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    Summary
    EudraCT Number:2021-003871-32
    Sponsor's Protocol Code Number:AL3818-US-002
    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:2021-09-09
    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 number2021-003871-32
    A.3Full title of the trial
    A Phase 1/2a/3 Evaluation of the Safety and Efficacy of Adding AL3818 (Anlotinib, INN: Catequentinib), a Dual Receptor Tyrosine Kinase Inhibitor, to Standard Platinum-Based Chemotherapy in Subjects with Recurrent or Metastatic Endometrial, Ovarian, Fallopian, Primary Peritoneal or Cervical Carcinoma
    Evaluación fase 1/2a/3 de la seguridad y eficacia de añadir AL3828 (Anlotinib, INN: Catequentinib), un inhibidor del receptor dual tirosina quinasa, a la quimioterapia estándar basada en platino en sujetos con carcinoma endometrial, ovárico, de trompas de Falopio, peritoneal primario o cervical recurrente o metastásico.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Evaluation of the Safety and Efficacy of Adding AL3818 (Anlotinib, INN: Catequentinib) to Standard Platinum-Based Chemotherapy in Patients with Recurrent or Metastatic Endometrial, Ovarian, Fallopian, Primary Peritoneal or Cervical Carcinoma
    Evaluación de la seguridad y eficacia de añadir AL3818 (Anlotinib, INN: Catequentinib) a la quimioterapia estándar basada en platino en pacientes con carcinoma endometrial, ovárico, de trompas de Falopio, peritoneal primario o cervical recurrente o metastásico.
    A.4.1Sponsor's protocol code numberAL3818-US-002
    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 SponsorADVENCHEN LABORATORIES, LLC
    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 supportAdvenchen Laboratories, LLC
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationADVENCHEN LABORATORIES, LLC
    B.5.2Functional name of contact pointNA
    B.5.3 Address:
    B.5.3.1Street Address887 Patriot Drive, Suite A
    B.5.3.2Town/ cityMoorpark
    B.5.3.3Post code93021
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018055301550
    B.5.5Fax number001626-608-0397
    B.5.6E-mailmelissac@advenchen.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 nameAnlotinib Hydrochloride
    D.3.2Product code AL3818
    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 INNCatequentinib
    D.3.9.1CAS number 1058156-90-3
    D.3.9.2Current sponsor codeAL3818
    D.3.9.4EV Substance CodeSUB192810
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typenot less then
    D.3.10.3Concentration number8
    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
    Recurrent or metastatic endometrial, ovarian, fallopian tube, primary peritoneal, or cervical carcinoma.
    Evaluación fase 1/2a/3 de la seguridad y eficacia de añadir AL3828 (Anlotinib, INN: Catequentinib), un inhibidor del receptor dual tirosina quinasa, a la quimioterapia estándar basada en platino en sujetos con carcinoma endometrial, ovárico, de trompas de Falopio, peritoneal primario o cervical recurrente o metastásico.
    E.1.1.1Medical condition in easily understood language
    Recurrent or metastatic endometrial, ovarian, fallopian tube, primary peritoneal, or cervical cancer.
    Cáncer de endometrio, de ovario, de las trompas de Falopio, peritoneal primario o de cuello de útero recurrente o con metástasis
    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 10014734
    E.1.2Term Endometrial cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10014736
    E.1.2Term Endometrial cancer recurrent
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10057529
    E.1.2Term Ovarian cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10066697
    E.1.2Term Ovarian cancer recurrent
    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
    Phase Ib/Part 1 – Completed
    ▪ To determine the RP2D for part 2 of adding oral AL3818 to standard platinum-based chemotherapy with carboplatin (or cisplatin) and paclitaxel in subjects with recurrent or metastatic endometrial or other uterine, ovarian, fallopian, primary peritoneal or cervical cancer via evaluation of DLT events.

    Phase IIa/Part 2 Objectives
    ▪ To measure objective response rates (ORR) in subjects with recurrent or metastatic endometrial or other uterine, ovarian, fallopian, primary peritoneal or cervical cancer treated with AL3818 in combination with platinum-based chemotherapy or other standard chemotherapies.

