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    Summary
    EudraCT Number:2022-000526-21
    Sponsor's Protocol Code Number:61186372NSC2002
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-11-18
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2022-000526-21
    A.3Full title of the trial
    A Phase 2, Open-Label, Parallel Cohort Study of Subcutaneous Amivantamab in Multiple Regimens in Patients with Advanced or Metastatic Solid Tumors including EGFR-mutated Non-Small Cell Lung Cancer.
    Studio di fase 2, in aperto, di coorte parallela su amivantamab per via sottocutanea in regimi multipli in pazienti con tumori solidi in stadio avanzato o metastatico, compreso il tumore polmonare non a piccole cellule con mutazioni di EGFR.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2, Open-Label, Parallel Cohort Study of Subcutaneous Amivantamab in Multiple Regimens in Patients with Advanced or Metastatic Solid Tumors including EGFR-mutated Non-Small Cell Lung Cancer.
    Studio di fase 2, in aperto, di coorte parallela su amivantamab per via sottocutanea in regimi multipli in pazienti con tumori solidi in stadio avanzato o metastatico, compreso il tumore polmonare non a piccole cellule con mutazioni di EGFR.
    A.3.2Name or abbreviated title of the trial where available
    PALOMA-2
    PALOMA-2
    A.4.1Sponsor's protocol code number61186372NSC2002
    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 SponsorJANSSEN CILAG INTERNATIONAL NV
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportJanssen Research and Development
    B.4.2CountryUnited States
    B.4.1Name of organisation providing supportJanssen Cilag SpA
    B.4.2CountryItaly
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationJanssen-Cilag International NV
    B.5.2Functional name of contact pointClinical Registry Group
    B.5.3 Address:
    B.5.3.1Street AddressArchimedesweg 29
    B.5.3.2Town/ cityLeiden
    B.5.3.3Post code2333CM
    B.5.3.4CountryNetherlands
    B.5.4Telephone number000000000
    B.5.5Fax number000000000
    B.5.6E-mailClinicalTrialsEU@its.jnj.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 nameLazertinib
    D.3.2Product code [JNJ-73841937-ZCY/YH25448AM]
    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 INNLazertinib
    D.3.9.2Current sponsor codeJNJ-73841937-ZCY/YH25448AM
    D.3.9.4EV Substance CodeSUB199596
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number80
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAmivantamab co-formulato con Ialuronidasi umana ricombinante (rHuPH20)
    D.3.2Product code [JNJ-61186372]
    D.3.4Pharmaceutical form Concentrate for solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAmivantamab
    D.3.9.1CAS number 2171511-58-1
    D.3.9.2Current sponsor codeJNJ-61186372
    D.3.9.3Other descriptive nameD.3.6.2.1: 1600-3360 per infusion mg milligram(s)
    D.3.9.4EV Substance CodeSUB193051
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number160
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVorhyaluronidase alfa
    D.3.9.1CAS number 757971-58-7
    D.3.9.2Current sponsor codeNAP
    D.3.9.4EV Substance CodeSUB33117
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.02
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Advanced or Metastatic Solid Tumors including EGFR-mutated Non-Small Cell Lung Cancer.
    Tumori solidi in stadio avanzato o metastatico, compreso il tumore polmonare non a piccole cellule con mutazioni di EGFR.
    E.1.1.1Medical condition in easily understood language
    Advanced or Metastatic Solid Tumors including EGFR-mutated Non-Small Cell Lung Cancer.
    Tumori solidi in stadio avanzato o metastatico, compreso il tumore polmonare non a piccole cellule con mutazioni di EGFR.
    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.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objectives are to assess anti-tumor activity (objective response rate [ORR]) (Cohorts 1, 2, and 3) and to evaluate the safety (Cohort 4) of amivantamab SC-CF via manual injection.
    Gli obiettivi primari sono valutare l’attività antitumorale (tasso di risposta obiettiva [objective response rate, ORR]) (Coorti 1, 2 e 3) e valutare la sicurezza (Coorte 4) di amivantamab SC-CF tramite iniezione manuale.
    E.2.2Secondary objectives of the trial
    Secondary objectives are to assess safety and additional measures of anti-tumor activity (Cohorts 1, 2, and 3) and to characterize the PK of amivantamab-SC-CF (Cohorts 1, 2, and 3). In Cohort 4 only, patient-reported outcomes (PROs) will be utilized to characterize participants’ experience with both formulations.
