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    Summary
    EudraCT Number:2021-003243-21
    Sponsor's Protocol Code Number:XL092-303
    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:2022-07-27
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2021-003243-21
    A.3Full title of the trial
    A Randomized Open-Label Phase 3 Study of XL092 + Atezolizumab vs Regorafenib in Subjects with Metastatic Colorectal Cancer
    Estudio en fase III aleatorizado y sin enmascaramiento de XL092 + Atezolizumab frente a Regorafenib en pacientes con cáncer colorrectal metastásico
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of XL092 + Atezolizumab vs Regorafenib in Subjects With Metastatic Colorectal Cancer (STELLAR-303)
    Estudio de XL092 + Atezolizumab frente a Regorafenib en pacientes con cáncer colorrectal metastásico (STELLAR-303)
    A.4.1Sponsor's protocol code numberXL092-303
    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 SponsorExelixis, 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 supportExelixis, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationExelixis, Inc.
    B.5.2Functional name of contact pointExelixis Medical Affairs
    B.5.3 Address:
    B.5.3.1Street Address1851 Harbor Bay Parkway
    B.5.3.2Town/ cityAlameda
    B.5.3.3Post codeCA 94502
    B.5.3.4CountryUnited States
    B.5.4Telephone number1888393 5494
    B.5.6E-maildruginfo@exelixis.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 nameXL092
    D.3.2Product code XL092
    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 INNNot yet assigned
    D.3.9.2Current sponsor codeXL092
    D.3.9.3Other descriptive nameXL092 hemifumarate
    D.3.9.4EV Substance CodeSUB223004
    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 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 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 nameXL092
    D.3.2Product code XL092
    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 INNNot yet assigned
    D.3.9.2Current sponsor codeXL092
    D.3.9.3Other descriptive nameXL092 hemifumarate
    D.3.9.4EV Substance CodeSUB223004
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    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: 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 nameXL092
    D.3.2Product code XL092
    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 INNNot yet assigned
    D.3.9.2Current sponsor codeXL092
    D.3.9.3Other descriptive nameXL092 hemifumarate
    D.3.9.4EV Substance CodeSUB223004
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    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: 4
    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 TECENTRIQ
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    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 nameAtezolizumab
    D.3.2Product code RO5541267
    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 INNAtezolizumab
    D.3.9.1CAS number 1380723-44-3
    D.3.9.2Current sponsor codeRO5541267/F01, RO5541267/F03, RO5541267/F05
    D.3.9.4EV Substance CodeSUB178312
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    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 Stivarga
    D.2.1.1.2Name of the Marketing Authorisation holderBayer Pharma AG
    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 nameRegorafenib
    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 INNRegorafenib
    D.3.9.1CAS number 755037-03-7
    D.3.9.2Current sponsor codeBAY 73-4506
    D.3.9.4EV Substance CodeSUB73090
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    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
    Metastatic colorectal cancer (CRC)
    Cáncer colorrectal metastásico
    E.1.1.1Medical condition in easily understood language
    Colorectal cancer
    Cáncer colorrectal
    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 10052362
    E.1.2Term Metastatic colorectal 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
    • Efficacy
    Primary: efficacy in RAS wild type (WT) subjects
    Other: efficacy in all subjects, efficacy in RAS mutant subjects
    • Safety: safety and tolerability
    • Other: characterize PK, immunogenicity of atezolizumab, quality of life, biomarkers, and healthcare utilization
    • Eficacia
    Principal: eficacia en pacientes con RAS natural
    Otros: eficacia en todos los pacientes, eficacia en pacientes con RAS mutado
    • Seguridad: seguridad y tolerabilidad
    • Otros: caracterización de la FC, inmunogenia del atezolizumab, calidad de vida, biomarcadores y utilización de servicios sanitarios
    E.2.2Secondary objectives of the trial
    None
    Ninguno
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Subjects with histologically or cytologically confirmed adenocarcinoma of the colon or rectum
    a. Documented RAS status (mutant or wild-type [WT]), by tissue-based analysis
    Note: Local RAS testing is permitted but must include testing for KRAS/NRAS exons 2, 3, and 4. After randomization of 400 subjects with RAS WT disease, subjects with RAS WT disease will not be eligible. After randomization of 200 subjects with RAS mutant disease, subjects with RAS mutant disease will not be eligible.
