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    Summary
    EudraCT Number:2021-005033-16
    Sponsor's Protocol Code Number:ASTX295-01
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2022-09-14
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2021-005033-16
    A.3Full title of the trial
    Phase 1/2 Open-Label Study of the Safety, Pharmacokinetics, and Preliminary Activity of ASTX295 in Subjects with Wild-Type TP53 Advanced Solid Tumors
    Studio in aperto di fase 1-2 della sicurezza, farmacocinetica e attività preliminare di ASTX295 in soggetti affetti da tumori solidi in stadio avanzato con TP53wild-type.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Clinical study to find out how safe is ASTX295 (study drug) and how ASTX295 affects the body in patients with advanced solid tumors with normal TP53 gene
    Studio clinico per stabilire la sicurezza di ASTX295 (farmaco dello studio) e l’effetto di ASTX295 sull’organismo di pazienti con tumori solidi in stadio avanzato con gene TP53 normale
    A.3.2Name or abbreviated title of the trial where available
    na
    na
    A.4.1Sponsor's protocol code numberASTX295-01
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03975387
    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 SponsorASTEX PHARMACEUTICALS
    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 supportAstex Pharmaceuticals, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAstex Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointASTX295-01 Clinical Operations
    B.5.3 Address:
    B.5.3.1Street Address4420 Rosewood Drive, Suite 200
    B.5.3.2Town/ cityPleasanton, CA
    B.5.3.3Post code94588
    B.5.3.4CountryUnited States
    B.5.4Telephone number0019255600100
    B.5.5Fax number000000
    B.5.6E-mailASTX295-01@astx.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 nameASTX295
    D.3.2Product code [ASTX295]
    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 INNASTX295
    D.3.9.2Current sponsor codeASTX295
    D.3.9.3Other descriptive nameASTX295 (Free Acid), AT35295, AT35295X, AT35295 (Free Acid)
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameASTX295
    D.3.2Product code [ASTX295]
    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 INNASTX295
    D.3.9.2Current sponsor codeASTX295
    D.3.9.3Other descriptive nameASTX295 (Free Acid), AT35295, AT35295X, AT35295 (Free Acid)
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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
    Subjects with Wild-Type TP53 Advanced Solid Tumors
    soggetti affetti da tumori solidi in stadio avanzato con TP53 wild-type
    E.1.1.1Medical condition in easily understood language
    Subjects with normal TP53 Advanced Solid Tumors
    Soggetti con tumori solidi avanzati TP53 normali
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10027406
    E.1.2Term Mesothelioma
    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 LLT
    E.1.2Classification code 10065147
    E.1.2Term Malignant solid tumor
    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 LLT
    E.1.2Classification code 10065252
    E.1.2Term Solid tumor
    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 10081431
    E.1.2Term Uveal melanoma
    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 2 (only phase 2 will be conducted in EU):
    • To evaluate the clinical activity of ASTX295 at the RP2D in MPM; and other tumor type(s) based on emerging clinical and biomarker data
    Fase II (in EU viene condotta solo la fase II):
    - Valutare l’attività clinica di ASTX295 alla RP2D nel MPM e altri tipi di tumore in base ai dati clinici e sui biomarcatori
    emergenti.
    E.2.2Secondary objectives of the trial
    Phase 2 (only phase 2 will be conducted in EU):
    • To characterize the safety profile of ASTX295.
    • To determine the PK profile of ASTX295.
    • To evaluate other parameters of clinical activity.
    Fase II (in EU viene condotta solo la fase II):
    - Caratterizzare il profilo di sicurezza di ASTX295.
    - Determinare il profilo PK di ASTX295.
    - Valutare altri parametri di attività clinica.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1) Participant must be 18 years of age or older, at the time of signing the informed consent.