    Gli obiettivi secondari sono valutare la sicurezza e le misure aggiuntive dell’attività antitumorale (Coorti 1, 2 e 3) e caratterizzare la PK di amivantamab-SC-CF (Coorti 1, 2 e 3). Solo nella Coorte 4, gli esiti riferiti dal paziente (patient-reported outcomes, PRO) saranno utilizzati per caratterizzare l’esperienza dei partecipanti con entrambe le formulazioni.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Age
    1. Be =18 years of age (or the legal age of consent in the jurisdiction in which the study is taking place) at the time of informed consent.
    Type of Participant and Disease Characteristics
    2. Participant must have histologically or cytologically confirmed, locally advanced or metastatic, NSCLC, characterized at the time of locally advanced or metastatic disease diagnosis.
    Additional Cohort specific disease requirements include:
    Cohorts 1 and 3: EGFR Exon19del or L858R mutation
    Cohort 2: EGFR Exon 20ins mutation
    EGFR Exon19del or Exon 21 L858R mutation (Cohort 1 and 3) or EGFR Exon 20 insertion mutation (Cohort 2) must have been identified as determined by an FDA-approved or other validated test of either ctDNA or tumor tissue in a CLIA certified laboratory (sites in the US) or an accredited local laboratory (sites outside of the US). A copy of the initial test report documenting the EGFR mutation must be included in the participant records and a deidentified copy must also be submitted to the sponsor.
    3. Have at least 1 measurable lesion, according to RECIST v1.1. If the only target lesion has been previously irradiated, it must show signs of disease progression since radiation was completed.
    Prior Malignancies
    4. May have a prior or concurrent second malignancy (other than the disease under study) which natural history or treatment is unlikely to interfere with any study endpoints of safety or the efficacy of the study treatment(s) (see Appendix 12 of the Protocol on Allowed Recent Second or Prior Malignancies for details).
    Prior Therapy Restrictions or Requirements
    5. Cohort-specific requirements with regards to prior therapy are as follows:
    Cohort 1 and 2:
    Participant should not have received any prior systemic therapy for metastatic NSCLC.
    Cohort 2: Participant should not have received any prior systemic therapy for metastatic NSCLC. However, prior monotherapy with an approved EGFR TKI targeting common EGFR mutations as first-line therapy for the treatment of locally advanced or metastatic disease is allowed, if: 1) treatment duration did not exceed 8 weeks; 2) lack of disease response was documented radiographically 3) associated toxicities have resolved to baseline; and 4) the EGFR TKI was discontinued at least 2 weeks or 4 half-lives prior to treatment initiation at C1D1, whichever is longer. Prior therapy with EGFR TKI agents targeting Exon20ins mutations (eg, TAK788/mobocertinib or poziotinib), is not allowed.
    Cohort 3:
    Participant should have progressed on or after osimertinib monotherapy as the immediate prior line of systemic therapy. Osimertinib must have been administered as the first EGFR TKI for metastatic disease or as the second TKI after prior treatment with first- or second-generation EGFR TKI.
    Cohort 4:
    Participants need to currently be on an amivantamab IV Q2W regimen without dose reduction (1,050 mg or 1,400 mg depending on weight) as part of standard of care for at least 3 months, an expanded access program, or as a rollover from a long-term extension prior amivantamab Q2W study. No washout is required between IV and SC-CF administration.
    6. Toxicities from prior anticancer therapy, if any, must have resolved to CTCAE Version 5.0 Grade 1 or baseline level (except for other toxicities as indicated in inclusion criteria 8, alopecia [any grade], Grade =2 peripheral neuropathy, and Grade <2 hypothyroidism stable on hormone replacement).
    For Cohort 4 only:
    Amivantamab related toxicities that are stable and deemed tolerable by the investigator and patient are not exclusionary.
    Performance Status
    7. Participant must have ECOG status of 0 or 1. Refer to Appendix 9 of the Protocol: Eastern Cooperative Oncology Group (ECOG) Performance Status.