    b.Documented NOT to have microsatellite instability-high (MSI-high) or mismatch repair deficient (dMMR) CRC by tissue-based analysis by an accredited laboratory
    2.Has received the following SOC anticancer therapies as prior therapy for metastatic CRC and has radiographically progressed, is refractory or intolerant to these therapies.
    a. Systemic SOC anticancer therapy must include ALL of the following agents if approved and available in the country where the subject is randomized:
    i. Fluoropyrimidine, irinotecan and oxaliplatin, with or without an anti-vascular endothelial growth factor (VEGF) monoclonal antibody (eg, bevacizumab)
    ii. Anti-epidermal growth factor receptor (EGFR) monoclonal antibody (eg, cetuximab or panitumumab) for RAS WT subjects
    iii. BRAF inhibitor for subjects with known BRAF V600E mutations
    b. Radiographic progression during treatment with or within 3 months following the last dose of the most recent approved SOC chemotherapy regimen
    3. Measurable disease according to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1; ) as determined by the Investigator.
    4. Available archival tumor biopsy material. If archival tissue is unavailable, must provide fresh tumor tissue biopsy prior to randomization.
    5. Recovery to baseline or ≤ Grade 1 severity (CTCAE v5) from AEs related to any prior treatments, unless AE(s) are clinically nonsignificant and/or stable on supportive therapy.
    6. Age 18 years or older on the day of consent.
    7. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
    8. Adequate organ and marrow function, based upon meeting all of the following laboratory criteria within 10 days before randomization:
    a. Absolute neutrophil count (ANC) ≥ 1500/mm3 (≥ 1.5 109/L) without granulocyte colony-stimulating factor support within 2 weeks before screening laboratory sample collection.
    b. Platelets ≥ 100,000/mm3 (≥ 100 109/L) without transfusion within 2 weeks before screening laboratory sample collection.
    c. Hemoglobin ≥ 9 g/dL (≥ 90 g/L) without transfusion within 2 weeks prior to screening laboratory sample collection.
    d. International Normalized Ratio (INR) ≤ 1.5 and activated partial thromboplastin time (aPTT) ≤ 1.2 × upper limit of normal (ULN).
    e. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) ≤ 3 × ULN.
    f. Albumin ≥ 3.0 g/dL.
    g. Lipase and amylase ≤ 1.5 × ULN.
    h. Total bilirubin ≤ 1.5 × ULN (for subjects with Gilbert’s disease ≤ 3 × ULN).
    i. Calculated creatinine clearance ≥ 40 mL/min (≥ 0.67 mL/sec) using the Cockcroft-Gault equation.
    j. Urine protein-to-creatinine ratio (UPCR) ≤ 1 mg/mg (≤113.1 mg/mmol).
    k. Negative hepatitis B surface antigen (HBsAg) test.
    l. Negative hepatitis C virus (HCV) antibody test, or positive HCV antibody test followed by a negative HCV RNA test and no ongoing anti-HCV therapy.
    Note: The HCV RNA test will be performed only for subjects who have a positive HCV antibody test.
    9. Capable of understanding and complying with the protocol requirements and must have signed the informed consent document.
    10. Sexually active fertile subjects and their partners must agree to use highly effective methods of contraception during the course of the study and for the following durations after the last dose of treatment (whichever is later):
    • Through 186 days after the last dose of XL092 for women of childbearing potential (WOCBP) or through 96 days after the last dose of XL092 for men,
    • Through 5 months after the last dose of atezolizumab (for both WOCBP and men), or
    • Through 2 months after the last dose of regorafenib (for both WOCBP and men).
    An additional contraceptive method, such as a barrier method (eg, condom), is required.
