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    Summary
    EudraCT Number:2021-005487-22
    Sponsor's Protocol Code Number:A2A-005
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2023-01-17
    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 number2021-005487-22
    A.3Full title of the trial
    A randomized, double-blind, placebo-controlled, Phase 2 study evaluating efficacy and safety of inupadenant in combination with carboplatin and pemetrexed in adults with nonsquamous non-small cell lung cancer who have progressed on immunotherapy.
    Studio di Fase 2, randomizzato, in doppio cieco, controllato con placebo, per valutare l’efficacia e la sicurezza di inupadenant in combinazione con carboplatino e pemetrexed in adulti affetti da carcinoma polmonare non a piccole cellule non squamoso progredito durante l’immunoterapia
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical study evaluating efficacy and safety of inupadenant in combination with carboplatin and pemetrexed in adults with metastatic nonsquamous non-small cell lung cancer who have progressed on immunotherapy.
    Studio per valutare l’efficacia e la sicurezza di inupadenant in combinazione con carboplatino e pemetrexed in adulti affetti da carcinoma polmonare non a piccole cellule non squamoso metastatico progredito durante l’immunoterapia
    A.3.2Name or abbreviated title of the trial where available
    na
    na
    A.4.1Sponsor's protocol code numberA2A-005
    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 SponsoriTeos Belgium SA
    B.1.3.4CountryBelgium
    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 supportiTeos Belgium SA
    B.4.2CountryBelgium
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationiTeos Belgium SA
    B.5.2Functional name of contact pointSally Ross
    B.5.3 Address:
    B.5.3.1Street Addressrue des Frères Wright 29
    B.5.3.2Town/ cityGosselies
    B.5.3.3Post code6041
    B.5.3.4CountryBelgium
    B.5.4Telephone number710585
    B.5.5Fax number710585
    B.5.6E-mailsally.ross@iteostherapeutics.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 nameInupadenant 20 mg
    D.3.2Product code [EOS100850]
    D.3.4Pharmaceutical form Capsule
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNInupadenant
    D.3.9.1CAS number 2411004-22-1
    D.3.9.2Current sponsor codeEOS100850
    D.3.9.4EV Substance CodeSUB218673
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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 nameInupadenant 40 mg
    D.3.2Product code [EOS100850]
    D.3.4Pharmaceutical form Capsule
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNInupadenant
    D.3.9.1CAS number 2411004-22-1
    D.3.9.2Current sponsor codeEOS100850
    D.3.9.4EV Substance CodeSUB218673
    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 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: 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 Pemetrexed Reddy
    D.2.1.1.2Name of the Marketing Authorisation holderDr. Reddy’s
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 namePemetrexed Reddy
    D.3.2Product code [na]
    D.3.4Pharmaceutical form Concentrate for solution for injection
    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 INNPEMETREXED DISODICO
    D.3.9.2Current sponsor codena
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    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: 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 Carboplatino
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    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 nameCarboplatino
    D.3.2Product code [na]
    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 INNCARBOPLATINO
    D.3.9.2Current sponsor codena
    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 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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboCapsule
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Nonsquamous non-small cell lung cancer
    Carcinoma polmonare non a piccole cellule non squamoso
    E.1.1.1Medical condition in easily understood language
    Nonsquamous non-small cell lung cancer
    Carcinoma polmonare non a piccole cellule non squamoso
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Part 1 (Dose-Finding):
    • To evaluate safety and tolerability of inupadenant in combination with carboplatin and pemetrexed
    • To identify the inupadenant recommended Phase 2 dose (RP2D) to be used in combination with carboplatin and pemetrexed in Part 2 of the study

    Part 2 (Randomized):
    • To evaluate efficacy of inupadenant in combination with carboplatin and pemetrexed compared to the efficacy of the placebo in combination with carboplatin and pemetrexed

    Parte 1 (determinazione della dose):
    • valutare la sicurezza e tollerabilità di inupadenant in combinazione con carboplatino e pemetrexed;
    • identificare la dose raccomandata per la Fase 2 (RP2D) di inupadenant da utilizzare in combinazione con carboplatino e pemetrexed nella Parte 2 dello studio.

