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    Summary
    EudraCT Number:2022-001087-10
    Sponsor's Protocol Code Number:ELA-0121
    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:2022-08-04
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2022-001087-10
    A.3Full title of the trial
    An Open-label Multicenter Phase 1b-2 Study of Elacestrant as Monotherapy and in Combination with Abemaciclib in Women and Men with Brain Metastasis from Estrogen Receptor Positive, HER-2 Negative Breast Cancer (ELECTRA)
    Studio multicentrico, in aperto, di fase Ib-II su elacestrant in monoterapia e in associazione ad abemaciclib in donne e uomini con metastasi cerebrali di carcinoma metastatico della mammella positivo per il recettore degli estrogeni, HER-2 negativo (ELECTRA)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    This study has 2 phases: a Phase 1b evaluation of elacestrant in combination with abemaciclib followed by a randomized Phase 2 evaluation of elacestrant alone or in combination with abemaciclib in women and men with brain metastases from ER positive, HER-2 negative breast cancer.
    Questo studio prevede 2 fasi: una valutazione di Fase 1b di elacestrant in combinazione con abemaciclib seguita da una valutazione randomizzata di Fase 2 di elacestrant da solo o in combinazione con abemaciclib in donne e uomini con metastasi cerebrali da tumore al seno ER positivo, HER-2 negativo.
    A.3.2Name or abbreviated title of the trial where available
    ELECTRA
    ELECTRA
    A.4.1Sponsor's protocol code numberELA-0121
    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 SponsorStemline Therapeutics 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 supportStemline Therapeutics, Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationStemline Therapeutics, Inc
    B.5.2Functional name of contact pointClinical Development
    B.5.3 Address:
    B.5.3.1Street Address750 Lexington Avenue, 4th Floor
    B.5.3.2Town/ cityNew York
    B.5.3.3Post code10022 NY
    B.5.3.4CountryUnited States
    B.5.4Telephone number+13013460961
    B.5.5Fax number0000000
    B.5.6E-mailkgrzegorzewski@stemline.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 nameElacestrant
    D.3.2Product code [Elacestrant]
    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 INNElacestrant
    D.3.9.1CAS number 722533-56-4
    D.3.9.2Current sponsor codeRAD1901
    D.3.9.4EV Substance CodeSUB184531
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 Yes
    D.2.1.1.1Trade name Verzenios®
    D.2.1.1.2Name of the Marketing Authorisation holderEli Lilly Nederland B.V. - AIC Number: EU/1/18/1307/021
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAbemaciclib
    D.3.2Product code [LY2835219]
    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 INNAbemaciclib
    D.3.9.1CAS number 1231929-97-7
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB171907
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Verzenios®
    D.2.1.1.2Name of the Marketing Authorisation holderEli Lilly Nederland B.V. - AIC Number: EU/1/18/1307/021
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAbemaciclib
    D.3.2Product code [LY2835219]
    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 INNAbemaciclib
    D.3.9.1CAS number 1231929-97-7
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB171907
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    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: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Verzenios®
    D.2.1.1.2Name of the Marketing Authorisation holderEli Lilly Nederland B.V. - AIC Number: EU/1/18/1307/021
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAbemaciclib
    D.3.2Product code [LY2835219]
    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 INNAbemaciclib
    D.3.9.1CAS number 1231929-97-7
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB171907
    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.IMP: 5
    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 nameElacestrant
    D.3.2Product code [Elacestrant]
    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 INNElacestrant
    D.3.9.1CAS number 722533-56-4
    D.3.9.2Current sponsor codeRAD1901
    D.3.9.4EV Substance CodeSUB184531
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number400
    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
    Brain Metastasis from Estrogen Receptor Positive, HER-2 Negative Breast Cancer
    Metastasi cerebrali da carcinoma mammario positivo al recettore degli estrogeni e negativo all'HER-2
    E.1.1.1Medical condition in easily understood language
    Brain Metastasis from Estrogen Receptor Positive, HER-2 Negative Breast Cancer
    Metastasi cerebrali da carcinoma mammario positivo al recettore degli estrogeni e negativo all'HER-2
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10027475
    E.1.2Term Metastatic breast cancer
    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
    Phase 1b
    Determine the recommended Phase 2 dose (RP2D) of this combination in patients with metastatic estrogen receptor (ER) positive, human epidermal growth factor receptor-2 (HER-2) negative breast cancer.

