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    Summary
    EudraCT Number:2022-001371-14
    Sponsor's Protocol Code Number:MK-3475-04B
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2023-01-25
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2022-001371-14
    A.3Full title of the trial
    A Phase 1/2 Randomized, Umbrella Study to Evaluate the Safety and Efficacy of Pembrolizumab Plus Enfortumab Vedotin (EV) in Combination With Investigational Agents Versus Pembrolizumab Plus EV, as First-Line Treatment for Participants With Advanced Urothelial Carcinoma (KEYMAKER-U04): Substudy 04B
    Estudio aleatorizado tipo paraguas de fase 1/2 para evaluar la seguridad y la eficacia de pembrolizumab más enfortumab vedotina (EV) en combinación con medicamentos en investigación frente a pembrolizumab más EV como tratamiento de primera línea para participantes con carcinoma urotelial avanzado (KEYMAKER-U04): subestudio 04B
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 1/2, Umbrella Study of the Efficacy and Safety of Pembrolizumab plus Enfortumab vedotin +/- Investigational Agents in First-Line metastatic urothelial carcinoma
    Estudio tipo paraguas de fase 1/2 de la eficacia y seguridad de pembrolizumab más EV +/- medicamentos en investigación en el tratamiento de primera línea del carcinoma urotelial metastásico
    A.4.1Sponsor's protocol code numberMK-3475-04B
    A.5.4Other Identifiers
    Name:INDNumber:152,554
    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 SponsorMerck Sharp & Dohme LLC
    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 supportMerck Sharp & Dohme LLC
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España S.A.
    B.5.2Functional name of contact pointInvestigación Clínica
    B.5.3 Address:
    B.5.3.1Street AddressC/ Josefa Valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+34913210600
    B.5.5Fax number+34913210590
    B.5.6E-mailensayos.clinicos@msd.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleComparator
    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 Padcev
    D.2.1.1.2Name of the Marketing Authorisation holderAstellas
    D.2.1.2Country which granted the Marketing AuthorisationUnited States
    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.3.4Pharmaceutical form Powder for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNEnfortumab vedotin
    D.3.9.3Other descriptive nameEnfortumab vedotin
    D.3.9.4EV Substance CodeSUB185524
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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 nameMK-7684A
    D.3.2Product code MK-7684A
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVibostolimab
    D.3.9.1CAS number 2231305-30-7
    D.3.9.2Current sponsor codeMK-7684
    D.3.9.4EV Substance CodeSUB203865
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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 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 nameMK-4280A
    D.3.2Product code MK-4280A
    D.3.4Pharmaceutical form Solution for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFavezelimab
    D.3.9.2Current sponsor codeMK-4280
    D.3.9.4EV Substance CodeSUB203633
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.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 KEYTRUDA (pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Locally advanced/unresectable or metastatic urothelial carcinoma previously untreated for their advanced disease
    Carcinoma urotelial localmente avanzado/irresecable o metastásico sin tratamiento previo por enfermedad avanzada
    E.1.1.1Medical condition in easily understood language
    Locally advanced or metastatic bladder cancer
    Cáncer de vejiga localmente avanzado o metastásico
    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 10064467
    E.1.2Term Urothelial carcinoma
    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
    1. Part 1: To evaluate ORR in participants treated with MK-4280A plus EV (Arm A), MK-7684A plus EV (Arm B), and pembrolizumab plus EV (Arm C) per RECIST 1.1 by BICR.
    2. Part 1: To evaluate the safety and tolerability in participants treated with MK-4280A plus EV (Arm A), MK-7684A plus EV (Arm B), and pembrolizumab plus EV (Arm C).
    3. Part 2: To compare EV plus MK-4280A (Arm A) and/or EV plus MK-7684A (Arm B) to EV plus pembrolizumab (Arm C) with respect to PFS per RECIST 1.1 by BICR.
    1. Parte 1: Evaluar la TRO en los participantes tratados con MK-4280A más EV (grupo A), MK-7684A más EV (grupo B) y pembrolizumab más EV (grupo C) conforme a los criterios RECIST 1.1, según una ECIE.