    Parte 2 (randomizzata):
    • valutare l’efficacia di inupadenant in combinazione con carboplatino e pemetrexed rispetto all’efficacia del placebo in combinazione con carboplatino e pemetrexed.
    E.2.2Secondary objectives of the trial
    Part 1 Only:
    • To evaluate efficacy of inupadenant in combination with carboplatin and pemetrexed
    Part 2 Only:
    • To evaluate safety and tolerability of inupadenant in combination with carboplatin and pemetrexed vs. placebo in combination with both drugs
    • To evaluate additional measures of efficacy of inupadenant in combination with carboplatin and pemetrexed vs. placebo in combination with both drugs
    • To assess the effect of inupadenant in combination with carboplatin and pemetrexed vs. placebo in combination with both drugs on time to onset and/or deterioration of lung cancer specific symptoms
    Part 1 and Part 2:
    • To evaluate pharmacokinetics of inupadenant and active metabolite EOS100612 in combination with carboplatin and pemetrexed

    Please refer to Protocol Section 2 for other secondary objectives.
    Solo Parte 1:
    • valutare l’efficacia di inupadenant in combinazione con carboplatino e pemetrexed.
    Solo Parte 2:
    • valutare la sicurezza e la tollerabilità di inupadenant in combinazione con carboplatino e pemetrexed vs. placebo in combinazione con entrambi i farmaci;
    • valutare le misure aggiuntive di efficacia di inupadenant in combinazione con carboplatino e pemetrexed vs. placebo in combinazione con entrambi i farmaci;
    • valutare l’effetto di inupadenant in combinazione con carboplatino e pemetrexed vs. placebo in combinazione con entrambi i farmaci sul tempo all’insorgenza e/o il deterioramento dei sintomi specifici del carcinoma polmonare. Parte 1 e Parte 2:
    • valutare la farmacocinetica di inupadenant e del metabolita attivo EOS100612 in combinazione con carboplatino e pemetrexed.

    Consultare la Sezione 2 del Protocollo per altri obiettivi secondari.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Have signed an Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved informed consent form prior to any study-specific evaluation.

    2. Be =18 years of age at the time informed consent is signed.

    3. Have a confirmed diagnosis of metastatic (Stage IV) or locally advanced, unresectable (Stage III) NSCLC of nonsquamous pathology that has relapsed or progressed.

    4. Have measurable disease as defined by RECIST v1.1 criteria based on local assessment. A measurable tumor lesion in a previously irradiated site is acceptable if subsequent progression has been demonstrated in that lesion.

    5. Have PD-L1 expression status available either at the time of or after the diagnosis of advanced or metastatic NSCLC disease has been made.

    6. Can provide existing biopsy taken within 2 years prior to entering trial or have at least one lesion that is accessible for a fresh biopsy (this lesion for fresh biopsy must not be the measurable target tumor lesion).

    7. Have relapsed or progressed after prior anti-programmed death (PD)-ligand (L)1 therapy as follows:
    - Have received only 1 line of anti- PD-L1 therapy in the metastatic setting, without concomitant chemotherapy, and have progressed on the anti-PD-(L)1 therapy. Immuno-oncology (IO)/IO combination therapy (standard or investigational) is allowed. Progression on the anti-PD-(L)1 therapy is defined as demonstrated radiological or clinical disease progression on or after at least 12 weeks of antiPD-(L)1 treatment.

    OR

    - Have received single-agent durvalumab therapy post-chemoradiation in the Stage III setting and have progressed. Progression on durvalumab therapy is defined as demonstrated radiological or clinical disease progression on or after at least 12 weeks of durvalumab treatment.

    8. Have adequate organ function confirmed by the following laboratory values obtained within 14 days prior to treatment assignment:
    Hematological:
    - Absolute neutrophil count: =1,500 /mL
    - Platelets: =100,000 /mL
    - Hemoglobin: =9.5 g/dL or =5.9 mmol/L– 4 weeks without transfusions
    Renal:
    - Estimated glomerular filtration rate (Modification of Diet in Renal Disease method) (Levey, 1999) = 60 mL/min
    Hepatic
    - Total bilirubin OR Direct bilirubin: =1.5× upper limit of normal (ULN) for total
    bilirubin OR =ULN for direct bilirubin for subjects with elevated total bilirubin levels; =1.5× ULN for direct bilirubin in case of Gilbert’s syndrome (hereditary indirect hyperbilirubinemia)
    - Alanine transaminase and aspartate transaminase: =3× ULN; =5× ULN if liver metastases
    Coagulation
    - International Normalized Ratio (INR) or Prothrombin Time (PTT): =1.5× ULN unless the subject is receiving anticoagulant therapy.

