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    Summary
    EudraCT Number:2021-006410-36
    Sponsor's Protocol Code Number:BORT-112
    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:2022-05-26
    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 number2021-006410-36
    A.3Full title of the trial
    Phase Ib/II open-label clinical study of intratumoral administration of BO-112 in combination with radiotherapy and nivolumab in patients with metastatic PD-1/PDL-1 refractory non-small cell lung cancer
    Estudio clínico abierto de fase Ib/II de administración intratumoral de BO-112 en combinación con nivolumab y radioterapia en pacientes con carcinoma de pulmón no microcítico refractario a PD-1/PD-L1.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Clinical study of intratumoral administration of BO-112 combined with radiotherapy and nivolumab in patients with metastatic resistant non-small cell lung cancer
    A.3.2Name or abbreviated title of the trial where available
    Study of BO-112 with radiotherapy and nivolumab for metastatic refractory NSCLC
    Estudio de BO-112 con radioterapia y nivolumab en pacientes con CPNM metastásico refractario.
    A.4.1Sponsor's protocol code numberBORT-112
    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 SponsorClínica Universidad Navarra
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportHighlight Therapeutics, S.L.
    B.4.2CountrySpain
    B.4.1Name of organisation providing supportClínica Universidad de Navarra
    B.4.2CountrySpain
    B.4.1Name of organisation providing supportMinisterio de Ciencia e Innovación
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationHealthCo Trials, S.L.
    B.5.2Functional name of contact pointClinical Research Information
    B.5.3 Address:
    B.5.3.1Street AddressCalle Núñez Morgado, 5
    B.5.3.2Town/ cityMADRID
    B.5.3.3Post code28036
    B.5.3.4CountrySpain
    B.5.4Telephone number34913593154
    B.5.5Fax number34913150677
    B.5.6E-mailnrpina@healthcotrials.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 nameBO-112
    D.3.2Product code BO-112
    D.3.4Pharmaceutical form Suspension for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntratumoral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNot available
    D.3.9.1CAS number 42424-50-0
    D.3.9.2Current sponsor codeBO-112
    D.3.9.3Other descriptive namePolyinosinic: Polycytidylic acid (Poly I:C)
    D.3.9.4EV Substance CodeSUB177592
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.6
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Opdivo
    D.2.1.1.2Name of the Marketing Authorisation holderBrystol 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 nameOpdivo
    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 INNNivolumab
    D.3.9.1CAS number 946414-94-4
    D.3.9.2Current sponsor codeN/A
    D.3.9.4EV Substance CodeSUB122750
    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 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 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
    Metastatic PD-1/PDL-1 refractory non-small-cell lung cancer
    Cáncer de pulmón no microcítico metastásico refractario a PD-1/PD-L1
    E.1.1.1Medical condition in easily understood language
    Metastatic non-small-cell lung cancer
    Cáncer de pulmón no microcítico
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level SOC
    E.1.2Classification code 10029104
    E.1.2Term Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    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 20.0
    E.1.2Level HLGT
    E.1.2Classification code 10038666
    E.1.2Term Respiratory and mediastinal neoplasms malignant and unspecified
    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 20.0
    E.1.2Level HLT
    E.1.2Classification code 10029664
    E.1.2Term Non-small cell neoplasms malignant of the respiratory tract cell type specified
    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
    Safety of repeated IT administrations of BO-112 in metastatic lesions in combination with IV nivolumab and radiotherapy.
    Investigación de la seguridad de la administración IT repetida de BO 112 en lesiones metastásicas en combinación con nivolumab IV y radioterapia.
    E.2.2Secondary objectives of the trial
    - Further characterization of safety and of clinical activity of the combination as well as determination of systemic exposure of BO 112 and radiotherapy.
    - Evaluation of antitumoral and immunological effects in the TME of the treated and un-treated lesion.
    - Evaluate preliminary efficacy as defined by tumor response rate of the treated and non-treated lesion(s). To assess imaging response biomarkers.
    - Caracterización más detallada de la seguridad y la actividad clínica de la combinación, así como determinación de la exposición sistémica a BO 112 y radioterapia
    - Evaluación de efectos antitumorales e inmunológicos en el MAT de las lesiones tratadas y no tratadas.