    2. Parte 1: Evaluar la seguridad y la tolerabilidad en los participantes tratados con MK-4280A más EV (grupo A), MK-7684A más EV (grupo B) y pembrolizumab más EV (grupo C).
    3. Parte 2: Comparar EV más MK-4280A (grupo A) y/o EV más MK 7684A (grupo B) con EV más pembrolizumab (grupo C) en cuanto a la SSP conforme a los criterios RECIST 1.1, según una ECIE.
    E.2.2Secondary objectives of the trial
    1. Part 1: To evaluate PFS in participants treated with MK-4280A + EV (Arm A), MK-7684A + EV (Arm B), & pembrolizumab + EV (Arm C) per RECIST 1.1 by BICR
    2. Part 2: To compare EV + MK-4280A (Arm A) and/or EV + MK-7684A (Arm B) versus EV + pembrolizumab (Arm C) with respect to OS
    3. Part 2: To evaluate ORR in participants treated with MK-4280A + EV (Arm A), MK-7684A + EV (Arm B), & pembrolizumab + EV (Arm C) per RECIST 1.1 by BICR
    4. Part 2: To evaluate safety and tolerability in participants treated with MK-4280A + EV (Arm A), MK-7684A + EV (Arm B), & pembrolizumab + EV (Arm C)
    5. Part 1 and Part 2: To evaluate DOR in participants treated with MK-4280A + EV (Arm A), MK-7684A + EV (Arm B), and pembrolizumab + EV (Arm C) per RECIST 1.1 by BICR
    6. Part 1 and Part 2: To evaluate changes in patient-reported outcomes from baseline and TTD using the EORTC QLQ-C30 instrument and EQ-5D-5L in participants treated with MK-4280A + EV (Arm A), MK-7684A + EV (Arm B) & pembrolizumab + EV (Arm C)
    1.Parte 1: Evaluar la SSP en participantes tratados con MK4280A+EV (gpo A), MK7684A+EV (gpo B) y pembro+EV (gpo C) conforme a los criterios RECIST 1.1, según ECIE
    2.Parte 2: Comparar EV+MK4280A (gpo A) y/o EV+MK7684A (gpo B) con EV+pembro (gpo C) en cuanto a la SG
    3.Parte 2: Evaluar la TRO en participantes tratados con MK4280A+EV (gpo A), MK7684A+EV (gpo B) y pembro+EV (gpo C) conforme a los criterios RECIST 1.1, según ECIE
    4.Parte 2: Evaluar la seguridad y la tolerabilidad en participantes tratados con MK4280A+EV (gpo A), MK7684A+EV (gpo B) y pembro+EV (gpo C)
    5.Parte 1+2: Evaluar la DR en participantes tratados con MK4280A+EV (gpo A), MK7684A+EV (gpo B) y pembro+EV (gpo C) conforme a los criterios RECIST 1.1, según ECIE
    6.Parte 1+2: Evaluar variaciones de resultados comunicados por los pacientes con respecto al momento basal y el THD mediante los cuestionarios QLQ-C30 de la EORTC y EQ-5D-5L en participantes tratados con MK4280A+EV (gpo A), MK7684A+EV (gpo B) y pembro+EV (gpo C)
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. The participants must have histologically documented, la/mUC (ie, cancer of the bladder, renal pelvis, ureter, or urethra). Histology will be confirmed locally.
    • Participants with mixed histology are eligible provided the urothelial component is ≥50% (and <10% plasmacytoid component).
    • Participants whose tumors contain any neuroendocrine component are not eligible (variant histology to be confirmed locally).
    2. Participants must have measurable disease by investigator assessment according to RECIST 1.1.
    • Participants treated with prior radiation therapy must have measurable disease per RECIST 1.1 that is outside the radiation field or has demonstrated unequivocal progression since completion of radiation therapy.
