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    Summary
    EudraCT Number:2021-005742-14
    Sponsor's Protocol Code Number:GS-US-592-6173
    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:2022-05-30
    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 number2021-005742-14
    A.3Full title of the trial
    A Randomized, Open-label, Phase 3 Study of Sacituzumab Govitecan and Pembrolizumab Versus Treatment of Physician’s Choice and Pembrolizumab in Patients With Previously Untreated, Locally Advanced, Inoperable, or Metastatic Triple-Negative Breast Cancer, Whose Tumors Express PD-L1
    Estudio de fase III, aleatorizado, abierto de sacituzumab govitecán y pembrolizumab frente al tratamiento elegido por el médico y pembrolizumab en pacientes con cáncer de mama triple negativo localmente avanzado, inoperable o metastásico, no tratado anteriormente cuyos tumores presenten expresión de PD-L1
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study of Sacituzumab Govitecan plus Pembrolizumab Versus Treatment of Physician's Choice Plus Pembrolizumab in Participants with Previously Untreated, Locally Advanced, Inoperable (cannot be removed surgically), or Metastatic (spread to other locations in the body) Triple Negative Breast Cancer (breast cancer that does not have receptors for Oestrogen and progesterone hormones or HER2 proteins) that express PD-L1 biomarker (a type of protein found on cancer cells).
    Estudio de Sacituzumab Govitecan + Pembrolizumab frente al tratamiento de elección del médico + Pembrolizumab en pacientes con cáncer de mama triple negativo(cáncer de mama sin receptores para hormonas estrógeno y progesterona ni para proteínas HER2) sin tratar previamente, localmente avanzado, inoperable(no puede ser extirpado mediante cirugía) o metastásico(se ha extendido a otras partes del cuerpo) y que expresa el biomarcador PD-L1(proteína que se encuentra en células cancerosas)
    A.4.1Sponsor's protocol code numberGS-US-592-6173
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT05382286
    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 AddressFlowers Building, Granta Park
    B.5.3.2Town/ cityAbington, Cambridge
    B.5.3.3Post codeCB21 6GT
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+441223897284
    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.3.2Product code IMMU-132
    D.3.4Pharmaceutical form Powder 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 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 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) 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 RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Paclitaxel 6 mg/ml concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderFresenius Kabi Deutschland GmbH
    D.2.1.2Country which granted the Marketing AuthorisationIreland
    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 namePaclitaxel
    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 INNPaclitaxel
    D.3.9.3Other descriptive namePACLITAXEL
    D.3.9.4EV Substance CodeSUB179428
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Abraxane 5 mg/ml powder for dispersion for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    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 namenab-Paclitaxel
    D.3.4Pharmaceutical form Powder for dispersion 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 INNnab-Paclitaxel
    D.3.9.3Other descriptive namePACLITAXEL ALBUMIN-BOUND
    D.3.9.4EV Substance CodeSUB127678
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    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 Yes
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Gemcitabin Aurobindo concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderAurobindo Pharma GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 nameGemcitabine
    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 INNGEMCITABINE
    D.3.9.1CAS number 95058-81-4
    D.3.9.4EV Substance CodeSUB07892MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number38
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Carboplatin 10 mg/ml concentrate for solution for infusion
    D.2.1.1.2Name of the Marketing Authorisation holderFresenius Kabi Deutschlan
    D.2.1.2Country which granted the Marketing AuthorisationIreland
    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 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: 6
    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 Keytruda
    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 25mg/ml
    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 INNPembrolizumab
    D.3.9.3Other descriptive namePembrolizumab
    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.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
    Programmed cell death ligand 1 (PD-L1) negative metastatic triple negative breast cancer or PD-L1-positive metastatic triple-negative breast cancer previously treated with an anti-PD-(L)1 agent in the curative setting.
    Cáncer de mama triple negativo metastásico con muerte celular programada del ligando 1 (PD-L1) o cáncer de mama triple negativo PD-L1 positivo metastásico tratado previamente con un agente anti PD-(L)1 con intención curativa.
    E.1.1.1Medical condition in easily understood language
    Triple Negative Breast Cancer (breast cancer that does not have receptors for Oestrogen and Progesterone hormones or HER2 proteins).
    Cáncer de mama triple negativo (cáncer de mama que no tiene receptores para hormonas de estrógeno o progesterona o proteínas
    HER2)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 23.0
    E.1.2Level LLT
    E.1.2Classification code 10084066
    E.1.2Term Triple negative breast cancer metastatic
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare progression-free survival (PFS) as assessed by blinded independent central review (BICR) between sacituzumab govitecan (SG) and pembrolizumab versus treatment of physician’s choice (TPC) and pembrolizumab
    Comparar la supervivencia sin progresión (SSP) evaluada mediante una evaluación central independiente enmascarada (ECIE) entre
    sacituzumab govitecán (SG) y pembrolizumab frente al tratamiento elegido por el médico y pembrolizumab.
    E.2.2Secondary objectives of the trial
    - To compare overall survival (OS) between the 2 arms
    - To compare objective response rate (ORR) as assessed by BICR between the 2 arms
    - To compare duration of response (DOR) as assessed by BICR between the 2 arms
    - To compare time to onset of response (TTR) as assessed by BICR between the 2 arms
    - To compare safety and tolerability between the 2 arms
    - To compare time to deterioration (TTD) in physical functioning as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 [Version 3.0]) between the 2 arms
    -To evaluate TTD in role functioning, global health status/ quality of life (QOL), pain, and fatigue as measured by the EORTC QLQ-C30 (Version 3.0) between the 2 arms
    - Comparar la supervivencia global (SGl) entre los 2 grupos
    - Comparar la tasa de respuesta objetiva (TRO) entre los 2 grupos, evaluada mediante una ECIE
    - Comparar la duración de la respuesta (DdR) entre los 2 grupos, evaluada mediante una ECIE
    - Comparar el tiempo hasta la respuesta (ThR) entre los 2 grupos, evaluado mediante una ECIE
    - Comparar la seguridad y la tolerabilidad entre los 2 grupos
    - Comparar el tiempo hasta el deterioro (TdD) en el funcionamiento físico medido por el Cuestionario de Calidad de Vida de la Organización Europea para la Cáncer (EORTC QLQ-C30 [versión 3.0]) entre los dos brazos.
    -Evaluar el TdD en el funcionamiento de los roles, el estado de salud global/la calidad de vida (QOL), el dolor y la fatiga medidos por el EORTC QLQ-C30 (Versión 3.0) entre los 2 brazos
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Patients must meet all of the following inclusion criteria to be eligible for participation in this study (no waivers for patient eligibility will be offered or permitted):

