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    Summary
    EudraCT Number:2021-004008-16
    Sponsor's Protocol Code Number:20190172
    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:2021-11-19
    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 number2021-004008-16
    A.3Full title of the trial
    A Phase 3 Multicenter, Randomized, Open-label, Active-controlled Study of Sotorasib and Panitumumab Versus Investigator’s Choice (Trifluridine and Tipiracil, or Regorafenib) for the Treatment of Previously Treated Metastatic Colorectal Cancer Subjects with KRAS p.G12C Mutation
    Estudio de fase 3 multicéntrico, aleatorizado, abierto y con control activo de sotorasib y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib) para el tratamiento de sujetos con cáncer colorrectal metastásico con la mutación p.G12C en el KRAS tratados previamente
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Sotorasib and Panitumumab Versus Investigator’s Choice for Subjects with KRAS p.G12C Mutation
    Sotorasib y panitumumab frente al tratamiento de elección del investigador para los sujetos con la mutación p.G12C en el KRAS
    A.3.2Name or abbreviated title of the trial where available
    Sotorasib and Panitumumab Versus Investigator’s Choice for Subjects with KRAS p.G12C Mutation
    Sotorasib y panitumumab frente al tratamiento de elección en sujetos con mutación KRAS G12C
    A.4.1Sponsor's protocol code number20190172
    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 SponsorAmgen, 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 supportAmgen Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAmgen S.A.
    B.5.2Functional name of contact pointIHQ medical Info-Clinical Trials
    B.5.3 Address:
    B.5.3.1Street AddressWTC Barcelona, Moll de Barcelona s/n, Edifici Sud, 7a planta
    B.5.3.2Town/ cityBarcelona
    B.5.3.3Post code08039
    B.5.3.4CountrySpain
    B.5.4Telephone number+34936001860
    B.5.6E-mailinformacion.medica.es@amgen.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 nameSotorasib
    D.3.2Product code AMG 510
    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.3.9.2Current sponsor codeAMG 510
    D.3.9.4EV Substance CodeSUB197397
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Vectibix 20mg/ml concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderAmgen Europe B.V.
    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 namePanitumumab
    D.3.2Product code AMG 954
    D.3.4Pharmaceutical form 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 INNPanitumumab
    D.3.9.1CAS number 339177-26-3
    D.3.9.2Current sponsor codeAMG 954
    D.3.9.4EV Substance CodeSUB25390
    D.3.10 Strength
    D.3.10.1Concentration unit mg/kg milligram(s)/kilogram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    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: 3
    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 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.3.9.4EV 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.IMP: 4
    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 Lonsurf
    D.2.1.1.2Name of the Marketing Authorisation holderLes Laboratoires Servier
    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 nametrifluridine/tipiracil
    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 INNTrifluridine
    D.3.9.3Other descriptive nameTrifluridine
    D.3.9.4EV Substance CodeSUB11291MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTipiracil
    D.3.9.3Other descriptive nameTIPIRACIL HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB174132
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6.14
    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: 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 Lonsurf
    D.2.1.1.2Name of the Marketing Authorisation holderLes Laboratoires Servier
    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 nametrifluridine/tipiracil
    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 INNTrifluridine
    D.3.9.3Other descriptive nameTrifluridine
    D.3.9.4EV Substance CodeSUB11291MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTipiracil
    D.3.9.3Other descriptive nameTIPIRACIL HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB174132
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number8.19
    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
    Previously Treated Metastatic Colorectal Cancer Subjects with KRAS p.G12C Mutation
    Sujetos con cáncer colorrectal metastático con mutación en KRAS G12C previamente tratados
    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
    •To compare progression free survival (PFS) in previously treated subjects with KRAS p.G12C mutated colorectal cancer (CRC) receiving sotorasib 240 mg once daily (QD) and panitumumab vs investigator’s choice (trifluridine and tipiracil or regorafenib), and sotorasib 960 mg QD and panitumumab vs investigator’s choice (trifluridine and tipiracil or regorafenib)
    • Comparar la supervivencia libre de progresión (SLP) en los sujetos tratados previamente con cáncer colorrectal (CCR) con la mutación p.G12C en el KRAS que recibieron 240 mg de sotorasib una vez al día (QD) y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib) y 960 mg de sotorasib QD y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib).
