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    Summary
    EudraCT Number:2021-004280-27
    Sponsor's Protocol Code Number:GS-US-576-6220
    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:2022-02-08
    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 number2021-004280-27
    A.3Full title of the trial
    An Open-label, Multicenter, Phase 2 Study of Sacituzumab Govitecan Combinations in First-line Treatment of Patients with Advanced or Metastatic Non−Small-Cell Lung Cancer (NSCLC) Without Actionable Genomic Alterations
    Estudio en fase II, multicéntrico, abierto, de combinaciones de sacituzumab govitecán como primera línea de tratamiento en pacientes con cáncer de pulmón no microcítico (CPNM) metastásico o avanzado sin alteraciones genómicas de utilidad clínica
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2 Study of Sacituzumab Govitecan Combinations in First-line Treatment of Patients with Advanced or Metastatic Non−Small-Cell Lung Cancer
    Estudio en fase II de combinaciones de sacituzumab govitecán como primera línea de tratamiento en pacientes con cáncer de pulmón no microcítico (CPNM) metastásico
    A.4.1Sponsor's protocol code numberGS-US-576-6220
    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 SponsorGilead Sciences, 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 supportGilead Sciences, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGilead Sciences International Ltd.
    B.5.2Functional name of contact pointClinical Trials Mailbox
    B.5.3 Address:
    B.5.3.1Street AddressGilead Sciences, Flowers Building, Granta Park, Great Abington
    B.5.3.2Town/ cityCambridge
    B.5.3.3Post codeCB21 6GT
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+441223 897284
    B.5.6E-mailclinical.trials@gilead.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 Yes
    D.2.1.1.1Trade name Trodelvy
    D.2.1.1.2Name of the Marketing Authorisation holderGilead Sciences Ireland UC
    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 nameSacituzumab govitecan
    D.3.4Pharmaceutical form Powder for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNSACITUZUMAB GOVITECAN
    D.3.9.2Current sponsor codeIMMU-132
    D.3.9.4EV Substance CodeSUB191213
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number10
    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) 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 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 Pembrolizumab
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme 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 namePembrolizumab
    D.3.4Pharmaceutical form Powder and solvent for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembroluzimab
    D.3.9.3Other descriptive namePembroluzimab
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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 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 Yes
    D.3.11.13.1Other medicinal product typeHumanised Monoclonal Antibody
    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 Yes
    D.2.1.1.1Trade name Carboplatin
    D.2.1.1.2Name of the Marketing Authorisation holderFresenius Kabi Deutschland GmbH
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCarboplatin
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCARBOPLATIN
    D.3.9.3Other descriptive nameCARBOPLATIN
    D.3.9.4EV Substance CodeSUB06614MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Cisplatin
    D.2.1.1.2Name of the Marketing Authorisation holderAccord Healthcare Ireland Ltd
    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 nameCisplatin
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCisplatin
    D.3.9.3Other descriptive nameCisplatin
    D.3.9.4EV Substance CodeSUB07483MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mEq/ml milliequivalent(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    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
    cáncer de pulmón no microcítico
    E.1.1.1Medical condition in easily understood language
    Lung cancer
    cáncer de pulmón
    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 Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    - To assess the ORR of SG in combination with pembrolizumab or pembrolizumab + a platinum agent.
    - Determine the RP2D of SG in combination with pembrolizumab + a platinum agent.
    - Evaluar la tasa de respuesta objetiva (TRO) de sacituzumab govitecán (SG) en combinación con pembrolizumab o pembrolizumab más un derivado del platino.

    - Determinar la dosis recomendada para la fase II (DRF2) de SG en combinación con pembrolizumab más un derivado del platino.
    E.2.2Secondary objectives of the trial
    To assess the effect of SG in combination with pembrolizumab or pembrolizumab + a platinum agent on the following:
    - PFS
    - OS
    - DOR
    - DCR
    - Safety and tolerability
    Evaluar el efecto de SG en combinación con pembrolizumab o pembrolizumab más un derivado del platino en lo siguiente:

    -Supervivencia libre de progresión (SSP).
    -Supervivencia global (SGl).
    -Duración de la respuesta (DdR).
    -Tasa de control de la enfermedad (TCE).
    -Seguridad y tolerabilidad.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Patients must meet all of the following inclusion criteria at screening/Day −1 to be eligible for participation in this study (no waivers for patient eligibility will be offered or permitted):
    1) Female or male patients, 18 years of age or older, able to understand and give written informed consent.