    - Evaluación de la eficacia preliminar definida por la tasa de respuesta tumoral de las lesiones tratadas y no tratadas. Determinación de la respuesta de biomarcadores por imagen.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    - Willing and able to give written informed consent for the study
    - ≥18 years of age
    - Diagnosis of histologically confirmed metastatic NSCLC
    - Participant must have either recurrence after, or progression on or lack of response to established standard of care anticancer therapies (including platine treatment) in the recurrent setting or subject refuses such available therapy.
    - At least one accessible metastasis of minimum 20 mm in diameter that is suitable for percutaneous IT injection of BO-112. The irradiated and injected site must be accessible to tumor biopsy
    - At least one measurable lesion according to RECIST v. 1.1
    - Prior resection of metastatic disease is allowed if completed more than 6 months previous to study enrollment and at the time of study entry there is progressive disease
    - Patients must be refractory to anti-PD-1, or anti−PD-L1 inhibitors in any prior treatment line
    - Participant must be candidate for SABR to at least one lesion with no more than five irradiated metastases in total. Maximum of three metastases in any one organ are allowed
    - Evaluation by a radiation oncologist within 21 days prior to study registration, including imaging workup to document metastases.
    - Irradiation by SABR should not include metastases located within 3 cm of the previously irradiated structures:
    • Spinal cord previously irradiated to >40 Gy
    • Brachial plexus previously irradiated to >50 Gy.
    • Small intestine, large intestine, or stomach previously irradiated to >45 Gy.
    • Brainstem previously irradiated to >50 Gy.
    • Lung previously irradiated with prior V20 Gy >30%.
    - ECOG performance status of 0 or 1
    - Adequate hematologic and end-organ function defined by the following laboratory results obtained at screening and Visit 1 prior to the first dose of study treatment:
    • ANC ≥1.5 × 109/L.
    • Platelet count ≥100 × 109/L.
    • Hemoglobin ≥9.0 g/dL.
    • AST and ALT ≤2.5x ULN (5 × ULN if presence of liver metastases).
    • Serum total bilirubin <2 × ULN (if known Gilbert’s syndrome, serum bilirubin level <3 × ULN).
    • Prothrombin time (PT) (or international normalized ratio [INR]) within normal limits and activated partial prothrombin time (aPTT) within normal limits
    • Serum creatinine <1.5 × ULN or creatinine clearance ≥30 mL/min (Cockroft-Gault formula).
    - Female participants of childbearing potential: negative urine or serum pregnancy test within 10 days of initiating study treatment.
    - Female participants of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile or abstain from heterosexual activity for the course of the study through 6 months after the last dose of study medication.
    - Male participant should agree to use an adequate method of contraception and refrain from sperm donation starting with the first dose of study therapy through 6 months after the last dose of study therapy.
    - HIV infected participants must be on anti-retroviral therapy (ART) and have a well-controlled HIV infection/disease defined as:
    • Participants on ART must have a CD4+ T-cell count >350 cells/mm3 at time of screening.
    • Participants 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 for at least 12 weeks prior to screening
    • Participants 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).
    • Participants who are HBsAg positive are eligible if they have received HBV antiviral therapy for at least 4 weeks and have undetectable HBV viral load prior to randomization.
    Note: Participants should remain on anti-viral therapy throughout study intervention and follow local guidelines for HBV anti-viral therapy post completion of study intervention.
    - Hepatitis B screening tests are not required unless:
    • Known history of HBV infection.
    • As mandated by local health authority.
    - Participants with history of HCV infection are eligible if HCV viral load is undetectable at screening. Note: Participants must have completed curative anti-viral therapy at least 4 weeks prior to randomization
    - Hepatitis C screening tests are not required unless:
    • Known history of HCV infection.
    • As mandated by local health authority.
    - Able and willing to comply with study and follow-up procedures
    - Disposición y capacidad de otorgar el consentimiento informado por escrito para el estudio
    - ≥18 años
    - Diagnóstico de CPNM metastásico confirmado histológicamente
    - Pacientes con recidiva, progresión o falta de respuesta a terapias anticancerosas previas (incluyendo platino) o paciente que haya rechazado dicha terapia
    - A menos una metástasis accesible con un diámetro mínimo de 20 mm que sea adecuada para la inyección IT percutánea de BO-112. El foco irradiado e inyectado debe ser accesible para la biopsia tumoral
    - Al menos una lesión mensurable conforme a los criterios RECIST, versión 1.1
    - Se permite la resección previa de metástasis, siempre que se haya realizado más de seis meses antes de la inclusión en el estudio y de que exista progresión de la enfermedad
    - Resistencia a fármacos anti-PD-1 o anti-PD-L1 en cualquier linea de tratamiento previa
    - El participante debe ser candidato a recibir RTAE en al menos una lesión, con no más de cinco metástasis irradiadas en total. Se permite un máximo de tres metástasis en cualquier órgano
    - Evaluación por un radioterapeuta en los 21 días previos a la inscripción en el estudio, incluidos estudios de imagen para documentar metástasis
    - La irradiación por RTAE no debe incluir metástasis localizadas a menos de 3 cm de estructuras irradiadas previamente:
    • Médula espinal irradiada previamente con una dosis >40 Gy.