    Renal, Hepatic and Hematological Function
    8. Participant must demonstrate adequate organ and bone marrow function required for safe administration of the cohort-specific regimen, without history of red blood cell transfusion or platelet transfusion within 7 days prior to the date of the laboratory test, as follows:
    Cohorts 1 and 4 (chemotherapy-free regimens):
    a. Hemoglobin =9 g/dL
    b. Absolute neutrophil count =1.5x109/L, without use of granulocyte colony stimulating factor (G-CSF) within 10 days prior to the date of the test
    c. Platelets =75x109/L
    d. ALT and AST =3xULN if no demonstrable liver metastases or =5xULN in the presence of liver metastases.
    e. Total bilirubin =1.5xULN (participants with Gilbert’s syndrome can enroll if conjugated bilirubin is within normal limits)
    f. eGFR >50 mL/min as measured or calculated by MDRD (Appendix 11: Formulas for Estimating Glomerular Filtration Rate Using Modified Diet in Renal Disease Formula [in mL/min])

    For full list of inclusion criteria please refer to the Protocol (pages 43-47).
    1.Essere di età =18 anni (o l’età legale del consenso nella giurisdizione in cui si svolge lo studio) al momento del consenso informato.
    2.Il partecipante deve presentare NSCLC istologicamente o citologicamente confermato, localmente avanzato o metastatico, caratterizzato al momento della diagnosi di malattia localmente avanzata o metastatica.
    Ulteriori requisiti specifici della coorte includono:
    Coorti 1 e 3: Delezione dell’esone 19 o mutazione L858R di EGFR
    Coorte 2: Mutazione di EGFR con inserzione dell’esone 20
    La mutazione di EGFR con delezione dell’esone 19 o la mutazione L858R dell’esone 21 (Coorte 1 e 3) o la mutazione di EGFR con l’inserzione dell’esone 20 (Coorte 2) deve essere stata identificata come determinata da un test approvato dalla FDA o da un altro test convalidato del ctDNA o del tessuto tumorale in un laboratorio certificato CLIA (centri negli Stati Uniti) o in un laboratorio locale accreditato (centri al di fuori degli Stati Uniti). Una copia del referto del test iniziale che documenta la presenza della mutazione di EGFR deve essere inclusa nella documentazione del partecipante e una copia deidentificata deve essere trasmessa allo sponsor.
    3.Presentare almeno 1 lesione misurabile, secondo i criteri RECIST v1.1. Se l’unica lesione target è stata precedentemente irradiata, deve mostrare segni di progressione della malattia dal completamento della radioterapia.
    4.Può presentare un secondo tumore maligno pregresso o concomitante (diverso dalla malattia oggetto di studio) il cui decorso naturale o trattamento non abbia probabilità di interferire con qualsiasi endpoint di sicurezza o efficacia del/i trattamento/i dello studio (per i dettagli, vedere l’Appendice 12: secondo tumore maligno recente o tumori maligni precedenti consentiti).
    5.I requisiti specifici delle coorti per quanto riguarda la terapia precedente sono i seguenti:
    Coorte 1 e 2: Il partecipante non deve aver ricevuto alcuna precedente terapia sistemica per NSCLC metastatico.
    Coorte 2: Il partecipante non deve aver ricevuto alcuna precedente terapia sistemica per NSCLC metastatico. Tuttavia, La precedente monoterapia con un TKI di EGFR approvato mirato alle mutazioni comuni di EGFR come terapia di prima linea per il trattamento della malattia localmente avanzata o metastatica è consentita, purché: 1) la durata del trattamento non abbia superato le 8 settimane; 2) la mancata risposta della malattia sia stata documentata radiologicamente; 3) le tossicità associate si siano risolte con ritorno al grado basale; e 4) il TKI di EGFR sia stato interrotto almeno 2 settimane o 4 emivite prima dell’inizio del trattamento al C1G1, a seconda di quale sia il periodo più lungo. La precedente terapia con agenti TKI di EGFR mirati alle mutazioni con inserzione dell’esone 20 (ad es. TAK788/mobocertinib o poziotinib) non è consentita.
    Coorte 3: Il partecipante deve aver manifestato progressione durante o dopo la monoterapia con osimertinib come linea di terapia sistemica immediatamente precedente. Osimertinib deve essere stato somministrato come primo TKI di EGFR per la malattia metastatica o come secondo TKI dopo il trattamento precedente con TKI di EGFR di prima o seconda generazione.
