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    Summary
    EudraCT Number:2021-003206-41
    Sponsor's Protocol Code Number:LOXO-BTK-20030(J2N-OX-JZNU)
    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:2022-06-10
    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 number2021-003206-41
    A.3Full title of the trial
    A Phase 3 Open-Label, Randomized Study of Pirtobrutinib (LOXO-305) versus Ibrutinib in Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (BRUIN-CLL-314).
    Studio di fase 3, in aperto, randomizzato per valutare pirtobrutinib (LOXO-305) rispetto a ibrutinib in pazienti affetti da leucemia linfatica cronica/linfoma linfocitico a piccole cellule (BRUIN-CLL-314).
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 3 Study Comparing Pirtobrutinib to Ibrutinib in CLL/SLL.
    Studio di fase 3 di confronto tra pirtobrutinib e ibrutinib nella LLC/SLL.
    A.3.2Name or abbreviated title of the trial where available
    A Phase 3 Study Comparing Pirtobrutinib to Ibrutinib in CLL/SLL.
    Studio di fase 3 di confronto tra pirtobrutinib e ibrutinib nella LLC/SLL.
    A.4.1Sponsor's protocol code numberLOXO-BTK-20030(J2N-OX-JZNU)
    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 SponsorLOXO ONCOLOGY INCORPORATED
    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 supportLoxo Oncology, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationIQVIA RDS GmbH
    B.5.2Functional name of contact pointMedical and Scientific Services
    B.5.3 Address:
    B.5.3.1Street AddressUnterschweinstiege 2-14.
    B.5.3.2Town/ cityFrankfurt am Main
    B.5.3.3Post code60549
    B.5.3.4CountryGermany
    B.5.6E-mailmarialeticia.solari@iqvia.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 namePirtobrutinib
    D.3.2Product code [LOXO-305]
    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.3.9.1CAS number 2101700-15-4
    D.3.9.2Current sponsor codeLOXO-305
    D.3.9.4EV Substance CodeSUB215610
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    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 IMBRUVICA
    D.2.1.1.2Name of the Marketing Authorisation holderJanssen-Cilag International NV - EU/1/14/945/008
    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 nameIbrutinib
    D.3.2Product code [n/a]
    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 INNIbrutinib
    D.3.9.1CAS number 936563-96-1
    D.3.9.2Current sponsor codeN/A
    D.3.9.4EV Substance CodeSUB120863
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number140
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    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 namePirtobrutinib
    D.3.2Product code [LOXO-305]
    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.3.9.1CAS number 2101700-15-4
    D.3.9.2Current sponsor codeLOXO-305
    D.3.9.4EV Substance CodeSUB215610
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
    Leucemia linfatica cronica/linfoma linfocitico a piccole cellule
    E.1.1.1Medical condition in easily understood language
    Chronic lymphocytic leukaemia/Small Lymphocytic Lymphoma is a type of cancer that affects the white blood cells and tends to progress slowly over many years
    Leucemia linfatica cronica/linfoma linfocitico a piccole cellule è un tipo di cancro che colpisce i globuli bianchi e tende a progredire lentamente nel corso di molti anni
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10008976
    E.1.2Term Chronic lymphocytic leukemia
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate overall response rate (ORR) of pirtobrutinib (Arm A) compared to ibrutinib (Arm B)
    Valutare il tasso di risposta complessiva (ORR) di pirtobrutinib (Braccio A) rispetto a ibrutinib (Braccio B)
    E.2.2Secondary objectives of the trial
    *To evaluate the effectiveness of Arm A compared to Arm B based on event-free survival (EFS), progression-free survival (PFS), ORR, duration
    of response (DOR), overall survival (OS), and time to next treatment (TTNT)
    *To evaluate the safety and tolerability of each treatment arm
    *To evaluate the patient-reported outcomes of Arm A compared to Arm B