    • Plexo braquial irradiado previamente con una dosis >50 Gy.
    • Intestino delgado, intestino grueso o estómago irradiados previamente con una dosis >45 Gy
    • Tronco encefálico irradiado previamente con una dosis >50 Gy
    • Pulmón irradiado previamente con un V20Gy >30%
    - Estado funcional según la escala del ECOG de 0 o 1
    - Función hematológica y de órganos efectores adecuada, definida por los siguientes resultados analíticos obtenidos en la fase de selección y en la visita 1 antes de la primera dosis del tratamiento del estudio:
    • RAN ≥1,5 × 109/lL.
    • Recuento de plaquetas ≥100 × 109/lL.
    • Hemoglobina ≥9,0 g/dldL.
    • ASLT y ALST <5 veces el límite superior de la normalidad (LSN).
    • Bilirrubina sérica total <2 veces el LSN (en caso de síndrome de Gilbert conocido, concentración sérica de bilirrubina <3 veces el LSN)
    • Tiempo de protrombina (TP) (o cociente internacional normalizado [INR]) dentro de los límites normales y tiempo de protrombina parcial activado (TTPa ) dentro de los límites normales
    • Creatinina sérica <1,5 veces el LSN o aclaramiento de creatinina ≥30 mlmL/min (Cockroft-Gault)
    - Las mujeres con capacidad de procrear deberán dar negativo en una prueba de embarazo en orina o suero sangre realizada en los 10 días previos al comienzo del tratamiento del estudio
    - Las mujeres con capacidad de procrear deberán mostrarse dispuestas a utilizar dos métodos anticonceptivos, estar esterilizadas quirúrgicamente o abstenerse de mantener relaciones heterosexuales durante todo el estudio y hasta 6 meses después de recibir la última dosis de la medicación del estudio
    - Los varones deberán comprometerse a utilizar un método anticonceptivo adecuado, así como a abstenerse de donar semen, desde la primera dosis del tratamiento del estudio y hasta 6 meses después de recibir la última dosis del tratamiento del estudio
    - Los sujetos infectados por el VIH deben estar recibiendo tratamiento antirretroviral (TAR) y tener bien controlada la infección o enfermedad por el VIH, definida como:
    • Recuento de linfocitos T CD4+ > 350 células/mm3 en el momento de selección
    • Consecución y mantenimiento de la supresión virológica durante al menos 12 semanas antes de la selección.
    • Recepción de un régimen estable (sin cambios en los fármacos ni modificación de las dosis) durante al menos cuatro semanas antes de la incorporación al estudio (día 1).
    • Podrán participar sujetos que sean positivos para HBsAg siempre que hayan recibido tratamiento antiviral contra el VHB durante al menos cuatro semanas y tengan una carga viral indetectable de VHB antes de la aleatorización.
    Nota: Los participantes deberán continuar con el tratamiento antiviral durante toda la intervención del estudio y seguir las directrices locales en relación con el tratamiento antiviral contra el VHB después de finalizar dicha intervención.
    - No será necesario realizar pruebas de detección de hepatitis B a menos que:
    • Haya antecedentes conocidos de infección por el VHB.
    • Lo exijan las autoridades sanitarias locales.
    - Podrán participar sujetos con antecedentes de infección por el VHC siempre que la carga viral del VHC sea indetectable en la fase de selección.
    Nota: Los participantes deberán haber completado el tratamiento antiviral curativo al menos cuatro semanas antes de la aleatorización.
    - No será necesario realizar pruebas de detección de hepatitis C a menos que:
    • Haya antecedentes conocidos de infección por el VHC.
    • Lo exijan las autoridades sanitarias locales.
    - Disposición y capacidad para cumplir los procedimientos del estudio y del seguimiento.
