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    Summary
    EudraCT Number:2021-003254-23
    Sponsor's Protocol Code Number:RMC-4630-03
    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:2022-03-21
    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 number2021-003254-23
    A.3Full title of the trial
    A Phase 2, Open-Label, Multicenter Study of the Combination of RMC-4630 and Sotorasib for Non-Small Cell Lung Cancer Subjects with KRASG12CMutation After Failure of Prior Standard Therapies
    Estudio en fase II, abierto y multicéntrico de la combinación de RMC-4630 y sotorasib para pacientes con cáncer de pulmón no microcítico (CPNM) con mutación KRASG12C tras el fracaso de tratamientos estándar previos
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Combination Study of RMC-4630 and Sotorasib for NSCLC Subjects with KRASG12C Mutation After Failure of Prior Standard Therapies
    Estudio de combinación de RMC-4630 y linaclotidarasib para pacientes con CPNM con mutación de KRASG12C tras el fracaso de tratamientos estándar previos
    A.4.1Sponsor's protocol code numberRMC-4630-03
    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 SponsorRevolution Medicines, 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 supportRevolution Medicines
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationRevolution Medicines, Inc.
    B.5.2Functional name of contact pointClinical Program Manager, Clinical
    B.5.3 Address:
    B.5.3.1Street Address700 Saginaw Drive
    B.5.3.2Town/ cityRedwood City, CA
    B.5.3.3Post code94063
    B.5.3.4CountryUnited States
    B.5.4Telephone number001650779 – 2241
    B.5.6E-mailmle@RevMed.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 nameRMC-4630 - 20 mg
    D.3.2Product code RMC-4630
    D.3.4Pharmaceutical form Capsule
    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 INNRMC-4630
    D.3.9.1CAS number 2172652-48-9
    D.3.9.2Current sponsor codeRMC-4630
    D.3.9.3Other descriptive nameSAR442720
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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 nameLUMAKRAS
    D.3.2Product code Sotorasib
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNSotorasib
    D.3.9.3Other descriptive nameLUMAKRAS
    D.3.9.4EV Substance CodeSUB197397
    D.3.10 Strength
    D.3.10.1Concentration unit millilitre(s)/gram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number120
    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 nameRMC-4630 - 100 mg
    D.3.2Product code RMC-4630
    D.3.4Pharmaceutical form Capsule
    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 INNRMC-4630
    D.3.9.1CAS number 2172652-48-9
    D.3.9.2Current sponsor codeRMC-4630
    D.3.9.3Other descriptive nameSAR442720
    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.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-Small Cell Lung Cancer Subjects with KRASG12C Mutation After Failure of Prior Standard Therapies
    cáncer de pulmón no microcítico en pacientes que presentan la mutación KRASG12C después del fracaso a terapias estándar previas
    E.1.1.1Medical condition in easily understood language
    Non-Small Cell Lung Cancer Subjects with KRASG12C Mutation After Failure of Prior Standard Therapies
    cáncer de pulmón no microcítico en pacientes que presentan la mutación KRASG12C después del fracaso a terapias estándar previas
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the antitumor effects of RMC-4630 and sotorasib in locally advanced or metastatic NSCLC subjects with KRASG12C mutation with and without coexisting genetic aberrations in specific genes such as STK11/LKB1, KEAP1, and PIK3CA after failure of prior standard therapy
    Evaluar los efectos antitumorales de RMC-4630 y sotorasib en pacientes con CPNM localmente avanzado o metastásico con mutación de KRASG12C con y sin anomalías genéticas coexistentes en genes específicos como STK11/LKB1, KEAP1 y PIK3CA
    E.2.2Secondary objectives of the trial
    1- To characterize the safety, tolerability, and PK of RMC-4630 in combination with sotorasib for subjects with KRASG12C mutant NSCLC after failure of prior standard therapy
    2- To further characterize efficacy of RMC-4630 in combination with sotorasib as assessed by DOR, DCR, PFS, and OS in subjects with KRASG12C mutant locally advanced or metastatic NSCLC after failure of prior standard therapy

    Exploratory
    • To explore PK relationships with safety and/or efficacy endpoints
    • To investigate potential biomarkers by biochemical and/or genetic analysis of blood and/or tumor tissue samples
    1- Caracterizar la seguridad, tolerabilidad y FC de RMC-4630 en combinación con sotorasib para sujetos con CPNM con mutación de KRASG12C tras el fracaso del tratamiento estándar previo
    2- Caracterizar mejor la eficacia de RMC-4630 en combinación con sotorasib según la evaluación de DR, TCE, SSP y SG en sujetos con CPNM localmente avanzado o metastásico con mutación de KRASG12C tras el fracaso del tratamiento estándar previo.