    *Valutare l’efficacia nel Braccio A rispetto al Braccio B in base alla sopravvivenza libera da eventi (EFS), alla sopravvivenza libera da progressione (PFS), all’ORR, alla durata della risposta (DOR), alla sopravvivenza complessiva (OS) e al tempo al trattamento successivo (TTNT)
    *Valutare la sicurezza e la tollerabilità in ciascun braccio di trattamento
    *Valutare gli esiti riferiti dal paziente nel Braccio A rispetto al Braccio B
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Age18 years or older per local regulations at time of enrollment
    2.Confirmed diagnosis by redacted local laboratory report of CLL/SLL,as defined by iwCLL 2018 criteria,and to include the following:
    a)B-cells co-expressing the surface antigen CD5 together with at least one B-cell antigen(CD19,CD20,CD23)and either ¿ or ¿ light -chain restricted
    b)=5×109 B lymphocytes/L(5000/µL) in the peripheral blood.For SLL patients,history of<5×109 B lymphocytes/L(5000/µL)in the peripheral blood is allowed
    c)Prolymphocytes may comprise=55%of blood lymphocytes
    3.A requirement for therapy consistent with iwCLL 2018 criteria for initiation of therapy such that at least 1 of the following should be met:
    a)Evidence of progressive marrow failure as manifested by the development of,or worsening of,anemia(such as hemoglobin<10g/dL and/or thrombocytopenia(such as platelets=100×109/L)
    b)Massive(i.e.,spleen edge=6cm below the left costal margin)or progressive or symptomatic splenomegaly(>13cm)
    c)Massive nodes(i.e.,=10cm in longest diameter)or progressive or symptomatic lymphadenopathy
    d)Progressive lymphocytosis with an increase of>50%over a2-month period or lymphocyte doubling time<6months.Factors contributing to lymphocytosis other than CLL/SLL(e.g.,infections,steroid administration)should be excluded
    e)Autoimmune complications including anemia or thrombocytopenia poorly responsive to corticosteroids
    f)Symptomatic or functional extranodal involvement(e.g., skin, kidney, lung, spine)
    g)Disease-related symptoms as defined by any of the following:
    i)Unintentional weight loss=10% within the previous 6months
    ii)Fevers=100.5°For38.0°C for2or more weeks without evidence of infection
    iii)Night sweats for=1 month without evidence of infection
    4.Known 17p deletion status(wildtype or deleted)
    5.ECOG 0 to 2
    6.Must have adequate organ function,as defined per protocol.These values must be met during the Screening Period as well as predose onC1D1
    7.Patients are required to have had the following washout periods prior to planned C1D1:
    a)Targeted agents or cytotoxic chemotherapy:5 half-lives or2weeks,whichever is greater
    b)Therapeutic monoclonal antibodies:4weeks
    c)Palliative limited field radiation:7days
    d)Broad field radiation (=30%of bone marrow or whole brain radiotherapy):28days
    8.Prior treatment related AEs must have recovered to Grade = 1, pretreatment baseline, or are controlled with medications without meeting other exclusion criteria (with the exception of alopecia)
    9.Willingness of men and WOCBP, and their partners, to observe barrier and highly effective birth control methods as outlined in Section 10.2 (and below) for the duration of treatment and for 6 months following the last dose of study treatment
    Highly effective birth control methods with a failure rate of less than 1% per year when used consistently and correctly are recommended (CTFG 2020):
    a.Combined estrogen and progestin containing hormonal contraception associated with inhibition of ovulation given orally, intravaginally, or transdermally
    b.Progestin-only hormonal contraception associated with inhibition of ovulation given orally, by injection, or by implant
    c.IUD
    d.IUS
    e.Bilateral tubal occlusion
    f.Vasectomized partner
    g.Sexual abstinence: Considered a highly effective method only if defined as refraining from heterosexual intercourse during an entire period of risk associated with the study drug.The reliability of sexual abstinence will be evaluated in relation to the duration of the study and to the usual lifestyle of the patient.