    Randomized Phase 2
    Evaluate the efficacy of elacestrant, alone and in combination with abemaciclib, in terms of ORR (per RECIST version 1.1) in ER positive, HER-2 negative breast cancer in patients with brain metastases.
    Fase Ib:
    Primario: determinare la dose raccomandata per la fase II (RP2D) di questa associazione in pazienti con carcinoma metastatico della mammella positivo per il recettore degli estrogeni (ER positivo), negativo per il recettore del fattore di crescita epidermico umano 2 (HER-2 negativo).
    Fase II randomizzata
    Primario: valutare l’efficacia di elacestrant in monoterapia e in associazione ad abemaciclib in termini di ORR (secondo RECIST versione 1.1) in pazienti con carcinoma mammario ER positivo, HER-2 negativo con metastasi cerebrali.
    E.2.2Secondary objectives of the trial
    Phase 1b
    • Characterize the safety of elacestrant in combination with abemaciclib.
    • Describe the plasma pharmacokinetics (PK) of elacestrant as well as abemaciclib and its metabolites.
    • Evaluate the efficacy of elacestrant in combination with abemaciclib, in terms of objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1, duration of response (DoR), clinical benefit rate (CBR), progression-free survival (PFS), and overall survival (OS).
    Randomized Phase 2
    • Evaluate the efficacy of elacestrant, alone and in combination with abemaciclib, in terms of:
    o Intracranial response rate (RR), per RECIST version 1.1.
    o Intracranial RR, per the Response Assessment in Neuro-Oncology (RANO) Working Group criteria (Wen et al., 2017) as adapted to the assessment of brain metastases (RANO-BM).
    o DoR, CBR, PFS, OS.
    Fase 1b
    - Caratterizzare la sicurezza di elacestrant in combinazione con abemaciclib.
    - Descrivere la farmacocinetica plasmatica (PK) di elacestrant, abemaciclib e dei suoi metaboliti.
    - Valutare l'efficacia di elacestrant in combinazione con abemaciclib, in termini di tasso di risposta obiettiva (ORR) secondo i criteri di valutazione della risposta nei tumori solidi [RECIST] versione 1.1, durata della risposta (DoR), tasso di beneficio clinico (CBR), sopravvivenza libera da progressione (PFS) e sopravvivenza globale (OS).
    Fase 2 randomizzata
    - Valutare l'efficacia di elacestrant, da solo e in combinazione con abemaciclib, in termini di:
    o Tasso di risposta (RR) intracranica, secondo RECIST versione 1.1.
    o RR intracranico, secondo i criteri del Response Assessment in Neuro-Oncology (RANO) Working Group (Wen et al., 2017) adattati alla valutazione delle metastasi cerebrali (RANO-BM).
    o DoR, CBR, PFS, OS.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patient has signed the informed consent form before any studyrelated activities according to local guidelines.
    2. Women or men aged equal or higher than 18 years, at the time of informed consent signature.
    - Female patients may be either postmenopausal or premenopausal or perimenopausal.
    Postmenopausal status is defined by:
    a) Age equeal or higher than 60 years
    b) Age less than 60 years and amenorrhea for 12 or more months (in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression) or a follicle-stimulating hormone (FSH) value higher than 40 mIU/mL and an estradiol value less than 40 pg/mL (140 pmol/L) or in postmenopausal ranges per local reference ranges
    c) Documentation of prior surgical sterilization (i.e., bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, at least 1 month before first dose of trial therapy).
    - Premenopausal or perimenopausal women must be concurrently given a luteinizing hormone-releasing hormone (LHRH) agonist starting at least 4 weeks before the start of trial therapy and is planning to continue LHRH during the study.