    Objetivos Exploratorios
    1- Explorar la relación de la PK con los endpoints the seguridad y/o eficacia
    2- Investigar biomarcadores potenciales por análisis bioquímicos y/o genéticos de sangre y/o muestras de tejido
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Subject must be ≥18 years of age at the time of signing the informed consent form (ICF).
    2. Subject must have pathologically documented, locally advanced or metastatic KRASG12C
    NSCLC (not amenable to curative surgery) that has progressed on prior standard therapies (no more than 3 prior lines of therapies are allowed), as follows:
    a. Subject with actionable oncogenic driver mutations (eg, epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase [ALK], and ROS1) must have received standard-of-care anticancer treatments, including approved drugs for oncogenic drivers in their tumor type.
    b. Subject’s tumor must harbor a KRASG12C mutation assessed by a CLIA-/CAP-certified laboratory.
    3. Subject must have measurable disease per RECIST v1.1, criteria.
    4. Subject must have a life expectancy of at least 3 months.
    5. The subject’s ECOG PS of 0 to 1 with no deterioration in PS 2 weeks prior to C1D1. Rescreening is required if PS is >1 for any reason prior to C1D1.
    6. Subject must have the ability to typically ingest and retain PO medications.
    7. Subject must have adequate hematological and biological function, as follows:
    a. Bone marrow function:
    i. Absolute neutrophil count (ANC) ≥1.5 × 109/L without use of hematopoietic growth factors
    ii. Hemoglobin ≥9 g/dL; subject must not have received a red blood cell (RBC) transfusion within 28 days of Screening
    iii. Platelets ≥100 × 109/L; subject must not have received a platelet
    transfusion within 14 days of Screening
    b. Subject must have hepatic function as follows:
    i. AST and ALT ≤2.5 × upper limit of normal (ULN)
    ii. Bilirubin ≤1.5 × ULN (<2.0 × ULN for subject with documented Gilbert’s
    syndrome or <3.0 × ULN for subject for whom the indirect bilirubin level suggests an extrahepatic source of elevation)
    c. Subject must have renal function as follows: Serum creatinine ≤1.5 × ULN or creatinine clearance (CrCl) of >50 mL/min (using the Cockcroft-Gault formula or 24-hour urine collection)
    d. Subject must have coagulation function as follows: Prothrombin time (PT)/international normalized ratio (INR) and activated partial thromboplastin time (aPTT)/partial thromboplastin time (PTT) <1.3 × ULN, or within target range if taking prophylactic anticoagulant(s).
    8. Female subject is eligible to participate if she meets the following criteria:
    a. Is not a woman of childbearing potential (WOCBP), OR
    b. Is a WOCBP and using a contraceptive method that is highly effective (ie, with a failure rate of <1% per year), preferably with low user dependency, during the treatment period and for at least 2 months after the last dose of study treatment and agree not to donate eggs (ie, ova and oocytes) for the purpose of reproduction during this period. The investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment. Hormonal contraception efficacy may potentially be decreased due to interaction with sotorasib; therefore, male condoms must be used in addition to any hormonal-based contraception methods.
    9. Male subject is eligible to participate if he agrees to the following during the treatment period and for ≥3 months after the last dose of study treatment:
    a) Refrains from donating sperm (any donation of sperm should be conducted prior to study start) PLUS, either:
    b) Abstain from intercourse as his preferred and usual lifestyle (abstinent on a longterm and persistent basis) and agree to remain abstinent, OR
    c) Must agree to use a male condom AND should also be advised of the benefit for a nonpregnant female partner to use a highly effective method of contraception as a condom may break or leak
    10. Subject is capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
    11. Subject must provide unstained, archived, tumor tissue samples collected within the past 3 years. Subjects who do not have archived tissue available are required to undergo a tumor biopsy.