    11. Female subjects of childbearing potential must not be pregnant at screening. Female subjects are considered to be of childbearing potential unless one of the following criteria is met: permanent sterilization (hysterectomy, bilateral salpingectomy, or bilateral oophorectomy) or documented postmenopausal status (defined as 12 months of amenorrhea in a woman > 45 years-of-age in the absence of other biological or physiological causes. In addition, females < 55 years-of-age must have a serum follicle stimulating hormone [FSH] level > 40 mIU/mL to confirm menopause).
    1 Pax con adenocarcinoma de colon o recto confirmado histológica o citológicamente. a Estado mutacional RAS documentado (natural/mutado) demostrado mediante un análisis del tejido Nota: pruebas RAS pueden realizarse en un lab local, pero deben incluir pruebas para exones 2, 3 y 4 KRAS y NRAS. Una vez aleatorizados 400 pax con tumores con RAS natural, no se incluirá a más pax de este tipo. Una vez aleatorizados 200 pax con tumores con RAS mutado, no se incluirá a más pax de este tipo. b Confirmación de NO padecer CCR con inestabilidad microsatelital alta o alteración de vía reparadora demostrado mediante análisis del tejido. 2 Haber recibido los siguientes Tº antineoplásicos de ref como Tº previo para CCR metastásico y haber presentado progresión radiológica, o ser resistente o intolerante a dichos Tº. a Tº antineoplásicos sistémicos de referencia deben incluir TODOS los fármacos sig si están autorizados y disponibles en el país en que se aleatorice al pax: i Fluoropirimidina, irinotecán y oxaliplatino, con o sin un anticuerpo monoclonal que se una al factor de crecimiento endotelial vascular (pe bevacizumab). ii Anticuerpo monoclonal contra receptor del factor de crecimiento epidérmico (pe, cetuximab o panitumumab) en caso de pax con RAS natural. iii Inhibidor de BRAF en caso de pax con mutaciones BRAF-V600E. b Progresión radiológica durante el Tº con pauta de quimioterapia autorizada de ref más reciente o durante 3M sig a última dosis de dicha pauta. 3 Enfer mensurable con arreglo a criterios de eval de respuesta en tumores sólidos v1.1 (RECIST 1.1; Eisenhauer y cols 2009) determinada por invest. 4 Material de biopsia tumoral de archivo disponible. Si no se dispone de tejido de archivo, se debe proporcionar una biopsia de tejido tumoral en fresco antes de aleatorización. 5 Recuperación al nivel inicial o a una intensidad de grado ≤1 (CTCAE v5) de AA relacionados con cualquier Tº previo, a menos que AA sean clínicamente no significativos o estables con Tº de apoyo. 6 18 años de edad o más en fecha de consentimiento. 7 Estado funcional del Eastern Cooperative Oncology Group de 0-1. 8 Actividad orgánica y medular adecuada, basada en cumplimiento de totalidad de sig criterios analíticos en 10D anteriores a aleatorización: a Recuento absoluto de neutrófilos (RAN) ≥1500/mm3 (≥1,5×109/l) sin Tº de apoyo con factor estimulante de colonias de granulocitos en 2S anteriores a obtención de muestra analítica en selec. b Plaquetas ≥100.000/mm3 (≥100×109/l) sin transfusión en 2S anteriores a obtención de muestra analítica en selec. c Hemoglobina ≥9 g/dl (≥90 g/l) sin transfusión en 2S anteriores a obtención de muestra analítica en selec. d Índice internacional normalizado ≤1,5 y T de tromboplastina parcial activado ≤1,2veces el límite superior de normalidad. e Alanina transaminasa, aspartato transaminasa y fosfatasa alcalina ≤3 veces el LSN. f Albúmina ≥3,0g/dl. g Lipasa y amilasa ≤1,5veces el LSN. h Bilirrubina total ≤1,5veces el LSN (para pax con enfermedad de Gilbert, ≤3veces el LSN). i Aclaramiento de creatinina calculado ≥40 ml/min (≥0,67ml/s) mediante ecuación de Cockcroft-Gault (apdo 5.6.5 para consultar fórmula de Cockcroft-Gault). j Cociente proteína/creatinina en orina (CPCo)≤1mg/mg (≤113,1mg/mmol). K Resultado