    Phase III/Part 3 Objectives (ALIFTUS)
    ▪ To evaluate the efficacy between the Active Arm (AL3818 in combination with background chemotherapy) and Control Arm (background chemotherapy alone arm) as measured by the primary endpoint of Progression Free Survival (PFS). PFS will be evaluated by a blinded independent
    radiological review (BICR).
    Fase Ib/Parte 1 - Completada
    Determinar la DRF2 para la parte 2 de añadir AL3818 oral a la quimioterapia estándar a base de platino con carboplatino (o cisplatino) y paclitaxel en sujetos con cáncer recurrente o metastásico endometrial, uterino, ovárico, de trompas de Falopio, peritoneal primario o de cuello uterino mediante la evaluación de los acontecimientos de TLD.

    Fase IIa/Parte 2
    Medir las TRO en sujetos con cáncer recurrente o metastásico de endometrio, de útero, ovario, trompas de Falopio, peritoneal primario o cervical tratado con AL3818 en combinación con quimioterapia a base de platino u otras quimioterapias estándar.

    Fase III/Parte 3 (ALIFTUS)
    Evaluar la eficacia entre el brazo activo (AL3818 con quimioterapia) y el brazo de control (brazo de quimioterapia sola) según lo medido por la variable principal de supervivencia libre de progresión (SLP). La SLP será evaluada mediante una revisión radiológica independiente ciega (RRIC).
    E.2.2Secondary objectives of the trial
    Phase Ib/Part 1 (Completed): To investigate the safety and tolerability of adding oral AL3818 to standard platinum-based chemotherapy with carboplatin (or cisplatin) and paclitaxel.

    Phase IIa/Part 2:
    ▪ To measure CBR, PFS and OS in subjects with recurrent or metastatic endometrial or other uterine, ovarian, fallopian, primary peritoneal or cervical cancer treated with AL3818 in combination with platinum-based chemotherapy or other standard chemotherapies.
    ▪ To obtain data on safety and tolerability in subjects with recurrent or metastatic endometrial or other uterine, ovarian, fallopian, primary peritoneal or cervical cancer treated with AL3818 in combination with platinum-based chemotherapy or other standard chemotherapies.

    Phase III/Part 3 Objectives (ALIFTUS): To evaluate the efficacy between the Active Arm and Control Arm as measured by the secondary endpoints of ORR, DOR and OS. ORR will be evaluated by a blinded independent radiological review.
    Fase Ib/Parte 1 (Completada): Investigar la seguridad y la tolerabilidad de añadir AL3818 oral a una quimioterapia estándar basada en platino con carboplatino (o cisplatino) y paclitaxel.

    Fase IIa/Parte 2:
    - Medir la TBC, SLP y SG en sujetos con cáncer recurrente o metastásico de endometrio u otros tipos de cáncer de útero, ovario, trompas de Falopio, peritoneal primario o de cuello uterino tratados con AL3818 en combinación con quimioterapia a base de platino u otras quimioterapias estándar.
    - Obtener datos sobre seguridad y tolerabilidad en sujetos con cáncer recurrente o metastásico de endometrio u otros tipos de cáncer de útero, ovario, trompas de Falopio, peritoneal primario o de cuello uterino tratados con AL3818 con quimioterapia a base de platino u otras quimioterapias estándar.

