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    Summary
    EudraCT Number:2022-000122-21
    Sponsor's Protocol Code Number:NVL-655-01
    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:2022-05-04
    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 number2022-000122-21
    A.3Full title of the trial
    A Phase 1/2 Study of the Selective Anaplastic Lymphoma Kinase (ALK) Inhibitor NVL-655 in Patients with Advanced NSCLC and Other Solid Tumors (ALKOVE-1)
    Estudio en fase I/II del inhibidor selectivo de la cinasa del linfoma anaplásico (ALK) NVL-655 en pacientes con CPNM avanzado y otros tumores sólidos (ALKOVE-1)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 1/2 Study of the Selective Anaplastic Lymphoma Kinase (ALK) Inhibitor NVL-655 in Patients with Advanced NSCLC and Other Solid Tumors (ALKOVE-1)
    A Phase 1/2 Study of the Selective Anaplastic Lymphoma Kinase (ALK) Inhibitor NVL-655 in Patients with Advanced NSCLC and Other Solid Tumors (ALKOVE-1)
    A.4.1Sponsor's protocol code numberNVL-655-01
    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 SponsorNuvalent, 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 supportNuvalent, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationNuvalent, Inc.
    B.5.2Functional name of contact pointTina Kehrig
    B.5.3 Address:
    B.5.3.1Street AddressOne Broadway, 14th Floor
    B.5.3.2Town/ cityCambridge, Massachusetts
    B.5.3.3Post code02142
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1857357-7000
    B.5.6E-mailtkehrig@nuvalent.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 nameNVL-655
    D.3.2Product code NVL-655
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNVL-655
    D.3.9.2Current sponsor codeNVL-655
    D.3.9.3Other descriptive nameNVL-655
    D.3.9.4EV Substance CodeSUB260709
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 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 nameNVL-655
    D.3.2Product code NVL-655
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNVL-655
    D.3.9.2Current sponsor codeNVL-655
    D.3.9.3Other descriptive nameNVL-655
    D.3.9.4EV Substance CodeSUB260709
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    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.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 Non-Small Cell Lung Cancer (NSCLC) and Other Solid Tumors with ALK rearrangement or activating ALK mutation.
    CPNM avanzado positivo para ALK y otros tumores sólidos avanzados
    positivos para ALK
    E.1.1.1Medical condition in easily understood language
    Advanced Non-Small Cell Lung Cancer (NSCLC) and Other Solid Tumors with ALK rearrangement or activating ALK mutation.
    CPNM avanzado positivo para ALK y otros tumores sólidos avanzados
    positivos para ALK
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    - To evaluate the efficacy of NVL-655 at the RP2D in patients with advanced ALK-positive NSCLC, including those with ALK resistance mutations, and other solid tumors.
    E.2.2Secondary objectives of the trial
    - To assess additional measures of clinical efficacy in patients with ALK-positive NSCLC, including those with ALK resistance mutations, and other solid tumors;
    - To evaluate the intracranial antitumor activity of NVL-655 at the RP2D in patients with advanced ALK-positive NSCLC and other solid tumors;
    - To characterize the safety and tolerability of NVL-655 at the RP2D.
    To confirm the PK profile of NVL-655 at the RP2D.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Age > or =18 years
    a. Phase 2 Cohort 2d only: Age > or =12 years and weighing >40 kg. (Patients age 12 to 17 will only be enrolled in countries and at sites where regulations allow.)
    2. Disease criteria
    a. Phase 1: Histologically or cytologically confirmed locally advanced or metastatic solid tumor with a documented ALK rearrangement or activating ALK mutation detected by certified assay (i.e. CLIA in the US). The report from this test is required to be submitted for eligibility.
    b. Phase 2 Cohorts 2a, 2b, and 2c: Histologically or cytologically confirmed locally advanced or metastatic NSCLC with a documented ALK rearrangement detected by certified assay. The report from this test is required to be submitted for eligibility.
    c. Phase 2 Cohort 2d: Any other histologically or cytologically confirmed locally advanced or metastatic solid tumor with a documented ALK rearrangement or activating ALK mutation detected by certified assay, including but not limited to anaplastic large cell lymphoma, inflammatory myofibroblastic tumors, diffuse large B-cell lymphoma, esophageal squamous cell carcinoma, renal medullary carcinoma, renal cell carcinoma, breast cancer, colorectal cancer, ovarian cancer, papillary thyroid carcinoma, cholangiocarcinoma, spitzoid tumors, neuroblastoma, anaplastic thyroid cancer, and patients with NSCLC not eligible for Cohorts 2a-c. The report from this test is required to be submitted for eligibility.