    E.4Principal exclusion criteria
    - Prior treatment with any Toll-like receptor agonist or sting agonist
    - Chemotherapy, definitive (curative) radiation, or biological cancer therapy within 4 weeks prior to the first dose of study treatment
    - Palliative radiotherapy (≤ 2 weeks of radiotherapy) within 1 week of start of study treatment
    - Symptomatic, untreated, or actively progressing central nervous system metastases. Patients with a history of treated CNS metastases are eligible, provided that all of the following criteria are met:
    *Measurable disease, per RECIST v1.1, must be present outside the CNS
    *Patient has no history of intracranial hemorrhage or spinal cord hemorrhage
    *Metastases are limited to the cerebellum or the supratentorial region
    *No evidence of interim radiological progression for at least 4 weeks between completion of CNS-directed therapy and the screening brain scan
    *Patient has clinical stability from the neurological point of view and doesn´t require corticosteroids as therapy for CNS disease for at least 14 day. Anti-convulsant therapy at a stable dose is permitted
    - History of leptomeningeal disease.
    - History of a second malignancy, unless potentially curative treatment has been completed with no evidence of malignancy for 2 years
    - Life expectancy <12 weeks.
    - Active infection requiring systemic therapy within 1 week of start of study treatment
    - Serious medical comorbidities precluding radiotherapy, including but not limited to:
    *Interstitial lung disease in patients requiring thoracic radiation
    *Crohn’s disease in patients where the GI tract will receive radiotherapy, or ulcerative colitis where the bowel will receive radiotherapy
    * Connective tissue disorders such as lupus or scleroderma
    * Known genetic disorders associated with increased toxicity to radiation therapy
    - For patients with liver metastases:
    *Moderate/severe liver dysfunction (Child Pugh B or C).
    *Liver metastasis(es) with macroscopic tumor infiltration into the main portal vein, hepatic vein, or vena cava.
    - Substantial overlap with a previously treated radiation volume:
    *Prior radiotherapy in general is allowed, as long as the composite plan meets dose constraints herein.
    *For patients treated with radiation previously, biological effective dose calculations should be used to equate previous doses to the tolerance doses listed in the technical radiotherapy manual
    *Lesions that have been treated with radiotherapy within the last 6 months should not be radiated
    - Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently)
    - History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan
    - Active autoimmune disease that required systemic treatment in past 2 years. Replacement therapy is not considered a form of systemic treatment and is allowed
    - Receiving systemic immunosuppressive therapy within 28 days before enrolment with the exceptions of intranasal, topical, and inhaled corticosteroids or oral corticosteroids at physiological doses not exceeding 10 mg/day of prednisone or equivalent
    - HIV-infected participants with a history of Kaposi sarcoma and/or Multicentric Castleman Disease
    - For WOCBP: pregnancy or a positive urine pregnancy test (eg within 72 hours) prior to treatment; or breastfeeding
    - Any other medical condition which would impact the safety of the subject or interfere with the subject’s ability to comply with the study and follow-up procedures
    - Has received a live vaccine within 28 days prior to the first dose of study drug. COVID vaccines may be administered at least 72 hours prior to BO-112 dose
    - Is currently participating or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment
    - Has had an allogenic tissue/solid organ transplant.
    - Significant bleeding event within the last 12 months that places the patient at risk for intrahepatic IT injection procedure
    - Contraindications to tumor biopsy and IT injections of BO-112 , such as coagulopathy, therapeutic dose anticoagulant treatment and treatment with long-acting agents. Anticoagulant or anti-platelet medication that cannot be interrupted prior to BO-112 IT injection, including:
    *Aspirin that cannot be discontinued for 7 days prior to B0112 IT injection
    *Coumadin that cannot be discontinued for 7 days prior to BO112 IT injection
    *Low molecular weight heparin (LMWH) that cannot be discontinued >24 hours prior to BO112 IT injection
    *Unfractionated heparin (UFH) that cannot be discontinued >4 hours prior to BO112 IT injection
    *Oral direct thrombin inhibitor (dabigatran) or direct Factor Xa inhibitor (rivaroxaban, apixiban, and endoxaban) that cannot be discontinued for 4 days prior to BO112 IT injection
    - Tratamiento previo con cualquier agonista de receptores tipo Toll o agonista de STING
    - Quimioterapia, radioterapia definitiva (curativa) o tratamiento antineoplásico biológico en las 4 semanas previas a la primera dosis
    - Radioterapia paliativa (≤2 semanas de radioterapia) en la semana previa al comienzo del tratamiento
    - Metástasis en el SNC sintomáticas, no tratadas o en progresión activa. Podrán participar sujetos con antecedentes de metástasis en el SNC tratadas, siempre que se cumplan todos los criterios siguientes:
    * Presencia de enfermedad mensurable fuera del SNC
    * Ausencia de antecedentes de hemorragia intracraneal o medular.
