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    Summary
    EudraCT Number:2022-000891-20
    Sponsor's Protocol Code Number:CA-4948-101
    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:2022-12-14
    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 number2022-000891-20
    A.3Full title of the trial
    An Open-Label, Dose Escalation and Dose Expansion Trial Evaluating the Safety, Pharmacokinetics, Pharmacodynamics, and Clinical Activity of Orally Administered CA-4948 in Patients with Relapsed or Refractory Hematologic Malignancies
    Sperimentazione in aperto, sull’incremento graduale della dose e sull’espansione della dose volta a valutare la sicurezza, la farmacocinetica, la farmacodinamica e l'attività clinica di CA-4948 somministrato per via orale in pazienti affetti da tumori maligni ematologici recidivanti o refrattari
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    An Open-Label, Dose Escalation and Dose Expansion Trial Evaluating the Safety, Pharmacokinetics, Pharmacodynamics, and Clinical Activity of Orally Administered CA-4948 in Patients with Relapsed or Refractory Hematologic Malignancies
    Sperimentazione in aperto, sull'incremento graduale della dose e sull'espansione della dose per valutare la sicurezza, la farmacocinetica, la farmacodinamica e l'attività clinica di CA-4948 in pazienti con tumori maligni ematologici recidivanti o refrattari
    A.3.2Name or abbreviated title of the trial where available
    NA
    NA
    A.4.1Sponsor's protocol code numberCA-4948-101
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT03328078
    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 SponsorCuris, 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 supportCuris, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCuris, Inc.
    B.5.2Functional name of contact pointOleg Zernovak
    B.5.3 Address:
    B.5.3.1Street Address128 Spring Street Building C, Suite 500
    B.5.3.2Town/ cityLexington, MA
    B.5.3.3Post code02421
    B.5.3.4CountryUnited States
    B.5.4Telephone number+16175036512
    B.5.6E-mailozernovak@curis.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 nameIbrutinib
    D.3.2Product code [-]
    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 INNIbrutininb
    D.3.9.1CAS number 936563-96-1
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB120863
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number140
    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 nameCA-4948 (emavusertib)
    D.3.2Product code [CA-4948]
    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 INNEmavusertib
    D.3.9.2Current sponsor codeCA-4948
    D.3.9.4EV Substance CodeSUB208117
    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 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
    Relapsed or Refractory Hematologic Malignancy
    tumori maligni ematologici recidivanti o refrattari
    E.1.1.1Medical condition in easily understood language
    Relapsed or Refractory Hematologic Malignancy
    tumori maligni ematologici recidivanti o refrattari
    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 LLT
    E.1.2Classification code 10066481
    E.1.2Term Hematological malignancy
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    - Part A (Dose Escalation Phase):
    To determine the safety and tolerability, dose-limiting toxicities (DLTs), maximum tolerated dose (MTD), and recommended Phase 2 dose (RP2D) of oral CA-4948 as monotherapy and in combination with ibrutinib
    - Part B (Dose Expansion Phase)
    To assess CR rate or ORR of CA-4948 in combination with ibrutinib
    - Parte A (fase di aumento della dose):
    Determinare la sicurezza e la tollerabilità, le tossicità dose-limitanti (DLT), la dose massima tollerata (MTD) e la dose raccomandata di Fase 2 (RP2D) di CA-4948 orale in monoterapia e in combinazione con ibrutinib

    -Parte B (fase di espansione della dose):
    Valutare il tasso di CR o l'ORR di CA-4948 in combinazione con ibrutinib
    E.2.2Secondary objectives of the trial
    Part A2: Dose escalation of CA-4948 in combination with ibrutinib. To assess:
    - the pharmacokinetic (PK) profile of CA-4948 and ibrutinib
    -overall response rate (ORR) following treatment
    -duration of response (DOR) following treatment
    -disease control rate (DCR) following treatment
    -progression-free survival (PFS) following treatment
    -overall survival (OS) following treatment

    Part B: Dose expansion cohorts of CA-4948 in combination with ibrutinib.