    3. Prior anticancer treatment:
    a. Phase 1: Patients with ALK fusion-positive NSCLC must have previously received > or =1 ALK TKI, one of which must be a 2nd or 3rd generation TKI (ceritinib, alectinib, brigatinib, or lorlatinib). Patients with other solid tumors must have previously received > or =1 prior systemic anticancer therapy or be those for whom no satisfactory standard therapy exists.
    b. Phase 2 Cohort 2a: 1 prior 2nd generation ALK TKI
    c. Phase 2 Cohort 2b: 2-3 prior 1st or 2nd generation ALK TKIs (crizotinib, ceritinib, alectinib, or brigatinib)
    d. Phase 2 Cohort 2c: 2-3 prior ALK TKIs, with lorlatinib received in the 2nd or 3rd line of therapy
    e. Phase 2 Cohort 2d: > or =1 prior systemic anticancer therapy, or for whom no satisfactory standard therapy exists
    f. All patients except Phase 2 Cohort 2d: < or = 2 prior lines of chemotherapy and/or immunotherapy in the locally advanced or metastatic setting. Patients who have received >2 prior lines of chemotherapy and/or immunotherapy in the locally advanced or metastatic setting may be enrolled in Phase 2 Cohort 2d.
    g. Phase 2 Cohorts 2a, 2b and 2c: No prior investigational agents targeting ALK. Patients who previously received investigational agents targeting ALK may be enrolled in Phase 1 and Phase 2 Cohort 2d.
    4. Phase 1: Must have evaluable disease according to RECIST 1.1
    Phase 2: Must have measurable disease, defined as > or =1 radiologically measurable target lesion according to RECIST 1.1
    Note: Patients with CNS-only disease are eligible, provided that the disease is evaluable (Phase 1) or measurable (Phase 2 and does not meet Exclusion Criterion #11.
    5. Pre-treatment tumor tissue (archived, if available, or a fresh biopsy) submitted for central analysis. It is preferable that submitted tumor tissue be obtained during or after the most recent disease progression. If appropriate tissue is not available, and if biopsy is not considered safe and medically feasible by the Investigator, the patient may be approved for enrollment after consultation with the Sponsor’s Medical Monitor.
    6. ECOG PS of 0 or 1
    7. Adequate organ function and bone marrow reserve as indicated by the following laboratory values on last assessment prior to the first dose of study drug:
    a. Bone marrow function: ANC > or =1500/microL; platelet count >75,000/microL; hemoglobin > or =8 g/dL (without transfusion).
    b. Renal function: estimated creatinine clearance > or =60 mL/min.
    c. Hepatic function: bilirubin <1.5×ULN, unless evidence of Gilbert Syndrome, in which the patient must have total bilirubin <3.0 mg/dL; AST and ALT < or =3.0×ULN (< or =5.0×ULN if liver metastases involvement).
    8. All clinically relevant toxicities related to prior anticancer therapy must have recovered to Grade < or =1 or baseline (except alopecia or ototoxicity).
    9. WOCBP and male patients must be surgically sterile or be willing to abstain from sexual activity or use an effective contraceptive method from the time of signing the ICF through at least 30 days after the last administration of study drug for women, and at least 90 days after the last administration of study drug for men (or longer, if required by local or country-specific guidance). Effective contraception for WOCBP includes 1 “highly effective method” or 2 “effective” methods based on WHO criteria. Refer to Section 8.3.2 for acceptable methods of contraception.