    E.2.2Secondary objectives of the trial
    Key Secondary
    •To compare overall survival (OS) in previously treated subjects with KRAS p.G12C mutated CRC receiving sotorasib 240 mg QD and panitumumab vs investigator’s choice (trifluridine and tipiracil or regorafenib), and sotorasib 960 mg QD and panitumumab vs investigator’s choice (trifluridine and tipiracil or regorafenib)
    •To evaluate efficacy of sotorasib 240 mg QD and panitumumab vs investigator’s choice (trifluridine and tipiracil or regorafenib), and sotorasib 960 mg QD and panitumumab vs investigator’s choice (trifluridine and tipiracil or regorafenib), as assessed by:
    •Objective response rate (ORR)
    • Comparar la supervivencia global (SG) en los sujetos tratados previamente con CCR con la mutación p.G12C en el KRAS que recibieron 240 mg de sotorasib QD y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib) y 960 mg de sotorasib QD y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib).
    • Evaluar la eficacia de 240 mg de sotorasib QD y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib) y de 960 mg de sotorasib QD y panitumumab frente al tratamiento de elección del investigador (trifluridina y tipiracilo o regorafenib) según:
    - La tasa de respuesta objetiva (TRO).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    101Subject has provided informed consent/assent prior to initiation of any study specific activities/procedures.
    102Age ≥ 18 years
    103Pathologically documented metastatic colorectal adenocarcinoma with KRAS p.G12C mutation as determined by central testing
    104Subjects will have received at least 1 prior line of therapy for metastatic disease. Subjects must have received and progressed or experienced disease recurrence on or after fluoropyrimidine, irinotecan, and oxaliplatin given for metastatic disease unless the subject, in the opinion of the investigator, is not a candidate for fluoropyrimidine, irinotecan, or oxaliplatin, in which case, the subject may be eligible after investigator discussion with Amgen medical monitor provided subject has received at least one prior line of therapy for metastatic disease and provided trifluridine and tipiracil or regorafenib is deemed the appropriate next line of therapy for the subject.
    Notes: Subjects with tumors known to be MSI-H must have received prior checkpoint inhibitor therapy if available in the region unless there is a medical contraindication, in which case, the subject may be eligible after investigator discussion with Amgen medical monitor.
    Subjects with tumors known to have BRAF V600E mutation must have received prior treatment with encorafenib and cetuximab if available for this indication in the country or region.
    Adjuvant therapy will count as a line of therapy for metastatic disease if the subject progressed on or within six months of completion of adjuvant therapy administration.
    Maintenance therapy is not considered as a separate regimen of therapy
    Adjuvant therapy given after resection of metastatic disease counts as a line of therapy for metastatic disease
    Perioperative chemotherapy with or without chemoradiation in the metastatic setting will count as one line of therapy for metastatic disease if that was part of a multidisciplinary treatment plan for surgery
    105Subjects must be willing to provide archived tumor tissue samples (formalin-fixed paraffin-embedded [FFPE] sample collected within 5 years) or agree to undergo a pretreatment tumor biopsy (excisional or core biopsy) prior to enrollment.
    106Measurable disease per RECIST 1.1 criteria. Lesions previously radiated are not considered measurable unless they have progressed after radiation.