    Coorte 4: I partecipanti devono attualmente assumere un regime con amivantamab per via endovenosa (EV) ogni due settimane senza riduzione della dose (1.050 mg o 1.400 mg, a seconda del peso) come parte dello standard di cura per almeno 3 mesi, come programma di accesso ampliato o come rollover da uno studio di estensione a lungo termine precedente con amivantamab ogni due settimane. Non è richiesto alcun washout tra la somministrazione EV e SC-CF.
    6.Le tossicità da una precedente terapia antitumorale, se presenti, devono essersi risolte al livello CTCAE Versione 5.0 Grado 1 o basale (eccetto per altre tossicità indicate nel criterio di inclusione 8, alopecia [di qualsiasi grado], neuropatia periferica di Grado =2 e ipotiroidismo di Grado <2 stabile per terapia ormonale sostitutiva).
    Solo per la Coorte 4: Le tossicità correlate ad amivantamab che sono stabili e ritenute tollerabili dallo sperimentatore e dal paziente non sono fattori di esclusione.
    7.Il partecipante deve avere uno stato ECOG (Eastern Cooperative Oncology Group [Gruppo orientale cooperativo di oncologia]) pari a 0 o 1. Consultare l’Appendice 9: Stato di validità del Gruppo orientale cooperativo di oncologia (Eastern Cooperative Oncology Group, ECOG).
    8.Il partecipante deve dimostrare una funzionalità d’organo e funzione del midollo osseo adeguate per una somministrazione sicura del regime specifico della coorte, in assenza di un’anamnesi di trasfusione di globuli rossi o trasfusione di piastrine nei 7 giorni precedenti la data del test di laboratorio:

    Elenco completo dei criteri di inclusione pagine 43-47 del Protocollo
    E.4Principal exclusion criteria
    Medical Conditions
    1. Participant has an uncontrolled illness, including but not limited to:
    a. Uncontrolled diabetes
    b. Ongoing or active infection (includes infection requiring treatment with antimicrobial therapy [participants will be required to complete antibiotics 1 week prior to starting study treatment] or diagnosed or suspected viral infection).
    c. Active bleeding diathesis
    d. Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product, or previous significant bowel resection that would preclude adequate absorption of study treatment
    e. Psychiatric illness or any other circumstances (including social circumstances) that would limit compliance with study requirements
    f. Any ophthalmologic condition that is clinically unstable
    2. Participant has a medical history of ILD, including drug induced ILD or radiation pneumonitis
    3. Participant has a history of hypersensitivity to any excipients of the investigational products to be used in their enrolment cohort
    4. Participant has a history of clinically significant cardiovascular disease including, but not limited to:
    a. Diagnosis of deep vein thrombosis or pulmonary embolism within 1 month prior to the first dose of study treatment(s), or any of the following within
    6 months prior to the first dose of study treatment(s): myocardial infarction, unstable angina, stroke, transient ischemic attack, coronary/peripheral artery bypass graft, or any acute coronary syndrome. Clinically non-significant thrombosis, such as non-obstructive catheter-associated clots, are not
    exclusionary.
    b. Prolonged QTcF interval >480 msec or clinically significant cardiac arrhythmia or electrophysiologic disease (eg, placement of implantable cardioverter defibrillator or atrial fibrillation with uncontrolled rate).
    c. Uncontrolled (persistent) hypertension: systolic blood pressure >160 mmHg; diastolic blood pressure >100 mmHg
    d. Congestive heart failure defined as NYHA class III-IV or hospitalization for CHF (any NYHA class) within 6 months of treatment initiation at C1D1
    e. Pericarditis/clinically significant pericardial effusion
    f. Myocarditis
    g. Baseline LVEF below the institution’s lower limit of normal at screening, as assessed by echocardiogram or MUGA scan.
    5. Participant had major surgery (eg, requiring general anesthesia), excluding placement of vascular access or tumor biopsy, or had significant traumatic injury within 4 weeks before signing the ICF, or will not have fully recovered from surgery, or has surgery planned during the time the participant is expected to participate in the study.
    Note: Participants with planned surgical procedures to be conducted under local anesthesia may participate.
    6. Participant has uncontrolled tumor-related pain:
    Symptomatic lesions amenable to palliative radiotherapy (eg, bone metastases, or metastases causing nerve impingement) should be treated more than 7 days prior to the treatment initiation at C1D1.