negativo en prueba del antígeno de superficie del virus de hepatitis B (AgHBs). l Resultado negativo en prueba de anticuerpos contra virus de hepatitis C o resultado positivo en prueba de anticuerpos contra VHC seguido de un resultado negativo en prueba de ARN del VHC sin Tº anti-VHC en curso. Nota: prueba de ARN del VHC solo se realizará a pax que den positivo en una prueba de anticuerpos contra VHC. 9 Capacidad para entender y cumplir requisitos del protocolo y haber firmado documento de CI. 10 Los pax fértiles que sean sexualmente activos y sus parejas deben aceptar uso de métodos anticonceptivos de gran eficacia (definidos en anexo H) durante el transcurso del estudio y durante sig plazos después de última dosis de Tº (lo que ocurra más tarde): • hasta 186D después de última dosis de XL092 en el caso de mujeres fértiles o hasta 96D después de última dosis de XL092 en caso de hombres, • hasta 5M después de última dosis de atezolizumab (tanto en caso de mujeres fértiles como en hombres) o • hasta 2M después de última dosis de regorafenib (tanto en caso de mujeres fértiles como en hombres). Es necesario utilizar un método anticonceptivo adicional, como un método de barrera (pe preservativo). 11 Pax fértiles no deberán estar embarazadas en selec. Se considera que pax son fértiles excepto si cumplen al menos uno de criterios sig: esterilización permanente (histerectomía, salpingectomía bilateral u ooforectomía bilateral) o estado posmenopáusico documentado (definido como 12M de amenorrea en mujeres de >45años de edad en ausencia de otras causas biológicas o fisiológicas. Además, mujeres <55años deben presentar una concentración de hormona foliculoestimulante >40mUI/ml para confirmar estado menopáusico)
    E.4Principal exclusion criteria
    1. Prior treatment with XL092, regorafenib, trifluridine/tipiracil, or PD-L1/PD-1 targeting immune checkpoint inhibitors (ICIs).
    2. Receipt of a small molecule kinase inhibitor (including investigational agents) within 2 weeks before randomization.
    3. Receipt of any type of anticancer antibody therapy, systemic chemotherapy, or hormonal anti-cancer therapy within 3 weeks (or bevacizumab within 4 weeks) before randomization.
    4. Radiation therapy for bone metastasis within 2 weeks, any other radiation therapy within 4 weeks before randomization. Subjects with clinically relevant ongoing complications from prior radiation therapy are not eligible.
    5. Known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks before randomization.
    6. Concomitant anticoagulation with oral anticoagulants (eg, warfarin, direct thrombin and Factor Xa inhibitors) and platelet inhibitors (eg, clopidogrel).
    7. The subject has uncontrolled, significant intercurrent or recent illness including, but not
    limited to, the following conditions:
    a. Cardiovascular disorders:
    i. Congestive heart failure New York Heart Association class 2 or higher, unstable angina pectoris, new-onset angina, unstable angina pectoris, serious cardiac arrhythmias (eg, ventricular flutter, ventricular fibrillation, Torsades de pointes).
    ii. Uncontrolled hypertension defined as sustained blood pressure (BP) > 140 mm Hg systolic or 90 mm Hg diastolic despite optimal antihypertensive treatment.
    iii. Stroke (including transient ischemic attack [TIA]), myocardial infarction, pulmonary embolism (PE), prior clinically significant venous or other arterial ischemic event within 6 months before randomization.
    iv. Deep vein thrombosis (DVT) within 3 months prior to randomization unless stable, asymptomatic, and treated with therapeutic anticoagulation for at least 4 weeks before randomization.
    b. Gastrointestinal (GI) disorders including those associated with a high risk of perforation or fistula formation:
    i. Tumors invading the GI-tract from external viscera.