    Other inclusion criteria - Please refer to the protocol
    1.Età>= a18anni secondo normative locali al momento di arruolamento
    2.Diagnosi confermata da rapporto laboratorio locale revisionato di LLC/SLL,come definito dai criteri iwCLL2018,che deve includere:
    a)Cellule B che co-esprimono antigene di superficie CD5insieme ad almeno un antigene cellule-B(CD19,CD20,CD23)e un catena leggera ristretta ¿ o ¿
    b)5×09linfociti B/l(5000/µl) nel sangue periferico.Per i paz con SLL è consentita l’anamnesi di <5×109linfociti B/l(5000/µl)nel sangue periferico
    c)Prolinfociti possono costituire55%dei linfociti ematici
    3.Un requisito per terapia coerente con criteri iwCLL 2018 per inizio di terapia,tale per cui almeno1elemento tra quelli riportati di seguito sia soddisfatto:
    a)Evidenza di insufficienza midollare progressiva manifestata da sviluppo o da peggioramento dell’anemia(es. emoglobina<10 g/dl e/o trombocitopenia(es. piastrine=100×109/l)
    b)Splenomegalia massiva(ossia margine della milza=6cm al di sotto del margine costale sinistro)o progressiva o sintomatica(>13 cm)
    c)Nodi massivi(ossia 10cm nell’asse maggiore) o linfadenopatia progressiva o sintomatica
    d)Linfocitosi progressiva con un aumento >50% nell’arco di un periodo 2mesi o tempo di raddoppio dei linfociti<6 mesi.fattori che contribuiscono alla linfocitosi diversi da LLC/SLL(es.infezioni,somministrazione steroidi)devono essere esclusi
    e)Complicanze autoimmuni,inclusa anemia o trombocitopenia,poco responsive ai corticosteroidi
    f)Coinvolgimento extranodale sintomatico o funzionale(es.pelle,reni,polmoni,colonna vertebrale)
    g)Sintomi correlati a malattia definiti da1qualsiasi dei seguenti elementi:
    i)Perdita peso involontaria del10%entro i 6mesi precedenti
    ii)Febbre a 38,0°C(o100,5°F)per2o più settimane senza evidenza di infezione
    iii)Sudorazioni notturne per 1mese senza evidenza di infezione
    4.Stato di delezione 17p noto(wild type o eliminato)
    5.ECOG da 0a2
    6.È necessario avere adeguata funzionalità d’organo,come definito dal protocollo.Questi valori devono essere soddisfatti durante periodo di screening e prima della dose C1G1
    7.I paz devono essere sottoposti ai seguenti periodi di washout prima delC1G1programmato:
    a)Agenti mirati o chemioterapia citotossica:5emivite o2settimane,a seconda del valore maggiore
    b)Anticorpi monoclonali terapeutici:4settimane
    c)Radiazione palliativa in campo limitato:7giorni
    d)Radiazione a campo ampio(radioterapia del30%del midollo osseo o dell’intero cervello):28giorni
    8.Eventuali EA precedenti correlati al trattamento devono essere tornati al Grado 1 o al basale pre-trattamento,o devono essere controllati con medicinali senza soddisfare altri criteri di esclusione(ad eccezione dell’alopecia)
    9.Volontà di uomini e donne in età fertile,e dei loro partner,di adottare metodi barriera e metodi contraccettivi altamente efficaci,come indicato nella Sez10.2(e di seguito)per la durata del trattamento e per6mesi dopo l’ultima dose del trattamento di studio
    Si raccomanda l’adozione metodi contraccezione altamente efficaci con tasso di fallimento inferiore all’1%all’anno se usati in maniera costante e corretta(CTFG 2020):
    a.Contraccezione ormonale combinata contenente estrogeno e progestinico,associata all’inibizione dell’ovulazione(somministrata per via orale,intravaginale o transdermica)
    b.Contraccezione ormonale solo a base di progestinico,associata all’inibizione dell’ovulazione(somministrata per via orale,mediante iniezione o impianto)
    c.Dispositivo intrauterino(IUD)
    d.Sistema intrauterino a rilascio di ormoni(IUS)
    e.Occlusione bilaterale delle tube
    f.Compagno vasectomizzato
    g.Astinenza sessuale:è considerata un metodo altamente efficace soltanto se intesa come astensione da rapporti sessuali durante l’intero periodo di rischio associato al farmaco di studio.L’affidabilità dell’astinenza sessuale sarà valutata in relazione alla durata dello studio e allo stile di vita abituale del paz
    Altri criteri di inclusione - Si prega di fare riferimento al protocollo