    - For perimenopausal women to be considered of non-childbearing potential, FSH levels must be higher than 40 mIU/ml.
    3. Patient must have ER positive, HER-2 negative tumor status as confirmed by local laboratory testing either from a fresh biopsy or from an archival tissue obtained no more than 2 years prior to signing of the
    informed consent form. For Phase 1b, the presence of brain metastases is allowed but not required for eligibility, in this case, at least 1 measurable lesion outside the brain is required.
    - ER and HER-2 testing must be performed in the following manner:
    o Documentation of ER positive tumor with equal or higher than 1% staining by immunohistochemistry (IHC) as defined in the 2010 or 2020 American Society for Clinical Oncology (ASCO) recommendations for ER testing (Hammond et al, 2010; Allison et al, 2020), with or without progesterone receptor (PGR) positivity
    o HER-2 negative tumor with an IHC result of 0 or 1+ for cellular membrane protein expression or an in situ hybridization negative result as defined in the 2013 or 2018 ASCO recommendations for HER-2 testing (Wolff et al, 2013; Wolff et al, 2018)
    4. In Phase 2, patients must have at least one active and measurable brain metastasis per RECIST version 1.1
    - Any of the following qualifies brain metastases as active:
    a) Newly diagnosed brain metastasis in patients who never received prior central nervous system (CNS)-directed therapy
    b) Newly diagnosed brain metastasis outside any area that was previously subjected to CNS-directed therapy
    c) Brain metastases that are progressing in an area that has previously been subjected to CNS-directed therapy.
    - For lesions, including brain metastases, to qualify as measurable, and possibly be selected as target lesions, per RECIST version 1.1, the longest diameter must be equal or higher than 10 mm by CT or MRI).
    5. Patients must be off corticosteroids or receiving a stable or decreasing corticosteroid dose at the time of starting trial therapy. The dose must be equal or less than 2.0 mg/day of dexamethasone or equivalent.
    6. Any neurological symptoms of brain metastases must be stable for at least 4 weeks before starting trial therapy.
    1. Il paziente deve aver firmato il modulo di consenso informato prima di qualunque attività correlata allo studio, in base alle linee guida locali.
    2. Uomini o donne di età uguale o maggiore a 18 anni al momento della firma del consenso informato.
    - Le pazienti potranno essere in post-, pre- o perimenopausa.
    Lo stato postmenopausale si definisce nel seguente modo:
    a) Età uguale o maggiore 60 anni
    b) Età inferiore 60 anni e amenorrea da 12 mesi o più (in assenza di chemioterapia, trattamento con tamoxifene o toremifene o di soppressione ovarica) oppure valore di ormone follicolo-stimolante (FSH) inferiore 40 mUI/mL e valore di estradiolo inferiore 40 pg/mL (140 pmol/L) o valori rientranti nei range di riferimento locali della post-menopausa.
    c) Documentazione di precedente sterilizzazione chirurgica (legatura tubarica bilaterale, isterectomia totale o ovariectomia bilaterale, almeno 1 mese prima della prima dose della terapia sperimentale).
    - Le donne in pre- o perimenopausa dovranno contemporaneamente assumere un agonista dell’ormone di rilascio dell’ormone luteinizzante (LHRL) a cominciare da almeno 4 settimane prima dell’inizio della terapia sperimentale e acconsentire a farne uso durante lo studio.
    - Affinché le donne in perimenopausa vengano considerate non potenzialmente fertili, i livelli di FSH dovranno essere maggiore a 40 mUI/ml.
    3. Il paziente deve avere uno stato tumorale ER positivo, HER-2 negativo confermato da test eseguiti dal laboratorio locale su un campione bioptico fresco o un tessuto di archivio prelevato non più di 2 anni prima della firma del modulo di consenso informato. Per la parte di fase Ib, è consentita la presenza di metastasi cerebrali ma ciò non costituisce un requisito per l’idoneità; in questo caso è richiesta almeno 1 lesione misurabile extra-cerebrale.