    1) Female or male patients, regardless of race and/or ethnic group, who are18 years of age or older, able to understand and give written informed consent

    2) Patients with locally advanced, inoperable, or metastatic TNBC who have not received previous systemic therapy for advanced disease and whose tumors are PD-L1 positive at screening.

    a) Patients must have completed treatment for Stage I to III breast cancer, if indicated, and ≥ 6 months must have elapsed between completion of treatment with curative intent (eg, date of primary breast cancer surgery or date of last (neo)adjuvant chemotherapy administration [including anti-PD-(L)1 treatment], whichever occurred last) and first documented local or distant disease recurrence. Dates of postoperative radiotherapy are not included in this calculation. Prior use of an anti-PD(L)1 agent in the curative TNBC setting is permitted.

    b) Patients presenting with de novo metastatic TNBC are eligible for this study.

    c) TNBC status and tumor PD-L1 CPS will be confirmed centrally on a recent or archival
    tumor specimen. Patients must have histologically or cytologically documented TNBC, according to current ASCO/CAP criteria, defined as negative for ER, progesterone receptor, and HER2 {Allison 2020, Wolff 2018}. Patients initially diagnosed with hormone receptor-positive or HER2-positive breast cancer must have central confirmation of TNBC in a tumor biopsy obtained from a local recurrence or distant metastasis site prior to study entry.Tumor CPS ≥ 10 using the PD L1 IHC 22C3 assay will be required for eligibility.

    d) Patients must have measurable disease by CT or MRI as per RECIST Version 1.1 criteria (Appendix 6) as evaluated locally. Tumor lesions situated in a previously irradiated area are considered measurable if unequivocal progression has been documented in such
    lesions since radiation.