    2) Life expectancy ≥ 3 months.
    3) Patients with the following pathologically documented NSCLC that meets all of the following criteria:
    a) Has documented evidence of Stage IV NSCLC disease at the time of enrollment (based on the American Joint Committee on Cancer, Eighth Edition).
    b) Has documented negative test results for EGFR and ALK.
    c) Has no known genomic alterations in ROS1, NTRK, BRAF, RET mutations, or other actionable driver oncogenes with approved therapies for frontline treatment (actionable genomic alteration). (Testing is not required if status is unknown.).
    d) Have provided tumor tissue from locations not radiated prior to biopsy. Formalin fixed specimens after the patient has been diagnosed with metastatic disease will be preferred
    for evaluation of Trop-2 expression and determination of PD-L1 status prior to enrollment if not already performed by an approved 22C3 assay. Biopsies obtained prior to receipt of adjuvant/neoadjuvant chemotherapy will be permitted if recent biopsy is not feasible. Bone biopsies and fine-needle aspirations are not suitable tissues. If no tissue is available, a new biopsy may be obtained prior to enrollment to the study.
    4) Measurable disease by CT or magnetic resonance imaging (MRI) as per RECIST Version 1.1 criteria (see Appendix 6) by investigator. Tumor lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions. Historical images within 28 days of the screening visit may be accepted as a screening image if deemed acceptable in the opinion of the investigator.
    5) No prior systemic treatment for mNSCLC. Patients who received adjuvant or neoadjuvant therapy are eligible if the adjuvant/neoadjuvant therapy was completed at least 6 months prior to the development of metastatic disease for a platinum agent.
    6) ECOG performance status score of 0 or 1 assessed within 7 days prior to treatment.
    7) Adequate hematologic counts without transfusional or growth factor support within 10 days of study drug initiation (hemoglobin ≥ 9 g/dL, absolute neutrophil count [ANC] ≥ 1500/mm3, and platelets ≥ 100,000/μL).
    8) Adequate hepatic function (bilirubin ≤ 1.5  ULN, AST and ALT ≤ 2.5  ULN or ≤ 5 ULN if known liver metastases, and serum albumin > 3 g/dL).
    9) Creatinine clearance of at least 30 mL/min as assessed by the Cockcroft-Gault equation {Cockcroft 1976}. For patients assigned to cohorts with cisplatin, creatinine clearance must be at least 60 mL/min.
    10) Patients with HIV must be on antiretroviral therapy (ART) and have a well-controlled HIV infection/disease defined as:
    a) Patients on ART must have a CD4 + T-cell count > 350 cells/mm3 at time of screening.
    b) Patients on ART must have achieved and maintained virologic suppression defined as confirmed HIV RNA level below 50 copies/mL or the lower limit of qualification (below the limit of detection) using the locally available assay at the time of screening and for at least 12 weeks prior to screening.
    c) Patients on ART must have been on a stable regimen, without changes in drugs or dose modification, for at least 4 weeks prior to study entry.
    d) The combination ART regimen must not contain any medications that may interfere with SN-38 metabolism.
    11) Male patients and female patients of childbearing potential who engage in heterosexual intercourse must agree to use protocol-specified method(s) of contraception as described in Appendix 3.
    Los pacientes deben cumplir todos los siguientes criterios de inclusión en la selección/día -1 para poder participar en este estudio (no se ofrecerá ni permitirá ninguna exención en cuanto a los requisitos para poder participar):
    1) Pacientes de ambos sexos, que tengan un mínimo de 18 años de edad y puedan comprender y otorgar su consentimiento informado por escrito.
    2) Tener una esperanza de vida ≥3 meses.
    3) Pacientes con CPNM documentado anatomopatológicamente que cumplan todos los criterios siguientes:
    a) Tener indicios documentados de CPNM en estadio IV en el momento de la inclusión (según el American Joint Committee on Cancer, octava edición).
    b) Tener documentación que confirme resultados analíticos negativos para EGFR y ALK.
    c) No presentar ninguna alteración genómica en las mutaciones ROS1, NTRK, BRAF y RET, u otros iniciadores oncogénicos de utilidad clínica con terapias aprobadas para el tratamiento de primera línea (alteración genómica de utilidad clínica). (No es necesario realizar análisis si ya se sabe si están presentes o no).
    d) Haber proporcionado tejido tumoral de zonas no irradiadas antes de la biopsia. Se prefieren las muestras fijadas en formol después de que el paciente haya recibido el diagnóstico de cáncer metastásico a fin de evaluar la expresión de Trop-2 y determinar la presencia o no de PD-L1 antes de la inclusión, si no se realizó anteriormente mediante un ensayo 22C3 aprobado. Si no es viable contar con una biopsia reciente, se permitirán las biopsias obtenidas antes de recibir quimioterapia pre/posquirúrgica. Las biopsias óseas y las aspiraciones con aguja fina no son tejidos aptos. Si no se dispone de ningún tejido, se podrá obtener una biopsia nueva antes de la inclusión en el estudio.