    10. Provide written informed consent and willing and able to comply with requirements of the study protocol
    1. > o =18 años
    a. Solamente para la cohorte 2d de la fase II: > o =2 años y peso >40 kg (de 12 a 17 años solo se inscribirán en países y centros donde lo permita la legislación).
    2. Criterios de la enfermedad
    a. Fase I: Tumor sólido localmente avanzado o metastásico confirmado histológica o citológicamente con un reordenamiento de ALK documentado o mutación activadora de ALK detectada mediante un análisis certificado . Es necesario enviar el informe de esta prueba para determinar su idoneidad.
    b. Cohortes 2a, 2b y 2c fase II: CPNM localmente avanzado o metastásico confirmado histológica o citológicamente con un reordenamiento de ALK documentado detectado mediante un análisis certificado. Es necesario enviar el informe de esta prueba para determinar su idoneidad.
    c. Cohorte 2d fase II: Otro tumor sólido confirmado histológica o citológicamente, localmente avanzado o metastásico, con un reordenamiento de ALK documentado o mutación activadora de ALK detectada mediante un análisis certificado, incluidos, entre otros, el linfoma anaplásico de células grandes, tumores miofibroblásticos inflamatorios, linfoma difuso de linfocitos B grandes, carcinoma epidermoide esofágico, carcinoma medular renal, carcinoma de células renales, cáncer de mama, cáncer colorrectal, cáncer de ovario, carcinoma tiroideo papilar, colangiocarcinoma, tumores spitzoides, neuroblastoma, cáncer de tiroides anaplásico, y pacientes con CPNM no aptos para las cohortes 2a-c.
    3. Tratamiento antineoplásico previo:
    a. Fase I: Los pacientes con CPNM y fusión del gen ALK deben haber recibido previamente > o =1 ITC de ALK, uno de los cuales debe ser un ITC de 2a o 3a generación (ceritinib, alectinib, brigatinib o lorlatinib). Los pacientes con otros tumores sólidos deben haber recibido previamente > o =1 tratamiento antineoplásico sistémico anterior o ser aquellos para los que no existe un tratamiento habitual satisfactorio.
    b. Cohorte 2a fase II: 1 ITC de ALK previo de 2a generación (ceritinib, alectinib o brigatinib)
    c. Cohorte 2b fase II: 2 a 3 ITC de ALK previos de 1a o 2a generación (crizotinib, ceritinib, alectinib o brigatinib)
    d. Cohorte 2c fase II: 2 a 3 ITC de ALK previos, con lorlatinib recibido en la 2a o 3a línea de tratamiento
    e. Cohorte 2d fase II: > o =1 tratamiento antineoplásico sistémico previo o para el que no
    existe un tratamiento habitual satisfactorio
    f. todos los pacientes excepto la cohorte 2d en fase II: < o =2 líneas previas de quimioterapia y/o inmunoterapia en un contexto localmente avanzado o metastásico. Los pacientes que hayan recibido >2 líneas previas de quimioterapia y/o inmunoterapia en el contexto localmente avanzado o metastásico pueden inscribirse en la cohorte 2d en fase II.
    g. Cohortes 2a, 2b y 2c en fase II: Sin fármacos en investigación anteriores dirigidos a
    ALK. Los pacientes que hayan recibido previamente fármacos en investigación dirigidos a ALK pueden inscribirse en la cohorte 2d en fase I y en fase II.
    4. Fase I: Los pacientes deben presentar enfermedad evaluable de acuerdo con RECIST 1.1
    Fase II: Los pacientes deben presentar una enfermedad medible, definida como > o =1 lesión diana radiológicamente medible de acuerdo con RECIST 1.1
    5. Tejido tumoral previo al tratamiento enviado para un análisis central. Es preferible que el tejido tumoral enviado se obtenga durante o después de la progresión de la enfermedad más reciente.