    Fase III/Parte 3 (ALIFTUS)
    Evaluar la eficacia entre el brazo activo y el brazo de control medida por las variables secundarias de la TRO, DDR y SG. La TRO se evaluará mediante una RRIC.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Subjects must meet all of the following inclusion criteria to be eligible for this study:
    1. Female ≥ 18 years of age
    2. Histologically proven diagnosis of:
    a. Endometrial and other uterine cancers with tumors of all histologies
    i. Recurrent Stage I to II endometrial and other uterine cancers, after at least one prior line of standard therapy, requiring further treatment with platinumbased chemotherapy
    ii. Advanced Stage III to IV endometrial and other uterine cancers requiring treatment with platinum-based chemotherapy
    b. Ovarian Cancer: Platinum-sensitive or platinum-resistant recurrent or metastatic ovarian, fallopian, or primary peritoneal cancer treated with at least one prior line of platinum-based chemotherapy and requiring further treatment. (Part 1/Phase Ib, Part 2/Phase 2a)

    Platinum-sensitive is defined as cancer progression ≥ 6 months after platinum-based chemotherapy. Platinum-resistant is defined as cancer progression < 6 months after platinum-based chemotherapy.
    Histologic cell types eligible are endometrioid adenocarcinoma, serous adenocarcinoma, undifferentiated carcinoma, clear cell adenocarcinoma, mixed
    epithelial carcinoma, mucinous ovarian carcinoma, adenocarcinoma or any other carcinoma not otherwise specified.
    Phase III/Part 3:
    (1) Platinum-resistant (progression within 6 months after last platinum-based chemotherapy) ovarian, fallopian, or primary peritoneal cancer that meets one of the following criteria:
    i. Subject has received at least two prior lines of systemic therapy including a bevacizumab-containing regimen as standard of care
    ii. Subject has received at least two prior lines of systemic therapy, has not received a prior bevacizumab-containing regimen and is not eligible for a
    bevacizumab containing regimen based on Investigator’s assessment (2) Platinum-refractory (progression during first-line platinum-based chemotherapy) ovarian, fallopian, or primary peritoneal cancer after at least one prior line of systemic therapy
    (3) For groups 1-2 above: Subjects with positive deleterious or suspected deleterious, germline or somatic BRCA mutated status must have received a PARP inhibitor as a prior line of therapy.
    c. Cervical cancer: recurrent or metastatic cervical cancer that is not amenable to curative treatment with surgery and/or radiation therapy after at least one prior line of standard therapy, requiring further treatment.
    Histologic cell types eligible are squamous cell carcinoma, adenosquamous carcinoma or adenocarcinoma
    3. Have measurable disease defined by RECIST 1.1 confirmed by CT or MRI scan within 28 days of enrollment.
    4. Life expectancy of ≥ 3 months at the time of enrollment.
    5. Able to take orally administered study medication.
    6. Have adequate baseline function and performance status within 28 days of enrollment:
    a. Bone marrow function: absolute neutrophil count (ANC) ≥ 1,500/mm3, platelets ≥ 100,000/mm3
    b. Renal function: creatinine ≤ 1.5 x institutional upper limit normal (ULN) or if creatinine is > 1.5 x ULN, creatinine clearance must be > 50 mL/min.
    c. Hepatic function: bilirubin ≤ 1.5 x ULN or ≤ 3.0 x ULN for subjects with Gilbert Syndrome; AST and ALT ≤ 3.0 × ULN.
    d. Coagulation profile: international normalized ratio (INR) is ≤ 1.5 and an aPTT or PTT < 1.2 x ULN.
    e. ECOG performance ≤ 2
    7. Women of child-bearing potential must agree to use contraceptive measures starting 1 week before C1D1 until 4 weeks after the last dose of study treatment and have a negative serum pregnancy test within 28 days of enrollment.
    8. Provide written informed consent and authorization permitting release of Protected Health Information.
    9. Ability and willingness to comply with the study protocol for the duration of the study and with follow-up procedures.
    Los sujetos deben cumplir con todos los siguientes criterios de inclusión para ser elegibles para este estudio:
    1. Mujer ≥ 18 años
    2. Diagnóstico histológicamente probado de:
    a. Cánceres de endometrio y otros tipos de cáncer de útero con tumores de todas las histologías
    I. Cánceres de endometrio y otros tipos de cáncer de útero en estadio I a II recurrentes, después de al menos una línea previa de terapia estándar, que requieren tratamiento adicional con quimioterapia basada en platino
    ii. Cánceres de endometrio y otros tipos de cáncer de útero en estadio III a IV avanzado que requieren tratamiento con quimioterapia a base de platino
    B. Cáncer de ovario: cáncer de ovario, de Falopio o peritoneal primario recurrente o metastásico sensible al platino o resistente al platino tratado con al menos una línea previa de quimioterapia a base de platino y que requiere tratamiento adicional. (Parte 1/Fase Ib, Parte 2/Fase 2a)