    1. El sujeto debe tener ≥18 años de edad en el momento de firmar el formulario de consentimiento informado (FCI).
    2. El sujeto debe tener cáncer de pulmón no microcítico (CPNM) con KRASG12C localmente avanzado o metastásico confirmado patológicamente (no susceptible de intervención quirúrgica curativa) que haya sufrido progresión con tratamientos estándar anteriores (no se permiten más de 3 líneas previas de tratamiento), de la siguiente manera:
    a. El sujeto que muestre mutaciones oncoiniciadoras susceptibles de ser dianas terapéuticas (p. ej., receptor del factor de crecimiento epidérmico [EGFR]), cinasa del linfoma anaplásico [ALK] y ROS1) debe haber recibido tratamientos antineoplásicos estándar, incluidos fármacos autorizados para las mutaciones oncoiniciadoras de su tipo de tumor.
    b. El tumor del sujeto debe presentar una mutación KRASG12C evaluada por un laboratorio que posea la certificación de Enmiendas para la mejora de los laboratorios clínicos (CLIA) o del Colegio Estadounidense de Patólogos (CAP).
    3. El sujeto debe tener enfermedad medible según los criterios de evaluación de la respuesta al tratamiento en tumores sólidos (RECIST), versión 1.1.
    4. El sujeto debe tener una esperanza de vida de al menos 3 meses.
    5. El estado funcional (EF) del Grupo Oncológico Cooperativo de la Costa Este (ECOG) del sujeto debe ser de 0 a 1, sin deterioro del EF 2 semanas antes del D1C1. Se requiere repetir la selección si el EF es superior a 1 por cualquier motivo antes del D1C1.
    6. Capacidad de ingerir medicamentos por vía oral y retenerlos con normalidad.
    7. Actividad hematológica y biológica adecuadas, de la siguiente manera:
    a. Actividad de la médula ósea
    i. Cifra absoluta de neutrófilos (CAN) ≥1,5 × 109/l sin uso de factores de crecimiento hematopoyéticos.
    ii. Hemoglobina ≥9 g/dl; el sujeto no debe haber recibido una transfusión de glóbulos rojos (GR) en los 28 días anteriores a la selección.
    iii. Plaquetas ≥100 × 109/l; el sujeto no debe haber recibido una transfusión de plaquetas en los 14 días anteriores a la selección.
    b. El sujeto debe tener la actividad hepática siguiente:
    i. AST y ALT ≤2,5 × límite superior de la normalidad (LSN).
    ii. Bilirrubina ≤1,5 × LSN (<2,0 × LSN en el caso de un sujeto que tenga síndrome de Gilbert confirmado o <3,0 × LSN en el caso de un sujeto cuya concentración de bilirrubina indirecta apunte a una fuente extrahepática de elevación).
    c. El sujeto debe tener la actividad renal siguiente:
    Creatinina sérica ≤1,5 × LSN o aclaramiento de creatinina (AcCr) de >50 ml/min (con la fórmula de Cockcroft-Gault o la recogida de orina de 24 horas).
    d. El sujeto debe tener la actividad de coagulación siguiente:
    Tiempo de protrombina (TP)/índice internacional normalizado (INR) y tiempo de tromboplastina parcial activada (TTPa)/tiempo de tromboplastina parcial (TTP) <1,3 × LSN, o dentro del intervalo objetivo si se toman anticoagulantes profilácticos.
    8. Los sujetos de sexo femenino son aptos para participar si cumplen los siguientes criterios:
    a. No son mujeres en edad fértil (MEF), O
    b. Son MEF y utilizan un método anticonceptivo muy eficaz (es decir, con una tasa de fallo inferior al 1 % anual), preferiblemente con baja dependencia del usuario, durante el periodo de tratamiento y durante al menos 2 meses después de la última dosis del tratamiento del estudio, y acceden a no donar óvulos (es decir, ovocitos) con fines reproductivos durante este periodo. El investigador debe evaluar la eficacia del método anticonceptivo en relación con la primera dosis del tratamiento del estudio. La eficacia de los anticonceptivos hormonales podría verse reducida debido a la interacción con sotorasib; por lo tanto, se deben utilizar preservativos masculinos además de cualquier método anticonceptivo hormonal.
    9. Los sujetos de sexo masculino son aptos para participar si acceden a lo siguiente durante el periodo de tratamiento y durante ≥3 meses contados a partir de la última dosis del tratamiento del estudio:
    a) Evitan donar esperma (toda donación de esperma debe realizarse antes del inicio del estudio)
    Y ADEMÁS:
    b) Se abstienen de mantener relaciones sexuales si este es su estilo de vida preferido y habitual (abstinencia a largo plazo y de forma persistente) y acceden a mantener la abstinencia, O BIEN
    c) Deben de acceder al uso de un preservativo masculino Y también quedar advertidos de los beneficios de que una pareja de sexo femenino no embarazada use un método anticonceptivo muy eficaz, ya que el preservativo puede romperse o sufrir fugas.