    4) Enfermedad medible mediante TC o resonancia magnética (RM) según la versión 1.1 de los criterios RECIST (véase el apéndice 6) evaluada por el investigador. Lesiones tumorales situadas en una zona previamente irradiada que se consideran medibles, si se ha demostrado la presencia de progresión en dichas lesiones. Si el investigador lo considera aceptable, como imagen de selección podrán aceptarse imágenes históricas obtenidas en un plazo de 28 días antes de la visita de selección.
    5) No haber recibido ningún tratamiento sistémico anterior para el CPNMm. Los pacientes que recibieron terapia pre o posquirúrgica son idóneos para participar si dicha terapia se completó al menos 6 meses antes de la aparición de enfermedad metastásica con un derivado del platino.
    6) Puntuación de 0 o 1 en el estado funcional ECOG evaluado durante los 7 días anteriores al tratamiento.
    7) Recuentos hematológicos adecuados sin apoyo transfusional o de factores de crecimiento durante los 10 días previos al comienzo de la administración del fármaco del estudio (hemoglobina ≥9 g/dl, recuento absoluto de neutrófilos [RAN] ≥1500/mm3 y plaquetas ≥100.000/μl).
    8) Función hepática adecuada (bilirrubina ≤1,5 veces el LSN, AST y ALT ≤2,5 veces el LSN o ≤5 veces el LSN en el caso de metástasis hepáticas conocidas, y albúmina sérica >3 g/dl).
    9) Aclaramiento de creatinina de al menos 30 ml/min evaluado mediante la ecuación de Cockcroft-Gault {Cockcroft 1976}. En el caso de los pacientes asignados a las cohortes con cisplatino, el aclaramiento de creatinina debe ser de al menos 60 ml/min.
    10) Los pacientes con VIH deben estar recibiendo un tratamiento antirretrovírico (TAR) y presentar una enfermedad/infección por el VIH controlada adecuadamente, lo que se define como:
    a) Los pacientes que reciban un TAR deben presentar un recuento de linfocitos T CD4+ >350 células/mm3 en el momento de la selección.
    b) Los pacientes que reciban un TAR deben haber alcanzado y mantenido una supresión vírica definida como un nivel confirmado de ARN del VIH inferior a 50 copias/ml o el límite inferior de cuantificación (por debajo del límite de detección) utilizando el ensayo disponible localmente, en el momento de la selección y durante al menos las 12 semanas anteriores a la selección.
    c) Los pacientes que reciban un TAR deben haber recibido una pauta posológica estable, sin cambios en los fármacos o modificaciones de la dosis, durante al menos las 4 semanas anteriores al ingreso en el estudio.
    d) La pauta combinada de TAR no debe contener ningún medicamento que pueda interferir con el metabolismo de SN-38.
    11) Los pacientes de ambos sexos con capacidad de procrear que mantengan relaciones heterosexuales deben acceder a utilizar métodos anticonceptivos especificados en el protocolo, según se describe en el apéndice 3.
    E.4Principal exclusion criteria
    1) Mixed SCLC and NSCLC histology.
    2) Active second malignancy.
    3) NSCLC that is eligible for definitive local therapy alone.
    4) Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7days prior to the first dose of study drug. Intermittent use of topical, inhalational, intranasal, and intraocular steroids is permitted.
    5) Has an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease-modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed.
    6) Has had an allogenic tissue/solid organ transplant.
    7) Has severe (≥ Grade 3) hypersensitivity to SG, pembrolizumab, carboplatin, or cisplatin, their metabolites, or formulation excipient.
    8) Requirement for ongoing therapy with or prior use of any prohibited medications listed in (Section 5.7).
    9) Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PDL2 agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX 40, CD137), and was discontinued from that treatment due to a Grade 3 or higher immune-related AEs (irAE).