    La sensibilidad al platino se define como la progresión del cáncer ≥ 6 meses después de la quimioterapia basada en platino. La resistencia al platino se define como la progresión del cáncer <6 meses después de la quimioterapia basada en platino.
    Los tipos de células histológicas elegibles son adenocarcinoma endometrioide, adenocarcinoma seroso, carcinoma indiferenciado, adenocarcinoma de células claras,
    carcinoma epitelial, carcinoma mucinoso de ovario, adenocarcinoma o cualquier otro carcinoma no especificado de otra manera.
    Fase III/Parte 3:
    (1) Cáncer de ovario, de Falopio o peritoneal primario resistente al platino (progresión dentro de los 6 meses posteriores a la última quimioterapia basada en platino) que cumple con uno de los siguientes criterios:
    I. El sujeto ha recibido al menos dos líneas previas de terapia sistémica, incluido un régimen que contiene bevacizumab como estándar de atención.
    ii. El sujeto ha recibido al menos dos líneas previas de terapia sistémica, no ha recibido un régimen previo que contenga bevacizumab y no es elegible para un régimen que contiene bevacizumab basado en la evaluación del investigador (2) cáncer de ovario, de Falopio o peritoneal primario refractario al platino (progresión durante la quimioterapia de primera línea basada en platino) después de al menos una línea previa de terapia sistémica
    (3) Para los grupos 1-2 anteriores: Los sujetos con estado de mutación de BRCA somático o de línea germinal deletérea positiva o sospechosa de ser deletérea, deben haber recibido un inhibidor de PARP como una línea de terapia previa.
    C. Cáncer de cuello uterino: cáncer de cuello uterino recurrente o metastásico que no es susceptible de tratamiento curativo con cirugía y/o radioterapia después de al menos una línea previa de terapia estándar, que requiere tratamiento adicional.
    Los tipos de células histológicas elegibles son carcinoma de células escamosas, carcinoma adenoescamoso o adenocarcinoma.
    3. Tener la enfermedad medible definida por RECIST 1.1 confirmada por tomografía computarizada o resonancia magnética dentro de los 28 días anteriores a la inclusión.
    4. Esperanza de vida ≥ 3 meses en el momento de la inclusión.
    5. Capaz de tomar la medicación del estudio administrada por vía oral.
    6. Tener una función basal y un estado funcional adecuados dentro de los 28 días anteriores a la inclusión:
    A. Función de la médula ósea: recuento absoluto de neutrófilos (RAN) ≥ 1.500/mm3, plaquetas ≥ 100.000/mm3
    B. Función renal: creatinina ≤ 1,5 x límite superior normal institucional (LSN) o si la creatinina es> 1,5 x LSN, el aclaramiento de creatinina debe ser> 50 ml/min.
    C. Función hepática: bilirrubina ≤ 1,5 x LSN o ≤ 3,0 x LSN para sujetos con síndrome de Gilbert; AST y ALT ≤ 3,0 × LSN.
    D. Perfil de coagulación: el índice internacional normalizado (INR) es ≤ 1,5 y un aPTT o PTT <1,2 x LSN.
    e. Rendimiento ECOG ≤ 2
    7. Las mujeres en edad fértil deben aceptar el uso de medidas anticonceptivas comenzando 1 semana antes de C1D1 hasta 4 semanas después de la última dosis del tratamiento del estudio y tener una prueba de embarazo en suero negativa dentro de los 28 días anteriores a la inclusión.
    8. Proporcionar autorización y consentimiento informado por escrito que permitan la divulgación de información médica protegida.
    9. Capacidad y voluntad de cumplir con el protocolo del estudio durante la duración del estudio y con los procedimientos de seguimiento.
    E.4Principal exclusion criteria
    Subjects presenting with any of the following will not be included in the study:
    1. Serious, non-healing wound, ulcer or bone fracture.
    2. Major surgical procedure within 28 days or minor surgical procedure performed within 7 days prior to C1D1 (a major surgical procedure is defined as requiring general anesthesia).
    3. (Intentionally left blank)
    4. Active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels.
    5. History or evidence upon physical examination of central nervous system (CNS) disease including primary brain tumor; seizures not controlled with standard medical therapy; and history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA), or subarachnoid hemorrhage within 6 months of enrollment.
    a. Subjects with metastatic CNS tumors may participate in this study if the subject is > 28 days from therapy completion (including radiation and/or surgery), is clinically stable at the time of study enrollment, and is not receiving corticosteroid therapy.