    10. El sujeto es capaz de otorgar el consentimiento informado firmado, lo que incluye el cumplimiento de los requisitos y las restricciones indicados en el FCI y en este protocolo.
    11. El sujeto debe aportar muestras de tejido tumoral sin teñir y de archivo que se hayan tomado en los últimos 3 años. Los sujetos que no tengan tejido de archivo disponible deben someterse a una biopsia tumoral.
    E.4Principal exclusion criteria
    Subjects with:
    1.Primary central nervous system tumor(s)
    2 Have known or suspected leptomeningeal or brain metastases or spinal cord compression. However, a subject who was previously treated for these conditions who have had stable CNS diseases are eligible to participate in the study, as long as stable disease is documented by a brain MRI performed within 28-days (D) of C1D1.
    3 Have any of the following cardiac abnormalities:
    a Medically uncontrolled hypertension,
    b Congestive heart failure Class ≥2,
    c Acute coronary syndrome; myocardial infarction within 6M of ICF,
    d History or evidence of current, uncontrolled, clinically significant, unstable arrhythmias: i Subject with medically controlled atrial fibrillation >1M prior to Study Day 1 is eligible. ii Subject who has a pacemaker in place to control atrial arrhythmias is a candidate for the study.
    e History of congenital long QT syndrome or prolonged corrected QT interval (QTc) >470 msec for females and > 450 msec for males using Fridericia’s formula or uncorrectable abnormalities in serum electrolytes: i Subject may use average of triplicate readings for assessing QTc interval. ii Subject with an implantable defibrillator is not eligible to participate in the study
    f Current cardiomyopathy or history within in the past 12M prior to ICF
    g Baseline left ventricular ejection fraction below the institutional lower limit
    of normal or <50%, whichever is lower.
    4 Any prior history of (or active) ILD or pneumonitis, or prior thoracic radiotherapy within 2M of enrollment.
    5 Subject has a history or current evidence of retinal pigment epithelial detachment (RPED), central serous retinopathy, retinal vein occlusion (RVO), or predisposing factors to RPED or RVO
    6 Visible retinal pathology as assessed on ophthalmic examination that is considered a significant risk factor for RVO or RPED by ophthalmologist
    7 Have of Grade ≥2 proteinuria
    8 Have a history of cerebrovascular accident or transient ischemic attack previous 6M of signing the ICF
    9 Have a known activating SHP2 mutation
    10 Have an active autoimmune disease requiring systemic treatment within the past 2 years of signing the ICF; includes current autoimmune sequelae or previous Grade >2 autoimmune sequelae from checkpoint inhibitors or other immunomodulatory treatments that require systemic therapy. Subject with autoimmune endocrine disorder on hormonal supplementation may be enrolled, even if Grade >2 upon initial presentation,
    11 Have known HIV infection
    12 Have an active/chronic hepatitis B or C virus infection
    13 Have a known impairment of gastrointestinal function that may significantly alter the absorption of RMC-4630
    14 Have a history of severe allergic reactions
    15 Have major surgical procedures ≤28 D or non-study-related minor procedures ≤7D prior to Cycle 1 Day 1 (C1D1)
    16 Have any clinically significant concurrent medical condition that would, in the opinion of the investigator, and/or impact their ability to comply with the protocol. Any subject who had a pulmonary embolism within 3M of C1D1 will also be excluded.
    17 Have had prior therapy with one or both of the following agents, meets criteria for exclusion: a KRASG12C inhibitor and b. SHP2 inhibitor
    18 Have had treatment with chemotherapy or biologics/monoclonal antibodies <21D or 5 half-lives before C1D1
    19 Have had treatment with non-thoracic radiation therapy <14D before C1D1
    20 Have had treatment with tyrosine kinase inhibitor (TKI), hormonal therapy <7D before C1D1
    21 Have had treatment with immunotherapy 14-21D before C1D1, depending on cycle length of drug
    22 Have had treatment with all other anticancer treatments including investigational agents that do not fit in the above categories <21D before C1D1
    23 Require treatment with proton pump inhibitors (PPIs) or H2 receptor antagonists (H2-blockers). If an acid reducing agent cannot be avoided, administer sotorasib and RMC-4630 either 4hrs before or 10hrs after a local antacid.