    - To assess DOR following treatment with CA-4948 in combination with ibrutinib
    - To assess DCR following treatment with CA-4948 in combination with ibrutinib
    - To assess the safety and tolerability of CA-4948 in combination with ibrutinib
    - To assess PFS following treatment with CA-4948 in combination with ibrutinib
    - To assess OS following treatment with CA-4948 in combination with ibrutinib
    -To assess the population PK and estimate blood-brain barrier penetration in central nervous system (CNS) lymphoma patients
    Parte A (fase di aumento della dose):
    -Valutare il profilo farmacocinetico (PK) di CA-4948 e ibrutinib
    -Valutare il tasso di risposta globale (ORR) dopo il trattamento con CA-4948 in monoterapia e in combinazione con ibrutinib
    -Valutare la durata della risposta (DOR) dopo il trattamento con CA-4948 in monoterapia e in combinazione con ibrutinib
    -Valutare il tasso di controllo della malattia (DCR) dopo il trattamento con CA-4948 in monoterapia e in combinazione con ibrutinib
    -Valutare la sopravvivenza libera da progressione (PFS) e la sopravvivenza complessiva (OS) dopo il trattamento con CA-4948 in monoterapia e in combinazione con ibrutinib

    Parte B (fase di espansione della dose):
    -Valutare il DOR, il DCR, la sicurezza e la tollerabilità, la PFS e la OS di CA-4948 dopo il trattamento con CA-4948 in combinazione con ibrutinib
    -Valutare la PK della popolazione e stimare la penetrazione della barriera emato-encefalica in pazienti affetti da linfoma del sistema nervoso centrale (SNC)
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Part A2
    1. Males and females >= 18 years of age
    2. Life expectancy of at least 3 months
    3. ECOG Performance Status of <= 1
    4. Diagnosis of histopathologically confirmed B-cell NHL, as per the WHO 2016 classification (Swerdlow et al. 2016). Eligible NHL subtypes include follicular lymphoma, MZL, MCL, DLBCL (including extranodal lymphomas of leg-, testicular-, or not otherwise specified [NOS]-type), and primary or secondary CNS lymphoma. NOTE: Once a dose has been shown not to exceed the MTD in NHL patients, other hematological malignancies can be considered for enrollment in specific malignancies that have been approved by the CSC and Sponsor. Patients with MCL or MZL should meet clinical criteria for requiring treatment of their disease.
    5. Relapsed or refractory disease (as defined below) for which patients are ineligible for or have exhausted standard therapeutic options that would be considered standard of care.
    a. Relapsed NHL is per Revised Response Criteria for Malignant Lymphoma and as documented by excisional/incisional biopsy (preferred) or FNA or CNB as PD after a CR, PR, or SD. NOTE: For confirmation of documented relapse during prior treatment, biopsy/FNA of the lymphoma at Screening is recommended but not mandatory.
    b. Refractory NHL is defined for all eligible NHL by PD (per Revised Response Criteria for Malignant Lymphoma) during prior treatment or failure to achieve an objective response on prior treatment. NOTE: Biopsy (preferred) or FNA at Screening is recommended but not mandatory.
    6.Measurable disease (as defined below):
    Defined as CT scan showing at least 1 or more clearly demarcated lymph node(s) with a long axis > 1.5 cm and short axis > 1.0 cm or 1 clearly demarcated extranodal lesion(s) with a long axis > 1.0 cm and short axis > 1.0 cm. All lesions must have a maximum diameter of < 10 cm
    7.Must have recovered from toxicity after any prior autologous stem cell transplants or CAR-T cell therapy, and must have disease progression prior to initiation of study treatment
    8.Acceptable marrow and organ function at screening as described below:
    a. ANC >= 1,000/µL*
    b. Platelet count >= 50,000/µL without transfusion within 1 week prior to start of study treatment*
    c. Serum creatinine <= 1.5 × ULN or a calculated creatinine clearance >= 30 mL/min according to Cockcroft-Gault formula (using actual body weight) or by 24-hour urine collection
    d. AST or ALT <= 2 × ULN
    e. Total bilirubin <= 1.5 × ULN or <= 3 × ULN in patients with documented Gilbert's syndrome
    *NOTE: For patients with bone marrow involvement of their disease, eligibility will be determined following discussion between Investigator and Medical Monitor
    9. Ability to swallow and retain oral medications
    10. Negative serum pregnancy test in WOCP
    11. WOCP and men who partner with a WOCP must agree to use highly effective contraceptive methods for the duration of the study and for 3 months after the last dose of study treatment.