    3) Have provided representative formalin-fixed paraffin-embedded (FFPE) tumor specimen in blocks (preferably) or have at least 20 to 25 freshly sectioned unstained slides from fresh biopsy tissue or archival tissue block for central testing of ER, progesterone receptor, HER2, PD-L1, Trop-2, and additional biomarker testing. A baseline biopsy is required if archival tissue is not available and this procedure must be performed prior to the first dose of study treatment and after the patient provides written informed consent. Fine needle aspirates and bone biopsies are not suitable samples.
    Note: Tumor tissue quality must be confirmed by the central laboratory. Submission of another tumor specimen may be required if provided specimen is not adequate for assessment.

    4) ECOG performance status score of 0 or 1 (Appendix 5).

    5) Life expectancy ≥ 3 months.

    6) Recovered from major surgery for ≥ 2 weeks.

    7) Adequate hematologic counts without transfusional or growth factor support within 2 weeks of study treatment initiations (hemoglobin ≥ 9 g/dL, 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 ≥ 30 mL/min as assessed by the Cockcroft-Gault equation {Cockcroft 1976}.

    10) International normalized ratio (INR)/PT and aPTT ≤ 1.5 ULN unless patient is currently receiving therapeutic anticoagulant therapy.

    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.

    12) 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 (Day 1).