    9. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.

    1. Aver firmato un modulo di consenso informato approvato da un Comitato di revisione istituzionale (IRB)/Comitato etico indipendente (CEI) prima di qualsiasi valutazione specifica per lo studio.
    2. Avere un’età =18 anni al momento della firma del consenso informato.
    3. Avere una diagnosi confermata di NSCLC non resecabile (stadio III), localmente avanzato o metastatico (stadio IV) di patologia non squamosa recidivato o progredito.
    4. Avere una malattia misurabile come definito dai criteri RECIST v1.1 sulla base di una valutazione locale. È accettabile una lesione tumorale misurabile in un sito precedentemente irradiato se è stata dimostrata la successiva progressione in quella lesione.
    5. Avere uno stato di espressione PD-L1 disponibile sia al momento sia dopo la diagnosi di malattia NSCLC avanzata o metastatica.
    6. Possibilità di fornire una biopsia esistente prelevata entro 2 anni prima dell’arruolamento nella sperimentazione o presenza di almeno una lesione accettabile per una biopsia fresca (questa lesione per la biopsia fresca non deve essere la lesione tumorale target misurabile).
    7. Avere recidiva o progressione dopo precedente terapia anti ligando di morte cellulare programmata 1 (PD-L1) come segue:
    - aver ricevuto 1 sola linea di terapia anti-PD-L1 in contesto metastatico, senza chemioterapia concomitante e avere avuto una progressione durante la terapia anti-PD-(L)1. La terapia combinata immuno-oncologica (IO)/IO (standard o sperimentale) è consentita. La progressione durante la terapia anti-PD-(L)1 è definita come progressione della malattia clinica o radiologica dimostrata durante o dopo almeno 12 settimane di trattamento anti-PD-(L)1;
    OPPURE
    - aver ricevuto terapia con durvalumab come agente singolo post-chemioradioterapia in contesto di Stadio III e progressione. La progressione durante la terapia con durvalumab è definita come progressione della malattia clinica o radiologica dimostrata durante o dopo almeno 12 settimane di trattamento con durvalumab.
    8. Avere una funzione organica adeguata confermata dai seguenti valori di laboratorio ottenuti entro 14 giorni prima dell’assegnazione del trattamento:
    Emocromo:
    - conta assoluta dei neutrofili =1.500/ml;
    - piastrine =100.000/ml;
    - emoglobina =9,5 g/dl o =5,9 mmol/l - 4 settimane senza trasfusioni.
    Renale:
    - velocità di filtrazione glomerulare (metodo Modifica della dieta nelle malattie renali) (Levey, 1999) =60 ml/min. Epatico:
    - bilirubina totale o bilirubina diretta =1,5× limite superiore del normale (ULN) per bilirubina totale O =ULN per bilirubina diretta per soggetti con livelli elevati di bilirubina totale; =1,5× ULN per bilirubina diretta in caso di sindrome di Gilbert (iperbilirubinemia indiretta ereditaria);
    - alanina transaminasi e aspartato transaminasi: =3× ULN; =5× ULN in caso di metastasi al fegato.
    Coagulazione:
    - rapporto normalizzato internazionale (INR) o tempo di protrombina (PTT): =1,5× ULN a meno che il soggetto non stia ricevendo una terapia anticoagulante.
    9. Avere un performance status ECOG (Eastern Cooperative Oncology Group) tra 0 e 1.
    E.4Principal exclusion criteria
    1. Symptomatic and/or untreated central nervous system (CNS) metastases or leptomeningeal disease. Participants with asymptomatic previously treated CNS metastases are eligible provided they have been clinically stable for at least 4 weeks.

    2. Presence of active second malignancy, except for:
    a. History of malignancy that has been successfully treated, with no evidence of active cancer for 1 year prior to enrollment
    b. Surgically cured and/or low risk tumors e.g., early stage cervical or endometrial cancer, any cancer in situ, non-melanoma skin cancers.

    3. Treatment with any prior systemic chemotherapy or >1 line of immunotherapy in the metastatic setting. Participants may have received prior chemotherapy or additional immunotherapy in the adjuvant setting, provided their first metastatic treatment occurred more than 6 months after completing adjuvant therapy).

    4. Have actionable mutation or genomic alteration in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) genes or have been treated with EGFR or ALK targeted therapy. Participants with presence of other driver mutations are allowed if targeted therapy is not available as per local SOC.

