeres capaces de quedarse embarazadas: prueba de embarazo negativa en orina o en suero.
    E.4Principal exclusion criteria
    1.Have received more than 4 lines of systemic therapy for locally advanced or MBC. 2.Have received prior treatment with tucatinib, vinorelbine for locally advanced or MBC or anti-HER2 TKI agents if administered less than 12 months prior to study entry. 3.Have used a strong CYP3A4 or CYP2C8 inhibitor or CYP3A substrate within 2 weeks, or a strong CYP3A4 or CYP2C8 inducer within 5 days prior to the first dose of study treatment (see Protocol Attachment 2 for more information). 4.Require therapy with warfarin or other coumarin derivatives (non-coumarin anticoagulants are allowed). 5.Patients who received before inclusión: a.Any investigational agent within 4 weeks. b.Chemotherapy within a period of time that is shorter than the cycle duration used for that treatment (e.g. < 3 weeks for fluorouracil, doxorubicine, epirubicine or < 1 week for weekly chemotherapy). c.Biologic therapy (e.g., antibodies): up to 4 weeks prior to starting study treatment. d.Endocrine therapy: tamoxifen or aromatase inhibitor (AI) within 2 weeks prior to starting study treatment. e.Corticosteroids within 2 weeks prior to starting study treatment. Note: the following uses of corticosteroids are permitted at any time: single doses, topical applications (e.g., for rash), inhaled sprays (e.g., for obstructive airways diseases), eye drops or local injections (e.g., intra-articular). f.Radiotherapy within 2 weeks (3 weeks if WBRT) prior to starting study treatment (all acute toxic effects must be resolved to NCI-CTCAE version 5.0 grade <1, except toxicities not considered a safety risk for the patient at investigator´s discretion). Patients who received prior radiotherapy to >25% of bone marrow are not eligible regardless of when it was administered. g.Major surgery or other anti-cancer therapy not previously specified within 4 weeks prior to starting study treatment, Resolution of all acute toxic effects of prior anti-cancer therapy or surgical procedures to NCI-CTCAE version 5.0 grade ≤ 1 (except alopecia or other toxicities not considered a safety risk for the patient at investigator´s discretion) is mandatory. 6. Are unable for any reason to undergo MRI of the brain. 7. Have any of the following with regards to CNS disease: a. Any untreated brain lesions >2 cm in size. b.Any brain lesion thought to require immediate local therapy, including (but not limited to) a lesion in an anatomic site where increase in size or possible treatment-related edema may pose risk to patient (e.g. brain stem lesions). Patients who undergo local treatment for such lesions identified by screening contrast brain MRI may still be eligible for the study based on criteria described under CNS inclusion criteria 7b. c.Known or concurrent leptomeningeal disease as documented by the investigator. d. Ongoing use of corticosteroids for control of symptoms of brain metastases at a total daily dose of >2 mg of dexamethasone (or equivalent). e.Poorly controlled (> 1/week) generalized or complex partial seizures or manifest neurologic progression due to brain metastases notwithstanding CNS-directed therapy. 8.Have clinically significant, uncontrolled heart disease and/or recent cardiac events including any of the following: a.Ventricular arrhythmia requiring therapy.
    b.Myocardial infarction or unstable angina within 6 months prior to first dose of study treatment. c.Uncontrolled hypertension (defined as persistent systolic blood pressure > 150 mm Hg and/or diastolic blood pressure > 100 mm Hg on antihypertensive medications). d.Any history of symptomatic congestive heart failure (CHF). e.History of LVEF decline below 50% during or after prior trastuzumab therapy or other cardiac toxicity during previous trastuzumab treatment that necessitated discontinuation of trastuzumab. 9. Have a diagnosis of any other malignancy within 3 years prior to inclusion, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ of the cervix or colorectal. 10. Have history of allergic reactions to trastuzumab, vinorelbine, or tucatinib (or compounds chemically or biologically similar), except for Grade 1 or 2 infusion related reactions to trastuzumab or vinorelbine that were successfully managed. "Please, consult the complet criteria in the protocol."