    d) The combination ART regimen must not contain any medications that may interfere with SN-38 metabolism
    Los pacientes deben cumplir los siguientes criterios de inclusión para ser elegibles para participar en el estudio (no se ofrecerán ni permitirán dispensas):
    1) Hombres o mujeres sin importar la raza u origen étnico mayores de 18 años capaces de comprender y dar su consentimiento por escrito
    2) Pacientes con cáncer de mama triple negativo localmente avanzado, inoperable o metastásico que no han recibido terapia sistémica previa para enfermedad avanzada y cuyos tumores son PD-L1 positivo en la selección
    a) Los pacientes deben haber completado el tratamiento del cáncer de mama en estadio I a III, si está indicado, y deben haber transcurrido ≥ 6 meses entre la finalización del tratamiento con intención curativa (por ejemplo, la fecha de la cirugía del cáncer de mama primario o la fecha de la última administración de quimioterapia (neo)adyuvante [incluido el tratamiento anti-PD-(L)1], lo que ocurra en último lugar) y la primera recidiva local o a distancia de la enfermedad documentada. Las fechas de la radioterapia postoperatoria no se incluyen en este cálculo. Se permite el uso previo de un agente anti-PD(L)1 en el entorno curativo del CMTN
    b) Los pacientes que presenten un CMTN metastásico de novo son elegibles para este estudio
    c) El estado del CMTN y el CPS de PD-L1 del tumor se confirmarán de forma centralizada en una muestra tumoral reciente o de archivo. Los pacientes deben tener un CMTN documentado histológica o citológicamente, según los criterios actuales de ASCO/CAP, definidos como negativos para RE, receptor de progesterona y HER2. Los pacientes diagnosticados inicialmente con cáncer de mama con receptores hormonales positivos o HER2 positivo deben tener confirmación central de CMTN en una biopsia tumoral obtenida de una recidiva local o de un sitio de metástasis a distancia antes de la entrada en el estudio. Se requerirá un CPS tumoral ≥ 10 utilizando el ensayo PD L1 IHC 22C3 para ser elegible
    d) Los pacientes deben tener una enfermedad medible por TC o RM según los criterios RECIST versión1.1 evaluados localmente. Las lesiones tumorales situadas en un área previamente irradiada se consideran medibles si se ha documentado una progresión inequívoca en dichas lesiones desde la radiación
    3) Haber proporcionado una muestra tumoral representativa fijada en formol e incluida en parafina (FFPE) en bloques (preferiblemente) o tener al menos 20 a 25 cortes sin teñir de tejido fresco de biopsia o bloque de tejido de archivo para pruebas centrales de ER, receptor de progesterona, HER2, PD-L1, Trop-2 y pruebas adicionales de biomarcadores. Se requiere una biopsia de referencia si no se dispone de tejido de archivo y este procedimiento debe realizarse antes de la primera dosis del tratamiento del estudio y después de que el paciente proporcione su consentimiento informado por escrito. Los aspirados con aguja fina y las biopsias óseas no son muestras adecuadas.
    Nota: La calidad del tejido tumoral debe ser confirmada por el laboratorio central. Puede ser necesaria la presentación de otra muestra tumoral si la muestra proporcionada no es adecuada para la evaluación
    4) Puntuación en la escala ECOG de 0 ó 1
    5) Esperanza de vida ≥3 meses
    6) Recuperado de cirugía mayor desde al menos hace 2 semanas
    7) Conteo hematológico adecuado sin transfusión o soporte al factor de crecimiento dentro de las 2 semanas del comienzo del tratamiento del estudio (hemoglobina ≥9 g/dL, ANC ≥1500/mm3, y plaquetas ≥100,000/μL)
    8) Función hepática adecuada (bilirrubina≤ 1.5 x ULN, AST y ALT ≤ 2.5 x ULN or ≤ 5 x ULN si hay metástasis hepática conocida, y albúmina en suero >3 g/dL)
    9) Aclaramiento de la creatinina ≥ 30 mL/min según la ecuación de Cockcroft-Gault
    10) INR/PT y PTT o aPTT ≤1.5 ULN a menos que el paciente esté recibiendo terapia terapeútica anticoagulante
    11) Hombres y mujeres en edad de procrear heterosexuales deben acceder a utilizar los métodos anticonceptivos definidos en el protocolo o bien según se describe en el apéndice 3 del protocolo
    12) Los pacientes con VIH deben estar con terapia antirretroviral y tener la infección/patología bien controlada definida como:
    a) Los pacientes en tratamiento antirretroviral deben tener un recuento de células T CD4+ ≥350 células/mm3 en el momento de la selección
    b) Los pacientes en tratamiento antirretroviral deben haber alcanzado y mantenido la supresión virológica, definida como un nivel de ARN del VIH confirmado inferior a 50 copias/mL o al límite inferior de calificación (por debajo del límite de detección) utilizando el ensayo disponible localmente en el momento de la selección y durante al menos 12 semanas antes del mismo
    c) Los pacientes en tratamiento antirretroviral deben haber estado en un régimen estable, sin cambios en los fármacos o modificación de la dosis, durante al menos 4 semanas antes de la entrada en el estudio (día 1)
    d) El régimen combinado de TAR no debe contener ningún medicamento que pueda interferir con el metabolismo del SN-38
    E.4Principal exclusion criteria
    Patients who meet any of the following exclusion criteria are not eligible to be enrolled in this study (no waivers for patient eligibility will be offered or permitted):

    1) Positive serum pregnancy test (Appendix 3) or women who are lactating.

    2) Known or severe (≥ Grade 3) hypersensitivity or allergy to SG, pembrolizumab, and/or the chemotherapy regimen of choice in the TPC arm (eg, nab paclitaxel, paclitaxel, gemcitabine, or carboplatin), their metabolites, or formulation excipient.

    3) Have received prior therapy with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX-40, CD137)

    4) Requirement for ongoing therapy with or prior use of any prohibited medications listed in Section 5.6.1.

    5) 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 from AEs due to a previously administered agent to ≤ Grade 1 or baseline at the time of study
    entry.

    6) Patients may not be participating in a study with an investigational agent or investigational device within 4 weeks prior to randomization. Patients participating in observational studies are eligible.

    7) Have previously received topoisomerase 1 inhibitors or antibody drug conjugates containing a topoisomerase inhibitor.

    8) Have an active second malignancy.


