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    Summary
    EudraCT Number:2022-001535-87
    Sponsor's Protocol Code Number:BLU-263-2101
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-10-21
    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 number2022-001535-87
    A.3Full title of the trial
    A Phase 1/2, open-label, 2-arm study evaluating BLU-263 as monotherapy and in combination with azacitidine, in patients with KIT altered hematologic malignancies
    Estudio de fase 1/2, abierto y de dos grupos para evaluar BLU-263 en monoterapia y en combinación con azacitidina en pacientes con neoplasias hematológicas malignas con alteración de KIT
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    AZURE: Study of BLU-263 in Advanced Systemic Mastocytosis
    AZURE: Estudio de BLU-2563 en Mastocitosis Sistémica Avanzada
    A.3.2Name or abbreviated title of the trial where available
    AZURE
    AZURE
    A.4.1Sponsor's protocol code numberBLU-263-2101
    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 SponsorBlueprint Medicines Corporation
    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 supportBlueprint Medicines Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPPD, part of Thermo Fisher Scientific
    B.5.2Functional name of contact pointGemma María García Aguilar
    B.5.3 Address:
    B.5.3.1Street AddressCalle Titán nº 15
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28045
    B.5.3.4CountrySpain
    B.5.4Telephone number+34900834 223
    B.5.6E-mailRegistroEspanolDeEstudiosClinicos@druginfo.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 nameBLU-263
    D.3.2Product code BLU-263
    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 INNBLU-263
    D.3.9.1CAS number 2505078-08-8
    D.3.9.2Current sponsor codeBLU-263
    D.3.9.4EV Substance CodeSUB222105
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameBLU-263
    D.3.2Product code BLU-263
    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 INNBLU-263
    D.3.9.1CAS number 2505078-08-8
    D.3.9.2Current sponsor codeBLU-263
    D.3.9.4EV Substance CodeSUB222105
    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 No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 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.2.1.2Country 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 nameAzacitidine
    D.3.2Product code Azacitidine
    D.3.4Pharmaceutical form Powder for suspension for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    Subcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAzacitidine
    D.3.9.1CAS number 320-67-2
    D.3.9.4EV Substance CodeSUB05624MIG
    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 Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Advanced Systemic Mastocytosis (AdvSM)
    Mastocitosis Sistémica Avanzada (MSAv).
    E.1.1.1Medical condition in easily understood language
    Advanced Systemic Mastocytosis
    Mastocitosis Sistémica Avanzada
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10042949
    E.1.2Term Systemic mastocytosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10056453
    E.1.2Term Aggressive systemic mastocytosis
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Arm 1 - Dose Escalation:
    1. To determine the RD for BLU-263 monotherapy
    Arm 1 - Dose Escalation & Dose Expansion:
    1. To assess the safety and tolerability of BLU-263 monotherapy
    2. To assess clinical efficacy of BLU-263 given as monotherapy at the RD to patients with AdvSM.

    Arm 2 - Dose Escalation:
    1. To determine the RD for BLU-263 in combination with azacitidine in patients with AdvSM.
    2. To assess the safety and tolerability of BLU-263 in combination with azacitidine.
    Arm 2 - Dose Expansion:
    1. To assess the safety and tolerability of BLU-263 in combination with azacitidine.
    Brazo 1 - Aumento de dosis:
    1. Determinar la Dosis Recomendada (DR) para monoterapia con BLU-263
    Brazo 1 - Aumento de dosis y expansión de dosis:
    1. Evaluar la seguridad y la tolerabilidad de la monoterapia con BLU-263
    2. Evaluar la eficacia clínica de BLU-263 administrado como monoterapia en el Dosis Recomendada a pacientes con MSAv.
    Brazo 2 - Aumento de dosis:
    1. Determinar la Dosis Recomendada de BLU-263 en combinación con azacitidina en pacientes con MSAv.
    2. Evaluar la seguridad y tolerabilidad de BLU-263 en combinación con azacitidina.
    Brazo 2 - Expansión de dosis:
    1. Evaluar la seguridad y tolerabilidad de BLU-263 en combinación con Azacitidina
    E.2.2Secondary objectives of the trial
    Arm 1 - Dose Escalation & Dose Expansion:
    1. To assess the ORR using modified IWGMRT-ECNM for AdvSM
    2. To characterize the PK profile of BLU263 when given as monotherapy
    3. To determine the OS of patients with AdvSM treated with BLU-263
    4. To assess additional measures of clinical efficacy of BLU-263 given as monotherapy