    5. Preexisting gastrointestinal disorders/conditions that would, in the opinion of the Investigator, interfere with ingestion or absorption of inupadenant.

    6. History of or active (non-infectious) pneumonitis/ interstitial disease or lung fibrosis. (Note: Stage III participants with pneumonitis Grade 1 from the prior chemoradiation therapy that did not worsen on durvalumab therapy are allowed).

    7. Have active or a history of autoimmune disease requiring systemic treatment in the last 6 months (e.g., with disease modifying agents, corticosteroids, or immunosuppressive drugs) or persistent immune-mediated toxicity caused by checkpoint inhibitor therapy > Grade 2, with the exception of residual endocrinopathy being adequately treated, vitiligo, Type 1 diabetes mellitus (T1DM), or psoriasis not requiring systemic therapy. Replacement therapy (e.g., thyroxine, insulin, or corticosteroid replacement therapy for adrenal/pituitary insufficiency) is allowed.

    8. Have known active or chronic hepatitis B or C infection unless treated with antiviral therapy for at least 4 weeks with no detectable viral load at the time of screening; known infection with human immunodeficiency virus (HIV) unless receiving antiretroviral therapy with well-controlled disease documented at the time of screening by a CD4+ T-cell count > 350 cell/µL, HIV RNA level of < 50 copies/mL or the lower-limit of detection at least 12 weeks prior to screening, and a stable treatment regimen for at least 4 weeks prior to enrollment that has been limited to the use of abacavir, dolutegravir, emtricitabine, lamivudine, raltegravir, rilpivirine, or tenofovir. Participants are not required to be tested for the presence of such viruses prior to therapy on this protocol in the absence of a history of such infection or unless required by local health authorities.

    9. History of life-threatening toxicity related to prior immune therapy or any toxicity resulting in permanent discontinuation from prior therapy after rechallenge.


    Please refer to Protocol Section 3.5.2 for other exclusion criteria.
    1. Metastasi del sistema nervoso centrale (SNC) sintomatiche e/o non trattate o malattia leptomeningea. I partecipanti con metastasi SNC precedentemente trattate asintomatiche sono idonei a condizione che siano clinicamente stabili da almeno 4 settimane.
    2. Presenza di malignità secondaria attiva, salvo:
    a. anamnesi di malignità che sia stata trattata con successo, senza evidenza di tumore attivo per 1 anno prima dell’arruolamento;
    b. tumori curati chirurgicamente e/o a basso rischio, come carcinoma dell’endometrio o della cervice agli stadi precoci, qualsiasi tumore in situ, tumori della pelle non melanoma.
    3. Trattamento con qualsiasi chemioterapia sistemica precedente o >1 linea di immunoterapia in ambito metastatico. I partecipanti possono avere ricevuto precedente chemioterapia o immunoterapia aggiuntiva in ambito adiuvante, a condizione che il primo trattamento per la malattia metastatica sia avvenuto più di 6 mesi dopo aver completato la terapia adiuvante.
    4. Avere alterazione genomica o mutazione azionabile del recettore dei geni della chinasi del linfoma anaplastico (ALK) o del recettore del fattore di crescita epidermoidale (EGFR) o essere stati trattati con terapia mirata a EGFR o ALK. I partecipanti con presenza di altre mutazioni driver sono ammissibili se la terapia mirata non è disponibile in base al SOC locale.
    5. Disturbi/condizioni gastrointestinali pre-esistenti che, secondo il parere dello sperimentatore, interferirebbero con l’ingestione o l’assorbimento di inupadenant.
    6. Anamnesi di malattia interstiziale/polmonite (non infettiva) attiva o fibrosi polmonare. (Nota bene: i partecipanti con malattia di Stadio III affetti da polmonite di Grado 1 da precedente terapia di chemioradioterapia che non sono peggiorati durante la terapia con durvalumab sono ammissibili).
    7. Avere un’anamnesi di o malattia autoimmune attiva che ha richiesto un trattamento sistemico negli ultimi 6 mesi (es., con agenti modificanti la malattia, corticosteroidi o immunosoppressori) o tossicità immuno-mediata persistente causata da terapia con inibitore del checkpoint >Grado 2, con l’eccezione di endocrinopatia residua adeguatamente trattata, vitiligine, diabete mellito di tipo 1 (T1DM) o psoriasi che non richieda terapia sistemica. La terapia sostitutiva (es., tiroxina, insulina o terapia sostitutiva con corticosteroidi per insufficienza surrenalica/ipofisaria) è ammessa.
    8. Avere un’infezione nota da epatite B o C attiva o cronica salvo se trattata con terapia antivirale per almeno 4 settimane senza carico virale rilevabile al momento dello screening; infezione nota da virus dell’immunodeficienza umana (HIV) salvo se riceventi terapia antiretrovirale con malattia ben controllata documentata al momento dello screening da una conta dei linfociti T CD4+ >350 cell/µL, livello RNA HIV di <50 copie/ml o il limite inferiore di rilevamento almeno 12 settimane prima dello screening e un regime di trattamento stabile per almeno 4 settimane prima dell’arruolamento che è stato limitato all’utilizzo di abacavir, dolutegravir, emtricitabina, lamivudina, raltegravir, rilpivirina, o tenofovir. I partecipanti non sono tenuti a essere sottoposti a test per la presenza di tali virus prima della terapia prevista in questo protocollo in assenza di un’anamnesi di tali infezioni o a meno che non sia richiesto dalle autorità sanitarie locali.
    9. Anamnesi di tossicità potenzialmente letale correlata a precedente immunoterapia o qualsiasi tossicità che comporti un’interruzione permanente della terapia precedente dopo la risomministrazione.