    12. Willing and able to provide written informed consent and comply with the requirements of the trial
    13. Creatinine Phosphokinase (CPK) < Grade 2
    14. Patients on a cholesterol lowering statin must be on a stable dose with no changes within 3 weeks prior to study start

    - Part B. Check protocol for complete list.
    1. Uomini e donne di età >=18 anni
    2. Aspettativa di vita di almeno 3 mesi
    3. Stato di performance ECOG di <= 1
    4. Diagnosi di NHL a cellule B confermata da esame istopatologico, secondo la classificazione dell'OMS 2016 (Swerdlow et al. 2016). I sottotipi di NHL eleggibili includono linfoma follicolare, MZL, MCL, DLBCL (inclusi i linfomi extranodali a livello della gamba, del testicolo o di tipo non altrimenti specificato [NOS]), e linfoma primitivo o secondario del SNC. NOTA: una volta dimostrato che una dose non supera la MTD nei pazienti affetti da NHL, potranno essere considerati altri tumori maligni ematologici ai fini dell'arruolamento per neoplasie specifiche che sono state approvate dal CSC e dallo Sponsor. I pazienti affetti da MCL o MZL dovranno soddisfare criteri clinici per richiedere il trattamento della malattia.
    5. Malattia recidivante o refrattaria (come definito di seguito) per la quale i pazienti hanno esaurito o non risultano eleggibili per le opzioni terapeutiche standard che sarebbero considerate standard di cura.
    a. Il NHL recidivante è definito secondo i criteri di risposta modificati per il linfoma maligno e documentato da biopsia escissionale/incisionale (preferibile) o FNA o CNB come PD dopo una CR, PR o SD. NOTA: per la conferma di una recidiva documentata durante il trattamento precedente, è consigliato ma non obbligatorio eseguire una biopsia/un FNA del linfoma allo Screening.
    b. Il NHL refrattario per tutti i NHL eleggibili è definito come PD (secondo i criteri di risposta modificati per il linfoma maligno) durante il trattamento precedente o mancato raggiungimento di una risposta oggettiva al trattamento precedente. NOTA: è consigliato ma non obbligatorio eseguire una biopsia (preferibile) o un FNA allo Screening.
    6. Malattia misurabile (come definito di seguito):
    Definita come TAC che mostra almeno 1 o più linfonodi chiaramente delimitati con un asse lungo > 1,5 cm e un asse corto > 1,0 cm o 1 o più lesioni extranodali chiaramente delimitate con un asse lungo > 1,0 cm e un asse corto > 1,0 cm. Tutte le lesioni devono avere un diametro massimo di < 10 cm
    7. Deve essere stato raggiunto il recupero dalla tossicità dopo qualsiasi precedente trapianto di cellule staminali autologhe o terapia con CAR-T e deve essersi manifestata la progressione della malattia prima dell'inizio del trattamento in studio
    8. Funzionalità del midollo e degli organi accettabile allo Screening come descritto di seguito:
    a. ANC >= 1.000/µl*
    b. Conta delle piastrine >= 50.000/µl senza trasfusione entro 1 settimana prima dell'inizio del trattamento in studio*
    c. Creatinina sierica <=1,5 × ULN o clearance della creatinina calcolata >= 30 ml/min secondo la formula di Cockcroft-Gault (usando il peso corporeo effettivo) o mediante raccolta di urine nelle 24 ore
    d. AST o ALT <= 2 × ULN
    e. Bilirubina totale <= 1,5 × ULN o <= 3 × ULN per pazienti con sindrome di Gilbert documentata
    *NOTA: per i pazienti con coinvolgimento del midollo osseo nella malattia, l'eleggibilità sarà stabilita dopo discussione tra lo Sperimentatore e il Medical Monitor
    9. Capacità di deglutire e trattenere farmaci per uso orale
    10. Test di gravidanza sul siero negativo per le WOCP
    11. Le WOCP e gli uomini che hanno come partner una WOCP devono accettare di usare metodi contraccettivi altamente efficaci per tutta la durata dello studio e per 3 mesi dopo l'ultima dose di trattamento in studio.