    1.El paciente ha recibido más de cuatro líneas de terapia sistémica para el CMM o localmente avanzado. 2.El paciente ha recibido tratamiento previo con tucatinib o vinorelbina para el CMM o localmente avanzado, o agentes TKI anti-HER2 si estos se administraron con una antelación inferior a 12 meses respecto a la inclusión en el estudio. 3.Uso de un inhibidor potente del CYP3A4 o el CYP2C8, o bien un sustrato del CYP3A, dentro de las 2 semanas anteriores, o bien un inductor potente del CYP3A4 o el CYP2C8 dentro de los 5 días anteriores a la primera dosis del tratamiento. del estudio (véase Anexo nº 2 del protocolo para más información). 4.Pacientes que requieran tratamiento con warfarina u otros derivados cumarínicos (se permiten los anticoagulantes no cumarínicos). 5.Pacientes que hayan recibido, antes de la inclusión: a.Cualquier agente en investigación dentro de las 4 semanas previas. b.Quimioterapia dentro de un período de tiempo inferior a la duración del ciclo usada para ese tratamiento (p. ej., <3 semanas para fluorouracilo, doxorubicina, epirubicina o <1 semana para la quimioterapia semanal).c.Terapias biológicas (p. ej., anticuerpos): hasta un máximo de 4 semanas antes de iniciar el tratamiento del estudio. d.Terapias endocrinas: tamoxifeno IA dentro de las 2 semanas previas al inicio del TTO. del estudio. e.Corticoides dentro de las 2 semanas previas al inicio del tratamiento del estudio. Nota: en todo momento se permiten los siguientes usos de los corticoides: dosis únicas, aplicaciones tópicas (p. ej., para las erupciones cutáneas), sprays inhalados (p. ej., para las enfermedades obstructivas de las vías aéreas), colirios e inyecciones locales (p. ej., infiltraciones intraarticulares). f.Radioterapia dentro de las 2 semanas (3 semanas si se trata de WBRT) previas al inicio del tratamiento del estudio (todos los efectos tóxicos agudos deberán haber quedado resueltos hasta alcanzar un grado ≤1 de la versión 5.0 de los NCI-CTCAE, a excepción de las toxicidades no consideradas como un riesgo de seguridad para el paciente, a criterio del investigador. Los pacientes que hayan recibido radioterapia previa en >25% de la médula ósea no serán elegibles, independientemente de cuándo se haya administrado esta. g.Cirugía mayor u otros tratamientos antineoplásicos no especificados anteriormente dentro de las 4 semanas previas al inicio del tratamiento del estudio. Es obligatoria la resolución de todos los efectos tóxicos agudos de los tratamientos antineoplásicos o procedimientos quirúrgicos previos hasta un grado ≤ 1 de la versión 5.0 de los NCI-CTCAE (a excepción de la alopecia u otras toxicidades no consideradas como un riesgo de seguridad para el paciente, a criterio del investigador). 6.Pacientes que no puedan someterse a RMN cerebral por cualquier razón. 7.Cualquiera de los siguientes criterios relativos a la enfermedad del SNC: a.Cualquier lesión cerebral no tratada de un tamaño >2 cm. b.Cualquier lesión cerebral que se considere que requiere tratamiento local inmediato, incluyendo (entre otras) las lesiones situadas en una localización anatómica cuyo aumento de tamaño o un posible edema debido al tratamiento pueda suponer un riesgo para el paciente (p. ej., lesiones del tronco encefálico). Los pacientes que se sometan a tratamiento local para este tipo de lesiones identificadas en la RMN cerebral con contraste de la selección podrán ser elegibles para el estudio en base a los criterios descritos en el criterio de inclusión 7b relativo al SNC.