    107Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2
    108Life expectancy of > 3 months, in the opinion of the investigator
    109Adequate hematologic and end-organ function, defined as the following within 10 days prior to randomization:
    Absolute neutrophil count (ANC) ≥ 1.5 x 109/L (without granulocyte colony stimulating factor support within 2 weeks of laboratory test used to determine eligibility)
    Hemoglobin ≥ 9.0 g/dL (without transfusion within 2 weeks of laboratory test used to determine eligibility)
    Platelet count ≥ 100 x 109/L (without transfusion within 2 weeks of laboratory test used to determine eligibility)
    Aspartate aminotransferase (AST) and ALT ≤ 2.5 times the upper limit of normal (ULN)
    Serum bilirubin ≤ 1.0 x ULN. For subjects with Gilbert’s disease, direct bilirubin ≤ 1.0 x ULN
    International normalized ratio (INR) and activated partial thromboplastin time (or partial thromboplastin time) ≤ 1.5 x ULN. Prothrombin time (PT) ≤ 1.5 x ULN may be used instead of INR for sites whose labs do not report INR.
    Estimated glomerular filtration rate based on Modification of Diet in Renal Disease (MDRD) calculation ≥ 30 mL/min/1.73 m2
    110Fridericia's Correction Formula (QTcF) ≤ 470 msec
    111Ability to take oral medications and willing to record daily adherence to investigational product
    101 El sujeto ha proporcionado su consentimiento informado/asentimiento antes de iniciar cualquier procedimiento/actividad específicos del estudio.
    102 Edad ≥ 18 años.
    103 Adenocarcinoma colorrectal metastásico anatomopatológicamente documentado con la mutación p.G12C en el KRAS determinada mediante pruebas realizadas en el laboratorio central.
    104 Los sujetos habrán recibido al menos 1 línea de tratamiento previa para la enfermedad metastásica. Los sujetos deben haber recibido y progresado o experimentado recurrencia de la enfermedad durante o después de la administración de fluoropirimidina, irinotecán y oxaliplatino para la enfermedad metastásica, a no ser que el sujeto, en opinión del investigador, no sea candidato para recibir fluoropirimidina, irinotecán u oxaliplatino, en cuyo caso, el sujeto puede ser elegible si el investigador lo considera oportuno después de consultarlo con el monitor médico de Amgen, siempre que el sujeto haya recibido al menos una línea de tratamiento previa para la enfermedad metastásica y que el tratamiento con trifluridina y tipiracilo o regorafenib se considere la siguiente línea de tratamiento adecuada para el sujeto.
    Notas: los sujetos con tumores conocidos con MSI-H deben haber recibido tratamiento previo con inhibidores de los puntos de control si están disponibles en la región en cuestión, a no ser que exista una contraindicación médica, en cuyo caso, el sujeto puede ser elegible si el investigador lo considera oportuno después de consultarlo con el monitor médico de Amgen.
    Los sujetos con tumores que se sabe que presentan la mutación BRAFV600E deben haber recibido tratamiento previo con encorafenib y cetuximab si está disponible para esta indicación en el país o la región en cuestión.
    • El tratamiento adyuvante contará como una línea de tratamiento para la enfermedad metastásica si el sujeto progresa durante o en los seis meses posteriores a la finalización de la administración del tratamiento adyuvante.
    • El tratamiento de mantenimiento no se considera un régimen de tratamiento distinto.
    • El tratamiento adyuvante administrado después de la resección de la enfermedad metastásica cuenta como una línea de tratamiento para la enfermedad metastásica.
    • La quimioterapia perioperatoria con o sin quimiorradiación en el contexto metastásico contará como una línea de tratamiento para la enfermedad metastásica si esta formaba parte de un plan de tratamiento multidisciplinario para la cirugía.
    105 Los sujetos deben estar dispuestos a proporcionar muestras de tejido tumoral archivadas (muestra incluida en parafina y fijada con formol [FFPE] obtenida en los 5 años previos) o a someterse a una biopsia tumoral previa al tratamiento (biopsia por escisión o con aguja gruesa) antes de la inclusión.
    106 Enfermedad medible según los criterios RECIST v. 1.1. Las lesiones previamente radiadas no se consideran medibles, a no ser que hayan progresado tras la radiación.
