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    Summary
    EudraCT Number:2021-006804-34
    Sponsor's Protocol Code Number:CYP003
    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:2022-06-09
    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 number2021-006804-34
    A.3Full title of the trial
    A Phase 1b/2a, Open-Label, Multi-Center Study of CyPep-1 in Combination With Pembrolizumab to Evaluate the Efficacy and Safety of CyPep-1 in Patients With Advanced or Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC), Melanoma, or Triple-Negative Breast Cancer (TNBC) (CATALYST)
    Estudio de fase 1b/2a, abierto y multicéntrico de CyPep-1 en combinación con
    pembrolizumab para evaluar la eficacia y la seguridad de CyPep-1 en pacientes con carcinoma
    epidermoide de cabeza y cuello (CECC), melanoma o cáncer de mama triple negativo (CMTN)
    avanzado o metastásico (CATALYST)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the safety and efficacy of CyPep-1 in combination with Pembrolizumab for the treatment of advanced or metastatic cancers.
    Un estudio para evaluar la seguridad y eficacia de CyPep-1 en combinación con Pembrolizumab para el tratamiento de cánceres avanzados o metastásicos.
    A.3.2Name or abbreviated title of the trial where available
    CATALYST
    CATALYST
    A.4.1Sponsor's protocol code numberCYP003
    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 SponsorCytovation ASA
    B.1.3.4CountryNorway
    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 supportCytovation ASA
    B.4.2CountryNorway
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMedpace UK
    B.5.2Functional name of contact pointDirector, Clinical Trial Management
    B.5.3 Address:
    B.5.3.1Street AddressVintners' Place, 68 Upper Thames Street
    B.5.3.2Town/ cityLondon
    B.5.3.3Post codeEC4V 3BJ
    B.5.3.4CountryUnited Kingdom
    B.5.6E-mailC.Synaeve@Medpace.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 nameCyPep-1
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntratumoral use
    Subcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCyPep-1
    D.3.9.3Other descriptive nameCyPep-1
    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) 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 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
    D.3.2Product code MK-3475
    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.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    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 Yes
    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
    Advanced or metastatic:
    -Head and Neck Squamous Cell Carcinoma (HNSCC);
    -Melanoma;
    -Triple-Negative Breast Cancer (TNBC);
    Avanzado o metastásico:
    -Carcinoma de células escamosas de cabeza y cuello (HNSCC);
    -Melanoma;
    -Cáncer de mama triple negativo (TNBC);
    E.1.1.1Medical condition in easily understood language
    Cancer
    Cáncer
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level PT
    E.1.2Classification code 10060121
    E.1.2Term Squamous cell carcinoma of head and neck
    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 PT
    E.1.2Classification code 10075566
    E.1.2Term Triple negative breast 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 21.1
    E.1.2Level PT
    E.1.2Classification code 10025650
    E.1.2Term Malignant melanoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase 1b
    -Confirm the recommended CyPep-1 dose (20 mg Q2W) when administered by IT injection in combination with pembrolizumab

    Phase 2a
    -Assess the anti-tumor activity of CyPep-1 administered by IT injection in combination with pembrolizumab
    Fase 1b
    -Confirmar la dosis recomendada de CyPep-1 (20 mg Q2W) cuando se administra por inyección IT en combinación con pembrolizumab

    Fase 2a
    -Evaluar la actividad antitumoral de CyPep-1 administrado por inyección IT en combinación con pembrolizumab
    E.2.2Secondary objectives of the trial
    Phase 1b
    -Evaluate the PK of CyPep-1 in combination with pembrolizumab

    Phase 2a
    -Expand evaluation of efficacy CyPep-1 + pembrolizumab
    -Evaluate the safety and tolerability of CyPep-1 in combination with pembrolizumab
    Fase 1b
    -Evaluar la farmacocinética de CyPep-1 en combinación con pembrolizumab