    6. Proteinuria on urinalysis within 28 days of enrollment. Subjects discovered to have a urine protein of 1+ on dipstick or ≥ 30 mg/dl at baseline should undergo a 24-hour urine collection and demonstrate < 1000 mg protein per 24 hours or spot urine protein (mg/dL) to creatinine (mg/dL) ratio must be <1.0 to allow participation in the study.
    7. Clinically significant cardiovascular disease including uncontrolled hypertension; myocardial infarction or unstable angina within 6 months prior to enrollment; New York Heart Association (NYHA) Grade II or greater congestive heart failure (Appendix E); serious cardiac arrhythmia requiring medication; and Grade II or greater peripheral vascular disease.
    8. Women who are pregnant or nursing.
    9. (Intentionally left blank)
    10. Clinically significant, uncontrolled hypokalemia, hypomagnesaemia, and/or hypocalcaemia.
    11. Hemoptysis within 3 months prior to enrollment.
    12. Acute or chronic liver disease, active hepatitis A or B with known cirrhosis or liver dysfunction.
    13. Cytotoxic chemotherapy, immunotherapy, or radiotherapy within 28 days (42 days in cases of mitomycin C, nitrosourea, lomustine) prior to enrollment.
    14. Concomitant treatment with strong inhibitors or inducers of CYP3A4, CYP2C9 and CYP2C19 within 14 days prior to enrollment and during the study unless there is an emergent or lifethreatening medical condition that required it.
    15. Known history of human immunodeficiency virus infection (HIV).
    16. Active bacterial infections requiring systemic antibiotics (excluding uncomplicated urinary tract infection).
    17. Other invasive malignancies, with the exception of non-melanoma skin cancer, who had (or have) any evidence of other cancer present within the last 5 years prior to enrollment or whose previous cancer treatment contraindicates this protocol therapy.
    18. History of non-malignant gastrointestinal bleeding, gastric stress ulcerations, or peptic ulcer disease within the past 3-months prior to enrollment that in the opinion of the investigator may place the subject at risk of side effects on an anti-angiogenesis product.
    19. History of significant vascular disease (e.g. aortic aneurysm, aortic dissection).
    20. Intra-abdominal abscess within the last 3 months of enrollment.
    21. Pre-existing uncontrolled hypertension as documented by two baseline blood pressure readings taken at least five minutes apart, defined as systolic BP >160 mm Hg or diastolic BP > 90 mm Hg pressure.
    22. QTc > 470 msec on screening ECG per Fridericia’s formula.
    23. History of or existing risk factors for Torsades de pointes (TdP) (e.g., heart failure, hypokalemia, family history of Long QT Syndrome).
    24. Concurrent use of concomitant medications that prolong the QT/QTc interval.
    25. Baseline echocardiogram (within 56 days of enrollment) with left ventricular ejection fraction (LVEF) < 50%.
    26. History of difficulty swallowing, malabsorption, active partial or complete bowel obstruction, or other chronic gastrointestinal disease or condition that may hamper compliance and/or absorption of AL3818.
    27. History of pancreatitis; history of renal disease that includes histologically confirmed glomerulonephritis, biopsy proven tubulointerstitial nephritis, crystal nephropathy or other renal insufficiencies.
    28. Treatment with an investigational agent within 28 days of enrollment.
    29. Known recreational substance abuse.
    30. Anticoagulation therapy with warfarin. Subjects treated with heparin, low molecular weight heparin, or any other anticoagulant may be included provided the subject has been on a stable therapeutic dose of the anticoagulant for at least 14 days prior to enrollment.
    31. Known hypersensitivity to AL3818 or components of the formulation.
    1.Herida, úlcera o fractura ósea grave que no cicatriza.
    2.Procedimiento quirúrgico mayor en los 28 días o procedimiento quirúrgico menor en los 7 días previos a C1D1 (un procedimiento quirúrgico mayor se define como que requiere anestesia general).
    3.(En blanco adrede)
    4.Hemorragia activa o afecciones patológicas que conllevan un alto riesgo de hemorragia, como trastorno hemorrágico conocido, coagulopatía o tumor que afecte a los vasos principales.
    5.Historia o evidencia en el examen físico de enfermedad del SNC incluyendo tumor cerebral primario; convulsiones no controladas con la terapia médica estándar; y antecedentes de ACV, AIT o hemorragia subaracnoidea en los 6 meses previos a la inclusión.