    2) Have histologically or cytologically confirmed advanced solid tumors that are metastatic or unresectable and are refractory or have relapsed after treatment with standard available therapies or for whom standard life-prolonging measures are not available.
    a. Phase 1: any tumor type is eligible
    b. Phase 2: eligible tumor types are as follows:
    i) MPM (Cohort 1)
    ii) Liposarcoma (WD, DD, or mix), intimal sarcoma, and other sarcomas with MDM2 amplification (Cohort 2)
    iii) GBM and tumors with CDNK2A LOF excluding MPM, liposarcoma, intimal sarcoma, and UVM (Cohort 3)
    iv) Tumors with BRCA1/2 or ATM deleterious mutations or with BAP1 LOF excluding MPM, liposarcoma, intimal sarcoma, and UVM (Cohort 4)
    v) Uveal melanoma (Cohort 5)
    vi) Any cancer type with MDM2 amplification excluding MPM, sarcoma, and UVM (Cohort 6)
    3) Wild-type TP53 and other molecular feature requirements.
    4) Have an Eastern Cooperative Oncology Group (ECOG) Performance status (PS) of 0 to 2.
    5) Acceptable bone marrow function, as evidenced by the following laboratory data:
    a. Absolute neutrophil count (ANC) =1500 cells/mm3
    b. Platelet count =100,000 cells/mm3
    c. Hemoglobin >9 g/dL
    6) Adequate hepatic function as evidenced by:
    a. Serum total bilirubin =1.5 × upper limit of normal (ULN).
    b. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =2.5 × ULN (=3 × ULN in the presence of liver metastases).
    c. Serum creatinine =1.5 × ULN OR calculated creatinine clearance (by the standard Cockcroft-Gault formula) of =50 mL/min or measured glomerular filtration rate of =50 mL/min.
    7) Participant can be male or female
    a. Male participants: Male participants are eligible to participate if they agree to the following during the treatment period and for at least 93 days (approximately 5 half-lives of ASTX295 [additional details can be found in the ASTX295
    IB] plus 90 days) after the last dose of study treatment:
    • Refrain from donating sperm.
    PLUS either:
    • Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent.
    OR
    • Must agree to use contraception/barrier as detailed below:
    o Agree to use a male condom when having sexual intercourse with a woman of childbearing potential.
    o Female partner should be advised of the benefit of using an additional highly effective contraceptive method (with a failure rate of <1% per year) as described in Appendix 2 (Section 10.2) as a condom may break or leak.
    b. Female participants:
    A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    i) Is not a woman of childbearing potential (WOCBP)
    OR
    ii) Is a woman of childbearing potential and is using a contraceptive method that is highly effective (with a failure rate of <1% per year), preferably with low user dependency, as described in Appendix 2 (Section 10.2 of the protocol) during the treatment period and for at least 93 days (approximately 5 half-lives of ASTX295 [additional details can be found in the ASTX295 IB] plus 90 days) after the last dose of study treatment and agrees not to donate eggs (ova, oocytes) for the
    purpose of reproduction during this period. The investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment.
    iii) A woman of childbearing potential must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 24 hours before the first dose of study treatment.
    iv) The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
    1) Aver compiuto 18 anni al momento della firma del consenso informato.
    2) Presenza di tumori solidi in stadio avanzato confermati istologicamente o citologicamente che siano metastatici o non resecabili e che siano refrattari o abbiano recidivato dopo trattamento con terapie standard disponibili o per i quali non siano disponibili misure standard per prolungarne la vita.
    a. Fase 1: qualsiasi tipi di tumore è eleggibile
    b. Fase 2: i tipi di tumore eleggibili sono i seguenti:
    i) MPM (Coorte 1);
    ii) liposarcoma [ben differenziato (WD), de-differenziato (DD) o misto], sarcoma intimale e altri sarcomi con amplificazione di MDM2 (Coorte 2);
    iii) glioblastoma multiforme (GMB) e tumori con mutazione di CDNK2A con perdita di funzione (LOF), esclusi MPM, liposarcoma, sarcoma intimale e melanoma uveale (UVM) (Coorte 3);
    iv) tumori con mutazioni deleterie di BRCA1/2 o ATM o con mutazione di BAP1 con LOF, esclusi MPM, liposarcoma, sarcoma intimale e UVM (Coorte 4);
    v) melanoma uveale (Coorte 5);
    vi) qualsiasi tipo di cancro con amplificazione di MDM2, esclusi MPM, sarcoma e UVM (Coorte 6).
    3) TP53 wild-type (non mutato) e altri requisiti circa le caratteristiche molecolari.
    4) Eastern Cooperative Oncology Group (ECOG) Performance status (PS) da 0 a 2.