    10) Has received radiation therapy to the lung that is > 30 Gy within 6 months of the first treatment cycle.
    11) Patients may not have received systemic anticancer treatment within the previous 6 months or radiation therapy within 2 weeks prior to enrollment. Patients must have recovered (ie, > Grade 2 is considered not recovered) from AEs at the time of study entry. Patients must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤ 2 weeks of radiotherapy) to non-central nervous system (CNS) disease.
    12) Have previously received treatment with any of the following:
    a) Topoisomerase 1 inhibitors. Any agent including an ADC containing a chemotherapeutic agent targeting topoisomerase 1.
    b) Trop-2-targeted therapy.
    13) Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment.
    14) Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses including, but not limited to, any underlying pulmonary disorder (ie, pulmonary emboli within 3 months of en-rollment, severe asthma, severe chronic obstructive pulmonary disease (COPD), restrictive lung dis-ease, pleural effusion, etc); any autoimmune, connective tissue, or inflammatory disorders with pul-monary involvement (ie, rheumatoid arthritis, Sjogren syndrome, sarcoidosis, etc); or prior pneumo-nectomy.
    15) Known active CNS metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases may participate provided they have stable CNS disease for at least 4 weeks prior to
    enrollment and all neurologic symptoms have returned to baseline, have no evidence of new or en-larging brain metastases, and are taking ≤ 10 mg/day of prednisone or its equivalent. All patients with carcinomatous meningitis are excluded regardless of clinical stability. Patients should be clinically sta-ble and without requirement of steroid treatment for at least 14 days prior to first dose of study treatment.
    16) Met any of the criteria for cardiac disease
    17) Active chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) or gastrointestinal (GI) perforation within 6 months of enrollment.
    18) Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
    19) Active serious infection requiring antibiotics.
    20) Patients positive for HIV-1 or 2 with a history of Kaposi sarcoma and/or multicentric Castleman disease.
    Please, refer to the protocol to see the complete list.
    1) Histología mixta de CPNM y CPM.
    2) Neoplasia maligna secundaria activa.
    3) CPNM idóneo para recibir un tratamiento local definitivo solo.
    4) Tener un diagnóstico de inmunodeficiencia o estar recibiendo un tratamiento sistémico con corticoesteroides (en dosis que superan los 10 mg diarios de un equivalente de la prednisona) o cualquier otra forma de tratamiento inmunodepresor durante los 7 días anteriores a la primera dosis del fármaco del estudio. Se permite el uso intermitente de corticoesteroides intraoculares, intranasales, inhalados o tópicos.
    5) Padecer una enfermedad autoinmunitaria activa que haya requerido un tratamiento sistémico durante los 2 años anteriores (es decir, uso de agentes modificadores de la enfermedad, corticoesteroides o fármacos inmunodepresores). El tratamiento de reposición (p. ej., tratamiento de reposición con tiroxina, insulina o fisiológico con corticoesteroides para la insuficiencia suprarrenal o hipofisaria) no se considera un tipo de tratamiento sistémico y, por lo tanto, está permitido.
    6) Haberse sometido a un alotrasplante de tejido o víscera maciza.
    7) Presentar hipersensibilidad grave (de grado ≥3) a SG, pembrolizumab, carboplatino o cisplatino, sus metabolitos o los excipientes de la formulación.
    8) Requerir tratamiento continuo con cualquier medicamento prohibido (apartado 5.7) o haberlo utilizado previamente.
    9) Haber recibido tratamiento previo con un fármaco anti-PD-1, anti-PD-L1, o anti-PDL2, o con un fármaco dirigido a otro receptor de los linfocitos T estimulador o coinhibidor (p. ej., CTLA-4, OX 40, CD137), y haber interrumpido dicho tratamiento debido a un AA inmunitario (AAi) de grado 3 o superior.
    10) Haber recibido radioterapia en los pulmones de >30 Gy durante los 6 meses anteriores al primer ciclo de tratamiento.
    11) Los pacientes no pueden haber recibido tratamiento antineoplásico sistémico durante los 6 meses anteriores o radioterapia durante las 2 semanas anteriores a la inclusión. Los pacientes deben haberse recuperado (es decir, si presentan un grado >2, se considera que no se han recuperado) de cualquier AA antes de su ingreso en el estudio. Los pacientes deben haberse recuperado de todas las toxicidades relacionadas con la radiación, no requerir corticoesteroides y ni padecer neumonitis por radiación. Se permite un periodo de reposo farmacológico de 1 semana para la radiación paliativa (≤2 semanas de radioterapia) de enfermedad que no afecte al sistema nervioso central (SNC).