    Arm 2 - Dose Escalation & Dose Expansion:
    1. To assess the ORR using modified IWGMRT-ECNM for SM
    2. To assess the PPR rate for SM of BLU-263 given in combination with azacitidine.
    3. To assess the PK of BLU-263 and azacitidine when given alone and in combination.
    Brazo 1 - Aumento de dosis y expansión de dosis:
    1. Evaluar la TRG (tasa de respuesta global) utilizando IWGMRT-ECNM modificado para MSAv
    2. Caracterizar el perfil farmacocinético de BLU263 cuando se administra como monoterapia
    3. Determinar la Supervivencia Global (SG) de pacientes con MSAv tratados con BLU-263
    4. Evaluar medidas adicionales de eficacia clínica de BLU-263 administrado como monoterapia

    Brazo 2 - Aumento de dosis y expansión de dosis:
    1. Evaluar la TRG utilizando IWGMRT-ECNM modificado para Mastocitosis sistémica (MS)
    2. Evaluar la tasa de respuesta anatomopatológica pura (RAP) para MS de BLU-263 administrado en combinación con azacitidina
    3. Evaluar la farmacocinética de BLU-263 y azacitidina cuando se administran solos y en combinación
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    All patients:
    1. Patient is ≥18 years of age at the time of signing the informed consent.
    2. Patient has Eastern Cooperative Oncology Group performance status of 0-3.
    3. Patient must have a new BM biopsy or may use archival tissue if taken within 56 days prior to C1D1
    4. Patients receiving antineoplastic therapy within the preceding 12 weeks must have discontinued therapy due to disease progression, refractory disease, lack of efficacy, or intolerance.
    5. Patients treated with 1 prior selective KIT inhibitor will be permitted on study after confirmation of KIT D816V mutation and with written approval of the study sponsor. Patients who discontinued due to a severe AE that was thought to be related to prior treatment will not be eligible to participate in the study.

    Arm 1 (Monotherapy):
    A1_1. For Arm 1, patients must have one of the following AdvSM diagnoses, based on WHO diagnostic criteria. Before enrollment, the Central Pathology Laboratory must confirm the diagnosis of AdvSM (based on Central Pathology Laboratory assessment of BM):
    a. ASM.
    b. SM-AHN which in the opinion of the investigator is not considered to be a candidate for HMA monotherapy. Incidental indolent, low-grade lymphoid AHNs (eg, chronic lymphocytic leukemia) not requiring treatment are eligible.
    c. MCL, including diagnoses with an AHN component, which does not require a C-finding.
    d. Upon discussion with the sponsor, other relapsed or refractory, potentially BLU-263-responsive hematologic neoplasms (e.g., those with evidence of aberrant KIT) may be considered for enrollment.

    Arm 2 (Combination Therapy):
    A2_1. For Arm 2, patients must have one of the following SM-AHN diagnoses, based on WHO diagnostic criteria. Central Pathology Laboratory assessment of the BM will be required to confirm the diagnosis of the AHN component of SM-AHN:
    a. Chronic myelomonocytic leukemia (CMML)-2 (per WHO 2016).
    b. High risk or very high risk myelodysplastic syndromes (MDS; per International Prognostic Scoring System for Myelodysplastic Syndromes-Revised (IPSS-R) scoring).
    c. Myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN) accelerated diagnosis phase as defined by blast count >10% in BM OR peripheral blood but not meeting diagnostic criteria of AML.
    d. MDS with excessive blasts-2 (MDS-EB-2; 10-19% in BM or 5-19% in peripheral blood) (per WHO 2016).
    e. Complex karyotype or >3 adverse risk mutations.
    f. Upon discussion with the sponsor and in consultation with the Response Assessment Committee where needed, hematologic neoplasms which are felt to have strong rationale to consider the combination treatment of BLU-263 and HMA may be considered for enrollment.
    Todos los pacientes
    1.Paciente de Edad >= 18 años en la firma del consentimiento informado.
    2.Paciente con Estado funcional de escala Eastern Cooperative Oncology Group de 0-3
    3.Paciente con nueva biopsia de médula ósea o usar tejido de archivo en los 56 días previos a C1 D1.
    4.Pacientes que han recibido tratamiento previo antineoplásico 12 semanas antes,deben haber suspendido el tratamiento por progresión, enfermedad resistente, falta de eficacia o intolerancia.
    5.Pacientes tratados previamente con un inhibidor selectivo de KIT podrán participar después confirmar la mutación KIT D816V y con la aprobación escrita del promotor. No podrán participar pacientes que suspendieron tratamiento por un evento adverso intenso relacionado.