    c.Enfermedad leptomeníngea conocida o concurrente, documentada por el investigador. d.Uso actual mantenido de corticoides para el control de los síntomas de las metástasis cerebrales, con una dosis diaria total >2 mg de dexametasona (o su equivalente). e.Convulsiones generalizadas o crisis parciales complejas mal controladas (> 1/semana) o progresión neurológica manifiesta debido a la presencia de metástasis, a pesar del tratamiento dirigido al SNC. 8. Pacientes con cardiopatías clínicamente significativas no controladas y/o acontecimientos cardíacos recientes, incluido cualquiera de los siguientes: a.Arritmia ventricular que requiera tratamiento. b.Infarto de miocardio o angina inestable dentro de los 6 meses previos a la primera administración del tratamiento del estudio. c.Hipertensión no controlada (definida como una presión arterial sistólica ≥ 150 mmHg y/o una presión arterial diastólica ≥ 100 mmHg persistentes con fármacos antihipertensivos). d.Cualquier tipo de antecedentes de insuficiencia cardíaca congestiva (IC) sintomática. e.Antecedentes de disminución de la FEVI por debajo del 50% durante o después del tratamiento con trastuzumab u otra toxicidad cardíaca durante un tratamiento previo con trastuzumab que requiriese la interrupción de trastuzumab. "Por favor, consultar criterios completos en el protocolo".
    E.5 End points
    E.5.1Primary end point(s)
    Objective response rate (ORR) defined as the rate of complete response (CR) plus partial response (PR) based on the investigator’s assessment using the response evaluation criteria for solid tumors (RECIST) version 1.1., out of the patients who received at least 1 dose of treatment.
    Tasa de respuestas objetivas (TRO), definida como la tasa de respuesta completa (RC) más la de respuesta parcial (RP), basada en la evaluación del investigador usando los criterios de evaluación de la respuesta de los tumores sólidos (RECIST) versión 1.1., en los pacientes que hayan recibido como mínimo una dosis de tratamiento.
    E.5.1.1Timepoint(s) of evaluation of this end point
    The primary analysis will present the percentage of patients with ORR and the 2-sided 90% confidence interval. All efficacy endpoints will be evaluated in the Efficacy and Per protocol populations as a sensitivity analysis. This primary analysis will be carried out when all patients have been enrolled and had a follow-up of at least 8 months or at least 50% of PFS events have happened.
    El análisis principal presentará el porcentaje de pacientes con TRO, junto con el intervalo de confianza del 90% bilateral. Todos los criterios de valoración de la eficacia se evaluarán en las poblaciones de Eficacia y Por protocolo como análisis de sensibilidad. Este análisis principal se llevará a cabo cuando todos los pacientes hayan sido incluidos y hayan tenido un seguimiento de al menos 8 meses o hayan ocurrido al menos el 50% de los eventos de SLP.
    E.5.2Secondary end point(s)
    - RR (already defined) in patients with brain metastasis at baseline.
    - Other efficacy endpoints in all patients and patients with brain metastasis at baseline:
    o Progression-free survival (PFS) defined as the time from the date of enrollment to the date of disease progression, based on the investigator’s assessment using RECIST version 1.1., or death from any cause, whichever occurs first.
    o Duration of response (DOR) defined as the time from the date of first documentation of objective tumor response (CR or PR) to the date of first documented progressive disease based on the investigator’s assessment using RECIST version 1.1, or death from any cause, whichever occurs first.
    o Disease control rate (DCR): is defined as the rate of CR plus PR plus stable disease (SD) of any duration, based on the investigator’s assessment using RECIST version 1.1 out of all enrolled patients/patients with brain metastasis.
    o Clinical benefit rate (CBR) defined as the rate of CR plus PR plus SD lasting more than 24 weeks, based on the investigator’s assessment using RECIST version 1.1 out of all enrolled patients/patients with brain metastasis.
    o Overall survival (OS) defined as the time from the date of enrollment to the date of death from any cause.
    - Safety: Incidence and severity of AEs and clinical lab abnormalities. AE grades will be defined by the NCI-CTCAE v. 5.0. AE terms will be coded according to the MedDRA dictionary.
    - Tolerability: Incidence of tucatinib and vinorelbine dose modifications, discontinuations due to AEs, number of administered cycles, dose intensity, etc.