    * Metástasis limitadas al cerebelo o a la región supratentorial
    * Ausencia de indicios de progresión radiológica intermedia durante al menos 4 semanas entre la finalización del tratamiento dirigido al SNC y el estudio de imagen cerebral de selección
    * Estabilidad clínica desde el punto de vista neurológico: no precisa corticoides como tratamiento de la afectación del SNC durante al menos 14 días
    - Antecedentes de afectación leptomeníngea
    - Antecedentes de segunda neoplasia maligna, a menos que se haya completado un tratamiento potencialmente curativo sin signos de neoplasia maligna durante 2 años
    - Esperanza de vida < 12 semanas
    - Infección activa con necesidad de tratamiento sistémico en la semana previa al comienzo del tratamiento del estudio
    - Enfermedades concomitantes graves, entre otras:
    * Neumopatía intersticial en pacientes con necesidad de radioterapia torácica
    * Enfermedad de Crohn en los pacientes que vayan a recibir radioterapia sobre el tracto gastrointestinal o colitis ulcerosa en los que vayan a recibirla sobre el intestino
    * Trastornos del tejido conjuntivo
    * Trastornos genéticos conocidos
    - En los sujetos con metástasis hepáticas:
    * Disfunción hepática moderada o grave (clase B o C de Child-Pugh)
    * Metástasis hepáticas con infiltración tumoral macroscópica de la vena porta principal, la vena hepática o la vena cava
    - Solapamiento sustancial con un volumen de irradiación tratado previamente:
    * Se permite radioterapia previa siempre que el plan compuesto cumpla las limitaciones de dosis indicadas
    * En los sujetos tratados previamente con radioterapia, deben utilizarse cálculos de dosis biológicas efectivas para que las dosis previas sean equivalentes a las dosis de tolerancia indicadas en el manual de radioterapia
    * Las lesiones tratadas con radioterapia en los seis últimos 6 meses no deben ser irradiadas.
    - Derrame pleural, pericárdico o ascitis no controlados con necesidad de procedimientos de drenaje recurrentes
    - Antecedentes de fibrosis pulmonar idiopática, neumonía organizada, neumonitis medicamentosa o neumonitis idiopática o signos de neumonitis activa en la TC de tórax de selección
    - Enfermedad autoinmune activa que haya precisado tratamiento sistémico en los últimos 2 años. El tratamiento de reposición no se considera una forma de tratamiento sistémico y está permitido
    - Tratamiento con inmunodepresores sistémicos en los 28 días previos al reclutamiento, con las excepciones de corticoides intranasales, tópicos e inhalados y de corticoides orales en dosis fisiológicas que no superen los 10 mg/día de prednisona o equivalente
    - Sujetos infectados por el VIH con antecedentes de sarcoma de Kaposi o de enfermedad de Castleman multicéntrica
    - Mujeres con capacidad de procrear: prueba de embarazo en orina positiva (en las 72 horas previas al tratamiento) o lactancia materna
    - Trastorno médico que pueda afectar a la seguridad del sujeto o interferir en su capacidad para cumplir los procedimientos del estudio y seguimiento
    - Recepción de vacuna de microorganismos vivos en los 28 días previos a la primera dosis del estudio. Puede administrarse la vacuna COVID al menos 72 horas antes de la dosis de BO-112
    - Participación activa o previa en un estudio de un fármaco o dispositivo en investigación en las 4 semanas previas a la primera dosis del estudio
    - Recepción de un alotrasplante de órgano sólido o tejidos
    - Episodio hemorrágico importante en los últimos 12 meses que suponga un riesgo para el paciente como consecuencia del procedimiento de inyección IT intrahepática
    - Contraindicaciones de la biopsia tumoral y las inyecciones IT de BO-112. Uso de anticoagulantes o antiagregantes plaquetarios que no puedan interrumpirse antes de la inyección IT de BO-112, como:
    * Ácido acetilsalicílico que no pueda suspenderse durante 7 días antes de la inyección IT de BO-112
    * Warfarina que no pueda suspenderse durante 7 días antes de la inyección IT de BO-112
    * Heparina de bajo peso molecular que no pueda suspenderse más de 24 horas antes de la inyección IT de BO-112
    * Heparina no fraccionada que no pueda suspenderse más de 4 horas antes de la inyección IT de BO-112
    * Inhibidor directo oral de la trombina o inhibidor directo del factor Xa que no pueda suspenderse durante 4 días antes de la inyección IT de BO-112
    E.5 End points
    E.5.1Primary end point(s)
    Safety: number and proportion of subjects with study treatment-related TEAEs with severity ≥ Grade 3 (NCI-CTCAE v 5.0) in the global population
    Seguridad: número y proporción de sujetos con AAST relacionados con el tratamiento del estudio de grado ≥3 de intensidad (criterios NCI-CTCAE, versión 5.0) en la población total.