    12) Haber recibido anteriormente tratamiento con cualquiera de los siguientes fármacos:
    a) Inhibidores de la topoisomerasa 1. Cualquier fármaco, incluido un ADC, que contenga un quimioterapéutico dirigido a la topoisomerasa 1.
    b) Tratamiento dirigido a Trop-2.
    13) Estar participando en la actualidad o haber participado en un estudio de un fármaco en fase de investigación, o haber usado un dispositivo en fase de investigación, durante las 4 semanas anteriores a la primera dosis del tratamiento del estudio.
    14) Afectación pulmonar clínicamente grave a consecuencia de enfermedades pulmonares intercurrentes incluidas, entre otras, cualquier trastorno pulmonar subyacente (es decir, embolia pulmonar durante los 3 meses anteriores a la inclusión, asma grave, enfermedad pulmonar obstructiva crónica (EPOC), neumopatía restrictiva, derrame pleural, etc.); cualquier trastorno autoinmunitario, del tejido conjuntivo o inflamatorio con afectación pulmonar (es decir, artritis reumatoide, síndrome de Sjögren, sarcoidosis, etc.); o neumonectomía previa.
    15) Meningitis carcinomatosa o metástasis del SNC activas conocidas. Los pacientes con metástasis cerebrales tratadas anteriormente podrán participar siempre que la enfermedad del SNC se haya mantenido estable durante un mínimo de 4 semanas antes de la inclusión y todos los síntomas neurológicos hayan vuelto a los valores iniciales, que no presenten signos de metástasis cerebrales nuevas o agrandadas y que estén tomando ≤10 mg/día de prednisona o su equivalente. Todos los pacientes con meningitis carcinomatosa quedan excluidos independientemente de la estabilidad clínica. Los pacientes deben haberse mantenido clínicamente estables y no haber requerido tratamiento con corticoesteroides durante al menos los 14 días anteriores a la primera dosis del tratamiento del estudio.
    16) Satisfacer cualquiera de los criterios de cardiopatía.
    17) Enfermedad intestinal inflamatoria crónica activa (colitis ulcerosa, enfermedad de Crohn) o perforación gastrointestinal (GI) durante los 6 meses anteriores a la inclusión.
    18) Presentar antecedentes de neumopatía intersticial/neumonitis (no infecciosa) que haya requerido corticoesteroides o padecer neumopatía intersticial/neumonitis.
    19) Infección grave activa que requiera antibióticos.
    20) Pacientes con VIH-1 o 2 y antecedentes de sarcoma de Kaposi o enfermedad de Castleman multicéntrica.
    Por favor, consultar protocolo para ver lista completa.
    E.5 End points
    E.5.1Primary end point(s)
    - ORR is defined as the proportion of patients who have measurable disease at baseline and achieve a complete response (CR) or partial response (PR) that is confirmed
    at least 4 weeks later as assessed by an independent review committee (IRC) according to the Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1.
    - Incidence of DLT(s) (ie, percentage of patients who had DLTs) per dose level during the first 21 days of treatment in the safety run-in cohorts.
    - La TRO se define como la proporción de pacientes que presentan enfermedad medible en el momento inicial y logran una respuesta completa (RC) o una respuesta parcial (RP) que se confirma al menos 4 semanas después, según lo evaluado por un comité de revisión independiente (CRI) de acuerdo con los criterios de evaluación de la respuesta en tumores sólidos (RECIST), versión 1.1.

    - Incidencia de toxicidad o toxicidades limitantes de la dosis (TLD, es decir, el porcentaje de pacientes que presentaron TLD) por nivel de dosis durante los primeros 21 días de tratamiento en las cohortes de análisis preliminar de la seguridad.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Individual Patient:
    Patients are considered to have reached the end of the study when they are no longer followed for long term or survival follow-up due to the following reasons: death, patient withdrew consent, lost to follow-up, the sponsor terminated study, or completion of survival follow-up, whichever comes first. For any patient who dies during the follow-up period, primary cause of death must be reported to the sponsor.
    All Patients:
    The end of the entire study for all patients is defined as the date on which the last patient remaining on study completes the last study visit/call or when the sponsor decides to end the study.