    - QoL:
    o Change from baseline (CFB) in the global health status score (GHS) and each scale of the EORTC QLQ-C30 questionnaire.
    o Time to deterioration (TTD) in QoL defined as the time from the date of enrollment to the date of first detection of a deterioration event (increase of ≥ minimally important difference (MID) from baseline for the EORTC QLQ-C30 symptom scales and a decrease of ≥ MID from baseline for the EORTC QLQ-C30 functional and GHS scales.
    - TRO (definida anteriormente) en los pacientes con metástasis cerebrales en la situación basal.
    - valuar otros criterios de valoración de la eficacia en todos los pacientes y en aquellos que presentan metástasis cerebrales en la situación basal:
    o Supervivencia sin progresión (SSP), definida como el tiempo transcurrido desde la inclusión hasta la fecha de progresión de la enfermedad, basándose en la evaluación del investigador al utilizar los criterios RECIST versión 1.1., o la muerte por cualquier causa, lo que ocurra en primer lugar.
    o Duración de la respuesta (DdR), definida como el tiempo desde la fecha de la primera respuesta objetiva (RC o RP) documentada hasta la fecha de la primera progresión documentada de la enfermedad, basada en la evaluación del investigador usando los criterios RECIST versión 1.1, o la muerte por cualquier causa, lo que ocurra en primer lugar.
    o Tasa de control de la enfermedad (TCE), definida como la tasa de RC más RP más enfermedad estable (EE) de cualquier duración basada en la evaluación del investigador, que utilizará los criterios RECIST versión 1.1, en todos los pacientes incluidos/en los pacientes con metástasis cerebrales.
    o Tasa de beneficio clínico (TBC), definida como la tasa de RC más RP más EE de una duración mayor a 24 semanas, de acuerdo con la evaluación del investigador y según los criterios RECIST versión 1.1, en todos los pacientes incluidos/en los pacientes con metástasis cerebrales.
    o Supervivencia global (SG), que se define como el tiempo transcurrido desde la fecha de la inclusión hasta la fecha de la muerte por cualquier causa. Seguridad: Incidencia e intensidad de los AA y las alteraciones de laboratorio. Los grados de los AA se definirán mediante la versión 5.0. de los NCI-CTCAE. Los términos de los AA se codificarán de acuerdo con el diccionario MedDRA.
    - Tolerabilidad: Incidencia de las modificaciones de dosis de tucatinib y vinorelbina, interrupciones debidas a AA, número de ciclos administrados, intensidad de la dosis, etc.
    - CdV:
    o Cambio desde la situación basal (CDB) en la puntuación del estado de salud global (ESG) y en cada una de las escalas del cuestionario EORTC QLQ-C30.
    o Tiempo hasta el deterioro (THD) de la CdV, definido como el tiempo transcurrido desde la fecha de la inclusión hasta la fecha de la primera detección de un acontecimiento de deterioro (incremento ≥ a la diferencia mínimamente importante (DMI) desde la situación basal en las escalas de síntomas de la EORTC QLQ-C30 y una disminución ≥ de la DMI desde la situación basal en las escalas funcional de la EORTC QLQ-C30 y del ESG.
    E.5.2.1Timepoint(s) of evaluation of this end point
    And the final analysis will be carried when at least 50% of patients have OS event, approximately 22 months from last enrolled patient date (assuming a OS median of 22 months according to HER2CLIMB results).
    Y el análisis final se llevará a cabo cuando al menos el 50% de los pacientes presenten un evento de SG, aproximadamente 22 meses desde la fecha del último paciente incluido (asumiendo una mediana de SG de 22 meses según los resultados de HER2CLIMB).
    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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned18
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    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
    LVLS
    última visita del último paciente
    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 months4
    E.8.9.1In the Member State concerned days
    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: 49
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 49
    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 No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state49
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 49
    F.4.2.2In the whole clinical trial 49
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    none
    ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-11-04
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-10-27
    P. End of Trial
    P.End of Trial StatusOngoing
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