    • Participants who have completed radiotherapy at least 2 weeks prior to randomization may be eligible. Participant must have recovered adequately from the toxicity from the intervention prior to starting study treatment.
    3. Participants must not have received prior systemic therapy for la/mUC. The following therapies in earlier disease settings are permitted:
    • Participants that received neoadjuvant or adjuvant chemotherapy are permitted.
    • Participants who received neo-adjuvant or adjuvant anti-PD-1 or PD-L1 therapy for an earlier disease stage with recurrence >12 months from completion of therapy are permitted.
    4. Participants must provide an archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion demonstrating UC, not previously irradiated, and adequate for biomarker evaluation. A newly obtained biopsy is strongly preferred, but not required if archival tissue is evaluable.
    5. Participants who have AEs due to previous anticancer therapies must have recovered to ≤Grade 1 or baseline. Participants with endocrine-related AEs who are adequately treated with hormone replacement or participants who have <Grade 2 neuropathy are eligible.
    6. Is male or female, and ≥18 years at the time the participant provides documented informed consent for the study.
    7. If male, agrees to the following during the intervention period and for at least 180 days after the last dose of EV:
    • Refrains from donating sperm
    PLUS either:
    • Abstains from heterosexual intercourse as their preferred and usual lifestyle and agrees to remain abstinent
    OR
    • Uses contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause, documented from the site personnel’s review of the participant’s medical records, medical examination, or medical history interview) as detailed below:
    - Uses a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a WOCBP who is not currently pregnant.
    - Contraceptive use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
    8. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    • Not a WOCBP
    OR
    • A WOCBP and:
    - Uses a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, or be abstinent from heterosexual intercourse as their preferred and usual lifestyle, during the intervention period and for at least 120 days (MK-4280A, MK-7684A, or pembrolizumab) or 180 days (EV) after the last dose of study intervention and agrees not to donate eggs (ova, oocytes) to others or freeze/store for her own use for the purpose of reproduction during this period. The investigator should evaluate the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention. Contraceptive use by women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
    - Has a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 24 hours before the first dose of study intervention. If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
    - Abstains from breastfeeding during the study intervention period and for at least 120 days after study intervention (for MK-4280A, MK-7684A, or pembrolizumab) or 180 days (EV) days after the last dose of study intervention.
    - Medical history, menstrual history, and recent sexual activity has been reviewed by the investigator to decrease the risk for inclusion of a woman with an early undetected pregnancy.
    9. Provides documented informed consent/assent for the study (either the participant or a legally acceptable representative, if applicable).
    10. An ECOG performance status of 0 to 1 assessed within 7 days prior to randomization.
    11. Adequate organ function.
    1.Los participantes deben tener un CUla/m (es decir, cáncer de vejiga,pelvis renal,uréter o uretra) documentado histológicamente (histología se confirmará localmente)
    •Podrán participar pacientes con histología mixta si el componente urotelial ≥50% (y con <10% de componente plasmocitoide)
    •No podrán participar pacientes cuyos tumores contengan cualquier componente neuroendocrino (histología se confirmará localmente)
    2.Presentar enfermedad mensurable según la evaluación del investigador conforme a los criterios RECIST 1.1
    •Participantes tratados previamente con radioterapia deben presentar enfermedad mensurable,conforme a los criterios RECIST 1.1,fuera del campo de irradiación o haber presentado progresión inequívoca desde la finalización de radioterapia
    •Pacientes que hayan completado la radioterapia al menos 2 sem antes de aleatorización. Deben haberse recuperado debidamente de la toxicidad o la intervención antes de iniciar el tto. del estudio
    3.Los participantes no pueden haber recibido tto. sistémico previo por el CUla/m.Se permiten los siguientes ttos. en contextos más tempranos de la enfermedad:
    •Quimioterapia neoadyuvante o adyuvante
    •Tto. anti-PD-1 o anti-PD-L1 neoadyuvante o adyuvante por un estadio más temprano de la enfermedad con recidiva más de 12 meses después de finalizar el tto.