    12. Volontà e capacità di fornire il consenso informato scritto e rispettare i requisiti della sperimentazione.
    13. Creatinina fosfochinasi (CPK) < Grado 2
    14. I pazienti che assumono statine per la riduzione del colesterolo devono essere in regime di dose stabile, senza cambiamenti nelle 3 settimane precedenti l'inizio dello studio.

    Parte B:
    Fare riferimento al protocollo per la lista completa
    E.4Principal exclusion criteria
    All exclusion criteria are detailed in protocol
    1.Patients with active CNS involvement other than PCNSL at study entry are ineligible. Patients with prior CNS disease (leptomeningeal disease or brain metastasis) that has been adequately treated (eg, radiation or intravenous or intrathecal chemotherapy) are permitted, but must have completed such treatment and have no evidence of active CNS disease for at least 4 weeks prior to the first dose of study treatment. Intrathecal chemoprophylaxis to prevent the emergence or recurrence of lymphoma in the CNS is permitted on study during dose expansion only and may be administered per institutional guidelines.
    2.Radiotherapy delivered to non-target lesions involving > 25% of bone marrow within 1 week prior to starting study treatment or delivered to target lesions that will be followed on the study (NOTE: prior sites of radiation will be recorded)
    3.Exclusion criterion 3 was deleted as of protocol v5.0 (retained here to preserve numbering).
    4.Any prior systemic anti-cancer treatment such as chemotherapy, immunomodulatory drug therapy, etc, received within 14 days prior to start of study treatment (with the exception of ibrutinib for Parts A2 and B, which may be continued as part of this study without interruption)
    5.Current or planned glucocorticoid therapy, with the following exceptions:
    a.Doses <= 10 mg/day prednisolone or equivalent is allowed, provided that the steroid dose has been stable or tapering for at least 14 days prior to the first dose of study treatment.
    b.Inhaled, intranasal, intra-articular, and topical steroids are permitted.
    6.Use of any investigational agent within 21 days or 5 half-lives, whichever is shorter, prior to start of study treatment
    7.Presence of an acute or chronic toxicity resulting from prior anticancer therapy, with the exception of alopecia, that has not resolved to Grade <= 1, as determined by NCI CTCAE v4.03, within 7 days prior to start of study treatment unless approved by the Medical Monitor
    8.Known allergy or hypersensitivity to any component of the formulation of CA-4948 (or ibrutinib for entry into Parts A2 or B) used in this study
    9.Major surgery, other than diagnostic surgery, < 28 days from the start of study treatment; minor surgery < 14 days from the start of study treatment
    NOTE: Insertion of a vascular access device is not considered minor surgery.
    10.Known to be human immunodeficiency virus positive or have an acquired immunodeficiency syndrome-related illness
    11.Hepatitis B virus (HBV) DNA positive or hepatitis C virus (HCV) infection < 6 months prior to start of study treatment unless viral load is undetectable, or HCV with cirrhosis (NOTE: testing required only in patients with history of HBV or history of HCV < 6 months prior to start of study treatment)
    12.In patients with a history of HBV, hepatitis B core antibody testing is required and if positive, then hepatitis B DNA testing will be performed and if positive the patient will be excluded.