    107 Estado funcional del Eastern Cooperative Oncology Group (ECOG) ≤ 2.
    108 Esperanza de vida > 3 meses, en opinión del investigador.
    109 Función hematológica y orgánica adecuada, definida de la manera siguiente durante los 10 días previos a la aleatorización:
    • Recuento absoluto de neutrófilos (RAN) ≥ 1,5 x 109/l (sin tratamiento de apoyo con factor estimulante de las colonias de granulocitos en las 2 semanas previas a la prueba analítica utilizada para determinar la elegibilidad).
    • Hemoglobina ≥ 9,0 g/dl (sin transfusión en las 2 semanas previas a la prueba analítica utilizada para determinar la elegibilidad).
    • Recuento plaquetario ≥ 100 x 109/l (sin transfusión en las 2 semanas previas a la prueba analítica utilizada para determinar la elegibilidad).
    • Aspartato aminotransferasa (AST) y ALT ≤ 2,5 veces el límite superior de la normalidad (LSN).
    • Bilirrubina sérica ≤ 1,0 x LSN. En el caso de los sujetos con enfermedad de Gilbert, bilirrubina directa ≤ 1,0 x LSN.
    • Cociente internacional normalizado (INR) y tiempo de tromboplastina parcial activada (o tiempo de tromboplastina parcial) ≤ 1,5 x LSN. Se puede utilizar el tiempo de protrombina (TP) ≤ 1,5 x LSN en lugar del INR en los centros cuyos laboratorios no informan del INR.
    • Tasa de filtración glomerular estimada basada en el cálculo de modificación de la dieta en la enfermedad renal (MDRD) ≥ 30 ml/min/1,73 m2.
    110 Fórmula de corrección de Fridericia (QTcF) ≤ 470 ms.
    111 Tener la capacidad de recibir medicamentos por vía oral y estar dispuesto a registrar diariamente la adherencia al producto en investigación.
    E.4Principal exclusion criteria
    201Active brain metastases. Subjects who have had brain metastases resected or have received radiation therapy ending at least 4 weeks prior to study day 1 are eligible if they meet all of the criteria specified in the protocol
    202History or presence of hematological malignancies unless curatively treated with no evidence of disease 2 years
    203History of other malignancy within the past 3 years, with exceptions specified in the protocol
    204Leptomeningeal disease
    205Significant GI disorder that results in significant malabsorption, requirement for IV alimentation, or inability to take oral medication
    206History of interstitial pneumonitis or pulmonary fibrosis or evidence of interstitial pneumonitis or pulmonary fibrosis
    207Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction within 6 months prior to randomization, unstable arrhythmias or unstable angina
    208Significant uncontrolled concomitant disease that could affect compliance with protocol procedures or interpretation of results or that pose a risk to subject safety, in the opinion of the investigator or Amgen medical monitor
    209Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures at a frequency greater than monthly. Subjects with PleurX catheters or intraperitoneal drainage catheters in place may be considered for the study with Medical Monitor approval.
    210Known history of human immunodeficiency virus infection
    211Exclusion of hepatitis infection based on the following results and/or criteria:
    a) Positive hepatitis B surface antigen
    b) Negative HepBsAg with a positive for hepatitis B core antibody
    c) Positive Hepatitis C virus antibody: Hepatitis C virus RNA by polymerase chain reaction is necessary. Detectable Hepatitis C virus RNA renders the subject ineligible.
    If above antibody/antigen testing is not able to be obtained, positive hepatitis B or C viral load
    212Subjects have received both trifluridine and tipiracil and regorafenib in the past
    213Unresolved toxicities from prior anti-tumor therapy, defined as not having resolved to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 grade 0 or 1, or to levels dictated in the eligibility criteria with the exceptions of alopecia (any grade allowed), neuropathy (up to grade 2 allowed), or toxicities from prior anti-tumor therapy that are considered irreversible (defined as having been present and stable for > 6 months), or endocrine adverse events that are stably maintained on appropriate replacement therapy
    214Previous treatment with a KRAS G12C inhibitor
    215Prior treatment with trifluridine and tipiracil in those subjects where investigator’s choice would be trifluridine and tipiracil
    216Prior treatment with regorafenib in those subjects where investigator’s choice would be regorafenib
    217Therapeutic or palliative radiation therapy within 2 weeks of study day 1. Subjects must have recovered from all radiotherapy related toxicity to CTCAE version 5.0 grade 1 or less with the exception of alopecia (any grade of alopecia allowed).