    ii. Active peptic ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, or acute pancreatitis.
    iii. Acute obstruction of the bowel, gastric outlet, or pancreatic or biliary duct within 6 months before randomization unless cause of obstruction is definitively managed and subject is asymptomatic.
    iv. Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months before randomization.
    v. Ascites, pleural effusion or pericardial fluid requiring drainage in last 4 weeks.
    c. Clinically significant hematuria, hematemesis, or hemoptysis of > 0.5 teaspoon (2.5 mL) of red blood, or other history of significant bleeding (eg, gastrointestinal or pulmonary hemorrhage) within 12 weeks before randomization.
    d. Cavitating pulmonary lesion(s) or known endobronchial disease manifestation.
    e. Lesions invading major blood vessels including, but not limited to, inferior vena cava, pulmonary artery, or aorta.
    f. Other clinically significant disorders, see protocol
    8. Major surgery (eg, GI surgery, removal or biopsy of brain metastasis) within 4 weeks prior to randomization. Complete wound healing from major or minor surgery must have occurred at least prior to randomization.
    9. Corrected QT interval calculated by the Fridericia formula (QTcF) > 460 ms within 10 days before randomization per electrocardiogram (ECG) before randomization (see Section 5.6.4 for Fridericia formula).
    10. History of psychiatric illness likely to interfere with ability to comply with protocol requirements or give informed consent.
    11. Pregnant or lactating females.
    12. Inability to swallow study treatment formulation, inability to receive IV administration. or presence of GI condition that might affect the absorption of study drug (eg, PEG tube).
    13. Previously identified allergy or hypersensitivity to components of the study treatment
    formulations.
    14. Any other active malignancy or diagnosis of another malignancy within 2 years before randomization, except for superficial skin cancers, or localized, low-grade tumors deemed cured and not treated with systemic therapy. Incidentally diagnosed prostate cancer is allowed if assessed as stage ≤ T2N0M0 and Gleason score ≤ 6.
    15. Administration of a live, attenuated vaccine within 30 days before randomization.
    1 Tº previo con XL092, regorafenib, trifluridina/tipiracilo o inhib del p control inmunitario dirigidos contra PD-L1/PD-1. 2 Recep inhib cinasas de peq tamaño molec (incl fármacos en inves) en 2S anter aleator. 3 Recep cualquier tipo de anticuerpo antineoplásico, quimioterapia sistémica u hormonoterapia antineoplásica en 3S (bevacizumab en 4S) anter aleator. 4 Radioterapia para metástasis óseas en 2S anter aleator o cualquier otra radioterapia en 4S anter aleator. Pax con complicaciones en curso de interés clínico causadas por radioterapia previa no serán aptos. 5 Constancia de metástasis cerebral o enf epidural craneal, salvo haya tratado satisfac con radioterapia o cirugía (incl radiocirugía) y haya permanecido estable al menos 4S anteriores a aleatorización. 6 Anticoagulación concomitante con anticoagulantes orales (warfarina e inhib direct de trombina y factor Xa) e inhib plaq (clopidogrel). 