    Fase 2a
    -Ampliar evaluación de eficacia CyPep-1 + pembrolizumab
    -Evaluar la seguridad y tolerabilidad de CyPep-1 en combinación con pembrolizumab
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    General Inclusion Criteria
    1. Is 18 years of age or older on the day of signing informed consent;
    2. Provides written informed consent and is able to comply with study procedures and assessments;
    3. Has measurable disease RECIST v1.1 as assessed by the local site Investigator/radiology. Lesions situated in a previously irradiated area
    are considered measurable if progression has been demonstrated in such lesions;
    4. Has at least 1 non-ulcerated, measurable, and accessible lesion for IT injection with a maximum diameter of 5 cm;
    5. Is able to provide tissue from a core or excisional biopsy at screening or has an acceptable stored tumor sample available that was collected within 90 days prior to screening;
    6. Has an ECOG performance status of 0 or 1;
    7. Has a life expectancy ≥3 months, as determined by the Investigator;
    8. Female patients of non-childbearing potential must be either surgically sterile (hysterectomy, bilateral tubal ligation, salpingectomy, and/or bilateral oophorectomy at least 26 weeks before screening), post-menopausal, defined as spontaneous amenorrhea for at least 2 years, or with follicle-stimulating hormone in the post-menopausal range at screening;
    9. Female patients of childbearing potential (defined as <2 years after last menstruation or not surgically sterile) must have a negative serum pregnancy test at screening and agree to use a highly effective method for contraception from the time of signing the ICF until at least 120 days after the last administration of study treatment. Highly effective methods of contraception are birth control methods with a failure rate of <1% per year when used consistently and correctly, including the following:
    a. Combined estrogen- and progestin-containing hormonal contraception associated with inhibition of ovulation given orally, intravaginally, or transdermally; progestin-only hormonal contraception associated with inhibition of ovulation given orally, by injection, or by implant; intrauterine devices; and intrauterine hormone-releasing systems;
    b. Female sterilization (surgical bilateral oophorectomy with/without hysterectomy, total hysterectomy, bilateral tubal occlusion/ligation) at least 26 weeks prior to first study treatment;
    c. Sterilization of male partner (at least 6 months prior to first study treatment dose); and
    d. Complete sexual abstinence. Periodic abstinence and withdrawal are not acceptable. Sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatment. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the study and the preferred and usual lifestyle of the patient.
    10. If a male patient is able to father children, he must agree to use 2 acceptable methods of contraception throughout the study (eg, condom plus spermicidal gel). Sperm donation is not recommended from the time of signing the ICF until at least 120 days after the last administration of study treatment; and
    11. Has adequate organ function. Specimens must be collected within 72 hours prior to the start of study treatment at Cycle 1 Visit 1.

    Inclusion Criteria for Arm A
    A patient who meets all of the general Inclusion Criteria and the following additional criteria will be eligible for inclusion in Arm A:
    1. Has histologically confirmed diagnosis of HNSCC;
    2. Has advanced or metastatic HNSCC incurable by standard of care therapies; and
    3. Has recurrent or metastatic HNSCC that has progressed on or failed both platinum-based chemotherapy AND an immune checkpoint
    inhibitor (ICI) (given either sequentially or concurrently).

    Inclusion Criteria for Arm B
    A patient who meets all of the general Inclusion Criteria and the following additional criteria will be eligible for inclusion in Arm B:
    1. Has histologically confirmed diagnosis of malignant melanoma;
    2. Has advanced or metastatic melanoma incurable by standard of care therapies; and
    3. Has failed or progressed on or after treatment with a checkpoint inhibitor administered either as monotherapy or in combination with other checkpoint inhibitors or other therapies.