    218Anti-tumor therapy (chemotherapy, antibody therapy, molecular targeted therapy, retinoid therapy, hormonal therapy [except for subjects with history of completely resected breast cancer with no active disease for over 3 years on long term adjuvant endocrine therapy], or investigational agent) within 4 weeks of study day 1; please note that bisphosphonates or anti-RANKL antibody therapy is allowed if needed for management of hypercalcemia or for prevention of skeletal events. Checkpoint inhibitor therapy within 6 weeks of study day 1 is also excluded.
    219Required dose reduction of panitumumab in the past for toxicity
    220Use of warfarin. Other anticoagulation may be allowed
    221Use of known cytochrome P450 (CYP) 3A4 sensitive substrates and P-glycoprotein (P-gp) substrates (with a narrow therapeutic window), within 14 days or 5 half-lives of the drug or its major active metabolite, whichever is longer, prior to study day 1 that was not reviewed and approved by the principal investigator and the Amgen medical monitor
    222Use of strong inducers of CYP3A4 within 14 days or 5 half-lives prior to study day 1 that was not reviewed and approved by the principal investigator and the Amgen medical monitor
    223Where Investigator’s choice is regorafenib: use of strong inhibitors of CYP3A4 (including herbal supplements such as Goldenseal) within 14 days or 5 half-lives (whichever is longer) or grapefruit juice or grapefruit containing products within 7 days prior to study day 1 that was not reviewed and approved by the principal investigator and the Amgen medical monitor.
    224Therapeutic oral or IV antibiotics within 2 weeks prior to randomization. Prophylactic antibiotics are allowed.
    201Metástasis cerebrales activas.Sujetos con metástasis cerebrales resecadas o que han recibido radioterapia hasta al menos 4semanas antes del día 1 del estudio son elegibles si cumplen los criterios especificados en protocolo
    202Antecedentes o presencia de neoplasias malignas hematológicas,a menos que se hayan tratado con intención curativa sin indicios de enfermedad durante ≥ 2 años
    203Antecedentes de otras neoplasias malignas en los últimos 3años(excepciones especificadas en protocolo)
    204Enfermedad leptomeníngea
    205Trastorno GI significativo que produce malabsorción significativa,necesidad de alimentación IV o incapacidad de recibir medicación por VO
    206Antecedentes de neumonitis intersticial o fibrosis pulmonar o evidencia de neumonitis intersticial o fibrosis pulmonar
    207Enfermedad cardiovascular significativa,como cardiopatía (clase II o > criterios NYHA), infarto de miocardio 6meses previos a aleatorización,arritmias inestables o angina inestable
    208Enfermedad concomitante significativa no controlada que pueda afectar al cumplimiento de los procedimientos del protocolo o la interpretación de los resultados o que sea un riesgo para la seguridad del sujeto,en opinión del IP o monitor de Amgen
    209Derrame pleural no controlado/derrame pericárdico/ascitis que requiera procedimientos de drenaje recurrentes > 1 vez al mes.Se puede considerar la inclusión de sujetos con catéteres PleurX o catéteres de drenaje intraperitoneal implantados tras aprobación del monitor
    210Antecedentes conocidos de infección VIH
    211Exclusión de la infección por hepatitis según los resultados y/o criterios siguientes:
    -Positivo para HepBsAg
    -Negativo para el HepBsAg y positivo para el Ac del núcleo de la hepatitis B
    -Positivo para Ac de hepatitis C: se requiere determinar el ARN del virus de la hepatitis C mediante PCR. La detección del ARN del virus de la hepatitis C hace inelegible al sujeto
    Si no se pueden realizar las pruebas de Ac/Ag mencionadas,la carga vírica para la hepatitis B o C se debe considerar positiva.