    5) Funzionalità del midollo osseo accettabile, come evidenziato dai seguenti dati di laboratorio:
    a. conta assoluta dei neutrofili (ANC) =1.500 cellule/mm3;
    b. conta piastrinica =100.000 cellule/mm3;
    c. emoglobina >9 g/dL.
    6) Funzionalità epatica adeguata, attestata dai seguenti valori:
    a. bilirubina totale sierica =1,5 × limite superiore della norma (ULN);
    b. aspartato aminotransferasi (AST) e alanina aminotransferasi (ALT) =2,5 × ULN (=3 × ULN in presenza di metastasi epatiche);
    c. creatinina sierica =1,5 × ULN OPPURE clearance della creatinina calcolata (con la formula di Cockcroft-Gault standard) =50 mL/min o velocità di filtrazione glomerulare misurata =50 mL/min.
    7) Di sesso maschile o femminile.
    a. Partecipanti di sesso maschile:
    I partecipanti di sesso maschile sono eleggibili a partecipare se acconsentono ad attenersi a quanto segue durante il periodo di trattamento e per almeno 93 giorni (circa 5 emivite di ASTX295 [ulteriori dettagli sono riportati nell’IB di ASTX295] più 90 giorni) dopo l’ultima somministrazione del trattamento in studio:
    • astenersi dalla donazione di sperma;
    PIÙ:
    • astenersi da rapporti sessuali eterosessuali come stile di vita abituale e preferito (astinenza a lungo termine e persistente) e acconsentire a rispettare l’astinenza;
    OPPURE
    • acconsentire a usare i metodi contraccettivi/di barriera riportati di seguito:
    o accettare di utilizzare un preservativo maschile durante i rapporti sessuali con una donna in età fertile;
    o la partner deve essere informata dei benefici derivanti dall’uso di un metodo contraccettivo altamente efficace aggiuntivo (con un tasso di fallimento <1% annuo) come descritto nell’Appendice 2 (Sezione 10.2), poiché un preservativo potrebbe rompersi o avere una perdita.
    b. Partecipanti di sesso femminile:
    Una partecipante di sesso femminile è eleggibile a partecipare se non è in stato di gravidanza, non allatta al seno, e soddisfa almeno una delle seguenti condizioni:
    i) non è una donna in età fertile;
    OPPURE
    ii) è una donna in età fertile e usa un metodo contraccettivo altamente efficace (con un tasso di fallimento <1% annuo), preferibilmente con bassa dipendenza dall’utente, come descritto nell’Appendice 2 (Sezione 10.2 del protocollo) durante il periodo di trattamento e per almeno 93 giorni (circa 5 emivite di ASTX295 [ulteriori dettagli sono riportati nell’IB di ASTX295] più 90 giorni) dopo l’ultima somministrazione del trattamento in studio e acconsente a non donare ovuli (ovociti) a fini di riproduzione nel corso del suddetto periodo. Lo sperimentatore deve valutare l’efficacia del metodo contraccettivo in relazione alla prima somministrazione del trattamento in studio.
    (fare riferimento al protocollo)
    E.4Principal exclusion criteria
    1) Poor medical risk in the investigator's opinion because of systemic diseases in addition to the cancer under study, for example, uncontrolled infections.
    Confidential Information 34 Amendment 4, 21 March 2022 2) Life-threatening illness, significant organ system dysfunction, or other condition that, in the investigator's opinion, could compromise subject safety, or the integrity of study outcomes, or interfere with the absorption or metabolism of ASTX295.
    3) History of, or at risk for, cardiac disease, as evidenced by any of the following conditions:
    a. Abnormal left ventricular ejection fraction (LVEF; <50%) on echocardiogram (ECHO) or multiple-gated acquisition (MUGA) scan at Screening.
    b. Congestive cardiac failure of =Grade 3 severity according to New York Heart Association (NYHA) functional classification defined as patients with marked limitation of activity and who are comfortable only at rest.
    c. Unstable cardiac disease including unstable angina or hypertension as defined by the need for overnight hospital admission within the last 3 months (90 days).
    d. History or evidence at Screening of long QT interval corrected for heart rate (QTcF), ventricular arrhythmias including ventricular bigeminy, clinically significant bradyarrhythmias such as sick sinus syndrome, third-degree atrioventricular (AV) block, presence of cardiac pacemaker or defibrillator, or other clinically significant arrhythmias.
    e. Screening 12-lead electrocardiogram (ECG) with measurable QTcF interval of =470 msec. (Fridericia's formula should be used).