    Inclusion Criteria for Arm C
    A patient who meets all of the general Inclusion Criteria and the following additional criteria will be eligible for inclusion in Arm C:
    1. Has histologically confirmed diagnosis of TNBC as per American Society of Clinical Oncology/College of American Pathologists guidelines;
    2. Has advanced or metastatic TNBC incurable by standard of care therapies; and
    3. Has failed or progressed on or after treatment with a checkpoint inhibitor administered either as monotherapy or in combination with other therapies (if ICI eligible based on programmed cell death ligand 1PD-L1 status) OR has received prior systemic therapy with either an anthracycline- or taxane containing regimen (if ICI non-eligible based on PD-L1 status).
    Criterios generales de inclusión
    1. Tiene 18 años de edad o más el día de la firma del consentimiento informado;
    2. Da su consentimiento informado por escrito y es capaz de cumplir con los procedimientos y evaluaciones del estudio;
    3. Tiene enfermedad medible RECIST v1.1 según lo evaluado por el investigador/radiología del sitio local. Lesiones situadas en una zona previamente irradiada
    se consideran medibles si se ha demostrado progresión en tales lesiones;
    4. Tiene al menos 1 lesión no ulcerada, medible y accesible para inyección IT con un diámetro máximo de 5 cm;
    5. Es capaz de proporcionar tejido de una biopsia central o por escisión en la selección o tiene disponible una muestra de tumor almacenada aceptable que se recolectó dentro de los 90 días anteriores a la selección;
    6. Tiene un estado funcional ECOG de 0 o 1;
    7. Tiene una esperanza de vida ≥3 meses, según lo determine el Investigador;
    8. Las pacientes femeninas que no pueden tener hijos deben ser estériles quirúrgicamente (histerectomía, ligadura de trompas bilateral, salpingectomía y/u ovariectomía bilateral al menos 26 semanas antes de la selección), posmenopáusicas, definidas como amenorrea espontánea durante al menos 2 años, o con hormona estimulante del folículo en el rango posmenopáusico en la selección;
    9. Las pacientes en edad fértil (definidas como <2 años después de la última menstruación o no estériles quirúrgicamente) deben tener una prueba de embarazo en suero negativa en la selección y aceptar usar un método anticonceptivo altamente efectivo desde el momento de firmar el ICF hasta por lo menos 120 días después de la última administración del tratamiento del estudio. Los métodos anticonceptivos altamente efectivos son métodos anticonceptivos con una tasa de falla de <1% por año cuando se usan de manera constante y correcta, incluidos los siguientes:
    una. Anticoncepción hormonal combinada que contiene estrógeno y progestina asociada con la inhibición de la ovulación administrada por vía oral, intravaginal o transdérmica; anticoncepción hormonal de progestágeno solo asociada con la inhibición de la ovulación administrada por vía oral, por inyección o por implante; dispositivos intrauterinos; y sistemas de liberación de hormonas intrauterinas;
    b. Esterilización femenina (ooforectomía bilateral quirúrgica con/sin histerectomía, histerectomía total, oclusión/ligadura de trompas bilateral) al menos 26 semanas antes del primer tratamiento del estudio;
    C. Esterilización de la pareja masculina (al menos 6 meses antes de la primera dosis del tratamiento del estudio); y
    d. Abstinencia sexual completa. La abstinencia y el retiro periódicos no son aceptables. La abstinencia sexual se considera un método altamente efectivo solo si se define como abstenerse de tener relaciones heterosexuales durante todo el período de riesgo asociado con el tratamiento del estudio. La fiabilidad de la abstinencia sexual debe evaluarse en relación con la duración del estudio y el estilo de vida preferido y habitual del paciente.
    10. Si un paciente masculino puede engendrar hijos, debe aceptar usar 2 métodos anticonceptivos aceptables durante todo el estudio (p. ej., condón más gel espermicida). No se recomienda la donación de semen desde el momento de la firma del ICF hasta al menos 120 días después de la última administración del tratamiento del estudio; y
    11. Tiene una función orgánica adecuada. Las muestras deben recolectarse dentro de las 72 horas anteriores al inicio del tratamiento del estudio en la Visita 1 del Ciclo 1.

    Criterios de inclusión para el brazo A
    Un paciente que cumpla con todos los Criterios de inclusión generales y los siguientes criterios adicionales será elegible para su inclusión en el Grupo A:
    1. Tiene un diagnóstico confirmado histológicamente de HNSCC;
    2. Tiene HNSCC avanzado o metastásico incurable por las terapias estándar de atención; y
    3. Tiene HNSCC recurrente o metastásico que progresó o fracasó con la quimioterapia basada en platino Y un punto de control inmunitario
    inhibidor (ICI) (administrado secuencial o simultáneamente).

    Criterios de inclusión para el brazo B
    Un paciente que cumpla con todos los Criterios de inclusión generales y los siguientes criterios adicionales será elegible para su inclusión en el Grupo B:
    1. Tiene un diagnóstico confirmado histológicamente de melanoma maligno;
    2. Tiene melanoma avanzado o metastásico incurable por las terapias estándar de atención; y
    3. Ha fallado o progresado durante o después del tratamiento con un inhibidor de puntos de control administrado como monoterapia o en combinación con otros inhibidores de puntos de control u otras terapias.