    - La verifica dello stato ER ed HER-2 dovrà avvenire nel seguente modo:
    o Documentazione di tumore ER positivo con colorazione immunoistochimica (ICH) uguale o maggiore a 1% secondo la definizione delle raccomandazioni ASCO 2010 o 2020 per la determinazione di ER (Hammond et al, 2010; Allison et al, 2020), con o senza positività per il recettore del progesterone
    (PGR). o Tumore HER-2 negativo con un risultato ICH di 0 o1+ per l’espressione proteica sulla membrana cellulare o un risultato negativo al test di ibridazione in situ, secondo quanto definito nelle raccomandazioni ASCO 2013 o 2018 per la determinazione di HER-2 (Wolff et al, 2013; Wolff et al, 2018).
    4. Nella parte di fase II, i pazienti dovranno avere almeno una metastasi cerebrale attiva e misurabile secondo RECIST versione 1.1
    - Le metastasi cerebrali sono qualificabili come attive se soddisfano uno qualunque dei seguenti criteri:
    a) Metastasi cerebrale di nuova diagnosi in pazienti che non hanno mai ricevuto in precedenza terapie dirette al sistema nervoso centrale (SNC).
    b) Metastasi cerebrale di nuova diagnosi localizzata non in aree precedentemente trattate con terapie dirette al SNC.
    c) Metastasi cerebrali in progressione in un’area precedentemente trattata con terapie dirette al SNC.
    - Le lesioni, comprese le metastasi cerebrali, sono qualificabili come misurabili e possono essere eventualmente scelte come lesioni target, secondo RECIST versione 1.1, se il diametro maggiore risulta essere maggiore o uguale a 10 mm alla TC o RM.
    5. I pazienti devono aver interrotto la terapia corticosteroidea o essere in trattamento con una dose stabile o decrescente di corticosteroidi al momento dell’inizio della terapia sperimentale.
    La dose deve essere inferiore o uguale a 2,0 mg/die di desametasone o equivalente.
    6. Eventuali sintomi neurologici di metastasi cerebrali devono essere stabili da almeno 4 settimane prima dell’inizio della terapia sperimentale.
    E.4Principal exclusion criteria
    1. Immediate CNS-specific treatment is likely to be required, per the treating physician's assessment.
    2. Patient has leptomeningeal metastases, defined as having positive CSF cytology or unequivocal radiologic or clinical evidence of leptomeningeal involvement.
    3. Breast cancer treatment-naïve patients in the metastatic setting. Patients who experience a recurrence while on adjuvant therapy or within 12 months of end of adjuvant therapy are allowed.
    4. Prior therapy with elacestrant or abemaciclib in the metastatic setting. Note: use of abemaciclib in the adjuvant setting is allowed if the last treatment administration was more than 12 months prior to first
    recurrence.
    5. Patient has a concurrent malignancy or malignancy within 3 years of enrollment, with the exception of adequately treated basal or squamous cell skin cancer, superficial bladder cancer, carcinoma in situ of the
    cervix or second primary breast cancer.
    6. Currently participating in another breast cancer intervention clinical study. Patients who are being followed for overall survival for another clinical trial with no therapy and study intervention are allowed.
    7. Prior anti-cancer or investigational drug treatment within the following windows:
    • Fulvestrant treatment (last injection) less than 42 days before first dose of study drug
    • Any other endocrine therapy higher than 14 days before first dose of study drug
    • Chemotherapy or other anti-cancer therapy less than 21 days before first dose of study drug
    • Any investigational anti-cancer drug therapy within higher than 28 days or less than 5 half-lives, whichever is shorter.
    • Bisphosphonates or RANKL inhibitors initiated or dose changed less than 3 months prior to first dose of study drug.
    8. Radiation therapy (other than CNS directed) within 14 days before the first dose of study drug.
    9. Uncontrolled significant active infections.
    • Patients with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection must have undetectable viral load during screening.
    • Patients known to be HIV+ are allowed as long as they have undetectable viral load at baseline.