    4) Known advanced human immunodeficiency virus (HIV) infection (including AIDS): clinical Stage =3 according to World Health Organization (WHO) classification (WHO 2007) and/or HIV-associated immunodeficiency (CD4 count less than 500 per mm3 of blood). Antiretroviral therapy (ART) is allowed (subjects should be on established ART for at least 4 weeks and have an HIV viral load less than 400 copies/mL prior to enrollment).
    5) Known active hepatitis B virus (HBV) or active hepatitis C virus (HCV) infection (inactive hepatitis carrier status and subjects with laboratory evidence of no active replication on antivirals - viral load below limit of detection- will be permitted).
    6) Known brain metastases, unless previously treated and clinically stable for at least 4 weeks with or without steroids.
    7) Known significant mental illness or other conditions, such as active alcohol or other substance abuse that, in the opinion of the investigator, predispose the subject to high risk of noncompliance with the protocol treatment or assessments.
    8) Prior anticancer treatments or therapies within the indicated time window prior to first dose of study treatment (ASTX295), as follows:
    a. Cytotoxic chemotherapy within 3 weeks prior. Any encountered treatment-related toxicities (excepting alopecia) must be stabilized or resolved to =Grade 1.
    b. Monoclonal antibodies, biologics, or immunotherapy within 4 weeks prior. Any encountered treatment-related toxicities must be stabilized or resolved to =Grade 1.
    c. Molecularly targeted drug or other investigational drugs, with the potential for delayed toxicity, within 4 weeks of the first dose of study treatment or 5 half-lives (minimum 14 days), whichever is shorter. Any encountered treatment-related toxicities must be stabilized or resolved to =Grade 1.
    d. Major surgery or radiation within 4 weeks prior to first dose (palliative radiotherapy to a single lesion within 2 weeks).
    9) Prior treatment with MDM2 antagonist.
    10) Inability to swallow oral medication or inability or unwillingness to comply with the administration requirements related to ASTX295.
    11) Active malignancy other than the cancer under study (excludes low risk prostate cancer or early breast cancer with or without hormonal therapy, superficial, or surgically or locally controlled basal cell or squamous carcinoma of the skin, and superficial bladder cancer).
    1) Rischio medico infausto, a parere dello sperimentatore, a causa di malattia sistemica oltre al tumore in studio, per esempio infezioni non controllate.
    Informazioni riservate 34 Emendamento 4, del 21 marzo 2022 2) Patologia potenzialmente fatale, disfunzione di sistemi e organi significativa o altra condizione che, a parere dello sperimentatore, potrebbe compromettere la sicurezza del soggetto o l’integrità degli esiti dello studio o interferire con l’assorbimento o il metabolismo di ASTX295.
    3) Positività in anamnesi o rischio di cardiopatia, attestato da una qualsiasi delle seguenti condizioni:
    a. frazione di eiezione ventricolare sinistra anomala (FEVS; <50%) accertata mediante ecocardiogramma (ECHO) o scansione con acquisizione a gate multipli (MUGA) allo screening;
    b. insufficienza cardiaca congestizia di grado =3 secondo la classificazione funzionale della New York Heart Association (NYHA) definita come pazienti con evidenti limitazioni nello svolgimento delle attività e che si sentono bene solo quando a riposo;
    c. patologia cardiaca instabile, incluse angina instabile o ipertensione, definite dalla necessità di ricovero ospedaliero superiore a un giorno negli ultimi 3 mesi (90 giorni).
    d. Anamnesi o evidenza allo screening di intervallo QT lungo corretto per la frequenza cardiaca (QTcF), aritmie ventricolari, incluso bigeminismo ventricolare, bradiaritmie clinicamente significative quali malattia seno-atriale, blocco atrioventricolare (AV) di terzo grado, presenza di pacemaker o defibrillatore cardiaco o altre aritmie clinicamente significative.
    e. Elettrocardiogramma (ECG) a 12 derivazioni allo screening con intervallo QTcF misurabile =470 msec (applicando la formula di Fridericia).