    Criterios de inclusión para el brazo C
    Un paciente que cumpla con todos los Criterios de inclusión generales y los siguientes criterios adicionales será elegible para su inclusión en el Grupo C:

    *Por falta de espacio de caracteres no es posible incluir todos los criterios, por favor consulte el protocolo.
    E.4Principal exclusion criteria
    1. Has only non-palpable cutaneous infiltrations (eg, breast cancer cutaneous carcinomatosis);
    2. Had anti-cancer therapy within 4 weeks prior to the first dose of study treatment (2 weeks for palliative radiotherapy);
    3. Has participated in a clinical trial and received an investigational therapy within 30 days prior to the first dose of study treatment;
    4. Has received or will receive a live or live attenuated vaccine within 30 days prior to the first dose of study treatment;
    5. Has tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection within 14 days prior to the Screening Visit;
    6. Has had a major surgical procedure within 14 days prior to the first dose of CyPep-1;
    7. Is expected to require a systemic or localized anti-neoplastic therapy during participation in this study, excluding localized palliative radiotherapy to tumors not selected for evaluation of treatment response;
    8. Is pregnant or breastfeeding;
    9. Has clinical evidence of a secondary malignancy actively progressing or requiring active treatment other than curative therapies for early stage (carcinoma in situ or Stage 1) carcinomas or non-melanoma skin cancer;
    10. Has had any autoimmune disease requiring immunosuppressive therapy within 2 years prior to the first dose of study treatment;
    11. Has a condition requiring continuous systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive agents within 2 weeks prior to the first dose of study treatment. Inhaled, intranasal, or topical (only on areas outside the injected lesion[s]) and physiological replacement doses of up to 10 mg daily prednisone equivalent are permitted in the absence of active autoimmune disease;
    12. Has abnormal or clinically significant coagulation parameters as determined by the Investigator (eg, prothrombin time, international normalized ratio, activated partial thromboplastin time) unless patients are on anti-coagulants in which case it must be within appropriate clinical levels;
    13. Has a significant history or clinical manifestation of any allergic disorders and/or Quincke’s edema (as determined by the Investigator) capable of significantly altering the absorption of drugs, of constituting a risk when taking CyPep-1 or pembrolizumab, or of interfering with the interpretation of the data;
    14. Has a known hypersensitivity to any component of CyPep-1 or pembrolizumab;
    15. Has a history of adverse reactions from treatment with ICIs, including pembrolizumab, which resulted in discontinuation of ICI or pembrolizumab or has ongoing pembrolizumab-related toxicity event(s) as per treatment-limiting toxicity definitions, except patients with ongoing endocrine disorders that are managed with replacement therapy (ie, hypothyroidism related to prior pembrolizumab treatment);
    16. Has an active infection requiring systemic therapy;
    17. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen reactive) or known active Hepatitis C virus (defined as Hepatitis C virus RNA [qualitative] is detected) infection;
    18. Has had radiotherapy within 2 weeks prior to the first dose of study treatment, is in recovery from radiation toxicity, or has had radiation pneumonitis;
    19. Has a history of non-infectious pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease;
    20. Has had a prior allogeneic tissue/solid organ transplant, stem cell, or bone marrow transplant;
    21. Has active HIV. Patient is eligible when on stable anti-retroviral therapy (no change in medication or dose) for at least 4 weeks prior to screening, has confirmed virologic suppression with HIV RNA less than 50 copies/mL or the lower limit of quantification (below the limit of detection) using the locally available assay at the time of screening and for at least 12 weeks prior to screening, and has a cluster of differentiation 4+ T cell count >350 cells/mm3 at screening. HIV-infected patients with a history of Kaposi sarcoma and/or Multicentric Castleman Disease will be excluded;
    22. Has a CNS metastasis that is symptomatic, progressing, or that requires current therapy (eg, evidence of new or enlarging CNS metastasis, carcinomatous meningitis, or new neurological symptoms attributable to CNS metastasis);
    23. Has a QTcF >480 ms at screening, history of long or short QT syndrome, Brugada syndrome, QTc prolongation, or Torsade de Pointes, with the exception of patients with controlled atrial fibrillation, pacemaker, or bundle branch block as the QTc will be prolonged due to the widened QRS; or