7 Presencia enf intercurrente o reciente, no controlada y signif: a Trast cardiov: i Insuf card congestiva clase 2 o super seg criterios de NY Heart Association, angina de pecho inest, angina de nueva aparición, arritmias card graves (aleteo ventricular, fibrilación ventricular, taquicardia ventricular en entorchado). ii Hipert incontrolada, def como tensión art sistólica >140mmHg o diastólica >90mmHg sostenida a pesar de recibir Tº antihipertensivo ópt. iii Accid cerebrovascular (incl accid isquémico transitorio), inf miocardio, embolia pulmonar, acont isquémico venoso u otro acont isquémico arterial clínica significativo en los 6M anteriores a aleator. iv Trombosis venosa profunda en 3M anter a aleator, salvo estén estables, sean asintomáticos y reciban Tº con anticoagulantes terap durante al menos 4S anteriores a aleator. b Trast digestivos, incl asociados a riesgo elevado de perforación o form de fístulas: i Tumores que invadan tubo digestivo desde vísceras externas. ii Enf ulcerosa péptica activa, enteropatía inflamatoria, diverticulitis, colecistitis, colangitis o apendicitis sintomáticas, o pancreatitis aguda. iii Obst aguda intestino, píloro o conducto pancreático o biliar en 6M anter a aleator, a menos causa de obstrucción se trate de forma def y pax se encuentre asintomático. iv Fístula abdominal, perf gastrointestinal o absceso intraabdominal en 6M anter a aleator. v Ascitis, derrame pleural o líq pericárdico requiera drenaje en 4 últimas S. c Hematuria, hematemesis o hemoptisis clínica signif 2,5ml sangre roja, u otros antecedentes de sangrado imp (hemorragia pulmonar o digestiva) en 12S anter aleator. d Lesiones pulmonares cavitadas o constancia de manifestación de enf endobronquial. e Lesiones invasoras de prin vasos sanguíneos, vena cava inf, arteria pulmonar o aorta. f Otros trastornos clínica signif: i Constancia o sospecha de cualquier enf autoinmunitaria activa (anexo D para consul lista exhaustiva de enf autoinmunitarias e inmunodeficiencias). ii Presencia de cualquier infec activa requiera Tº antibiótico. iii Constancia de infec por virus inmunodeficiencia humana o enf relacionada con síndrome de inmunodeficiencia adquirida. v Constancia COVID-19, a menos que pax haya demostrado que se ha recuperado enf 30D antes de aleator. vi Antec fibrosis pulmonar idiopática, neumonía organizada, neumonitis medicamentosa, neumonitis idiopática o sig de neumonitis activa en TC torácica realizada en selec. vii Herida o úlcera grave no cicatriza o fract ósea grave no se consolida seg criterio invest. viii Sínd de malabsorción clínica signif según criterio invest. ix Hipotiroidismo sintomático no compensado farmacológicamente. x Trastorno hepático moderado o grave (B o C seg criterios Child-Pugh) o constancia de cirrosis. xi Necesidad de hemodiálisis o diálisis peritoneal. xii Antec trasplante de víscera maciza. 8 Inter cirugía mayor (cirugía apa digestivo, extirpación o biopsia metástasis cerebral) en 4S anteriores aleator. Heridas ocasionadas por cirugía mayor o menor deben haber cicatrizado como mín antes aleator. 9 Intervalo QT corregido calculado mediante fórm Fridericia (QTcF) >460 ms seg electrocardiograma en 10 ante. a aleator (fórm Fridericia). 10 Ant enf psiquiátrica con prob de interferir capacidad cumplir requisitos protocolo o otorgar CI. 11 Mujeres embarazadas o en período de lactancia. 12 Incapacidad para tragar formulación del Tº estudio, incapacidad para recibir admin iv o presencia enf apa digestivo pueda afectar a absorción del med del estudio (sonda gastrostomía endoscópica percutánea). 13 Alergia o hipersensibilidad identificada previamente a componentes de formulaciones del Tº estudio. 14 Cualquier otra neoplasia maligna activa o diagnóstico de otra neoplasia maligna en 2A anter a aleator, salvo cáncer de piel superf o tumores localizados de grado bajo que consideren curados y no se haya utilizado Tº sistémico. Se admite cáncer próstata de diagnóstico accid, siempre eval indique estadificación ≤T2N0M0 y punt ≤6 esc Gleason. 15 Admin vacuna con microbios vivos atenuada 30D ant aleator
    E.5 End points
    E.5.1Primary end point(s)
    Duration of OS
    Duración de SG
    E.5.1.1Timepoint(s) of evaluation of this end point
    The time from randomization to death due to any cause, in RAS WT subjects.