    4) Infezione nota da virus dell’immunodeficienza umana (HIV) in stadio avanzato (AIDS incluso): stadio clinico =3 secondo la classificazione dell’Organizzazione Mondiale della Sanità (OMS 2007) e/o immunodeficienza associata ad HIV (conta dei CD4 inferiore a 500 per mm3 di sangue). La terapia con antiretrovirali (ART) è ammessa (i soggetti devono essere in terapia ART stabile da almeno 4 settimane e avere una carica virale dell’HIV inferiore a 400 copie/mL prima dell’arruolamento).
    5) Infezione nota da virus dell’epatite B (HBV) in fase attiva o da virus dell’epatite C (HCV) in fase attiva (saranno ammessi i portatori di virus dell’epatite inattivo e i soggetti con evidenze di laboratorio di assenza di replicazione attiva in terapia con antivirali – carica virale inferiore ai limiti di rivelazione).
    6) Metastasi cerebrali note, se non trattate in precedenza e clinicamente stabili da almeno 4 settimane con o senza steroidi.
    7) Presenza nota di malattia mentale significativa o di altre condizioni, come abuso attivo di alcool o di altre sostanze che, a parere dello sperimentatore, espongono il soggetto al rischio di mancata compliance al trattamento o alle valutazioni del protocollo.
    8) Trattamenti o terapie antineoplastiche precedenti entro la finestra temporale indicata antecedente alla prima dose del trattamento in studio (ASTX295) come segue:
    a. chemioterapia citotossica nelle 3 settimane precedenti. Qualsiasi tossicità (alopecia esclusa) sviluppata correlata al trattamento deve essersi stabilizzata o risolta a un grado =1;
    b. anticorpi monoclonali, farmaci biologici o immunoterapia nelle 4 settimane precedenti. Qualsiasi tossicità sviluppata correlata al trattamento deve essersi stabilizzata o risolta a un grado =1;
    c. farmaco a target molecolare o altri farmaci sperimentali, con potenziale tossicità ritardata, nelle 4 settimane o 5 emivite antecedenti la prima dose del trattamento in studio (minimo 14 giorni), a seconda di quale dei due periodi sia più breve. Qualsiasi tossicità sviluppata correlata al trattamento deve essersi stabilizzata o risolta a un grado =1;
    (fare riferimento al protocollo)
    E.5 End points
    E.5.1Primary end point(s)
    Phase 2 Primary end points (only phase 2 will be conducted in EU):
    • Cohort 1 (MPM): DCR is defined as the proportion of participants who have a CR, PR, or stable disease at Week 16 according to mRECIST 1.1 as assessed by the investigator.
    • Cohorts 2, 3, 4, 5, and 6: ORR is defined as the proportion of participants whose best response is CR or PR according to RECIST 1.1 as assessed by the investigator.
    Endpoint primario fase II (in EU viene condotta solo la fase II):
    • Coorte 1 (MPM): il DCR è definito come la percentuale di partecipanti che presentano una CR, PR o malattia stabile alla Settimana 16 secondo i criteri mRECIST 1.1, come valutato dallo sperimentatore.
    • Coorti 2, 3, 4, 5 e 6: l’ORR è definito come la percentuale di partecipanti la cui migliore risposta è CR o PR secondo i criteri RECIST 1.1, come valutato dallo sperimentatore.
    E.5.1.1Timepoint(s) of evaluation of this end point
    • Cohort 1 (MPM): DCR assessed at Week 16 according to mRECIST 1.1 by the investigator.
    • Cohorts 2, 3, 4, 5, and 6: ORR assessed according to RECIST 1.1 by the investigator.
    Disease response assessment (CT or MRI) performed at screening, Cycle 3 Day 1, Cycle 5 Day 1 (±7 days) and then every 3 cycles thereafter (±2 weeks) and at treatment termination visit.
    • Coorte 1 (MPM): il DCR è definito alla Settimana 16 secondo i criteri mRECIST 1.1, come valutato dallo sperimentatore.