    4.Proporcionar una muestra de tejido tumoral de archivo o de biopsia reciente,con aguja gruesa o por escisión,de lesión tumoral que demuestre CU,no irradiada previamente y que sea adecuada para la evaluación de biomarcadores. Preferible biopsia reciente,aunque no será obligatoria si se dispone de tejido de archivo evaluable
    5.Los participantes con AA debidos a ttos. antineoplásicos previos deben haberse recuperado hasta un grado ≤1 o la situación basal. Podrán participar pacientes con AA endocrinos que se encuentren debidamente tratados con reposición hormonal o con neuropatía de grado <2
    6.Varón/mujer mayor de 18 años en el momento de otorgar el consentimiento para el estudio
    7.Los varones deben comprometerse durante el período de intervención y, como mínimo, hasta 180días después de la última dosis de EV:
    •Abstenerse de donar semen
    Y:
    •Abstenerse de mantener relaciones heterosexuales como modo de vida habitual y preferido y compromiso de mantener dicha abstinencia
    O
    •Usar anticonceptivos,a menos que se confirme la presencia de azoospermia (vasectomía o secundaria a una causa médica,documentada a partir de la revisión por el personal del centro de la historia clínica del participante,una exploración médica o una entrevista sobre los antecedentes médicos),según se detalla a continuación:
    -Uso de preservativo masculino + uso por la pareja de un método anticonceptivo adicional cuando mantenga relaciones sexuales con penetración vaginal con MEF que no estén embarazadas
    -El uso de anticonceptivos por los varones deberá cumplir la normativa local sobre métodos anticonceptivos para participantes en estudios clínicos
    8.Podrán participar mujeres que no estén embarazadas ni en período de lactancia y que cumplan al menos una de las condiciones siguientes:
    •No es una MEF
    O
    •Es una MEF y:
    -Usa un método anticonceptivo muy eficaz (índice de fallos <1% anual), con baja dependencia de la usuaria, o practica la abstinencia de relaciones heterosexuales como modo de vida preferido y habitual, durante el período de intervención y hasta, como mínimo, 120d (MK4280A, MK7684A o pembro) o 180d (EV) después de la última dosis de la intervención del estudio y se compromete a no donar óvulos ni congelarlos o conservarlos para su propio uso con fines de reproducción. El investigador debe evaluar la posibilidad de fracaso del método anticonceptivo en relación con la 1a dosis de la intervención del estudio. El uso de anticonceptivos por las mujeres deberá cumplir la normativa local sobre métodos anticonceptivos para participantes en estudios clínicos
    -Resultado negativo en una prueba de embarazo de alta sensibilidad (orina o suero,según exija la normativa local) realizada en las 24hs previas a la 1a dosis de la intervención del estudio. Cuando no pueda confirmarse el resultado negativo de una prueba en orina, será necesaria una prueba de embarazo en suero. En tales casos, se excluirá a la posible participante si el resultado es positivo.
    -Abstenerse de amamantar durante el período de intervención del estudio y hasta, como mínimo, 120d (MK-4280A, MK-7684A o pembro) o 180d (VE) después de la última dosis de la intervención del estudio.
    -El investigador ha repasado los antecedentes médicos y menstruales y la actividad sexual reciente para reducir el riesgo de incluir a una mujer con un embarazo de poco tiempo no detectado
    9.Obtención del consentimiento/asentimiento informado documentado (del participante o de su representante legal, si procede)
    10.Estado funcional del ECOG de 0 o 1 evaluado en los 7d previos a la aleatorización
    11.Función orgánica adecuada
    E.4Principal exclusion criteria
    1. Known additional malignancy, except if the participant has undergone potentially curative therapy with no evidence of that disease recurrence for at least 3 years since initiation of that therapy.
    2. Participants with treated CNS metastases are permitted on-study if all of the following are true: a) CNS metastases have been clinically stable for at least 4 weeks prior to screening and baseline scans show no evidence of new or enlarged metastasis; b) the participant is on a stable dose of ≤10 mg/day of prednisone or equivalent for at least 2 weeks (if requiring steroid treatment); c) participant does not have leptomeningeal disease.