    6. ECOG 0 o 1
    7. Función orgánica y reserva de médula ósea adecuadas según lo indicado por lo siguienteen la última evaluación antes de la primera dosis:
    a. RAN > o =1500/microL; recuento plaquetario >75 000/microL; hemoglobina > o =8 g/dl (sin transfusión).
    b. aclaramiento de creatinina estimado > o =60 ml/min.
    c. bilirrubina <1,5×LSN, excepto síndrome de Gilbert
    8. Las toxicidades clínicamente relevantes relacionadas con el tratamiento antineoplásico previo deben haberse recuperado a grado < o =1 o al valor inicial (excepto alopecia u ototoxicidad).
    9. Mujeres en edad fértil y los varones deben haberse sometido a anticoncepción quirúrgica o estar dispuestos a abstenerse de mantener relaciones sexuales o a usar un método anticonceptivo eficaz desde el momento de firmar el FCI hasta al menos 30 días después de la última administración del fármaco del estudio para las mujeres y al menos 90 días después de la última administración del fármaco del estudio para los hombres (o durante más tiempo, si así lo requieren las directrices locales o específicas del país). Los
    métodos anticonceptivos eficaces para las mujeres en edad fértil incluyen 1 “método altamente eficaz” o 2 métodos “eficaces” basados en los criterios de la OMS.
    10. Consentimiento informado por escrito y dispuesto y ser capaz de cumplir con los requisitos del protocolo del estudio.
    E.4Principal exclusion criteria
    1. Patient’s cancer has a known oncogenic driver alteration other than ALK. Investigators should discuss enrollment with the Sponsor regarding co-mutations.
    2. Known allergy/hypersensitivity to excipients of NVL-655.
    3. Major surgery within 4 weeks of the first dose of study drug. Minor surgical procedures (e.g., port insertion) are permitted, but with sufficient time for wound healing as deemed clinically appropriate.
    4. Ongoing or recent anticancer therapy within the following timeframe prior to first dose of study drug (NVL-655 may be started within limits for prior TKI or chemotherapy if considered by the Investigator to be safe and within the best interest of the patient, with prior approval from the Sponsor):
    a. TKI or other non-chemotherapy/non-immunotherapy anticancer agents <5 half-lives or <7 days, whichever is longer.
    b. Chemotherapy <21 days
    c. Immunotherapy or cellular therapy <28 days
    5. Ongoing or recent radiation therapy within the following timeframe prior to first dose of study drug:
    a. Radiation therapy (except palliative radiation to relieve bone pain) <14 days
    b. Palliative radiation to relieve bone pain <48 hours
    c. Stereotactic or small field brain irradiation <7 days
    d. Whole brain radiation <14 days
    6. Prior high-dose chemotherapy requiring stem cell rescue.
    7. Uncontrolled clinically relevant bacterial or fungal infection requiring systemic therapy.
    8. Has known active tuberculosis or active Hepatitis B or C. Active Hepatitis B is defined as a known positive HBsAg result and known quantitative HBV DNA results greater than the lower limits of detection of the assay. Active Hepatitis C is defined by a known positive Hep C Ab result and known quantitative HCV RNA results greater than the lower limits of detection of the assay.
    9. Patient has a QTcF >450 msec (repeated demonstration on more than one assessment). Patient has a history of prolonged QT syndrome or Torsades de pointes.
    10. Patients with clinically significant cardiovascular disease as follows:
    a. Within 3 months of enrollment: cerebral vascular accident/stroke; myocardial infarction; unstable angina; uncontrolled atrial fibrillation of any grade.
    b. History of congestive heart failure (New York Heart Association Classification Class > or = II); second-degree or third-degree atrioventricular block (unless paced) or any atrioventricular block with PR consistently >220 msec; or ongoing cardiac dysrhythmias of NCI-CTCAE Grade > or =2.
    11. Patient has CNS metastases or a primary CNS tumor that is associated with progressive neurological symptoms or requires increasing doses of corticosteroids to control the CNS disease. If a patient requires corticosteroids for management of CNS disease, the dose must have been stable for the 2 weeks preceding C1D1. Asymptomatic leptomeningeal carcinomatosis is allowed.