    9) Have known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases may participate (with the exception of those treated with chemotherapy) provided they have stable CNS disease (defined as radiographic stability demonstrated with a minimum of 2 posttreatment brain imaging assessments; one performed during screening) for at least 4 weeks prior to enrollment and all neurologic symptoms have returned to baseline, have no evidence of new or enlarging brain metastases, and have also been clinically stable for at least 2 weeks while taking ≤ 10 mg/day of prednisone or its equivalent. All patients with carcinomatous meningitis are excluded regardless of clinical stability.

    10) Have undergone an allogenic tissue or solid organ transplant.

    11) Met any of the following criteria for cardiac disease:
    a) Myocardial infarction or unstable angina pectoris within 6 months of enrollment.
    b) History of serious ventricular arrhythmia (ie, ventricular tachycardia or ventricular fibrillation), high-grade atrioventricular block, or other cardiac arrhythmias requiring antiarrhythmic medications (except for atrial fibrillation that is well controlled with antiarrhythmic medication); history of QT interval prolongation.
    c) New York Heart Association Class III or greater congestive heart failure or known left ventricular ejection fraction of < 40%.

    12) Have active chronic inflammatory bowel disease (ulcerative colitis, Crohn’s disease) or GI perforation within 6 months of enrollment.

    13) Have active serious infection requiring systemic antimicrobial therapy.

    14) Patients positive for HIV-1 or 2 with a history of Kaposi sarcoma and/or Multicentric Castleman Disease.

    15) Have active HBV (defined as having a positive HBsAg test) or HCV.

    16) Have other concurrent medical or psychiatric conditions that, in the investigator’s opinion, may be likely to confound study interpretation or prevent completion of study procedures and follow-up examinations.

    17) Has a diagnosis of immunodeficiency or receiving systemic corticosteroid therapy (higher than physiologic doses) ≥ 10 mg of prednisone per day or equivalent or any other form of immunosuppressive therapy within 14 days prior to randomization.

    18) Has received a live or live-attenuated vaccine within 30 days prior to randomization. Administration of killed vaccines are allowed.

    19) Has an active autoimmune disease that has required systemic treatment in the past 2 years (eg, with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, physiologic corticosteroid replacement therapy
    for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed.

    20) Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease. Has a known history of active tuberculosis.