    212Haber recibido trifluridina, tipiracilo y regorafenib en el pasado
    213Se permiten toxicidades no resueltas derivadas de un tto antitumoral previo, definidas por no haberse resuelto hasta el grado 0 o 1 de los CTCAE v5.0, o hasta los niveles dictados en los criterios de elegibilidad, con excepción de alopecia (se permite cualquier grado),neuropatía (se permite hasta el grado 2) o toxicidades derivadas de un tto antitumoral previo que se consideren irreversibles (haber estado presentes y estables durante > 6meses) o AA endocrinos que se mantengan estables con el tto sustitutivo adecuado
    214Tto previo con un inhibidor de KRASG12C
    215Tto previo con trifluridina y tipiracilo en aquellos sujetos en los que el tto de elección del investigador sería trifluridina y tipiracilo
    216Tto previo con regorafenib en sujetos en los que el tto de elección del IP sería regorafenib
    217Radioterapia terapéutica o paliativa en las 2semanas previas al día1 del estudio.Los sujetos se deben haber recuperado de toxicidades relacionadas con la radioterapia hasta el grado 1 o inferior de los criterios CTCAE v5.0,con excepción de alopecia (se permite cualquier grado de alopecia)
    218Tto antitumoral (quimioterapia,tto con anticuerpos,tto molecular dirigido,tto con retinoides,tto hormonal [excepto en pacientes con antecedentes de cáncer de mama completamente resecado sin enfermedad activa tras más de 3años de tto endocrino adyuvante a largo plazo] o tto con agente en investigación) en las 4semanas previas al día1 del estudio.Se permite el tto con bisfosfonatos o Ac anti-RANKL si es necesario para el tto de la hipercalcemia o para la prevención de acontecimientos esqueléticos.Se descarta el tto con inhibidores de los puntos de control en las 6semanas previas al día 1 del estudio
    219Reducción de dosis de panitumumab por toxicidad en el pasado
    220Uso de warfarina.Permitido el uso de otros anticoagulantes
    221Uso de sustratos sensibles de CYP450-3A4 y sustratos de P-gp (estrecho margen terapéutico), durante 14días o 5semividas del fármaco/principal metabolito activo, lo que dure más, antes del día1 del estudio no revisado y aprobado por el IP y el monitor de Amgen
    222Uso de inductores potentes de CYP3A4 (incluidos suplementos de fitoterapia como hipérico) durante 14días o 5semividas (lo que dure más) antes del día 1 del estudio no revisado y aprobado por el IP y el monitor médico de Amgen
    223Cuando el tto de elección del IP es regorafenib:uso de inhibidores potentes de CYP3A4 (incluidos suplementos de fitoterapia como hidrastis) durante 14días o 5semividas (lo que dure más) o zumo de pomelo o productos que contengan pomelo en los 7días previos al día1 del estudio que no haya sido revisado y aprobado por el IP y el monitor de Amgen
    224Antibióticos IV u orales terapéuticos en las 2semanas previas a la aleatorización.Se permiten antibióticos profilácticos
    E.5 End points
    E.5.1Primary end point(s)
    •Progression Free Survival (PFS) – defined as time from randomization until disease progression or death from any cause, whichever occurs first, for all subjects. Progression unless noted otherwise, use Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) per Blinded Independent Central Review (BICR)
    SLP, definida como el tiempo desde la aleatorización hasta la progresión de la enfermedad o la muerte por cualquier causa, lo que ocurra primero, para cada sujeto. Progresión, a no ser que se indique lo contrario, según los criterios de evaluación de la respuesta en tumores sólidos, versión 1.1, (RECIST v. 1.1) mediante una revisión central enmascarada independiente (RCEI).