    Grupo 1 (monoterapia):
    A1_1. Brazo 1, pacientes con uno de siguientes diagnosticos de MSAv, según criterios de la OMS. Antes de inclusión, el laboratorio central de anatomía patológica debe confirmar el diagnóstico (según la evaluación de la médula ósea por el laboratorio central de anatomía patológica):
    a.MSA.
    b.MS-NHA, que en opinión del investigador, no es candidata a recibir FHM en monoterapia. Pacientes indolentes accidentales con NHA linfoides de bajo grado (leucemia linfocítica crónica) podrán participar si no requieren tratamiento.
    c.LM, incluido diagnóstico con un componente NHA, que no requiere hallazgo C.
    d.Tras acordar con el promotor, podrían incluirse pacientes con otras neoplasias hematológicas recidivantes o resistentes sensibles a BLU-263 (indicios de KIT anómalo).

    Grupo 2 (tratamiento combinado):
    A2_1. Brazo 2, pacientes con uno de siguientes diagnósticos de MS-NHA, según criterios de la OMS. Es necesaria la evaluación de la médula ósea por laboratorio central de anatomía patológica para el diagnóstico de componente de NHA de la MS-NHA:
    a.Leucemia mielomonocítica crónica (LMMC)-2 (OMS 2016).
    b.Síndromes mielodisplásicos (SMD de alto o muy alto riesgo (según la puntuación IPSS-R ).
    c.Diagnóstico de fase acelerada de un SMD/neoplasia mieloproliferativa (NMP), definida por un recuento de blastos >10% en médula ósea O sangre periférica pero sin cumplir criterios diagnósticos de Leucemia Mielode Aguda (LMA).
    d. SMD con exceso de blastos-2 (SMD-EB-2; 10%-19% en médula ósea o 5%-19% en sangre periférica) (OMS 2016).
    e. Cariotipo complejo o >3 mutaciones de pronóstico desfavorable.
    f. Tras acordar con el promotor, y con el Comité de Evaluación de la Respuesta de ser necesario, podría incluirse pacientes con neoplasias hematológicas que se considere que tienen una justificación sólida para contemplar el tratamiento combinado con BLU-263 y un FHM.
    E.4Principal exclusion criteria
    All Patients:
    1. Diagnosis of a Philadelphia chromosome positive malignancy.
    2. AML.
    3. If the patient is receiving corticosteroids, and the dose has not been stable for ≥7 days. This exclusion criterion is not applicable if a patient has disease that is progressing and there is a safety concern around delaying the patient’s study enrollment in order to stabilize the steroid dose and it is in the patient’s best interest to enroll in the study rapidly. In such cases, patients may be considered for enrollment following Sponsor Medical Monitor approval.
    4. Within the 14 days prior to enrollment, patient has received any antineoplastic therapy or an investigational agent. Before obtaining the Screening BM Biopsy, at least 28 days must have
    elapsed since the most recent dose of Cladribine, interferon alpha, pegylated interferon and any antibody therapy (eg, brentuximab, vedotin). If the site is unsure of the appropriate wash out period for a specific drug product, they should consult the Medical Monitor.
    5. Patient has received hydroxyurea within 7 days prior to the first dose of BLU-263.
    6. Have any of the following laboratory abnormalities on last laboratory assessment within 14 days prior to the first dose of initiation of study drug:
    a. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >3 × upper limit of normal (ULN); >5 × ULN if associated with clinically suspected liver infiltration by mastocytosis or another disease for which the patient enrolled into the study.
    b. Total bilirubin >1.5 × ULN; >3 × ULN if associated with liver infiltration by the disease being treated or in the presence of Gilbert’s Disease. (In the case of Gilbert’s disease, a direct bilirubin >2.0 ULN would be an exclusion.)
    c. Estimated (Cockcroft-Gault formula) or measured creatinine clearance <40 mL/min.
    d. Absolute neutrophil count (ANC) <0.5 × 109/L.
    7. Patient received prior HMA therapy (e.g., azacitidine, decitabine) for the current diagnosis.
    8. At the time of enrollment, patient must not be eligible for allogeneic hematopoietic stem cell transplantation, in the opinion of the Investigator. However, patients who may become eligible
    for transplant after cytoreduction while on study are eligible to participate.
    9. Patient received prior radiotherapy within 14 days of screening BM biopsy. Prior radiotherapy given to palliate specific sites of disease (eg, bone lesion) may be allowed with written approval
    of the Sponsor Medical Monitor.
    10. Patient received any hematopoietic growth factor (except erythropoietin) within 14 days of screening BM biopsy, or requiring growth factors to maintain adequate neutrophil or platelet levels. Those patients maintained on a chronic dose of erythropoietin, whose hemoglobin is stable, and dose of erythropoietin has not been changed in the prior 28 days are allowed on study.
    11. Patient received >1 prior selective KIT inhibitor.
    12. Patients who discontinued a prior selective KIT inhibitor due to a severe AE that was thought to be related to prior treatment will not be eligible to participate in the study.
    13. Patient requires therapy with a concomitant medication that is a strong inhibitor, strong inducer, or moderate inducer of CYP3A4.
    14. Patient has had a major surgical procedure within 14 days of the first dose of study drug. Minor surgical procedures such as central venous catheter placement, bone marrow biopsy, and
    feeding tube placement are not considered major surgical procedures and may be performed within the 14-day window.
    15. History of another primary malignancy that has been diagnosed or required therapy within 1 year prior to the first dose of study drug. The following are exempt from the 1-year limit: completely resected basal cell and squamous cell skin cancer, curatively treated localized prostate cancer, GI stromal tumor, and completely resected carcinoma in situ of any site.
    16. Tryptase <20 except in patients with MCL.
    17. Mean resting QT interval corrected using Fridericia’s formula (QTcF) >480 msec, a history of prolonged QT syndrome or Torsades de pointes, or a familial history of prolonged QT syndrome.
    18. Patient has a history of a seizure disorder (eg, epilepsy) or requirement for antiseizure medication
    19. Patient has a history of a cerebrovascular accident or transient ischemic attacks within 1 year prior to the first dose of study drug.
    20. Patient has a known risk of intracranial bleeding, such as a brain aneurysm or history of subdural or subarachnoid bleeding.
    21. A primary brain malignancy or metastases to the brain.
    22. Clinically significant, uncontrolled, cardiovascular disease, including congestive heart failure Grade III or IV according to the New York Heart Association classification, myocardial infarction or unstable angina within the previous 6 months, clinically significant, uncontrolled arrhythmias, or uncontrolled hypertension.