    24. Has a history of or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the patient’s participation for the full duration of the study, or make participation in the study not in the best interest of the patient, in the opinion of the Investigator.
    1. Solo tiene infiltraciones cutáneas no palpables (p. ej., carcinomatosis cutánea por cáncer de mama);
    2. Recibió terapia contra el cáncer dentro de las 4 semanas anteriores a la primera dosis del tratamiento del estudio (2 semanas para radioterapia paliativa);
    3. Ha participado en un ensayo clínico y recibido una terapia en investigación dentro de los 30 días anteriores a la primera dosis del tratamiento del estudio;
    4. Ha recibido o recibirá una vacuna viva o atenuada dentro de los 30 días anteriores a la primera dosis del tratamiento del estudio;
    5. Ha dado positivo para la infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2) dentro de los 14 días anteriores a la visita de selección;
    6. Ha tenido un procedimiento quirúrgico mayor dentro de los 14 días anteriores a la primera dosis de CyPep-1;
    7. Se espera que requiera una terapia antineoplásica sistémica o localizada durante la participación en este estudio, excluyendo la radioterapia paliativa localizada para tumores no seleccionados para la evaluación de la respuesta al tratamiento;
    8. Está embarazada o amamantando;
    9. Tiene evidencia clínica de una neoplasia maligna secundaria que progresa activamente o que requiere un tratamiento activo que no sean terapias curativas para carcinomas en etapa temprana (carcinoma in situ o Etapa 1) o cáncer de piel no melanoma;
    10. Ha tenido alguna enfermedad autoinmune que requiera terapia inmunosupresora dentro de los 2 años anteriores a la primera dosis del tratamiento del estudio;
    11. Tiene una afección que requiere tratamiento sistémico continuo con corticosteroides (>10 mg de equivalentes de prednisona diarios) u otros agentes inmunosupresores dentro de las 2 semanas anteriores a la primera dosis del tratamiento del estudio. Se permiten dosis de reemplazo inhaladas, intranasales o tópicas (solo en áreas fuera de la lesión inyectada) y fisiológicas de hasta 10 mg diarios de equivalente de prednisona en ausencia de enfermedad autoinmune activa;
    12. Tiene parámetros de coagulación anormales o clínicamente significativos según lo determine el investigador (p. ej., tiempo de protrombina, índice normalizado internacional, tiempo de tromboplastina parcial activada), a menos que los pacientes tomen anticoagulantes, en cuyo caso debe estar dentro de los niveles clínicos apropiados;
    13. Tiene antecedentes o manifestación clínica significativa de cualquier trastorno alérgico y/o edema de Quincke (según lo determine el Investigador) capaz de alterar significativamente la absorción de medicamentos, de constituir un riesgo al tomar CyPep-1 o pembrolizumab, o de interferir con la interpretación de los datos;
    14. Tiene una hipersensibilidad conocida a cualquier componente de CyPep-1 o pembrolizumab;
    15. Tiene antecedentes de reacciones adversas del tratamiento con ICI, incluido pembrolizumab, que dieron lugar a la suspensión de ICI o pembrolizumab o tiene eventos de toxicidad en curso relacionados con pembrolizumab según las definiciones de toxicidad limitante del tratamiento, excepto pacientes con trastornos endocrinos en curso que se manejan con terapia de reemplazo (es decir, hipotiroidismo relacionado con el tratamiento previo con pembrolizumab);
    16. Tiene una infección activa que requiere terapia sistémica;
    17. Tiene antecedentes conocidos de infección por hepatitis B (definida como antígeno de superficie reactivo de hepatitis B) o virus de hepatitis C activo conocido (definido como detección de ARN [cualitativo] del virus de hepatitis C);
    18. Ha recibido radioterapia dentro de las 2 semanas anteriores a la primera dosis del tratamiento del estudio, se está recuperando de la toxicidad de la radiación o ha tenido neumonitis por radiación;
    19. Tiene antecedentes de neumonitis/enfermedad pulmonar intersticial no infecciosa que requirió esteroides o tiene neumonitis/enfermedad pulmonar intersticial actual;
    20. Ha tenido un trasplante alogénico previo de tejido/órgano sólido, células madre o trasplante de médula ósea;
    21. Tiene VIH activo. El paciente es elegible cuando recibe una terapia antirretroviral estable (sin cambios en la medicación o la dosis) durante al menos 4 semanas antes de la selección, tiene una supresión virológica confirmada con ARN del VIH inferior a 50 copias/mL o el límite inferior de cuantificación (por debajo del límite de detección) utilizando el ensayo disponible localmente en el momento de la selección y durante al menos 12 semanas antes de la selección, y tiene un grupo de diferenciación 4+ Recuento de células T >350 células/mm3 en la selección. Se excluirán los pacientes infectados por el VIH con antecedentes de sarcoma de Kaposi y/o enfermedad de Castleman multicéntrica;