    Disease Characteristics
    7. Participant has received radiotherapy for palliative purposes less than 7 days prior to treatment initiation at C1D1.
    8. Participant has symptomatic brain metastases. A participant with asymptomatic or previously treated and stable brain metastases may participate in this study. Participants who have received definitive radiation or surgical treatment for symptomatic or unstable brain metastases and have been clinically stable and asymptomatic for at least 2 weeks before Screening are eligible, provided they have been either off corticosteroid treatment
    or are receiving low-dose corticosteroid treatment (=10 mg/day prednisone or equivalent) for at least 2 weeks prior to treatment allocation.
    9. Participant has a history of leptomeningeal disease, or participant has spinal cord compression not definitively treated with surgery or radiation.
    Prior/Concomitant Therapy or Clinical Study Experience
    10. Taken any disallowed therapies as noted in Section 6.8, Concomitant Therapy before the planned first dose of study treatment.
    11. Participant has received a live or live attenuated vaccine within 3 months before Cycle 1 Day 1. The seasonal influenza vaccine and non-live vaccines against COVID 19 are not exclusionary.
    12. Cohorts 1, 3, and 4 (regimens potentially including lazertinib): Participant is currently receiving medications or herbal supplements known to be potent CYP3A4/5 inducers and is unable to stop use for an appropriate washout period prior to Cycle 1 Day 1.
    Other Exclusions
    13. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (eg, compromise well-being) or that could prevent, limit, or confound the protocol-specified assessments

    For full list of exclusion criteria please refer to the Protocol (pages 47-50).
    1.Presenza di malattia non controllata, tra cui:
    a.Diabete non controllato
    b.Infezione in atto o attiva (comprese le infezioni che richiedono un trattamento con terapia antimicrobica [la terapia antibiotica dovrà essere completata 1 settimana prima dell’avvio del trattamento dello studio] o le infezioni virali diagnosticate o sospette).
    c.Diatesi emorragica attiva
    d.Nausea e vomito refrattari, malattie gastrointestinali croniche, incapacità di deglutire il prodotto formulato o pregressa resezione intestinale significativa che potrebbe impedire l’adeguato assorbimento del trattamento dello studio
    e.Malattia psichiatrica o qualsiasi altra circostanza che potrebbe limitare l’aderenza ai requisiti dello studio
    f.Qualsiasi condizione oftalmologica che sia clinicamente instabile
    2.Anamnesi di ILD [Interstitial Lung Disease (malattia polmonare interstiziale)], compresa l’ILD da farmaci, o infiammazione polmonare da radiazioni
    3.Anamnesi di ipersensibilità a qualsiasi eccipiente dei prodotti sperimentali da utilizzare nella coorte di arruolamento
    4.Il partecipante presenta un’anamnesi di malattia cardiovascolare clinicamente significativa, tra cui, a titolo esemplificativo ma non esaustivo:
    a.Diagnosi di trombosi venosa profonda o embolia polmonare entro 1 mese prima della prima dose del/i trattamento/i dello studio o una qualsiasi delle seguenti condizioni entro 6 mesi prima della prima dose del/i trattamento/i dello studio: infarto miocardico, angina instabile, ictus, attacco ischemico transitorio, innesto di bypass coronarico/arterioso periferico o qualsiasi sindrome coronarica acuta. La trombosi non clinicamente significativa, per esempio le forme associate a catetere non ostruttive, non costituisce motivo di esclusione.
    b.Intervallo QTcF prolungato >480 msec o aritmia cardiaca clinicamente significativa o malattia elettrofisiologica (ad es. posizionamento di defibrillatore cardioverter impiantabile o fibrillazione atriale con frequenza incontrollata).
    c.Ipertensione non controllata (persistente): pressione arteriosa sistolica >160 mmHg; pressione arteriosa diastolica >100 mmHg
    d.Insufficienza cardiaca congestizia (congestive heart failure, CFH), definita come classe NYHA III-IV o ricovero per CHF (qualsiasi classe NYHA) entro 6 mesi dall’inizio del trattamento al C1G1
    e.Pericardite/Versamento pericardico clinicamente significativo
    f.Miocardite
    g.LVEF [Left Ventricular Ejection Fraction (frazione di eiezione ventricolare sinistra)] al basale al di sotto del limite inferiore della norma dell’istituto allo screening, valutata mediante ecocardiogramma o scansione con acquisizione a gate multipli (MUGA).