    10. Major surgery within 4 weeks of starting trial therapy.
    11. Inability to take oral medication, or history of malabsorption syndrome or any other uncontrolled gastrointestinal condition.
    12. Females of childbearing potential who:
    - Within 28 days of study entry, did not use a highly effective method of contraception, which includes any of the following:
    a. Intrauterine device
    b. Double-barrier contraception
    c. Total abstinence
    d. Have a vasectomized partner with confirmed azoospermia.
    - Do not agree to use a highly effective method of contraception, as described above, throughout the entire study period and for 28 days after trial therapy discontinuation.
    13. Men who do not agree abstain from donating sperm or to use a highly effective method of contraception during the treatment period and for 120 days thereafter. Highly effective methods include any of the following:
    a. Double-barrier contraception
    b. Total abstinence
    c. Vasectomized with confirmed azoospermia
    d. Female partner with intrauterine device.
    1. È probabile che il paziente necessiti di un trattamento immediato specifico per il SNC, secondo l’opinione del medico curante.
    2. Il paziente presenta metastasi leptomeningee, definite come positività citologica del LCS oppure evidenze radiologiche o cliniche inequivocabili di coinvolgimento leptomeningeo.
    3. Pazienti con tumore della mammella naïve al trattamento nel setting metastatico. I pazienti che manifestano una recidiva nel corso della terapia adiuvante o entro 12 mesi dalla conclusione della terapia adiuvante sono ammessi.
    4. Precedente terapia con elacestrant o abemaciclib nel setting metastatico. Nota: l’uso di abemaciclib nel setting adiuvante è consentito se l’ultima somministrazione del trattamento è avvenuta più di 12 mesi prima della prima recidiva.
    5. Il paziente presenta un’altra neoplasia maligna concomitante o ha avuto una neoplasia maligna nei 3 anni che precedono l’arruolamento, eccetto carcinoma basocellulare o squamocellulare della cute, carcinoma superficiale della vescica, carcinoma in situ della cervice uterina o un secondo carcinoma mammario primitivo adeguatamente trattati.
    6. Partecipazione concomitante a un altro studio clinico interventistico sul carcinoma mammario.
    L’inclusione di pazienti che stanno partecipando al follow-up per la sopravvivenza globale di un’altra sperimentazione clinica è consentita, a condizione che non siano in corso terapie o interventi sperimentali.
    7. Precedenti trattamenti farmacologici antitumorali o sperimentali nelle seguenti finestre temporali:
    - Trattamento con fulvestrant (ultima iniezione) inferiore a 42 giorni prima della prima dose del medicinale sperimentale
    - Qualunque altra terapia endocrina maggiore a 14 giorni prima della prima dose del medicinale sperimentale
    - Chemioterapia o altra terapia antitumorale inferiore a 21 giorni prima della prima dose del medicinale sperimentale
    - Qualunque terapia antitumorale sperimentale inferiore a 28 giorni o inferiore a 5 emivite prima, a seconda di quale di questi intervalli sia più breve
    - Avvio di terapia o modifica della dose di bifosfonati o inibitori di RANKL meno di 3 mesi prima della prima dose del medicinale sperimentale
    8. Radioterapia (non diretta al SNC) nei 14 giorni che precedono la prima dose del medicinale sperimentale.
    9. Importanti infezioni attive non controllate.
    - I pazienti con infezione da virus dell’epatite B (HBV) e/o da virus dell’epatite C (HCV) devono avere una carica virale non rilevabile durante lo screening (Appendice B).
    - La partecipazione di pazienti per i quali è nota una positività per l’HIV è consentita a condizione che abbiano una carica virale non rilevabile al basale.
    10. Intervento di chirurgia maggiore nelle 4 settimane che precedono l’inizio della terapia sperimentale.
    11. Impossibilità di assumere terapie farmacologiche per via orale o sindrome da malassorbimento o qualunque altra condizione gastrointestinale non controllata in anamnesi.