    Per altri criteri di esclusione, consultare la Sezione 3.5.2 del Protocollo.
    E.5 End points
    E.5.1Primary end point(s)
    Part 1 (Dose-Finding):
    • Incidence of adverse events (AEs), serious adverse events (SAEs), dose-limiting toxicities (DLTs), AEs leading to discontinuation, deaths, and clinically significant laboratory abnormalities.

    Part 2 (Randomized):
    • Progression-free survival (PFS), defined as time from randomization to the date of first documented radiological progression using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria or death due to any cause.

    Parte 1 (determinazione della dose):
    • incidenza di eventi avversi (EA), eventi avversi gravi (EAG), tossicità dose-limitanti (DLT), EA che comportano l’interruzione, decessi e anomalie di laboratorio clinicamente significative.

    Parte 2 (randomizzata):
    • sopravvivenza libera da progressione (PFS), definita come tempo dalla randomizzazione alla data della prima progressione radiologica documentata in base ai Criteri di valutazione della risposta nei tumori solidi (RECIST), v1.1 o del decesso per qualsiasi causa.
    E.5.1.1Timepoint(s) of evaluation of this end point
    AEs/SAEs/DLTs: Continuously from first intake of study drug up to 30 day follow-up visit or start of a new therapy, whichever date is first. Also at unscheduled visits.

    Vital signs: Screening (Scr); Day (D) 1, D8 and D15 of Cycles 1 and 2; D1 for Cycle 3 onwards; End of Treatment (EoT); D30 after last dose then every 12 weeks until death, withdrawal of consent, lost to follow-up, or end of study

    Hematology and serum/plasma chemistry: Scr; D1, D8 and D15 of Cycles 1 and 2; on D1 for Cycle 3 onwards; EoT; D30 after last dose

    ECOG: Scr; D1 of all cycles; EoT; D30 after last dose

    ECG: Scr; D1 of cycles 1-4; EoT

    ECHO: Scr; EoT

    Tumor assessment: every 6 weeks for the first 24 weeks of treatment, then every 12 weeks until end of study (more frequently, if clinically indicated).
    EA/EAG/DLT: continuo dalla 1 assunzione di farmaco alla visita di FU/30 gg/inizio di una nuova terapia (quale evento si verifichi prima).Anche durante le visite non programmate.Parametri vitali:Screening(Scr); Giorno (G) 1, G8 e G15 dei Cicli 1 e 2; G1 dal Ciclo 3 in poi; Fine trattamento (EOT); G30 dopo l’ultima dose, ogni 12 sett fino al decesso, al ritiro del consenso, alla perdita al FU, o alla EOT. Ematochimica del sangue/plasma: Scr; G1, G8 e G15 dei Cicli 1/2; G1 dal Ciclo 3 in poi; EOT; G30 dopo l’ultima dose; ECOG: Scr; G1 di tutti i cicli; EoT; G30 dopo l’ultima dose; ECG: Scr; G1 dei cicli 1-4; EoT; ECHO:Scr; EoT; Valutazione del tumore: ogni 6 sett per le prime 24 sett di trattamento, quindi ogni 12 sett fino alla EoT (più frequentemente se indicato dal punto di vista clinico).
    E.5.2Secondary end point(s)
    Part 1 (Dose-Finding) Only:
    •Overall response rate (ORR); duration of response; percent change in tumor size (CTS) from baseline; disease control rate, PFS, overall survival (OS).