    E.4Principal exclusion criteria
    1.Known or suspected Richter's transformation to DLBCL,prolymphocytic leukemia,or Hodgkin's lymphoma at any time preceding enrollment
    2.Known or suspected history of CNSinvolvement byCLL/SLL
    3.Previous or concurrent cancer distinct from CLL/SLL within3years prior to randomization;pts with prior cancers may be enrolled with documented Sponsor approval,examples include:
    a)Curatively treated nonmelanomatous skin cancer or lentigo maligna melanoma
    b)Curatively treated cervical carcinoma in situ
    c)Localized(e.g.,lymph node negative) breast cancer treated with curative intent with no evidence of active disease present for more than3years(may be receiving adjuvant hormonal therapy)
    d)Localized prostate cancer undergoing active surveillance
    4.Major surgery within4weeks of planned start of study drug
    5.Asignificant history of renal,neurologic,psychiatric,endocrine,metabolic or immunologic,that, in the opinion of the Investigator,would adversely affect the pt's participation in this study or interpretation of study outcomes
    6.Ongoing drug-induced liver injury,primary biliary cirrhosis,and/or extrahepatic obstruction caused by cholelithiasis and/or cirrhosis of the liver
    7.History of allogeneic or autologous SCT or CAR-T therapy within the past 60days
    8.Active uncontrolled autoimmune cytopenia(e.g., autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura)for at least 4 weeks prior to study enrollment
    9.Significant cardiovascular disease defined as any of the following:
    a)Unstable angina or acute coronary syndrome within the past 2months prior to randomization,
    b)History of myocardial infarction within 3months prior to randomization,
    c)Documented LVEF by any method of=40% within the 12months prior to randomization,unless subsequent measurements(=2 of any kind,separated by a minimum of 3weeks)documents LVEF recovery>40%, and/or
    d)=Grade 3 New York Heart Association functional classification system of heart failure,uncontrolled or symptomatic arrhythmias
    10.Prolongation of the QTc for heart rate using Fridericia's Formula(QTcF)>470 msec on at least 2of3 consecutive ECGs,and mean QTcF>470 msec on all 3 ECGs,during Screening
    a)QTcF is calculated using Fridericia's Formula(QTcF=QT/(RR^0.33)
    b)Correction of suspected drug-induced QTcF prolongation or prolongation due to electrolyte abnormalities can be attempted at the Investigator's discretion,and only if clinically safe to do so with either discontinuation of the offending drug or switch to another drug not known to be associated with QTcF prolongation or electrolyte supplementation based on Screening laboratory tests as defined as:
    a)HBV:Pts with positive HBsAg are excluded. Pts with positive anti-HBc and negative HBsAg require hepatitis B PCR evaluation before randomization. Pts who are hepatitis B PCR-positive will be excluded
    b)HCV:Pts with positive hepatitis C antibody are excluded.If positive hepatitis C antibody result,pt will need to have a negative result for hepatitis C RNA before randomization.Pts who are hepatitis C RNA-positive will be excluded
    12.Known active CMV infection.Pts with negative status are eligible
    Other Exclusions - Please refer to protocol
    1.Trasformazione di Richter nota o sospetta in DLBCL,leucemia prolinfocitica o linfoma di Hodgkin in qualsiasi momento prima dell’arruolamento
    2.Anamnesi nota o sospetta di coinvolgimento dell’SNC da LLC/SLL
    3.Cancro pregresso o concomitante distinto da LLC/SLL entro 3anni prima della randomizzazione;i pazienti con tipi di cancro pregressi possono essere arruolati con approvazione dello sponsor documentata, ad es:
    a)Cancro cutaneo diverso dal melanoma trattato a scopo curativo o melanoma lentigo maligna
    b)Carcinoma in situ cervicale trattato a scopo curativo
    c)Cancro della mammella(es. linfonodale negativo)localizzato,trattato con intento curativo senza alcuna evidenza di malattia attiva presente per oltre3anni(può ricevere terapia ormonale adiuvante)
    d)Cancro alla prostata localizzato sottoposto a sorveglianza attiva