    21) Has received prior radiotherapy within 2 weeks of start of study intervention. 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-CNS disease.
    Los pacientes(ptes) que cumplan cualquiera de los siguientes criterios de exclusión no son elegibles para participar en el estudio (no se ofrecerán ni permitirán dispensas):
    1)Test de embarazo positivo en suero o mujeres lactantes
    2)Hipersensibilidad, alergia conocida o severa (≥ Grado 3) a sacitumumab govitecan, pembrolizumab y/o al régimen de quimioterapia elegido en el brazo de tratamiento(tto) asignado por el Dr(ej.nab-paclitaxel, paclitaxel, gemcitabina o carboplatino), metabolitos o excipientes en su formulación
    3)Haber recibido una terapia previa con agente dirigido a otro receptor de célulasT estimulante o coinhibidor(ej., CTLA-4, OX-40, CD137)
    4)No estar recibiendo o haber recibido terapia con alguna medicación prohibida de las listadas en la sección 5.6.1
    5)Los ptes no pueden haber recibido tto sistémico anticáncer en los 6 meses anteriores o radioterapia en las 2 semanas previas a la inscripción. Los ptes deben haberse recuperado de los EAs debidos a agente administrado previamente a ≤Grado1 o a la línea base en el momento de la entrada al estudio
    6)Los ptes no deben estar participando en estudio con agente en investigación o producto sanitario en investigación en las 4 semanas anteriores a la aleatorización. Los ptes que participen en estudios observacionales son elegibles
    7)Haber recibido con anterioridad inhibidores de la topoisomerasa1 o anticuerpos conjugados que contengan inhibidor de la topoisomerasa.
    8)Tener una segunda malignidad activa
    9)Tener metástasis conocida en sistema nervioso central(SNC) y/o meningitis carcinomatosa. Ptes con metástasis cerebral previamente tratada pueden participar (excepto aquellos tratados con quimioterapia) si tienen enfermedad en SNC estable (definida como estabilidad radiográfica demostrada mediante al menos 2 evaluaciones por imagen tras el tto; 1 realizada durante la selección) durante al menos 4 semanas antes de la inclusión y todos los síntomas neurológicos han regresado a la selección, no hay evidencia de metastasis nueva o metástasis cerebral mayor y han permanecido clínicamente estables durante al menos 2 semanas mientras reciben ≤10 mg/día de prednisona o equivalente. Todos los ptes con meningitis carcinomatosa están excluidos sin importar estabilidad clínica
    10)Haber sido sometido a trasplante alogénico de tejidos/órganos sólidos
    11)Cumplir cualquiera de los siguientes criterios para enfermedad cardíaca:
    a)Infarto de miocardio o angina de pecho inestable en los 6 meses anteriores a la inclusión
    b)Historial de arritmia ventricular grave (ej.: taquicardia ventricular o fibrilación ventricular), bloqueo atrioventricular de alto grado u otras arritmias cardiacas que requieran medicación antiarrítmica (excepto fibrilación atrial bien controlada con medicación antiarrítmica); historia de intervalo QT prolongado
    c)Fallo cardiaco congestivo de gradoIII o mayor según escala de New York Heart Association o eyección ventricular izquierda conocida<40%
    12)Tener inflamación intestinal crónica (colitis ulcerosa, enfermedad de Crohn) o perforación gastrointestinal los 6 meses anteriores a la inclusión
    13)Tener infección grave activa que requiera tto antimicrobiano sistémico
    14)Ptes VIH-1 ó 2 positivo con historial de sarcoma de Kaposi y/o enfermedad multicentrica de Castleman.
    15)Tener VHB activa(definida como tener test + HbsAg) o VHC
    16)Tener otra condición médica o psiquiátrica concurrente que pueda confundir la interpretación del estudio o impedir la realización completa de los procedimientos del estudio y evaluaciones de seguimiento
    17)Tener diagnóstico de inmunodeficiencia o está recibiendo una terapia sistémica de corticosteroides(dosis superiores a las fisiológicas) ≥ 10 mg de prednisona al día o equivalente o cualquier otra forma de terapia inmunosupresora 14 días anteriores a la aleatorización
    18)Ha recibido vacuna viva o viva atenuada en los 30 días anteriores a la aleatorización. Se permite la administración de vacunas inactivadas
    19)Tener enfermedad autoinmune activa que ha requerido tto sistémico en los últimos 2 años(ej, uso de agentes modificadores de la enfermedad, corticosteroides o fármacos inmunosupresores). Terapia de sustitución (ej., tiroxina, insulina, terapia de sustitución fisiológica de corticosteroides para la insuficiencia suprarrenal o hipofisaria) no se considera una forma de tto sistémico y está permitido
    20)Tener historial de neumonitis/enfermedad pulmonar intersticial (no infecciosa) que requirió esteroides o tiene una neumonitis/enfermedad pulmonar intersticial actual. Tiene historial conocido de tuberculosis activa
    21)Ha recibido radioterapia previa en las 2 semanas anteriores al inicio de la intervención del estudio. Los ptes deben haberse recuperado de todas las toxicidades relacionadas con la radiación, no necesitar corticosteroides y no haber tenido neumonitis por radiación. Se permite un lavado de 1 sem para la radiación paliativa (2 sem de radioterapia) a la enfermedad no relacionada con SNC
    E.5 End points
    E.5.1Primary end point(s)
    PFS is defined as the time from the date of randomization until the date of objective progressive disease (PD), as assessed by BICR per RECIST Version 1.1, or death (whichever comes first)
    Supervicencia sin progresión (SSP) es definida como tiempo desde la fecha de aleatorización hasta la fecha de progresión objetiva de la enfermedad (PE), evaluada mediante una ECIE según los criterios de evaluación de la respuesta en tumores sólidos (RECIST) versión 1.1, o la muerte (lo que ocurra antes)
    E.5.1.1Timepoint(s) of evaluation of this end point
    Monitored throughout the study.
    Monitorizada a lo largo del estudio.
    E.5.2Secondary end point(s)
    - OS is defined as the time from the date of randomization until death due to any cause
    - ORR is defined as the proportion of patients who achieve CR or PR that is confirmed at least 4 weeks after initial documentation of response as assessed by BICR per RECIST Version 1.1
    - DOR is defined as the time from the first documentation of CR or PR to the earlier of the first documentation of objective PD or death from any cause (whichever comes first) as assessed by BICR per RECIST Version 1.1
    - TTR is defined as the time from the date of randomization until the first documentation of CR or PR as assessed by BICR per RECIST Version 1.1
    - Incidence of treatment-emergent AEs (TEAEs) and clinical laboratory abnormalities
    -TTD of physical functioning domain of the EORTC QLQ-C30
    - TTD of role functioning, global health status/QOL, pain, and fatigue
    - Se define la SG como el tiempo transcurrido desde la fecha de la aleatorización hasta la muerte por cualquier causa.
    - El IRO se define como la proporción de pacientes que alcanzan la respuesta completa (RC) o respuesta parcial (RP), confirmada al menos 4 semanas tras la documentación inicial de la respuesta evaluada mediante RCIE según los RECIST, versión 1.1.
    - La DdR se define como el tiempo transcurrido desde la primera documentación de RC o RP hasta la primera documentación de EP objetiva o la muerte por cualquier causa (lo que ocurra primero) evaluada mediante RCIE según los RECIST, versión 1.1.
    - El THR se define como el tiempo transcurrido desde la aleatorización hasta la primera documentación de RC o RP evaluada mediante RCIE según los RECIST, versión 1.1.
    - Incidencia de AA surgidos del tratamiento (AAST) y anomalías analíticas
    - TdD del dominio de funcionamiento físico del EORTC QLQ-C30
    - TdD de funcionamiento de roles, estado de salud global/Calidad de vida, dolor y fatiga
    E.5.2.1Timepoint(s) of evaluation of this end point
    Monitored throughout the study.
    Monitorizada a lo largo del 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 No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over Yes
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the 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 concerned15
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA104
    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
    Argentina
    Australia
    Brazil
    Canada
    Chile
    Hong Kong
    Israel
    Japan
    Korea, Republic of
    Mexico
    Peru
    Puerto Rico
    South Africa
    Taiwan
    United States
    Austria
    France
    Poland
    Netherlands
    Spain
    Switzerland
    Czechia
    Germany
    Italy
    Belgium
    Hungary
    Turkey
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study will be the date of the last visit/contact/survival follow-up in the study.