    Part 2 (Randomized) Only:
    • Incidence and frequency of AEs, SAEs, and AEs leading to dose modifications, deaths, and clinically significant laboratory abnormalities.
    • ORR; duration of response; percent CTS from baseline; disease control rate; OS.
    • Time to definitive deterioration in global health status/quality of life (QoL), shortness of breath and pain per European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life of Cancer Patients (QLQ-C30) questionnaire.
    • Time to definitive 10-point deterioration symptom scores of pain, cough, and dyspnea per EORTC Lung (QLQ-LC13) questionnaire.
    Part 1 and Part 2:
    • Summary measures of pharmacokinetic (PK) parameters of inupadenant and EOS100612 on Day1 followed by Cmax and trough (Cmin) level monitoring at steady state.

    Please refer to Protocol Section 2 for other secondary endpoints.
    Solo Parte 1 (determinazione della dose):
    •tasso di risposta complessiva (ORR); durata della risposta; variazione percentuale della dimensione del tumore (CTS) rispetto al basale; tasso di controllo della malattia, PFS, sopravvivenza globale (OS).

    Solo Parte 2 (randomizzata):
    • incidenza e frequenza degli EA, EAG ed EA che comportano modifiche della dose, decesso e anomalie di laboratorio clinicamente significative;
    • ORR; durata della risposta; CTS percentuale rispetto al basale; tasso di controllo della malattia; OS;
    • tempo al deterioramento definitivo dello stato di salute globale/qualità della vita (QoL), respiro affannoso e dolore secondo il questionario Qualità della vita dei pazienti con cancro (QLQ-C30) della European Organisation for Research and Treatment of Cancer (EORTC);
    • tempo al deterioramento definitivo a 10 punti, punteggi dei sintomi relativi a dolore, tosse e dispnea in base al questionario EORTC polmone (QLQ-LC13);
    Parte 1 e Parte 2:
    • misure riassuntive dei parametri di farmacocinetica (PK) di inupadenant ed EOS100612 il Giorno 1 seguite da monitoraggio del livello Cmax e Cmin allo stato stabile.

    Per altri endpoint secondari, consultare la Sezione 2 del Protocollo
    E.5.2.1Timepoint(s) of evaluation of this end point
    AEs/SAEs and tumour assessment: as above.

    Survival status: every 12 weeks until death, withdrawal of consent, lost to follow-up, or end of study.

    QoL questionnaire: Days 1 of all Cycles; EoT; Day 30 after last dose.

    PK: Days 1 and 8 of Cycles 1 and 2; Day 1 of cycles 3 and 4 and once anytime between cycle 5 and cycle 12; EoT.
    Unscheduled PK sample should be collected at the onset of the first Grade =3 AE(s) that is at least possibly related to the study drug.
    Valutazione del tumore ed EA/EAG: come sopra.

    Stato di sopravvivenza: ogni 12 settimane fino al decesso, al ritiro del consenso, alla perdita al follow-up, o alla fine dello studio.

    Questionario QoL: giorno 1 di tutti i cicli; EoT; G30 dopo l’ultima dose.

    PK: giorni 1 e 8 dei Cicli 1 e 2; Giorno 1 dei cicli 3 e 4 e una volta tra i cicli 5 e 12; EoT.
    Il campione PK non programmato deve essere prelevato all’insorgenza del primo EA di Grado =3 che sia almeno probabilmente correlato al farmaco in studio.
    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 Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Determination of RP2D
    Determinazione della RP2D
    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 Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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 concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA46
    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
    Canada
    United States
    France
    Poland
    Spain
    Switzerland
    Czechia
    Germany
    Italy
    Belgium
    Georgia
    Hungary
    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
    LVLS
    LVLS
    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 months1
    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 months1
    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: 48
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 144
    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 state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 122
    F.4.2.2In the whole clinical trial 192
    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
    Nessuno
    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 Decision2022-04-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-04-04
    P. End of Trial
    P.End of Trial StatusOngoing
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