    13.Uncontrolled or severe cardiovascular disease, including myocardial infarction, unstable angina, or atrial fibrillation within 6 months prior to the start of study treatment; New York Heart Association Class II or greater congestive heart failure; serious arrhythmias requiring medication for treatment; clinically significant pericardial disease; cardiac amyloidosis; or QTc with Fridericia's correction (QTcF) that is unmeasurable or >= 480 msec on Screening ECG. NOTE: For QTcF >= 480 msec on the Screening ECG, the ECG may be repeated twice at least 24 hours apart; the mean QTcF from the 3 Screening ECGs must be < 480 msec in order to meet eligibility for trial participation.
    14.Gastrointestinal disease or disorder that could interfere with the swallowing, oral absorption, or tolerance of study treatment. This includes uncontrolled diarrhea (> 1 watery stool/day), major abdominal surgery, significant bowel obstruction, and/or gastrointestinal diseases that could alter the assessment of PK or safety, including but not limited to irritable bowel syndrome, ulcerative colitis, Crohn's disease, and hemorrhagic coloproctitis

    for the remaining exclusion criteria please refer to the study protocol
    1. I pazienti con coinvolgimento attivo del SNC diverso dal PCNSL al momento dell'ingresso nello studio non sono eleggibili. I pazienti con precedente malattia del SNC (malattia leptomeningea o metastasi cerebrali) che è stata adeguatamente trattata (per es. radioterapia o chemioterapia endovenosa o intratecale) sono ammessi, ma devono aver completato tale trattamento e non mostrare alcuna evidenza di malattia attiva del SNC da almeno 4 settimane prima della prima dose di trattamento in studio. La chemioprofilassi intratecale per prevenire la comparsa o la recidiva di linfoma nel SNC è consentita nello studio solo durante l'espansione della dose e può essere somministrata secondo le linee guida dell'istituto.
    2. Radioterapia mirata alle lesioni non target che coinvolgono > 25% del midollo osseo entro 1 settimana prima dell'inizio del trattamento in studio o mirata alle lesioni target che saranno seguite nello studio (NOTA: saranno registrate le sedi precedentemente irradiate)
    3. Il criterio di esclusione 3 è stato eliminato dal protocollo v5.0 (qui mantenuto per preservare la numerazione).
    4. Qualsiasi trattamento antitumorale sistemico precedente, quali chemioterapia, terapia con farmaci immunomodulanti, ecc., ricevuto nei 14 giorni precedenti l'inizio del trattamento in studio (ad eccezione di ibrutinib per le Parti A2 e B, che può essere proseguito nell'ambito di questo studio senza interruzione)
    5. Terapia con glucocorticoidi in corso o pianificata, con le seguenti eccezioni:
    a. Sono ammesse dosi <= 10 mg/die di prednisolone o equivalente, a condizione che la dose di steroidi sia stabile o in fase di riduzione da almeno 14 giorni prima della prima dose di trattamento in studio.
    b. Sono consentiti steroidi per uso inalatorio, intranasale, intra-articolare e topico.
    6. Uso di qualsiasi agente sperimentale nei 21 giorni o nelle 5 emivite, a seconda del periodo più breve, precedenti l'inizio del trattamento in studio
    7. Presenza di una tossicità acuta o cronica derivante da una precedente terapia antitumorale, ad eccezione dell'alopecia che non si è risolta al Grado <= 1, come stabilito secondo i criteri NCI CTCAE v4.03, nei 7 giorni precedenti l'inizio del trattamento in studio, salvo approvazione del Medical Monitor
    8. Allergia o ipersensibilità nota a qualsiasi componente della formulazione di CA-4948 (o ibrutinib per l'ingresso nelle Parti A2 o B) usata in questo studio
    9. Intervento chirurgico importante, non di tipo diagnostico, < 28 giorni prima dell'inizio del trattamento in studio; intervento chirurgico di minore entità < 14 giorni prima dell'inizio del trattamento in studio
    NOTA: l'inserimento di un dispositivo di accesso vascolare non è considerato un intervento chirurgico di minore entità.