    12. Symptomatic spinal cord compression.
    13. Patients with moderate to severe cognitive impairment or psychiatric disturbances that would compromise the patient’s ability to comply with study requirements, in the Investigator’s opinion.
    14. Evidence of active malignancy (other than current ALK-positive solid malignancy) requiring systemic therapy within the prior 2 years. Exceptions: nonmelanoma skin cancer, in situ melanoma, in situ cervical cancer, papillary thyroid cancer, ductal carcinoma in situ of the breast, or localized and presumed cured prostate cancer. Patients on long-term anti-hormonal therapy for a prior malignancy are allowed if the malignancy has not been active within the prior 2 years.
    15. Concomitant use (within 12 days of first dose of study drug) of strong CYP3A4 inducers or strong CYP3A4 inhibitors
    16. Manifestation of malabsorption due to prior gastrointestinal surgery, disease, or other illness that could affect oral absorption, distribution, metabolism, or excretion of the study drug.
    17. Patient is pregnant or breastfeeding. WOCBP must have a negative serum pregnancy test at Screening and negative serum or urine test prior to first dose of study drug.
    18. Patient is actively receiving systemic treatment or direct medical intervention on another therapeutic clinical study.
    19. Any evidence of current ILD or pneumonitis or a prior history of ILD or non-infectious pneumonitis.
    20. Any medical condition or laboratory abnormality that in the opinion of the Investigator or Sponsor would pose a risk to study patient or confound the ability to interpret study results.
    1.El cáncer del paciente tiene una alteración oncogénica conocida distinta de ALK. Los investigadores deben comentar la inscripción con el promotor en relación a mutaciones simultáneas.
    2.Alergia/hipersensibilidad conocida a los excipientes de NVL-655.
    3.Cirugía mayor en las 4 semanas anteriores a la primera dosis. Se permiten procedimientos quirúrgicos menores, pero con tiempo suficiente para la cicatrización de heridas, según se considere clínicamente apropiado.
    4.Tratamiento antineoplásico en curso o reciente dentro de los siguientes plazos antes de la primera dosis del fármaco del estudio (NVL-655 puede iniciarse dentro de los límites para ITC o quimioterapia previos si el investigador considera que es seguro y que es lo mejor para el paciente, con la aprobación previa del promotor):
    a.menos de 5 semividas o menos de 7 días, lo que suponga más tiempo, de ITC u otros antineoplásicos distintos de la quimioterapia/de la inmunoterapia.
    b.menos de 21 días para quimioterapia
    c.menos de 28 días para inmunoterapia o tratamiento celular
    5.Radioterapia en curso o reciente en los siguientes plazos antes de la primera dosis
    a.menos de 14 días para radioterapia
    b.menos de 48 horas en el caso de radiación paliativa para aliviar el dolor óseo
    c.menos de 7 días para irradiación cerebral estereotáctica o de campo pequeño
    d.menos de 14 días para radiación cerebral total
    6.Quimioterapia previa a dosis altas que requiere terapia de rescate con células madre.
    7.Infección bacteriana o fúngica de interés clínico no controlada que requiere tratamiento sistémico.
    8.Tuberculosis activa o hepatitis B o C activa conocida. La hepatitis B activa se define como un resultado positivo conocido del HBsAg y resultados cuantitativos conocidos del ADN del VHB superiores a los límites inferiores de detección del ensayo. La hepatitis C activa se define por un resultado positivo conocido de anticuerpos contra la hepatitis C y resultados cuantitativos conocidos de ARN del VHC superiores a los límites inferiores de
    detección del ensayo.
    9.QTcF >450 ms (demostración repetida en más de una evaluación). El paciente tiene antecedentes de síndrome de QT prolongado o Torsades de pointes.
    10.Pacientes con enfermedad cardiovascular clínicamente significativa de la siguiente manera:
    a.en los 3 mesea antes de la inclusión: ictus; infarto de miocardio; angina inestable; fibrilación auricular no controlada de cualquier grado.
    b.Antecedentes de insuficiencia cardíaca congestiva (clase > o =II de la NYHA); bloqueo auriculoventricular de segundo o tercer grado (o cualquier bloqueo auriculoventricular con RP sistemáticamente >220 ms; o disritmias cardíacas en curso de grado > o = 2 según NCI-CTCAE.