    4.Intervento chirurgico maggiore entro4settimane dall’inizio programmato del farmaco di studio
    5.Anamnesi significativa patologie renali,neurologiche,psichiatriche,endocrine,metaboliche o immunologiche che,a giudizio del PI,potrebbero influire negativamente sulla partecipazione del paz a questo studio o sull’interpretazione degli esiti di studio
    6.Lesione epatica indotta da farmaco,cirrosi biliare primaria e/o ostruzione extraepatica causata da colelitiasi e/o cirrosi epatica in corso
    7.Anamnesi di terapia CAR-T o SCT autologo o allogenico negli ultimi60giorni
    8.Citopenia autoimmune attiva non controllata (ad es. anemia emolitica autoimmune, porpora trombocitopenica idiopatica) per almeno 4 settimane prima dell’arruolamento nello studio
    9.Malattia cardiovascolare significativa,definita come una qualsiasi delle seguenti:
    a)Angina instabile o sindrome coronarica acuta entro gli ultimi2mesi precedenti la randomizzazione,
    b)Anamnesi di infarto miocardico entro i3mesi prima della randomizzazione,
    c)FEVS documentata con qualsiasi metodo pari al40%entro12 mesi prima della randomizzazione,a meno che misurazioni successive(2di qualsiasi tipo,separate da un minimo3 settimane)non documentino un miglioramento della FEVS>40%,e/o
    d)Grado3del sistema classificazione funzionale dell’Associazione dei cardiologi New York(New York Heart Association),aritmie sintomatiche o non controllate
    10.Prolungamento del QTc per la frequenza cardiaca usando la formula di Fridericia(QTcF)>470msec in almeno2di3elettrocardiogrammi (ECG)consecutivi e QTcF medio>470 msec in tutte le3ecografie(ECG),durante screening
    a)La QTcF viene calcolata utilizzando la formula di Fridericia(QTcF=QT/(RR^0,33)
    b)Lo sperimentatore,a sua discrezione,può provare a correggere il prolungamento sospetto del QTcF indotto da farmaco o il prolungamento dovuto ad anomalie elettrolitiche, solo se è sicuro farlo a livello clinico mediante l’interruzione del farmaco responsabile oppure il passaggio a un altro farmaco non noto per essere associato al prolungamento del QTcF o all’integrazione di elettroliti, in base agli esami di laboratorio di screening definiti come:
    a)HBV: i pazienti positivi all’HBsAg sono esclusi. Per i pazienti positivi all’anti-HBc e negativi all’HBsAg è necessaria la valutazione della PCR per l'epatite B prima della randomizzazione. Saranno esclusi i pazienti positivi alla PCR per l’epatite B
    b)HCV: i pazienti positivi per l’anticorpo dell’epatite C sono esclusi. In caso di risultato positivo per l’anticorpo dell’epatite C, il paziente dovrà ottenere un risultato negativo per l’RNA dell’epatite C prima della randomizzazione. I pazienti positivi all’RNA dell’epatite C saranno esclusi
    12.Infezione da CMV attiva nota. I pazienti con stato negativo sono idonei
    Altri criteri di esclusione-Si prega di fare riferimento al protocollo
    E.5 End points
    E.5.1Primary end point(s)
    ORR as assessed by Independent Review Committee (IRC) per International Workshop on Chronic Lymphocytic Leukemia criteria (iwCLL 2018) criteria; ORR is defined as the proportion of patients who achieve a best overall response (BOR) of complete remission (CR), complete remission with incomplete hematologic recovery (CRi), nodular partial remission (nPR), or partial remission (PR) at or before the initiation of subsequent anti-cancer therapy
    ORR come valutato dal Comitato di Revisione Indipendente (IRC) secondo i criteri dell'International Workshop on Chronic Lymphocytic Leukemia (iwCLL 2018); l'ORR è definito come la proporzione di pazienti che ottengono una migliore risposta globale (BOR) di remissione completa (CR), remissione completa con recupero ematologico incompleto (CRi), remissione parziale nodulare (nPR) o remissione parziale (PR) al momento o prima dell'inizio di una successiva terapia antitumorale
    E.5.1.1Timepoint(s) of evaluation of this end point
    The interim analysis of ORR is planned when the first 455 patients (70% of 650 patients) are followed for at least 9 months since enrollment or discontinue study whichever occurs first.