    El tiempo desde la aleatorización hasta la muerte por cualquier causa en los pacientes con RAS natural
    E.5.2Secondary end point(s)
    Additional Efficacy Endpoints
    • Duration of progression-free survival (PFS) as assessed by the Investigator per RECIST 1.1
    • Objective response rate (ORR) as assessed by the Investigator per RECIST 1.1
    • Duration of response (DOR) as assessed by the Investigator per RECIST 1.1
    • Change in tumor markers from baseline
    2.1.2. Endpoints Supporting Safety Objectives
    • Evaluation of AEs, including adverse events of special interest (AESIs) and SAEs
    • Change in laboratory parameters and vital signs
    2.1.3. Endpoints Supporting Other Objectives
    • Change in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and global health as assessed by the European Organization for the Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-CR29, and EQ-5D-5L measures
    • Change in tumor status by circulating tumor DNA (ctDNA)
    • Correlation of biomarker analyses with clinical outcomes
    • Plasma concentration of XL092 given in combination with atezolizumab
    • Serum concentration of atezolizumab given in combination with XL092
    • The incidence of antidrug antibody (ADA) response against atezolizumab given in combination with XL092
    • Hospital ER visits, hospital admissions, and/or ICU admissions
    Criterios de valoración adicionales de la eficacia:
    • Duración de la supervivencia sin progresión (SSP) evaluada por el investigador con arreglo a los criterios RECIST 1.1
    • Tasa de respuesta objetiva (TRO) evaluada por el investigador con arreglo a los criterios RECIST 1.1
    • Duración de la respuesta (DR) evaluada por el investigador con arreglo a los criterios RECIST 1.1
    • Cambio en los marcadores tumorales con respecto al inicio
    Criterios de valoración que sustentan los objetivos relativos a la seguridad:
    • Evaluación de acontecimientos adversos (AA), incluidos los acontecimientos adversos de especial interés (AEI) y los AAG
    • Cambio en los parámetros analíticos y las constantes vitales
    Criterios de valoración que sustentan otros objetivos:
    • Cambio en la movilidad, el autocuidado, las actividades cotidianas, el dolor/malestar, la ansiedad/depresión y la salud global evaluado mediante el cuestionario QLQ-C30 de la Organización Europea para la Investigación y Tratamiento del Cáncer (EORTC), el QLQ-CR29 de la EORTC y el EQ-5D-5L
    • Cambio en el estado del tumor mediante el análisis del ADN tumoral circulante (ADNtc)
    • Correlación entre los análisis de biomarcadores y los desenlaces clínicos
    • Concentración plasmática de XL092 administrado en combinación con atezolizumab
    • Concentración sérica de atezolizumab administrado en combinación con XL092
    • Incidencia de la respuesta mediante anticuerpos antifármaco (AAF) contra el atezolizumab administrado en combinación con XL092
    • Visitas a un servicio de urgencias hospitalario, ingresos hospitalarios o ingresos en una UCI
    E.5.2.1Timepoint(s) of evaluation of this end point
    26 months
    26 meses
    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 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) 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 concerned11
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA49
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Canada
    Hong Kong
    Korea, Republic of
    New Zealand
    Singapore
    Taiwan
    Thailand
    United States
    France
    Poland
    Spain
    Czechia
    Germany
    Belgium
    Hungary
    Portugal
    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
    End of trial is defined as the later of two dates: the date of the last visit or procedure for the last subject remaining on treatment or the date at which the last data point required for follow-up for the last subject is obtained.
    El fin del ensayo se define como la fecha de la última visita o procedimiento del último paciente en tratamiento, o bien como la fecha en que se obtengan los últimos datos necesarios para el seguimiento del último paciente, lo que ocurra más tarde.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months11
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months11
    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: 269
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 331
    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 state55
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 211
    F.4.2.2In the whole clinical trial 600
    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)
    Subjects will receive study treatment as long as they continue to experience clinical benefit in the investigator’s opinion or until there is unacceptable toxicity, the need for subsequent systemic anticancer treatment, or any other reasons for treatment discontinuation.
    Following study treatment discontinuation (and for subjects randomized but never treated) each subject will continue to be followed for survival and NPACT.
    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 Decision2022-10-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-09-13
    P. End of Trial
    P.End of Trial StatusOngoing
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