    12. Donne potenzialmente fertili che:
    - Entro i 28 giorni precedenti l’ingresso nello studio non hanno fatto uso di un metodo contraccettivo altamente efficace tra quelli elencati di seguito:
    a. Dispositivo intrauterino
    b. Metodo contraccettivo a doppia barriera
    c. Astinenza totale
    d. Partner vasectomizzato con azoospermia confermata
    - Non acconsentono a usare un metodo contraccettivo altamente efficace come specificato sopra per l’intero periodo di studio e per 28 giorni dopo l’interruzione della terapia sperimentale.
    13. Uomini che non acconsentono ad astenersi dalla donazione di sperma o a usare un metodo contraccettivo altamente efficace durante il periodo di trattamento e per i 120 giorni successivi.
    I metodi altamente efficaci comprendono i seguenti:
    a. Metodo contraccettivo a doppia barriera
    b. Astinenza totale
    c. Vasectomia con azoospermia confermata
    d. Partner femminile con dispositivo intrauterino
    E.5 End points
    E.5.1Primary end point(s)
    Phase 1b:
    The primary study endpoint is determination of the RP2D based on the observed number of DLTs during the first cycle.

    Randomized Phase 2:
    - ORR per blinded independent central review.
    Fase Ib:
    L’endpoint primario dello studio consiste nella determinazione della RP2D in base al numero di DLT osservate durante il primo ciclo.

    Fase II randomizzata:
    - ORR secondo la revisione centrale indipendente in cieco.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Phase 1b: Cycle 1 (28 days)
    Randomized Phase 2: throughout the study duration (based on CT/MRI scans performed every 8 weeks until radiological disease progression)
    Fase 1b: Ciclo 1 (28 giorni)
    Fase 2 randomizzata: per tutta la durata dello studio (sulla base di scansioni CT/MRI eseguite ogni 8 settimane fino alla progressione radiologica della malattia)
    E.5.2Secondary end point(s)
    Phase 1b:
    - AEs and serious adverse events (SAEs) as well as changes in clinical laboratory values, vital signs measurements and ECG parameters.
    - Plasma PK parameters including, but not limited to, the area under the plasma concentration-time curve over the dosing interval (AUC0-tau), Cmax, time of the maximum observed plasma concentration (Tmax), and Ctrough.
    - ORR, DoR, CBR, PFS, and OS.
    Randomized Phase 2:
    - Intracranial RR per blinded independent central review; defined as the proportion of patients achieving a best overall response of confirmed PR+CR, based on intracranial lesions (per RECIST version 1.1,).
    - Intracranial RR per blinded independent central review; defined as the proportion of patients achieving a best overall response of confirmed PR+CR, based on intracranial lesions (per RANO criteria [Wen et al., 2017]). All radiological measurements and assessments will be provided by independent central review; the clinical components required by RANO criteria will be derived from the electronic case report form.
    - DoR, CBR, and PFS per blinded independent central review.
    - ORR, intracranial RR (per RECIST version 1.1 [Appendix C]), intracranial RR (per RANO criteria [Wen et al., 2017]), DoR, CBR, PFS, and OS, per local investigator's assessment.
    - Plasma PK parameters including, but not limited to AUC0-tau, Cmax, Tmax, and Ctrough.
    - Change in patients' responses to EORTC QLQ-C30, EORTC QLQ-BN20, and EQ-5D-5L.
    - Change in patients' responses to MMSE-2, HVLT-R: learning and memory, and NANO scale.
    - AEs and SAEs as well as changes in clinical laboratory values, vital signs measurements and ECG parameters.
    Fase 1b:
    - AEs ed eventi avversi gravi (SAEs), nonché variazioni dei valori clinici di laboratorio, delle misurazioni dei segni vitali e dei parametri ECG.
    - Parametri PK plasmatici, tra cui, ma non solo, l'area sotto la curva concentrazione plasmatica-tempo nell'intervallo di dosaggio (AUC0-tau), Cmax, tempo della massima concentrazione plasmatica osservata (Tmax) e Ctrough.
    - ORR, DoR, CBR, PFS e OS.