    If the interim analysis of ORR is not significant, a final analysis of ORR will be performed when all the patients (100% of patients enrolled) are followed for at least 9 months since enrollment or discontinue study, whichever occurs first
    L'analisi ad interim dell'ORR è prevista quando i primi 455 pazienti (70% dei 650 pazienti) saranno seguiti per almeno 9 mesi dall'arruolamento o, se si verifica prima, dalla sospensione dello studio.
    Se l'analisi ad interim dell'ORR non è significativa, l'analisi finale dell'ORR sarà effettuata quando tutti i pazienti (100% dei pazienti arruolati) saranno seguiti per almeno 9 mesi dall'arruolamento o interromperanno lo studio, a seconda di quale situazione si verifichi per prima.
    E.5.2Secondary end point(s)
    Key secondary endpoints:
    EFS is defined as a composite endpoint of the following, whichever occurs first:
    • Treatment discontinuation due to adverse event (AE)/toxicity
    • Atrial fibrillation or atrial flutter of any grade (assessed by Investigator)
    • Progressive disease (PD) (by IRC per iwCLL 2018 criteria) or death PFS is defined as the time from the date of randomization until PD (per iwCLL 2018 criteria) or death from any cause, whichever occurs first.
    Additional secondary endpoints:
    • Assessed by IRC and Investigator:
    - ORR, including PR with lymphocytosis (PR-L), assessed by both IRC and the Investigator
    - DOR; DOR is defined as the time from the date of the first documented response of CR, CRi, nPR, or PR to the earlier of the documentation of definitive PD (per iwCLL 2018 criteria) or death from any cause
    - DOR, including PR-L
    • Assessed by Investigator:
    - EFS and PFS evaluated per iwCLL 2018
    - ORR evaluated per iwCLL 2018
    - OS; OS is defined as the time from randomization until death from any cause
    - TTNT; TTNT is defined as time from the date of randomization to the date of the initiation of the next systemic anticancer therapy for CLL/SLL or death due to any cause, whichever occurred first; Endpoint secondari chiave:
    L'EFS è definito come un endpoint composito dei seguenti, a seconda di quale si verifichi per primo:
    - Interruzione del trattamento a causa di eventi avversi (AE)/tossicità
    - Fibrillazione atriale o flutter atriale di qualsiasi grado (valutata dallo sperimentatore)
    - Malattia progressiva (PD) (secondo i criteri IRC iwCLL 2018) o morte PFS è definita come il tempo trascorso dalla data di randomizzazione fino alla PD (secondo i criteri iwCLL 2018) o alla morte per qualsiasi causa, a seconda di quale si verifichi per prima.
    Ulteriori endpoint secondari:
    - Valutati dall'IRC e dallo sperimentatore:
    - ORR, compresa la PR con linfocitosi (PR-L), valutata dall'IRC e dallo sperimentatore.
    - DOR; la DOR è definita come il tempo trascorso dalla data della prima risposta documentata di CR, CRi, nPR o PR alla prima delle due date in cui è stata documentata la PD definitiva (secondo i criteri iwCLL 2018) o la morte per qualsiasi causa.