    3. Received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent, or with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, LAG3, TIGIT, OX-40, CD137). Exception includes participants who received neo-adjuvant or adjuvant anti-PD-1 or PD-L1 therapy for an earlier disease stage (eg, MIUC) with recurrence >12 months from completion of therapy.
    4. Received therapy with hematopoietic growth factor such as G-CSF or GM-CSF within 14 days prior to randomization.
    5. Received prior systemic anticancer therapy including investigational agents (including EV or other MMAE-based ADCs) within 3 years prior to randomization. Exception includes participants that received neoadjuvant or adjuvant chemotherapy or anti-PD-1/L1 therapy for an earlier disease stage (eg, MIUC).
    6. Received a live or live-attenuated vaccine within 30 days prior to the first dose of study intervention.
    7. Has received an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study intervention administration.
    8. Ongoing sensory or motor neuropathy Grade 2 or higher.
    9. A diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study intervention. Inhaled or topical steroids are permitted in the absence of active autoimmune disease. Physiologic replacement doses of corticosteroids are permitted for participants with adrenal insufficiency.
    10. Severe hypersensitivity (≥Grade 3) to mAb (including pembrolizumab) and/or any of their excipients.
    11. Known severe hypersensitivity (≥Grade 3) to any excipient contained in the drug formulation of EV (including histidine, trehalose dihydrate, and polysorbate 20).
    12. Active keratitis or corneal ulcerations. Participants with superficial punctate keratitis are allowed if the disorder is being adequately treated in the opinion of the investigator.
    13. Active autoimmune disease that has required systemic treatment in past 2 years except replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid).
    14. A history of uncontrolled diabetes. Uncontrolled diabetes is defined as HbA1c ≥8% or HbA1c 7% to < 8% with associated diabetes symptoms (polyuria or polydipsia) that are not otherwise explained.
    15. A history of (noninfectious) pneumonitis that required steroids or has current pneumonitis.
    16. An active infection (viral, bacterial, or fungal) requiring systemic therapy. Participant may be rescreened after resolution of the infection.
    17. A known history of HIV infection. No HIV testing is required unless mandated by local health authority.
    18. Hepatitis B (defined as HBsAg reactive) or hepatitis C virus (defined as HCV RNA qualitative is detected) infection.
    19. A history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant’s participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.
    20. A known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study.
    21. Had major surgery within 4 weeks prior to first dose of study intervention.
    22. Has had an allogenic tissue/solid organ transplant.
    1. Otra neoplasia maligna conocida, salvo si el participante se ha sometido a un tto. potencialmente curativo y no ha habido signos de recidiva de la enfermedad durante al menos 3 años desde el comienzo de ese tto.
    2. En el estudio podrán participar pacientes con metástasis en el SNC tratadas si se cumplen todas las condiciones siguientes: a) las metástasis en el SNC se han mantenido clínicamente estables durante al menos 4 semanas antes de la selección y el estudio de imagen basal no muestra signos de metástasis nuevas o que hayan crecido, b) el participante ha recibido una dosis estable ≤10 mg/día de prednisona o equivalente durante al menos 2 semanas (si necesita tto. con corticoides) y c) el participante no presenta afectación leptomeníngea
    3. Tto. previo con un fármaco anti-PD-1, anti-PD-L1 o anti-PD-L2 o con un fármaco dirigido contra otro receptor de los linfocitos T estimulador o coinhibidor (p. ej., CTLA-4, LAG3, TIGIT, OX-40 o CD137). Una excepción son los pacientes que hayan recibido tto. anti-PD-1 o anti-PD-L1 neoadyuvante o adyuvante por un estadio más temprano de la enfermedad (p. ej., CUIM) con recidiva más de 12 meses después de finalizar el tto.