    *Por falta de espacio de caracteres no es posible incluir todos los criterios, por favor consulte el protocolo.
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1b
    • Incidence, frequency, and seriousness of TEAEs;
    • Incidence of DLTs; and
    •Changes from baseline in vital signs, body weight, 12 lead ECG parameters, and laboratory assessments.

    Phase 2a
    ORR based on radiological assessment according to RECIST v1.1
    Fase 1b
    • Incidencia, frecuencia y gravedad de los TEAE;
    • Incidencia de DLT; y
    •Cambios desde el inicio en los signos vitales, el peso corporal, los parámetros del ECG de 12 derivaciones y las evaluaciones de laboratorio.

    Fase 2a
    ORR basado en evaluación radiológica según RECIST v1.1
    E.5.1.1Timepoint(s) of evaluation of this end point
    • TEAEs: Continuously throughout trial
    • The dose-limiting toxicity (DLT) period for the Phase 1b portion of the study will be 6 weeks
    • The Objective Response Rate (ORR) will be based on the number of patients achieving a partial response (PR) or CR based on the RECIST v1.1 and iRECIST
    • TEAE: continuamente durante todo el ensayo
    • El período de toxicidad limitante de la dosis (DLT) para la parte de la Fase 1b del estudio será de 6 semanas.
    • La tasa de respuesta objetiva (ORR) se basará en la cantidad de pacientes que logran una respuesta parcial (PR) o CR según RECIST v1.1 e iRECIST.
    E.5.2Secondary end point(s)
    Phase 1b
    • Plasma concentration-time profile of CyPep-1
    Phase 2a
    • ORR according to iRECIST;
    • DCR according to iRECIST and RECIST v1.1;
    • DoR according to iRECIST and RECIST v1.1;
    • PFS according to iRECIST and RECIST v1.1; and
    • OS for up to 26 months from Cycle 1 Visit 1.
    • Incidence, frequency, and seriousness of TEAEs; and
    • Changes from baseline in vital signs, body weight, 12 lead ECG parameters, and laboratory assessments.
    Fase 1b
    • Perfil de concentración plasmática-tiempo de CyPep-1
    Fase 2a
    • ORR según iRECIST;
    • DCR según iRECIST y RECIST v1.1;
    • DoR según iRECIST y RECIST v1.1;
    • PFS según iRECIST y RECIST v1.1; y
    • OS por hasta 26 meses desde la Visita 1 del Ciclo 1.
    • Incidencia, frecuencia y gravedad de los TEAE; y
    • Cambios desde el inicio en signos vitales, peso corporal, parámetros de ECG de 12 derivaciones y evaluaciones de laboratorio.
    E.5.2.1Timepoint(s) of evaluation of this end point
    • Continuously throughout trial
    • Plasma samples will be collected pre dose and 15 minutes, 30 minutes, 1 hour, 2 hours, and 4 hours post-dose on Cycle 1 Day 15.
    • Progression Free Survival (PFS) (percentage of patients alive and progression-free) at 6, 12, 18, and 24 months after the first treatment with CyPep 1 + pembrolizumab
    • Continuamente durante todo el ensayo
    • Las muestras de plasma se recolectarán antes de la dosis y 15 minutos, 30 minutos, 1 hora, 2 horas y 4 horas después de la dosis en el Día 15 del Ciclo 1.
    • Supervivencia libre de progresión (PFS) (porcentaje de pacientes vivos y libres de progresión) a los 6, 12, 18 y 24 meses después del primer tratamiento con CyPep 1 + pembrolizumab
    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 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
    To confirm the recommended CyPep-1 dose (20 mg Q2W) when administered by IT injection
    Para confirmar la dosis recomendada de CyPep-1 (20 mg Q2W) cuando se administra por inyección IT
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA18
    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
    United States
    France
    Netherlands
    Spain
    Italy
    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 (“study completion”) is defined as the date of the last protocol-specified visit/assessment for the last patient in the study.
    El final del estudio ("finalización del estudio") se define como la fecha de la última visita/evaluación especificada en el protocolo para el último paciente del estudio.
    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 months4
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months4
    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: 45
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 45
    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 state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 60
    F.4.2.2In the whole clinical trial 90
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Patients who are alive at the end of the study after completing all 18 cycles of treatment and the Safety Follow-up Visit may be entered into a separate long-term follow-up study.
    Los pacientes que están vivos al final del estudio después de completar los 18 ciclos de tratamiento y la visita de seguimiento de seguridad pueden ingresar en un estudio de seguimiento a largo plazo por separado.
    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 Decision2022-09-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-29
    P. End of Trial
    P.End of Trial StatusOngoing
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