    24 Have had consumption of strong CYP3A4 inducers or inhibitors within 7D prior to initiation of study treatment and requires treatment with strong CYP3A4 inducers or inhibitors
    25 Have had consumption of strong P-glycoprotein (P-gp) inhibitors within 7D prior to initiation of study treatment and requires treatment with a strong P-gp inhibitor
    26 Use of known CYP3A4 and P-gp sensitive substrates, within 14D or 5 half-lives of the drug prior to study D1 that was not reviewed and approved by the principal investigator.
    27 Have had clinically significant reversible toxicities from prior cancer therapy that have not recovered to Grade 1 or baseline, except for alopecia. Subject with Grade ≤2 neuropathies due to prior treatment will be allowed on study. Subject with other Grades ≤2 clinical nonsignificant toxicities, may be allowed on study after discussion with Medical Monitor.
    28 Female who is pregnant or breastfeeding
    29 Unwillingness or inability to comply with the protocol
    1. Uno o varios tumores del sistema nervioso central (SNC).
    2. Metástasis leptomeníngea o cerebral o compresión de la médula espinal o se sospecha de ellas.
    3. Alguna de las siguientes anomalías cardíacas:
    a. Hipertensión no controlada médicamente (≥160 mmHg de tensión arterial sistólica o ≥100 mmHg de tensión arterial diastólica).
    b. Insuficiencia cardíaca congestiva de clase ≥2, según la definición de la Asociación de Cardiología de Nueva York.
    c. Síndrome coronario agudo (incluida angina inestable, colocación de una endoprótesis de la arteria coronaria o angioplastia o revascularización coronaria en los 6 meses anteriores); infarto de miocardio en los 6 meses anteriores al consentimiento informado.
    d. Antecedentes o indicios de arritmias actuales inestables, de importancia clínica y no estabilizadas.
    e. Antecedentes de síndrome de QT largo congénito o intervalo QT corregido prolongado (QTc) >470 ms en las mujeres y >450 ms en los hombres mediante la fórmula de Fridericia (a menos que se lleve un marcapasos), o anomalías no corregibles en los electrolitos séricos (es decir, sodio, potasio, calcio, magnesio o fósforo):
    f. Miocardiopatía actual o antecedentes de ella en los 12 meses anteriores al consentimiento informado.
    g. Fracción de expulsión del ventrículo izquierdo (FEVI) inicial por debajo del límite inferior de la normalidad (LIN) establecido por los centros sanitarios o <50 % (el valor que sea inferior).
    4. Cualquier antecedente de EPI (o enfermedad activa) o neumonitis, o radioterapia torácica previa en los 2 meses anteriores a la inscripción.
    5. Antecedentes o indicios actuales de desprendimiento del epitelio pigmentario retiniano (DEPR), retinopatía serosa central, oclusión de la vena retiniana (OVR) o factores predisponentes a DEPR u OVR (p. ej., glaucoma u hipertensión ocular no controlados, diabetes mellitus no controlada, hiperviscosidad o síndromes de hipercoagulabilidad).
    6. Trastorno retiniano visible evaluado mediante exploración ocular que el oftalmólogo considere un factor de riesgo significativo de OVR o DEPR.
    7. Proteinuria ≥2.
    8. Antecedentes de accidente cerebrovascular o accidente isquémico transitorio en los 6 meses anteriores a la firma del formulario de consentimiento informado (FCI).
    9. Mutación activadora conocida de SHP2 (p. ej., síndrome de Noonan).
    10. Enfermedad autoinmunitaria activa que requiere tratamiento sistémico (es decir, con el uso de fármacos modificadores de la enfermedad, dosis no fisiológicas de corticoesteroides o fármacos inmunosupresores) en los 2 años anteriores a la firma del FCI;
    11.Infección conocida por el virus de la inmunodeficiencia humana (VIH).
    12. Infección activa o crónica por el virus de la hepatitis B o C.
    13. Deterioro conocido de la función gastrointestinal (GI)
    14. Antecedentes de reacciones alérgicas graves a alguno de los componentes del tratamiento del estudio.
    15. El sujeto se somete a procedimientos quirúrgicos importantes dentro de ≤28 días antes del día 1 del ciclo 1 (D1C1), o a procedimientos menores no relacionados con el estudio dentro de un plazo de ≤7 días antes del D1C1
    16. Alguna otra afección médica concomitante inestable o de importancia clínica
    17. Tratamiento anterior con una de las siguientes sustancias, o con las dos, y cumple los criterios de exclusión:
    a. Inhibidor de KRASG12C.
    b. Inhibidor de SHP2.