    E.5.1.1Timepoint(s) of evaluation of this end point
    In all study visits
    En todas las visitas del estudio
    E.5.2Secondary end point(s)
    • Safety: number and proportion of subjects with study treatment-related TEAEs Grade ≥3 (NCI-CTCAE v. 5.0) evaluated by separate in the safety run-in cohorts.
    • Safety: number and proportion of subjects with TEAEs (any grade) in the global population and by cohorts.
    • Safety: number and proportion of subjects with related TEAEs (any grade).
    • Efficacy: progression-free survival (PFS), defined as the time from C1D1 to the first occurrence of disease progression or death from any cause (whichever occurs first) as determined by the investigator according to RECIST v. 1.1, in ITT population.
    • Tolerability: number of study discontinuations due to related TEAE.
    • Efficacy: PFS in ITT population based on iRECIST.
    • Efficacy: ORR based on the best overall response (BOR) using RECIST v. 1.1 in ITT population.
    • Efficacy: disease control rate (DCR = CR, PR and SD of at least 12 weeks duration) on the global tumor assessment by RECIST v. 1.1 in ITT population.
    • Efficacy: DCR = iCR, iPR + iSD of at least 12 weeks duration) using iRECIST in ITT population.
    • Efficacy: overall survival rate at 6 and 12 months
    • Seguridad: número y proporción de sujetos con AAST relacionados con el tratamiento del estudio de grado ≥3 de intensidad (criterios NCI-CTCAE, versión 5.0) determinados por separado en las cohortes A y B.
    • Seguridad: número y proporción de sujetos con AAST (de cualquier grado) en la población total y por cohortes.
    • Seguridad: número y proporción de sujetos con AAST relacionados (de cualquier grado).
    • Eficacia: supervivencia sin progresión (SSP), definida como el tiempo transcurrido entre el C1D1 y el primer episodio de progresión de la enfermedad o la muerte por cualquier causa (lo que ocurra antes), según lo determinado por el investigador conforme a los criterios RECIST, versión 1.1, en la población por ITT.
    • Tolerabilidad: número de retiradas del estudio por AAST relacionados.
    • Eficacia: SSP en la población por ITT conforme a los criterios iRECIST.
    • Eficacia: TRG basada en la mejor respuesta global (MRG) conforme a los criterios RECIST, versión 1.1, en la población por ITT
    • Eficacia: tasa de control de la enfermedad (TCE = RC, RP y EE de al menos 12 semanas de duración) en la evaluación global del tumor y en las lesiones tratadas y no tratadas conforme a los criterios RECIST, versión 1.1, en la población por ITT
    • Eficacia: TCE = RCi, RPi + EEi de al menos 12 semanas de duración conforme a los criterios iRECIST en la población por ITT
    • Eficacia: tasa de supervivencia global a los 6 y 12 meses
    E.5.2.1Timepoint(s) of evaluation of this end point
    Several timepoints throughout the study and at the end of the study.
    Diferentes momentos del estudio y en la visita de final 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 No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    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 No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Phase Ib/II trial
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months10
    E.8.9.1In the Member State concerned days
    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: 15
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 15
    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.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)
    For those patients with clinical benefit after 6 months of treatment, the sponsor will evaluate on a case-by-case basis the possibility of continuing an additional 6 months of treatment with BO112 administered in conjunction with nivolumab.
    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 Decision2022-05-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-04-25
    P. End of Trial
    P.End of Trial StatusOngoing
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