    10. Positività nota al virus dell'immunodeficienza umana o presenza di malattia correlata a sindrome da immunodeficienza acquisita
    11. Positività per il DNA del virus dell'epatite B (HBV) o infezione da virus dell'epatite C (HCV) < 6 mesi prima dell'inizio del trattamento in studio, salvo che la carica virale sia non rilevabile, o HCV con cirrosi (NOTA: il test è richiesto solo nei pazienti con anamnesi di HBV o anamnesi di HCV < 6 mesi prima dell'inizio del trattamento in studio)
    12. Nei pazienti con anamnesi di HBV, è richiesto il test degli anticorpi anti-core dell'epatite B e, se positivo, sarà eseguito il test del DNA dell'epatite B, in seguito al quale, se positivo, il paziente sarà escluso.
    13. Malattia cardiovascolare non controllata o grave, tra cui infarto miocardico, angina instabile o fibrillazione atriale nei 6 mesi precedenti l'inizio del trattamento in studio; insufficienza cardiaca congestizia di Classe II o superiore secondo la New York Heart Association; gravi aritmie che richiedono farmaci per il trattamento; malattia pericardica clinicamente significativa; amiloidosi cardiaca o QTc con correzione di Fridericia (QTcF) che non è misurabile o >= 480 msec all'ECG di screening. NOTA: per QTcF >= 480 msec all'ECG di screening, l'ECG potrà essere ripetuto due volte a distanza di almeno 24 ore; il valore medio di QTcF dei 3 ECG di screening deve essere < 480 msec per soddisfare i criteri di eleggibilità per la partecipazione alla sperimentazione.
    14. Malattia o disturbo gastrointestinale che potrebbe interferire con la deglutizione, l'assorbimento orale o la tolleranza del trattamento in studio. Sono compresi diarrea non controllata (> 1 feci acquose/giorno), interventi chirurgici addominali importanti, ostruzione intestinale significativa e/o malattie gastrointestinali che potrebbero alterare la valutazione della PK o della sicurezza, incluse a titolo di esempio sindrome dell'intestino irritabile, colite ulcerosa, malattia di Crohn e coloproctite emorragica.

    Fare riferimento al protocollo di studio per i rimanenti criteri d'esclusione
    E.5 End points
    E.5.1Primary end point(s)
    Part A (Dose Escalation Phase):
    -Incidence of DLTs
    -Incidence of adverse events (AEs)
    -Clinically significant changes in vital signs and laboratory parameters
    -Clinically significant changes from baseline in electrocardiograms (ECGs)

    Part B (Dose Expansion Phase):
    -CR
    -ORR: CR + PR
    Parte A (fase di aumento della dose):
    - Incidenza di DLT
    - Incidenza degli eventi avversi (AE)
    - Variazioni clinicamente significative nei segni vitali e nei parametri di laboratorio
    - Variazioni clinicamente significative dal basale negli elettrocardiogrammi (ECG)

    Parte B (fase di espansione della dose):
    - CR
    - ORR: CR + PR
    E.5.1.1Timepoint(s) of evaluation of this end point
    Part A: First 21 days after first dose
    Part B: there is no defined patient duration period. Permitted to continue until the point of disease progression, intolerable toxicity or withdrawal of consent
    Parte A: Primi 21 giorni dopo la prima dose
    Parte B: non esiste un periodo di durata per il paziente definito. Si permette di continuare fino al punto di progressione della malattia, tossicità intollerabile o revoca del consenso
    E.5.2Secondary end point(s)
    Part A (Dose Escalation Phase):
    - Maximum observed plasma concentration (Cmax)
    -Minimum observed plasma concentration (Tmax)
    -Area under the concentration-time curve (AUC)
    -Terminal elimination half-life (T1/2)
    -ORR: complete response (CR) + partial response (PR)
    -Waldenström macroglobulinemia/ lymphoplasmacytic lymphoma (WM/LPL) ORR: CR + PR + very good partial response (VGPR)
    -DOR: time from CR or PR to first documentation of relapse, disease progression, or death from any cause
    -WM/LPL DOR: time from CR, PR, or VGPR to first documentation of relapse, disease progression, or death from any cause
    -DCR: PR + CR + stable disease (SD)
    -WM/LPL DCR: CR + PR + VGPR + SD
    -PFS: time from date of first dose of study treatment until first documentation of relapse, disease progression, or death from any cause
    -OS: time from date of first dose of study treatment until death from any cause
    Part B (Dose Expansion Phase):
    -DOR: time from CR or PR to first documentation of relapse, disease progression, or death from any cause