    a.Los sujetos con tumores metastásicos del SNC pueden participar en este estudio si el sujeto está a > 28 días de la finalización de la terapia (incluida la radiación o la cirugía), está clínicamente estable en el momento de la inclusión en el estudio y no está recibiendo tratamiento con corticosteroides.
    6.Proteinuria en el análisis de orina en los 28 días anteriores a la inclusión. Los sujetos a los que se descubra que tienen una proteína en orina de 1+ en la tira reactiva o ≥ 30 mg/dl al inicio del estudio deben someterse a una recolección de orina de 24 horas y demostrar <1000 mg de proteína por 24 horas o detectar proteína en la orina (mg/dL) a creatinina (mg/dL) debe ser <1.0 para permitir la participación en el estudio.
    7.Enfermedad cardiovascular clínicamente significativa, incluida la hipertensión no controlada; infarto de miocardio o angina inestable dentro de los 6 meses anteriores a la inclusión; Insuficiencia cardíaca congestiva de grado II o superior de la NYHA (Apéndice E); arritmia cardíaca grave que requiere medicación; y enfermedad vascular periférica de grado II o mayor.
    8.Mujeres embarazadas o en período de lactancia.
    9.(En blanco adrede)
    10.Hipopotasemia, hipomagnesemia y/o hipocalcemia no controladas y clínicamente significativas.
    11.Hemoptisis en los 3 meses previos a la inclusión.
    12.Enfermedad hepática aguda o crónica, hepatitis A o B activa con cirrosis conocida o disfunción hepática.
    13.Quimioterapia citotóxica, inmunoterapia o radioterapia en de los 28 días (42 días en casos de mitomicina C, nitrosourea, lomustina) antes de la inclusión.
    14.Tratamiento concomitante con inhibidores o inductores potentes de CYP3A4, CYP2C9 y CYP2C19 en los 14 días previos a la inclusión y durante el estudio, a menos que exista una afección médica emergente o potencialmente mortal que lo requiera.
    15.Infección por VIH.
    16.Infecciones bacterianas activas que requieren antibióticos sistémicos (excluyendo la infección del tracto urinario no complicada).
    17.Otras neoplasias invasivas, con la excepción del cáncer de piel no melanoma, que han tenido (o tienen) cualquier evidencia de otro cáncer presente en los últimos 5 años antes de la inclusión o cuyo tratamiento previo contra el cáncer contraindica esta terapia de protocolo.
    18.Antecedentes de hemorragia gastrointestinal no maligna, úlceras por estrés gástrico o enfermedad de úlcera péptica en los últimos 3 meses antes de la inclusión que, en opinión del investigador, pueden poner al sujeto en riesgo de sufrir efectos secundarios con un producto antiangiogénico.
    19.Historia de enfermedad vascular significativa (por ej., aneurisma aórtico, disección aórtica).
    20.Absceso intraabdominal en los últimos 3 meses previos a la inclusión.
    21.Hipertensión preexistente no controlada documentada por dos lecturas de la presión arterial basal tomadas con al menos cinco minutos de diferencia, definida como PAS >160 mm Hg o PAD >90 mm Hg de presión.
    22.QTc> 470 mseg en ECG de detección según la fórmula de Fridericia.
    23.Antecedentes o factores de riesgo existentes para TdP (por ejemplo, insuficiencia cardíaca, hipopotasemia, antecedentes familiares de síndrome de QT largo).
    24.Uso concurrente de medicamentos concomitantes que prolongan el intervalo QT/QTc.
    25.Ecocardiograma basal (en los 56 días previos a la inclusión) con FEVI <50%.
    26.Antecedentes de dificultad para tragar, malabsorción, obstrucción intestinal activa parcial o completa u otra enfermedad o afección gastrointestinal crónica que pueda obstaculizar el cumplimiento y/o la absorción de AL3818.
    27.Historia de pancreatitis; antecedentes de enfermedad renal que incluyen glomerulonefritis confirmada histológicamente, nefritis tubulointersticial comprobada por biopsia, nefropatía por cristales u otras insuficiencias renales.
    28.Tratamiento con un agente en investigación en los 28 días previos a la inclusión.
    29.Abuso de sustancias recreativas.
    30.Terapia de anticoagulación con warfarina. Pueden incluirse sujetos tratados con heparina, heparina de bajo peso molecular o cualquier otro anticoagulante, siempre que el sujeto haya recibido una dosis terapéutica estable del anticoagulante durante al menos 14 días antes de la inclusión.
    31.Hipersensibilidad conocida a AL3818 o sus componentes.
    E.5 End points
    E.5.1Primary end point(s)
    Phase Ib/Part 1 – Completed
    To determine the RP2D for part 2 of adding oral AL3818 to standard platinum-based chemotherapy with carboplatin (or cisplatin) and paclitaxel in subjects with recurrent or metastatic endometrial or other uterine, ovarian, fallopian, primary peritoneal or cervical cancer via evaluation of DLT events.