    E.5.1.1Timepoint(s) of evaluation of this end point
    PFS - will be event driven and occur when approximately 60 PFS events have been observed from the sotorasib 960 mg and panitumumab arm and the investigator’s choice arm. The PFS primary analysis may be delayed to ensure that the enrollment is finished and the delayed primary analysis will be triggered when the last randomized subject has had the opportunity to have at least 8 weeks of follow-up.
    SLP - será en base a los acontecimientos y tendrá lugar cuando se hayan observado aproximadamente 60 acontecimientos de SLP en el grupo de 960mg de sotorasib y panitumumab y el grupo del tratamiento de elección del investigador. El análisis principal se puede retrasar para asegurar que el reclutamiento ha finalizado y el análisis primario será pospuesto hasta que el último sujeto aleatorizado haya tenido la oportunidad de completar al menos 8 semanas de seguimiento.
    E.5.2Secondary end point(s)
    Key Secondary
    •Overall survival (OS) - defined as time from randomization until death from any cause
    •Objective response rate (ORR) = complete response (CR) + partial response (PR), assessed per RECIST 1.1. Response will be assessed by BICR. CR and PR require confirmatory repeat assessment at least 4 weeks after the first detection of response.
    Secundarios clave
    •Supervivencia global, definida como el tiempo desde la aleatorización hasta la muerte por cualquier causa.
    •Tasa de Respuesta objetiva (TRO) = respuesta completa (RC) + respuesta parcial (RP), evaluada según los criterios RECIST 1.1. La respuesta se evaluará mediante la RCEI. La RC y la RP deben confirmarse mediante una evaluación repetida al menos 4 semanas después de la primera detección de la respuesta.
    E.5.2.1Timepoint(s) of evaluation of this end point
    OS - at the 960 mg dose level for the combination treatment group of sotorasib and panitumumab versus the control group will occur when PFS is claimed statistically significant at primary analysis at the 960 mg dose level or at both the 960 mg and 240 mg dose levels. The primary analysis of OS at the 240 mg dose level will occur when the primary analysis of OS at the 960 mg dose level is claimed statistically significant.
    ORR - for the combination treatment group of sotorasib and panitumumab versus the control group at either 960 mg or 240 mg dose level will occur when both PFS and OS are claimed statistically significant at primary analysis at this dose level.
    SG – en el nivel de dosis de 960mg para el grupo de tratamiento en combinación de sotorasib y panitumumab frente al grupo control tendrá lugar cuando en el análisis primario del nivel de dosis de 960mg o ambos niveles de dosis (960mg y 240mg) la SLP se considere estadísticamente significativa. El análisis primario de la SG al nivel de dosis de 240mg tendrá lugar cuando el análisis primario de la SG al nivel de dosis de 960mg sea considere clínicamente significativo.
    TRO - para el grupo de tratamiento en combinación de sotorasib y panitumumab frente al grupo control o bien al nivel de dosis de 960mg o a 240mg tendrá lugar cuando en el análisis primario a este nivel de dosis ambos, SLP y SG, se consideren estadísticamente significativos.
    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 Yes
    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 trial3
    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 concerned10
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA50
    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
    Korea, Republic of
    Mexico
    Taiwan
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of study date is defined as the date when the last subject across all sites is assessed or receives an intervention for evaluation in the study (ie, last subject last visit), including any additional parts in the study (eg, LTFU), as applicable.
    La fecha de fin de estudio se define como la fecha en la que el último sujeto entre todos los centros es evaluado o recibe una intervención para la evaluación en el estudio (p.ej, última visita del último sujeto), incluyendo cualquier parte adicional en el estudio (p.ej; LTFU), según aplique.
    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 months8
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months11
    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: 118
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 35
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 66
    F.4.2.2In the whole clinical trial 153
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    none
    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 Decision2022-02-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-12-23
    P. End of Trial
    P.End of Trial StatusOngoing
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