    -DCR: PR + CR + SD
    -Incidence AEs
    -Clinically significant changes in vital signs and laboratory parameters
    -Clinically significant changes from baseline in ECGs
    -PFS: time from date of first dose of study treatment until first documentation of relapse, disease progression, or death from any cause
    -OS: time from date of first dose of study treatment until death from any cause
    -Population PK parameters
    -Blood-brain barrier penetration of CA-4948 at Tmax
    Parte A:
    -Concentrazione plasmatica massima osservata (Cmax)
    - Concentrazione plasmatica minima osservata (Cmax)
    - Tempo dopo la somministrazione in cui un farmaco è presente alla massima concentrazione nel siero (Tmax)
    - Area sotto la curva concentrazione-tempo (AUC)
    - Emivita di eliminazione terminale (T1/2)
    - ORR: risposta completa (CR) + risposta parziale (PR)
    - ORR per macroglobulinemia di Waldenström/linfoma linfoplasmocitico (WM/LPL): CR + PR + risposta parziale molto buona (VGPR)
    - DOR: tempo dalla CR o PR alla prima documentazione di recidiva, progressione della malattia o decesso per qualsiasi causa
    - DOR per WM/LPL: tempo dalla CR, PR o VGPR alla prima documentazione di recidiva, progressione della malattia o decesso per qualsiasi causa
    - DCR: PR + CR + malattia stabile (SD)
    - DCR per WM/LPL: CR + PR + VGPR + SD
    - PFS: tempo dalla data della prima dose di trattamento in studio alla prima documentazione di recidiva, progressione della malattia o decesso per qualsiasi causa
    - OS: tempo dalla data della prima dose di trattamento in studio al decesso per qualsiasi causa
    Parte B:
    -DOR: tempo dalla CR o PR alla prima documentazione di recidiva, progressione della malattia o decesso per qualsiasi causa
    -DCR: PR + CR + SD
    -Incidenza degli AE
    - Variazioni clinicamente significative nei segni vitali e nei parametri di laboratorio
    - Variazioni clinicamente significative dal basale negli ECG
    - PFS: tempo dalla data della prima dose di trattamento in studio alla prima documentazione di recidiva, progressione della malattia o decesso per qualsiasi causa
    - OS: tempo dalla data della prima dose di trattamento in studio al decesso per qualsiasi causa
    - Parametri PK della popolazione
    - Penetrazione della barriera emato-encefalica di CA-4948 a Tmax
    E.5.2.1Timepoint(s) of evaluation of this end point
    Part A: First 21 days after first dose
    Part B: there is no defined patient duration period. Permitted to continue until the point of disease progression, intolerable toxicity or withdrawal of consent
    Parte A: Primi 21 giorni dopo la prima dose
    Parte B: non esiste un periodo di durata per il paziente definito. Si permette di continuare fino al punto di progressione della malattia, tossicità intollerabile o revoca del consenso
    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 Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Tolerability
    Tollerabilità
    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 Yes
    E.7.1.3.1Other trial type description
    Part A1 is closed
    la Parte A1 è chiusa
    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 Yes
    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 Yes
    E.8.2.3.1Comparator description
    -
    -
    E.8.2.4Number of treatment arms in the trial0
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA17
    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
    Israel
    United States
    France
    Poland
    Spain
    Czechia
    Germany
    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
    UVUP
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years8
    E.8.9.1In the Member State concerned months3
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years8
    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: 88
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 133
    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 state12
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 69
    F.4.2.2In the whole clinical trial 221
    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)
    NONE
    NESSUNO
    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 Decision2023-09-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-01-20
    P. End of Trial
    P.End of Trial StatusOngoing
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