    Phase IIa/Part 2
    Objective Tumor Response Rate (ORR) is defined as the proportion of subjects who achieve Complete Response (CR) or Partial Response (PR) as best responses according to RECIST 1.1.

    Phase III/Part 3 Objectives (ALIFTUS)
    To evaluate the efficacy between the Active Arm (AL3818 in combination with background chemotherapy) and Control Arm (background chemotherapy alone arm) as measured by the primary endpoint of Progression Free Survival (PFS). PFS will be evaluated by a blinded independent
    radiological review (BICR).
    Fase Ib/Parte 1 - Completada
    Determinar la DRF2 para la parte 2 de añadir AL3818 oral a la quimioterapia estándar a base de platino con carboplatino (o cisplatino) y paclitaxel en sujetos con cáncer recurrente o metastásico endometrial, uterino, ovárico, de trompas de Falopio, peritoneal primario o de cuello uterino mediante la evaluación de los acontecimientos de TLD.

    Fase IIa/Parte 2
    La tasa de respuesta tumoral objetiva (TRO) se define como la proporción de sujetos que logran respuesta completa (RC) o respuesta parcial (RP) como mejores respuestas según RECIST 1.1.

    Fase III/Parte 3 (ALIFTUS)
    Evaluar la eficacia entre el brazo activo (AL3818 con quimioterapia) y el brazo de control (brazo de quimioterapia sola) según lo medido por la variable principal de supervivencia libre de progresión (SLP). La SLP será evaluada mediante una revisión radiológica independiente ciega (RRIC).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Phase Ib/Part 1: C1D8 to C1D21, C2D8

    Phase IIa/Part 2: Baseline/screening, C4D1, C8D1, C10D1, C12D1, C16D1, C20D1, C24D1