    - DOR, inclusa PR-L
    - Valutato dallo sperimentatore:
    - EFS e PFS valutate secondo i criteri iwCLL 2018
    - ORR valutato secondo i criteri iwCLL 2018
    - OS; l'OS è definita come il tempo trascorso dalla randomizzazione fino al decesso per qualsiasi causa
    - TTNT; il TTNT è definito come il tempo trascorso dalla data di randomizzazione alla data di inizio della successiva terapia antitumorale sistemica per la LLC/SLL o alla morte per qualsiasi causa, a seconda di quale si sia verificata prima
    E.5.2.1Timepoint(s) of evaluation of this end point
    *If interim analysis of ORR is significant, the interim analysis of EFS will be performed when 173 EFS events (75% of total EFS events) have been observed.
    * If the interim analysis of EFS is significant, the first interim analysis of PFS will also be performed. If the first interim analysis of PFS is not significant, the second interim analysis of PFS will be performed when 176 PFS events (70% of total PFS events) have been observed. If the second interim analysis of PFS is not significant, a final analysis of PFS will be performed when 251 PFS events (100% of total PFS events) have been observed.
    * If the final analysis of ORR is significant, the interim analysis of EFS will be performed at the same timepoint
    *Se l'analisi ad interim di ORR è significativa, l'analisi ad interim di EFS sarà eseguita quando saranno stati osservati 173 eventi EFS (75% degli eventi EFS totali).
    * Se l'analisi ad interim della EFS è significativa, verrà eseguita anche la prima analisi ad interim della PFS. Se la prima analisi ad interim della PFS non è significativa, la seconda analisi ad interim della PFS sarà eseguita quando saranno stati osservati 176 eventi PFS (70% degli eventi PFS totali). Se la seconda analisi ad interim della PFS non è significativa, l'analisi finale della PFS sarà effettuata quando saranno stati osservati 251 eventi PFS (100% degli eventi PFS totali).
    * Se l'analisi finale dell'ORR è significativa, l'analisi ad interim dell'EFS sarà eseguita allo stesso momento.
    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 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 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) 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 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 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 concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA60
    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
    Japan
    Korea, Republic of
    New Zealand
    Taiwan
    United States
    France
    Poland
    Spain
    Czechia
    Germany
    Italy
    Belgium
    Hungary
    Turkey
    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
    The end of the study is defined as the date of the last visit of the last patient in the study or last scheduled procedure shown in the Schedule of Assessment (SoA) for the last patient in the study globally, which is estimated at approximately 72 months from the first patient randomized to allow 30 months recruitment and 42 months of follow up.
    La fine dello studio è definita come la data dell'ultima visita dell'ultimo paziente dello studio o dell'ultima procedura programmata indicata nella Schedule of Assessment (SoA) per l'ultimo paziente dello studio a livello globale, stimata a circa 72 mesi dal primo paziente randomizzato per consentire 30 mesi di reclutamento e 42 mesi di follow-up.
    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 months0
    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 months0
    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: 195
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 455
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Consent can be given by legally authorized representative
    Il consenso può essere dato da un rappresentante legalmente autorizzato.
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state31
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 237
    F.4.2.2In the whole clinical trial 650
    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)
    For patients randomized to Arm A, it is anticipated patients will receive study treatment with pirtobrutinib until they are able to obtain commercially available pirtobrutinib in their respective country.
    For patients randomized to Arm B, as the study drug used in Arm B is all locally approved and marketed, the patients on this study treatment may continue treatment as commercially available therapy via physician prescription.
    Per i pazienti randomizzati al braccio A,si prevede che riceveranno il trattamento di studio con pirtobrutinib fino a quando non saranno in grado di ottenere pirtobrutinib disponibile in commercio nei rispettivi Paesi.Per i pazienti randomizzati nel Braccio B,poiché il farmaco di studio utilizzato nel Braccio B è approvato e commercializzato a livello locale,i pazienti in trattamento possono continuare il trattamento come terapia disponibile in commercio tramite prescrizione medica.
    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 Decision2022-08-11
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-13
    P. End of Trial
    P.End of Trial StatusOngoing
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