    11.Metástasis en el SNC o un tumor primario del SNC que está asociado a síntomas neurológicos progresivos o requiere dosis crecientes de corticoesteroides para controlar la enfermedad del SNC. Si un paciente necesita corticoesteroides para el tratamiento de la enfermedad del SNC, la dosis debe haber sido estable durante las 2 semanas anteriores al C1D1. Se permite la carcinomatosis leptomeníngea asintomática.
    12.Compresión sintomática de la médula espinal.
    13.Deterioro cognitivo de moderado a grave o trastornos psiquiátricos que pudieran comprometer la capacidad del paciente para cumplir con los requisitos del estudio, en opinión del investigador.
    14.Indicios de neoplasia maligna activa (distinta de la actual neoplasia maligna sólida ALK-positivo) que haya requerido tratamiento sistémico en los 2 años anteriores. Excepciones: cáncer de piel no melanomatoso, melanoma in situ, cáncer cervicouterino in situ, cáncer tiroideo papilar, carcinoma ductal in situ de mama o cáncer de próstata localizado y presuntamente curado. Los pacientes con tratamiento antihormonal a largo plazo para una
    neoplasia maligna previa están permitidos si la neoplasia maligna no ha estado activa en los 2 años anteriores.
    15.Uso concomitante (en los 12 días previos a la primera dosis) de inductores potentes del CYP3A4 o inhibidores potentes del CYP3A4
    16.Manifestación de malabsorción debida a cirugía gastrointestinal previa, enfermedad u otra patología que pudiera afectar a la absorción oral, distribución, metabolismo o excreción del fármaco
    17.Mujeres: paciente está embarazada o en periodo de lactancia. Las mujeres en edad fértil deben tener una prueba de embarazo en suero negativa en la selección y una prueba en suero u orina negativa antes de la primera dosis del fármaco del estudio.
    18.Paciente que reciba activamente tratamiento sistémico o intervención médica directa en otro estudio clínico terapéutico.
    19.Cualquier indicio de EPI actual o neumonitis o antecedentes de EPI o neumonitis no infecciosa.
    20.Cualquier afección médica o anomalía de laboratorio que, en opinión del investigador o del promotor, suponga un riesgo para el paciente del estudio o confunda la capacidad de interpretar los resultados del estudio.
    E.5 End points
    E.5.1Primary end point(s)
    RP2D and, if applicable, the MTD as determined by incidence of DLTs during Cycle 1, overall safety profile, PK, PD, and preliminary efficacy.
    La DRF2 y, si procede, la DMT determinada por la incidencia
    de TLD durante el ciclo 1, el perfil de seguridad general, la
    FC, la FD y la eficacia preliminar
    E.5.1.1Timepoint(s) of evaluation of this end point
    Table 1: Schedule of Assessments Phase 1 and Phase 2 (All Cohorts)
    Table 2: Schedule of Pharmacokinetic Sampling Timepoints (Phase 1 and Phase 2)
    Tabla 1: Cronograma de Evaluaciones Fase 1 y Fase 2 (todas las cohortes)
    Tabla 2: Cronograma de muestreo farmacocinético (Fase 1 y Fase 2)
    E.5.2Secondary end point(s)
    Incidence and severity of TEAEs and changes in clinically relevant laboratory parameters;
    PK parameters of NVL-655: Cmax; Cmax – dose normalized; Ctau; Cavg; Tmax; AUCtau; AUCtau – dose normalized; AUC0-24; AUC0-24 – dose normalized; AUCinf; AUCinf – dose normalized; CL/F; Vz/F; and t1/2;
    ORR: Defined as the percent of patients with a CR or PR according to RECIST 1.1 per Investigator assessment;
    DOR: In responders, defined as the time from first Investigator-assessed response per RECIST 1.1 to radiographic disease progression or death;
    IC-ORR: In patients with measurable metastatic CNS disease at baseline, defined as the proportion of patients with a confirmed intracranial response (IC-CR or IC-PR) per investigator, based on assessment of up to 5 intracranial target lesions according to RECIST 1.1 principles;
    IC-DOR: In patients with intracranial response, defined as the time from first Investigator-assessed IC-response per RECIST 1.1 to radiographic IC-disease progression or death;
    CBR: Defined as the percent of patients with a confirmed CR or PR, or SD of at least 24 weeks duration according to RECIST 1.1 per Investigator assessment;
    Time to response: Defined as the time from first dose to first confirmed radiographic response according to RECIST 1.1 per Investigator assessment;
    PFS: Defined as the time from first dose to radiographic disease progression per RECIST 1.1 based on Investigator assessment or death.