    4. Tto. con factores de crecimiento hematopoyéticos como G-CSF o GM-CSF en los 14 días previos a la aleatorización
    5. Tto. antineoplásico sistémico previo, incluidos fármacos experimentales (como EV u otros CAF basados en MMAE), en los 3 años previos a la aleatorización. Una excepción son los pacientes que hayan recibido quimioterapia o tto. anti-PD-1/L1 neoadyuvante o adyuvante por un estadio más temprano de la enfermedad (p. ej., CUIM).
    6. Recepción de una vacuna de microorganismos vivos o vivos atenuados en los 30 días previos a la primera dosis de la intervención del estudio
    7. Recepción de un fármaco o dispositivo experimental en las 4 semanas previas a la administración de la primera dosis de la intervención del estudio
    8. Neuropatía sensitiva o motora de grado 2 o superior activa
    9. Diagnóstico de inmunodeficiencia o tto. sistémico crónico con corticoides (en dosis superiores a 10mg diarios de prednisona o equivalente) o cualquier otra forma de tto. inmunodepresor en los 7 días previos a la primera dosis de la intervención del estudio. Se permiten los corticoides inhalados o tópicos en ausencia de enfermedad autoinmunitaria activa. Se permiten dosis de reposición fisiológica de corticosteroides en los participantes con insuficiencia suprarrenal
    10. Hipersensibilidad grave (grado≥3) a anticuerpos monoclonales (incluido pembrolizumab) y/o a cualquiera de sus excipientes
    11. Hipersensibilidad grave (grado≥3) conocida a cualquiera de los excipientes contenidos en la formulación de EV (como histidina,trehalosa dihidrato y polisorbato 20)
    12. Queratitis activa o úlceras corneales. Se permitirá la participación de pacientes con queratitis punteada superficial si, en opinión del investigador, el trastorno se está tratando correctamente
    13. Enfermedad autoinmunitaria activa que ha precisado tto. sistémico en los 2 últimos años, excepto tto. de reposición (p. ej., tiroxina, insulina o corticoides fisiológicos)
    14. Antecedentes de diabetes no controlada. La diabetes no controlada se define como una HbA1c ≥8 % o del 7 % a <8 % con síntomas de diabetes asociados (poliuria o polidipsia) que no se explican de otro modo
    15. Antecedentes de neumonitis (no infecciosa) que haya precisado la administración de corticoides o presencia de una neumonitis activa
    16. Infección activa (vírica, bacteriana o micótica) con necesidad de tto. sistémico. El posible participante podrá repetir el proceso de selección una vez resuelta la infección
    17. Antecedentes conocidos de infección por el VIH. No es necesario realizar pruebas de VIH a menos que lo exijan las autoridades sanitarias locales
    18. Infección por el virus de la hepatitis B (definida como reactividad de HBsAg) o el virus de la hepatitis C (definida como detección cualitativa de ARN del VHC)
    19. Antecedentes o datos presentes de cualquier proceso, tto. o anomalía analítica que, en opinión del investigador responsable del tratamiento, pueda confundir los resultados del estudio, dificultar la participación durante la totalidad del estudio o motivar que la participación no sea lo más conveniente para el posible participante
    20. Trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante para colaborar en el cumplimiento de los requisitos del estudio
    21. Antecedentes de una intervención de cirugía mayor en las 4 semanas previas a la primera dosis de la intervención del estudio