    18. Tratamiento con quimioterapia o fármacos biológicos o anticuerpos monoclonales dentro de un plazo <21 días o 5 semividas (el periodo que sea más breve) antes del D1C1.
    19. Tratamiento con radioterapia no torácica dentro de un plazo <14 días antes del D1C1.
    20. Tratamiento con inhibidores de la tirosina-cinasa (ITC) o tratamiento hormonal (excepto acetato de megestrol) <7 días antes del D1C1.
    21. Tratamiento con inmunoterapia.
    22. Cualquier otro tratamiento antineoplásico, incluidos fármacos en investigación, que no encajen en las categorías anteriores <21 días antes del D1C1.
    23. Necesita tratamiento con inhibidores de la bomba de protones (IBP) o antagonistas de los receptores H2 (bloqueantes de H2).
    24. Inductores o inhibidores potentes del CYP3A4 en los 7 días anteriores al inicio del tratamiento del estudio y requiere tratamiento con los mismos.
    25. Inhibidores potentes de la P-glicoproteína (P-gp) (p. ej., ciclosporina o tacrólimus) en los 7 días anteriores al inicio del tratamiento del estudio y requiere tratamiento con los mismos.
    26. Uso de sustratos sensibles conocidos del CYP3A4 y la P-gp (con un margen terapéutico estrecho) dentro de los 14 días o las 5 semividas del fármaco, anteriores al día 1 del estudio.
    27. Toxicidades reversibles de importancia clínica debidas a un tratamiento antineoplásico previo que no se hayan recuperado hasta alcanzar el grado 1 o el valor inicial, excepto alopecia.

    28. Mujer embarazada o en periodo de lactancia.
    29. Falta de voluntad o incapacidad para cumplir el protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    Objective response rate as assessed per Response Evaluation Criteria in Solid Tumours, Version 1.1;
    Tasa de respuesta global según los Criterios de Evaluación de la Respuesta para Tumores sólidos v.1.1
    E.5.1.1Timepoint(s) of evaluation of this end point
    By March 31, 2023
    31 Marzo 2023
    E.5.2Secondary end point(s)
    • Incidence, nature, and severity of treatment-emergent adverse event, SAEs, clinically significant changes in laboratory tests, ECGs, and vital signs
    • Trough and approximate peak concentrations of RMC-4630 and sotorasib
    • duration of response, disease control rate and progression-free survival as assessed per RECIST v1.1, and overall survival

    Exploratory
    • Sotorasib and RMC-4630 exposure/safety and exposure/efficacy relationships
    • Quantification of biomarker expression (protein, RNA, and DNA levels) as appropriate in ctDNA and archival tumor tissues (or fresh, if archival tumor is not available)
    Incidencia, naturaleza y severidad de los efectos adversos que aparecen con el tratamiento, y de los efectos adversos severos, cambios clínicamente significativos en los análisis de laboratorio, en los electrocardiogramas y en los signos vitales. Concentraciones medias y concentraciones máximas de RMC-4630 y sotorasib. Duración de la Respuesta, Tasa de Control de la Enfermedad y Supervivencia Libre de Enfermedad evaluadas por RECIST 1.1, y supervivencia global.
    E.5.2.1Timepoint(s) of evaluation of this end point
    By March 31, 2023
    31 Marzo 2023
    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 Yes
    E.6.13.1Other scope of the trial description
    tolerability
    Tolerancia
    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 Yes
    E.8.1.7.1Other trial design description
    Study drug combined with Sotorasib
    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 concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA25
    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
    Korea, Republic of
    Taiwan
    United States
    France
    Germany
    Italy
    United Kingdom
    Spain
    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 study duration is approximately 2 years. The End of study is defined as the date of last subject, last visit or 12 months after the last subject receives the first dose of study treatment, whichever occurs first.
    La duración del estudio es aproximadamente 2 años. El Final de Estudio se define como la fecha de la última visita del último paciente, o 12 meses después de que el último paciente reciba la primera dosis de tratamiento, lo que ocurra antes.
    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 months5
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years2
    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: 40
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 6
    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 state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 15
    F.4.2.2In the whole clinical trial 46
    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)
    Each investigator will provide the best treatment or care after the end of the study
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-05-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-04-12
    P. End of Trial
    P.End of Trial StatusOngoing
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