    Paciente individual:Se considera que el paciente ha llegado al final del estudio cuando ya no se le somete a seguimiento a largo plazo o de la supervivencia debido a los motivos siguientes: muerte,retirada del consentimiento por parte del pac,pérdida de contacto pra realizar el seguimiento,finalización del estudio por parte del promotor o haber completado el seguimiento de la supervivencia,lo q ocurra en 1er lugar.En el caso de que el paciente fallezca durante el periodo de seguimiento, deberá informarse al promotor de la causa ppal de la muerte.
    Todos los pacientes:El final de la totalidad del estudio para todos los pacientes se define como la fecha en la que el último paciente del estudio complete la última visita o llamada del estudio o cuando el promotor decida poner fin al estudio.
    E.5.2Secondary end point(s)
    - PFS is defined as the time from the date of the first dose until the date of objective disease progression or death (whichever comes first) as assessed by IRC per RECIST Version 1.1.
    - OS is defined as the time from the date of first dose until death due to any cause.
    - DOR is defined as the time from the first documentation of CR or PR to the earlier of the first documentation of progressive disease (PD) or death from any cause (whichever comes first) as assessed by IRC per RECIST Version 1.1.
    - DCR is defined as the proportion of patients who achieve a CR, PR, or stable disease (SD) as assessed by IRC per RECIST Version 1.1.
    - Incidence of treatment-emergent adverse events (TEAEs) and clinical laboratory abnormalities.
    - La SSP se define como el tiempo que transcurre desde la fecha de la primera dosis hasta la fecha de la progresión objetiva de la enfermedad o la muerte (lo que ocurra en primer lugar), según lo evaluado por el CRI de acuerdo con los RECIST, versión 1.1.
    - La SGl se define como el tiempo que transcurre desde la fecha de la primera dosis hasta la muerte por cualquier causa.
    - La DdR se define como el tiempo que transcurre desde la fecha en que se documenta por primera vez RC o RP hasta la fecha en que se documenta por primera vez progresión de la enfermedad (PE) o la muerte por cualquier causa (lo que ocurra en primer lugar), según lo evaluado por el CRI de acuerdo con los RECIST, versión 1.1.
    - La TCE se define como la proporción de pacientes que logran una RC, RP o enfermedad estable (EE), según lo evaluado por el CRI de acuerdo con los RECIST, versión 1.1.
    - Incidencia de acontecimientos adversos aparecidos durante el tratamiento (AAAT) y anomalías analíticas clínicas.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Individual Patient: Patients are considered to have reached the end of the study when they are no longer followed for long term or survival follow-up due to the following reasons: death, patient withdrew consent, lost to follow-up, the sponsor terminated study, or completion of survival follow-up, whichever comes first. For any patient who dies during the follow-up period, primary cause of death must be reported to the sponsor.

    All Patients: The end of the entire study for all patients is defined as the date on which the last patient remaining on study completes the last study visit/call or when the sponsor decides to end the study.
    Paciente individual: Se considera que los pacientes han llegado al final del estudio cuando dejan de ser objeto de seguimiento a largo plazo o de supervivencia debido a las siguientes razones: muerte, retirada del consentimiento del paciente, pérdida de seguimiento, finalización del estudio por parte del patrocinador o finalización del seguimiento de supervivencia, lo que ocurra primero. En el caso de cualquier paciente que fallezca durante el periodo de seguimiento, deberá comunicarse al promotor la causa principal de la muerte.


    Todos los pacientes: El final de todo el estudio para todos los pacientes se define como la fecha en la que el último paciente que permanece en el estudio completa la última visita/llamada del estudio o cuando el patrocinador decide terminar el estudio.
    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 Yes
    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) 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 No
    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.8.2.4Number of treatment arms in the trial6
    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 EEA30
    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
    France
    Germany
    Hong Kong
    Italy
    Korea, Democratic People's Republic of
    Spain
    Taiwan
    United Kingdom
    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 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 months8
    E.8.9.1In the Member State concerned days5
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days1
    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: 136
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 30
    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 state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 71
    F.4.2.2In the whole clinical trial 166
    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)
    Patients who discontinue study drug and agree to remain in the study will follow the requirements outlined in Table 1 of the protocol for continued follow-up.
    Los pacientes que suspendan el fármaco del estudio y acepten permanecer en él seguirán los requisitos descritos en la Tabla 1 del protocolo para continuar el seguimiento.
    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 Decision2022-03-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-03-15
    P. End of Trial
    P.End of Trial StatusOngoing
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