    22. Recepción de un alotrasplante de órgano sólido o tejidos.
    E.5 End points
    E.5.1Primary end point(s)
    1. Part 1: Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 as assessed by Blinded Independent Central Review (BICR)
    2. Part 1: Percentage of Participants Who Experienced At Least One Adverse Event (AE)
    3. Part 1: Percentage of Participants Who Discontinued Study Treatment Due to an AE
    4. Part 1: Percentage of Participants Who Experienced at Least One Dose-Limiting Toxicity (DLT)
    5. Part 2: Progression Free Survival (PFS) per RECIST 1.1 as assessed by BICR
    1. Parte 1: Tasa de respuesta objetiva (TRO) conforme a los criterios RECIST 1.1, según una ECIE
    2. Parte 1: Porcentaje de participantes que experimentaron al menos un Acontecimiento Adverso (AA)
    3. Parte 1: Porcentaje de participantes que interrumpieron el tratamiento del estudio debido a un AA
    4. Parte 1: Porcentaje de participantes que experimentaron al menos Toxicidad limitante de la dosis (TLD)
    5. Parte 2: Supervivencia sin progresión (SSP) conforme a los criterios RECIST 1.1, según una ECIE
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 4 years
    2. Up to approximately 4 years
    3. Up to approximately 4 years
    4. Up to approximately 21 days
    5. Up to approximately 4 years
    1. Hasta aproximadamente 4 años
    2. Hasta aproximadamente 4 años
    3. Hasta aproximadamente 4 años
    4. Hasta aproximadamente 21 días
    5. Hasta aproximadamente 4 años
    E.5.2Secondary end point(s)
    1. Part 1: Progression Free Survival (PFS) per RECIST 1.1 as assessed by BICR
    2. Part 2: Overall Survival (OS)
    3. Part 2: ORR per RECIST 1.1 as assessed by BICR
    4. Part 2: Percentage of Participants Who Experienced At Least One AE
    5. Part 2: Percentage of Participants Who Discontinued Study Treatment Due to an AE
    6. Part 2: Percentage of Participants Who Experienced at Least One DLT
    7. Part 1: Duration of Response (DOR) per RECIST 1.1 as assessed by BICR
    8. Part 2: DOR per RECIST 1.1 as assessed by BICR
    9. Part 1: Change from Baseline in the European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status/Quality of Life (Items 29 and 30) Combined Score
    10. Part 1: Change from Baseline in EORTC QLQ-C30 Physical Functioning Scale (Items 1-5) Combined Score
    11. Part 1: Change from Baseline in EuroQoL-5 Dimensions, 5-level Questionnaire (EQ-5D-5L) Visual Analogue Score (VAS)
    12. Part 1: Time to Deterioration (TTD) in the EORTC-QLQ-C30 Global Health Status/Quality of Life (Items 29 and 30) Combined Score
    13. Part 1: TTD in the EORTC QLQ-C30 Physical Functioning Scale (Items 1-5) Combined Score
    14. Part 1: TTD in the EQ-5D-5L VAS
    15. Part 2: Change from Baseline in the EORTC-QLQ-C30 Global Health Status/Quality of Life (Items 29 and 30) Combined Score
    16. Part 2: Change from Baseline in EORTC QLQ-C30 Physical Functioning Scale (Items 1-5) Combined Score
    17. Part 2: Change from Baseline in EQ-5D-5L VAS
    18. Part 2: Time to Deterioration (TTD) in the EORTC-QLQ-C30 Global Health Status/Quality of Life (Items 29 and 30) Combined Score
    19. Part 2: TTD in the EORTC QLQ-C30 Physical Functioning Scale (Items 1-5) Combined Score
    20. Part 2: TTD in the EQ-5D-5L VAS
    1. Parte 1: Supervivencia sin progresión (SSP) conforme a los criterios RECIST 1.1, según una ECIE2
    2. Parte 2: Supervivencia Global (SG)
    3. Parte 2: TRO conforme a los criterios RECIST 1.1, según una ECIE2
    4. Parte 2: Porcentaje de participantes que experimentaron al menos un Acontecimiento Adverso
    5. Parte 2: Porcentaje de participantes que interrumpieron el tratamiento del estudio debido a un AA
    6. Parte 2: Porcentaje de participantes que experimentaron al menos Toxicidad limitante de la dosis (TLD)
    7. Parte 1: Duración de la respuesta (DR) conforme a los criterios RECIST 1.1, según una ECIE2
    8. Parte 2: DR conforme a los criterios RECIST 1.1, según una ECIE2
    9. Parte 1: Variación con respecto al momento basal del Estado general de salud/calidad de vida del cuestionario QLC-C30 de la EORTC (apartados 29 y 30) puntuación combinada
    10. Parte 1: Variación con respecto al momento basal de Escala de función física del cuestionario QLQ-C30 de la EORTC (apartados 1-5) puntuación combinada