    Incidencia e intensidad de los AAST y cambios en los parámetros analíticos clínicamente relevantes
    Parámetros FC de NVL-655: C máx ; C máx . – dosis normalizada; C tau ; C media ; T máx. ; AUC tau ; AUC tau – dosis normalizada; AUC 0-24 ; AUC 0-24 – dosis normalizada; AUC inf ; AUC inf – dosis normalizada; CL/F; Vz/F; y t 1/2
    TRO: Se define como el porcentaje de pacientes con RC o RP según los criterios RECIST 1.1 según la evaluación del investigador.
    DR: En pacientes con respuesta, se define como el tiempo transcurrido desde la primera respuesta evaluada por el investigador según los criterios RECIST 1.1 hasta la progresión radiográfica de la enfermedad o la muerte.
    TRO-IC: En pacientes con enfermedad metastásica en SNC medible al inicio, se define como la proporción de pacientes con una respuesta intracraneal confirmada (RC-IC o RP-IC) según el investigador, a partir de la evaluación de hasta 5 lesiones diana de acuerdo con los principios RECIST 1.1.
    DR-IC: En pacientes con respuesta intracraneal, se define como el tiempo transcurrido desde la primera respuesta IC evaluada por el investigador según los criterios RECIST 1.1 hasta la progresión radiográfica de la enfermedad IC o la muerte.
    TBC: Se define como el porcentaje de pacientes con RC o RP confirmada o EE de al menos 24 semanas de duración de acuerdo con los criterios RECIST 1.1, según la evaluación del investigador.
    Tiempo hasta la respuesta: Se define como el tiempo desde la primera dosis hasta la primera respuesta radiográfica confirmada de acuerdo con los criterios RECIST 1.1 según la evaluación del investigador.
    SSP: Se define como el tiempo transcurrido desde la primera dosis hasta la progresión radiográfica de la enfermedad según los criterios RECIST 1.1 a partir de la evaluación del investigador o la muerte.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Table 1: Schedule of Assessments Phase 1 and Phase 2 (All Cohorts)
    Table 2: Schedule of Pharmacokinetic Sampling Timepoints (Phase 1 and Phase 2)
    Tabla 1: Cronograma de Evaluaciones Fase 1 y Fase 2 (todas las cohortes)
    Tabla 2: Cronograma de muestreo farmacocinético (Fase 1 y Fase 2)
    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 Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans Yes
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open 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 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 concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA6
    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
    Australia
    Canada
    United States
    France
    Spain
    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 is defined as the date of the last visit of the last patient in the study or Sponsor’s decision to terminate the study.
    If supported by clinical rationale, adequate drug supply, and establishment of appropriate mechanisms for continued provision of NVL-655, patients who are deriving clinical benefit at study closure or termination may continue to receive NVL-655 until disease progression or commercial availability of NVL-655.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months7
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months7
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 3
    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) Yes
    F.1.1.6.1Number of subjects for this age range: 3
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 57
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 100
    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 state6
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 60
    F.4.2.2In the whole clinical trial 100
    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)
    Expected normal treatment of the condition
    El tratamiento que proceda para la enfermedad
    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 Decision2022-07-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-11
    P. End of Trial
    P.End of Trial StatusOngoing
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