    • Coorti 2, 3, 4, 5 e 6: l’ORR è definito secondo i criteri RECIST 1.1, come valutato dallo sperimentatore.
    La valutazione della risposta alla malattia (TC o RM) eseguita allo screening, Ciclo 3 Giorno 1, Ciclo 5 Giorno 1 (±7 giorni) e successivamente ogni 3 cicli (±2 settimane) e alla visita di fine trattamento.
    E.5.2Secondary end point(s)
    Phase 2 secondary end points (only phase 2 will be conducted in EU):
    • Incidence and severity of AEs including SAEs, as well as other safety assessments.
    • ASTX295 plasma concentration profiles and PK parameters such as AUC, Cmax, Cmin, Tmax, and t½.
    • PK parameters of ASTX295 metabolites if applicable.
    • Progression free survival (PFS) is defined as the time from date of the first dose until the earliest date of disease progression, as assessed by the investigator, or death from any cause, whichever occurs first.
    • Overall survival (OS) is defined as the time from the date of first dose to date of death due to any cause.
    • ORR is defined as the proportion of participants whose best response is CR or PR according mRECIST 1.1 for MPM as assessed by the investigator.
    Endpoint secondario fase II (in EU viene condotta solo la fase II):
    • Incidenza e gravità degli EA, compresi i SAE, nonché altre valutazioni di sicurezza
    • Profili di concentrazione plasmatica di ASTX295 e parametri PK quali AUC, Cmax, Cmin, Tmax e t1/2.
    • Parametri PK dei metaboliti di ASTX295, se applicabile.
    • La sopravvivenza senza progressione (PFS) è definita come il tempo dalla data della prima dose fino alla prima data di progressione della malattia, come valutato dallo sperimentatore, o al decesso per qualsiasi causa, a seconda di quale evento si verifichi prima.
    • La sopravvivenza complessiva (OS) è definita come il tempo dalla data della prima dose alla data del decesso per qualsiasi causa.
    • L’ORR è definito come la percentuale di partecipanti la cui migliore risposta è CR o PR secondo i criteri mRECIST 1.1 per MPM, come valutato dallo sperimentatore.
    E.5.2.1Timepoint(s) of evaluation of this end point
    AE monitoring performed at each visit.
    PK parameter analysis: Cycle 1 Day 1, Cycle 1 Day 2, Cycle 3 Day 1, Cycle 3 Day 2
    Disease response assessment (CT or MRI) performed at screening, Cycle 3 Day 1, Cycle 5 Day 1 (±7 days) and then every 3 cycles thereafter (±2 weeks) and at treatment termination visit.
    Monitoraggio AE eseguito ad ogni visita.
    Analisi dei parametri PK: Ciclo 1 Giorno 1, Ciclo 1 Giorno 2, Ciclo 3 Giorno 1, Ciclo 3 Giorno 2
    Valutazione della risposta alla malattia (TC o RM) eseguita allo screening, giorno 1 del ciclo 3, giorno 1 del ciclo 5 (±7 giorni) e successivamente ogni 3 cicli (±2 settimane) e alla visita di fine trattamento.
    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 Yes
    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) Yes
    E.7.1.1First administration to humans Yes
    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 No
    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 trial1
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA29
    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 Information not present in EudraCT
    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
    France
    Spain
    Germany
    Italy
    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 Phase 2 portion of the study will be considered complete when all subjects have died or withdrawn from the study or 1 year after the last subject receives their first dose.
    La parte di Fase 2 dello studio sarà considerata completa quando tutti i soggetti saranno deceduti o si si saranno ritirati dallo studio o 1 anno dopo che l'ultimo soggetto ha ricevuto la prima dose.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months3
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months6
    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: 140
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 46
    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 state16
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 70
    F.4.2.2In the whole clinical trial 186
    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)
    Upon completion of each phase of the study, the sponsor will continue to provide ASTX295 and collect, at a minimum, safety information from subjects who are still deriving benefit from continued treatment.
    Al completamento di ogni fase dello studio, lo sponsor continuerà a fornire ASTX295 e raccogliere, come minimo, informazioni sulla sicurezza da soggetti che stanno ancora traendo beneficio dal proseguimento del trattamento.
    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 Decision2022-11-29
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-20
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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