    5.Anamnesi di intervento di chirurgia maggiore (per es., con necessità di anestesia generale), esclusi il posizionamento di accesso vascolare o la biopsia tumorale, o di lesione traumatica significativa entro 4 settimane prima della firma del Modulo di consenso informato, oppure recupero incompleto da un intervento chirurgico o intervento chirurgico in programma nel periodo previsto di partecipazione allo studio.
    Nota: sono ammessi i partecipanti con procedure chirurgiche in programma da condurre in anestesia locale.
    6.Il partecipante presenta dolore correlato al tumore non controllato: Le lesioni sintomatiche suscettibili di radioterapia palliativa (ad es. metastasi ossee o metastasi che causano impingement nervoso) devono essere state trattate da più di 7 giorni prima dell’inizio del trattamento al C1G1.
    7.Il partecipante ha ricevuto radioterapia a scopi palliativi meno di 7 giorni prima dell’inizio del trattamento al C1G1.
    8.Presenza di metastasi cerebrali sintomatiche. Un partecipante con metastasi cerebrali asintomatiche o precedentemente trattate e stabili possono partecipare allo studio. I partecipanti che hanno ricevuto un trattamento radioterapico o chirurgico definitivo per metastasi cerebrali sintomatiche o instabili e sono stati clinicamente stabili e asintomatici per almeno 2 settimane prima dello screening sono considerati idonei, a condizione che non abbiano ricevuto un trattamento corticosteroideo, salvo se a bassa dose (=10 mg/giorno di prednisone o equivalente), per almeno 2 settimane prima dell’assegnazione del trattamento.
    9.Il partecipante è affetto da malattia leptomeningea o presenta compressione del midollo spinale non trattata in modo definitivo con intervento chirurgico o radioterapia.
    10.Aver assunto eventuali terapie non consentite indicate nella Sezione 6.8, Terapia concomitante prima della prima dose in programma del trattamento dello studio.
    11.Vaccinazione con vaccino vivo o vivo attenuato nei 3 mesi precedenti il Ciclo 1 Giorno 1.
    12.Coorti 1, 3 e 4 (regimi potenzialmente comprendenti lazertinib): Attuale assunzione di farmaci o integratori erboristici noti per essere induttori potenti del CYP3A4/5 e impossibilità di interromperne l’uso per un periodo di washout adeguato prima del Ciclo 1 Giorno 1.

    Elenco completo dei criteri di inclusione pagine 47-50 del Protocollo
    E.5 End points
    E.5.1Primary end point(s)
    Cohorts 1, 2, and 3
    - ORR (INV)
    Cohort 4
    - Incidence and severity of adverse events and clinical laboratory abnormalities
    Coorti 1, 2 e 3
    - ORR (INV)
    Coorte 4:
    - Incidenza e gravità degli eventi avversi e anomalie cliniche di laboratorio
    E.5.1.1Timepoint(s) of evaluation of this end point
    Cohort 1,2,3: The primary analysis of primary endpoints for Cohorts 1, 2, and 3 will be performed after all participants have completed at least 3 disease assessments (unless they withdrew consent or died prior). Cohort 4: The primary analysis of primary endpoints will be performed 3 months after the last participant in that cohort received the first dose (i.e., once all enrolled patients have completed at least 3 cycles of treatment or discontinued prior). The final analysis of primary and secondary endpoints as well as the analysis of exploratory endpoints will be performed after the last participant in that cohort completed the Follow-up Phase.
    Coorte 1,2,3: L'analisi primaria degli endpoint primari per le coorti 1, 2 e 3 verrà seguita dopo che tutti i partecipanti avranno completato almeno 3 valutazioni della malattia (a meno che non abbiano revocato il consenso o siano deceduti prima).
    Coorte 4: l'analisi primaria degli endpoint primari verrà eseguita 3 mesi dopo che l'ultimo partecipante di quella coorte ha ricevuto la prima dose (cioè, una volta che tutti i pazienti arruolati hanno completato almeno 3 cicli di trattamento o interrotto prima). L'analisi finale degli endpoints primari e secondari così come l'analisi degli endpoint esplorativi verrà eseguito dopo che l'ultimo partecipante di quella coorte ha completato la Fase di follow-up.