    Fase 2 randomizzata:
    - RR intracranico per revisione centrale indipendente in cieco; definito come la proporzione di pazienti che hanno ottenuto una migliore risposta globale di PR+CR confermata, sulla base delle lesioni intracraniche (secondo RECIST versione 1.1).
    - RR intracranico per revisione centrale indipendente in cieco; definito come la proporzione di pazienti che ottengono una migliore risposta complessiva di PR+CR confermata, sulla base di lesioni intracraniche (secondo i criteri RANO [Wen et al., 2017]). Tutte le misurazioni e le valutazioni radiologiche saranno fornite da una revisione centrale indipendente; le componenti cliniche richieste dai criteri RANO saranno ricavate dal modulo elettronico di case report.
    - DoR, CBR e PFS per revisione centrale indipendente in cieco.
    - ORR, RR intracranico (secondo RECIST versione 1.1 [Appendice C]), RR intracranico (secondo i criteri RANO [Wen et al., 2017]), DoR, CBR, PFS e OS, secondo la valutazione dello sperimentatore locale.
    - Parametri di PK plasmatica, tra cui, ma non solo, AUC0-tau, Cmax, Tmax e Ctrough.
    - Variazione delle risposte dei pazienti a EORTC QLQ-C30, EORTC QLQ-BN20 e EQ-5D-5L.
    - Variazione delle risposte dei pazienti a MMSE-2, HVLT-R: apprendimento e memoria e scala NANO.
    - AEs e SAEs e cambiamenti nei valori clinici di laboratorio, nelle misurazioni dei segni vitali e nei parametri ECG.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Phase 1b:
    Safety throughout the study duration
    Plasma PK based on samples collected on Cycle 1 Day 15
    Radiological response throughout the study duration (based on CT/MRI scans performed every 8 weeks until radiological disease progression)
    Randomized Phase 2:
    Radiological response throughout the study duration (based on CT/MRI scans performed every 8 weeks until radiological disease progression)
    Plasma PK based on samples collected on Cycle 1 Day 15 (only 10 patients in Arm B)
    QoL and neurocognitive questionnaires administered on each cycle Day 1 and at the end of treatment visit
    Safety throughout the study duration
    Fase 1b:
    Sicurezza per tutta la durata dello studio
    PK plasmatica basata su campioni raccolti al 15° giorno del ciclo 1.
    Risposta radiologica per tutta la durata dello studio (basata su scansioni CT/MRI eseguite ogni 8 settimane fino alla progressione radiologica della malattia)
    Fase 2 randomizzata:
    Risposta radiologica per tutta la durata dello studio (basata su scansioni CT/MRI eseguite ogni 8 settimane fino alla progressione radiologica della malattia)
    PK plasmatica basata su campioni raccolti al 15° giorno del ciclo 1 (solo 10 pazienti nel braccio B).
    Questionari sulla QoL e neurocognitivi somministrati ad ogni ciclo il giorno 1 e alla visita di fine trattamento
    Sicurezza per tutta la durata dello studio
    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 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 No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Phase 1b evaluation of elacestrant in combination with abemaciclib
    Valutazione di fase 1b di elacestrant in combinazione con abemaciclib
    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
    randomizzato e in aperto
    randomised and open
    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 trial2
    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 concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA27
    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
    Korea, Republic of
    United States
    France
    Spain
    Germany
    Italy
    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 study will be closed within 6 months of the cutoff date for the survival analysis. If a patient is still receiving trial therapy, he/she will continue to be provided with study treatment, until treatment discontinuation or until elacestrant is approved for marketing in his/her country.
    Lo studio verrà chiuso entro 6 mesi dalla data di cutoff per l'analisi di sopravvivenza. Se un paziente è ancora in terapia, continuerà a ricevere il trattamento dello studio fino all'interruzione del trattamento o fino all'approvazione dell'immissione in commercio di elacestrant nel suo Paese.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months0
    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: 40
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 66
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 42
    F.4.2.2In the whole clinical trial 106
    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
    Standard of care
    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 Decision2023-03-28
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-20
    P. End of Trial
    P.End of Trial StatusOngoing
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