    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. The sponsor reserves the right to terminate the study at any time for any reason (including safety).
    El fin del estudio será la fecha de la última visita/contacto/seguimiento de supervivencia en el estudio.

    Todos los pacientes:
    El final global del estudio para todos los pacientes se define como la fecha en que el último paciente que permanezca en el estudio complete la última visita/llamada o cuando el promotor decida finalizarlo. El promotor se reserva el derecho de finalizar el estudio en cualquier momento por cualquier razón (incluyendo seguridad)
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months5
    E.8.9.1In the Member State concerned days30
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months5
    E.8.9.2In all countries concerned by the trial days30
    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: 348
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 92
    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 state30
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 149
    F.4.2.2In the whole clinical trial 440
    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)
    Following study treatment discontinuation, patients may receive other breast cancer treatments under the direction of their primary treating physician. Subsequent breast cancer therapies should be recorded on the Anti-Cancer Therapy eCRF
    Tras la interrupción del tratamiento del estudio, los pacientes pueden recibir otros tratamientos contra el cáncer de mama bajo la dirección de su médico de cabecera. Las terapias posteriores contra el cáncer de mama deben registrarse en el eCRF de terapias contra el cáncer
    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 Decision2022-09-02
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-08-31
    P. End of Trial
    P.End of Trial StatusOngoing
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