    E.5.2Secondary end point(s)
    Cohorts 1, 2 and 3
    - Incidence and severity of adverse events and clinical laboratory abnormalities
    - ORR (ICR)
    - DoR
    - TTR
    - CBR (INV)
    - PFS
    - OS
    - Serum Ctrough of amivantamab on Cycle 2 Day 1
    - Serum amivantamab concentrations and serum anti-amivantamab antibodies (Cohorts 1, 2, and 3)
    - Plasma lazertinib concentrations (Cohorts 1 and 3)
    - The presence or absence of anti-rHuPH20 antibodies

    Cohort 4
    - Incidence and severity of adverse events and clinical laboratory abnormalities
    - Modified TASQ-IV
    - Modified TASQ-SC
    - PGIC
    - PGIS
    Coorti 1, 2 e 3:
    - Incidenza e gravità degli eventi avversi e anomalie cliniche di laboratorio
    - tasso di risposta obiettiva (objective response rate, ORR)
    - durata della risposta (duration of response, DoR)
    - tempo alla risposta (time to response, TTR)
    - tasso di beneficio clinico (Clinical benefit Rate, CBR (INV))
    - sopravvivenza libera da progressione (progression-free survival, PFS)
    - sopravvivenza complessiva (overall survival, OS)
    - concentrazione sierica minima di amivantamab al ciclo 2 giorno 1
    - concentrazioni sieriche di amivantamab e concentrazioni sieriche di anticorpi anti-amivantamab (coorti 1, 2 e 3)
    - concentrazione plasmatica di lazertinib (coorti 1 e 2)
    - la presenza o assenza di anticorpi anti-rHuPH20

    Coorte 4
    - Incidenza e gravità degli eventi avversi e anomalie cliniche di laboratorio
    - Questionario modificato sulla soddisfazione della somministrazione della terapia per via endovenosa (Therapy Administration Satisfaction Questionnaire- intravenous, TASQ-IV)
    - Questionario modificato sulla soddisfazione della somministrazione della terapia per via sottocutanea (Therapy Administration Satisfaction Questionnaire subcutaneous, TASQ-SC)
    - Impressione globale del paziente del cambiamento (Patient Global Impression of Change, PGIC)
    - Impressione globale del paziente della gravità (Patient Global Impression of Severity, PGIS)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Cohort 1,2,3: The primary analysis of secondary endpoints for Cohorts 1, 2, and 3 will be performed after all participants have completed at least 3 disease assessments (unless they withdrew consent or died prior). Cohort 4: The primary analysis of secondary endpoints will be performed 3 months after the last participant in that cohort received the first dose (i.e., once all enrolled patients have completed at least 3 cycles of treatment or discontinued prior). The final analysis of primary and secondary endpoints as well as the analysis of exploratory endpoints will be performed after the last participant in that cohort completed the Follow-up Phase.
    Coorte 1,2,3: L'analisi primaria degli endpoint secondari per le coorti 1, 2 e 3 verranno eseguiti dopo che tutti i partecipanti avranno completato almeno 3 valutazioni della malattia (a meno che non abbiano revocato il consenso o siano deceduti prima).
    Coorte 4: l'analisi primaria degli endpoint secondari sarà eseguita 3 mesi dopo che l'ultimo partecipante di quella coorte ha ricevuto la prima dose (cioè, una volta che tutti i pazienti arruolati hanno completato almeno 3 cicli di trattamento o interrotto prima).
    L'analisi finale degli endpoints primari e secondari secondari, così come l'analisi degli endpoints esplorativi verrà eseguito dopo che l'ultimo partecipante di quella coorte ha completato la Fase di follow-up.
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) 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 No
    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 Yes
    E.8.1.7.1Other trial design description
    In aperto, gruppi paralleli
    open-label, parallel group
    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 trial4
    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 concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA31
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Brazil
    China
    India
    Israel
    Japan
    Korea, Democratic People's Republic of
    Malaysia
    Taiwan
    United States
    Spain
    Turkey
    United Kingdom
    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
    La fine dello studio è considerata come l'ultima valutazione dello studio programmata indicata nel Programma delle attività per l'ultimo partecipante allo studio.
    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 months8
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months8
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 130
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 130
    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 Yes
    F.3.3.2Women of child-bearing potential using contraception No
    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 state14
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 100
    F.4.2.2In the whole clinical trial 260
    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)
    Standard of care
    Normale pratica clinica
    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 Decision2022-12-22
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-02-16
    P. End of Trial
    P.End of Trial StatusOngoing
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