    Phase III/Part 3: Baseline/screening, C3D1, C5D1, C8D1, C11D1, C15D1, C19D1, C24D1
    Fase Ib/Parte 1: C1D8 a C1D21, C2D8

    Fase IIa/Parte 2: Basal/screening, C4D1, C8D1, C10D1, C12D1, C16D1, C20D1, C24D1

    Fase III/Parte 3: Basal/screening, C3D1, C5D1, C8D1, C11D1, C15D1, C19D1, C24D1
    E.5.2Secondary end point(s)
    Phase Ib/Part 1 (Completed): To investigate the safety and tolerability of adding oral AL3818 to standard platinum-based chemotherapy with carboplatin (or cisplatin) and paclitaxel.

    Phase IIa/Part 2
    1. Clinical Benefit Rate (CBR) is defined as the proportion of subjects who achieve a Complete Response (CR), Partial Response (PR) or Stable Disease (SD) as best responses according to RECIST 1.1.
    2. Progression-Free Survival (PFS) is defined as the median number of months from the date of C1D1 until the first documented sign of disease progression or death due to any causes, whichever occurs earlier.
    3. Overall Survival (OS) is defined as the time from C1D1 until death from any cause.

    Phase III/Part 3 Objectives (ALIFTUS): To evaluate the efficacy between the Active Arm and Control Arm as measured by the secondary endpoints of ORR, DOR and OS. ORR will be evaluated by a blinded independent radiological review.
    Fase Ib/Parte 1 (Completada): Investigar la seguridad y la tolerabilidad de añadir AL3818 oral a una quimioterapia estándar basada en platino con carboplatino (o cisplatino) y paclitaxel.

    Fase IIa/Parte 2:
    1. La tasa de beneficio clínico (TBC) se define como la proporción de sujetos que logran una respuesta completa (RC), respuesta parcial (RP) o enfermedad estable (EE) como mejores respuestas según RECIST 1.1.
    2. La supervivencia libre de progresión (SLP) se define como la mediana del número de meses desde la fecha de C1D1 hasta el primer signo documentado de progresión de la enfermedad o muerte por cualquier causa, lo que ocurra antes.
    3. La supervivencia global (SG) se define como el tiempo desde C1D1 hasta la muerte por cualquier causa.

    Fase III/Parte 3 (ALIFTUS)
    Evaluar la eficacia entre el brazo activo y el brazo de control medida por las variables secundarias de la TRO, DDR y SG. La TRO se evaluará mediante una RRIC.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Phase Ib/Part 1: C1D1 to EoT
    Phase IIa/Part 2: Baseline/screening, C4D1, C8D1, C10D1, C12D1, C16D1, C20D1, C24D1
    Phase III/Part 3: Baseline/screening, C3D1, C5D1, C8D1, C11D1, C15D1, C19D1, C24D1
    OS: from C1D1 until death from any cause.
    Fase Ib/Parte 1: C1D1 a EoT
    Fase IIa/Parte 2: Basal/screening, C4D1, C8D1, C10D1, C12D1, C16D1, C20D1, C24D1
    Fase III/Parte 3: Basal/screening, C3D1, C5D1, C8D1, C11D1, C15D1, C19D1, C24D1
    SG: desde C1D1 hasta la muerte por cualquier causa
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic 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) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    RP2D
    E.7.2Therapeutic exploratory (Phase II) Yes
    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 Yes
    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 trial4
    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 concerned2
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA 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
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    Última visita del último paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months5
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years9
    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: 420
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 49
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    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 state50
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 50
    F.4.2.2In the whole clinical trial 469
    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)
    Compassionate care past 24 cycles or at trial closing: Any subject who has not progressed after 24 cycles of AL3818 therapy or at trial closing may continue AL3818, at the discretion of the investigator, until disease progression or unacceptable toxicity as part of compassionate care. If the subject continues into compassionate care in this study, the subject should still have a Final Study Visit 4-5 weeks after the completion of C24 or at trial closing.
    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 Decision2021-11-11
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-10-14
    P. End of Trial
    P.End of Trial StatusOngoing
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