    11. Parte 1: Variación con respecto al momento basal de la Puntuación analógica visual (VAS) del cuestionario EQ-5D-5L.
    12. Parte 1: Tiempo hasta el deterioro del estado general de salud/calidad de vida del cuestionario QLQ-C30 de la EORTC (apartados 29 y 30) puntuación combinada
    13. Parte 1: Tiempo hasta el deterioro de la Escala de función física del cuestionario QLQ-C30 de la EORTC (apartados 1-5) puntuación combinada
    14. Parte 1: Tiempo hasta el deterioro de VAS del cuestionario EQ-5D-5L
    15. Parte 2: Variación con respecto al momento basal del Estado general de salud/calidad de vida del cuestionario QLC-C30 de la EORTC (apartados 29 y 30) puntuación combinada
    16. Parte 2: Variación con respecto al momento basal de Escala de función física del cuestionario QLQ-C30 de la EORTC (apartados 1-5) puntuación combinada
    17. Parte 2: Variación con respecto al momento basal de la Puntuación analógica visual (VAS) del cuestionario EQ-5D-5L
    18. Parte 2: Tiempo hasta el deterioro del estado general de salud/calidad de vida del cuestionario QLQ-C30 de la EORTC (apartados 29 y 30) puntuación combinada
    19. Parte 2: Tiempo hasta el deterioro de la Escala de función física del cuestionario QLQ-C30 de la EORTC (apartados 1-5) puntuación combinada
    20. Parte 2: Tiempo hasta el deterioro de VAS del cuestionario EQ-5D-5L
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 4 years
    2. Up to approximately 4 years
    3. Up to approximately 4 years
    4. Up to approximately 4 years
    5. Up to approximately 4 years
    6. Up to approximately 21 days
    7. Up to approximately 4 years
    8. Up to approximately 4 years
    9. Baseline and up to approximately 4 years
    10. Baseline and up to approximately 4 years
    11. Baseline and up to approximately 4 years
    12. Up to approximately 4 years
    13. Up to approximately 4 years
    14. Up to approximately 4 years
    15. Baseline and up to approximately 4 years
    16. Baseline and up to approximately 4 years
    17. Baseline and up to approximately 4 years
    18. Up to approximately 4 years
    19. Up to approximately 4 years
    20. Up to approximately 4 years
    1. Hasta aproximadamente 4 años
    2. Hasta aproximadamente 4 años
    3. Hasta aproximadamente 4 años
    4. Hasta aproximadamente 4 años
    5. Hasta aproximadamente 4 años
    6. Hasta aproximadamente 21 días
    7. Hasta aproximadamente 4 años
    8. Hasta aproximadamente 4 años
    9. Momento basal y hasta aproximadamente 4 años
    10. Momento basal y hasta aproximadamente 4 años
    11. Momento basal y hasta aproximadamente 4 años
    12. Hasta aproximadamente 4 años
    13. Hasta aproximadamente 4 años
    14. Hasta aproximadamente 4 años
    15. Momento basal y hasta aproximadamente 4 años
    16. Momento basal y hasta aproximadamente 4 años
    17. Momento basal y hasta aproximadamente 4 años
    18. Hasta aproximadamente 4 años
    19. Hasta aproximadamente 4 años
    20. Hasta aproximadamente 4 años
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    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
    First administration of the investigational agents combination in the specified population
    Primera administración de la combinación de agentes en investigación en la población especificada
    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 Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    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) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA14
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Canada
    Chile
    Israel
    Korea, Republic of
    Taiwan
    United States
    France
    Netherlands
    Spain
    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
    LVLS
    LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years4
    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: 72
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 318
    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 state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 175
    F.4.2.2In the whole clinical trial 390
    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
    Ninguno
    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 Decision2023-09-21
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-03-02
    P. End of Trial
    P.End of Trial StatusOngoing
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