    Please refer to the study protocol for the complete list.
    Pacientes:
    1. Diagnóstico de neoplasia maligna positivo en cromosoma Filadelfia.
    2. LMA (leucemia mielode aguda).
    3. Paciente recibiendo corticosteroides y con dosis no estable durante >=7 días. No aplicable si un paciente tiene enfermedad progresando y hay preocupación de seguridad por retrasar la inclusión en estudio por estabilizar dosis de esteroide y lo mejor es inscribirlo en estudio rápidamente. Necesario
    Aprobación de Monitor Médico del promotor.
    4. Haber recibido 14 días antes terapia antineoplásica o un medicamento en investigación. Antes de obtener Biopsia de médula ósea en selección, debe haber al menos 28 días de lavado desde dosis más reciente de cladribina, interferón alfa, interferón pegilado y cualquier terapia con anticuerpos (p. ej., brentuximab, vedotina). Consultar al Monitor Médico en caso de duda.
    5. Haber recibido hidroxiurea en 7 días antes de primera dosis de BLU-263.
    6. Tener alguna de siguientes anomalías de laboratorio en la última evaluación en 14 días antes de primera dosis de inicio del estudio:
    a. Alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST) >3 × límite superior de lo normal (LSN); >5 × LSN si se asocia con sospecha clínica de infiltración hepática por mastocitosis u otra enfermedad por el que paciente se incluyó en estudio.
    b. Bilirrubina total >1,5 × LSN; >3 × LSN si se asocia con hígado infiltrado por enfermedad que se está tratando o en presencia de la enfermedad de Gilbert (en caso de enfermedad de Gilbert, una bilirrubina directa >2,0 LSN podría ser exclusión.)
    c. Aclaramiento de creatinina estimado (fórmula de Cockcroft-Gault) o medido <40 ml/min
    d. Recuento absoluto de neutrófilos (RAN) <0,5 × 109/L.
    7. Paciente recibió ttro previo con FHM (p. ej., azacitidina, decitabina) por diagnóst. actual.
    8. En selección, el paciente no debe ser elegible para trasplante alogénico de células madre hematopoyéticas, a juicio de Investig. Sin embargo, pacientes que pueden llegar a ser elegibles para trasplante después de citorreducción durante el estudio son elegibles para participar.
    9. Paciente que recibió radioterapia previa en los 14 días post a biopsia de BM en selección. Radioterapia previa administrada para paliar sitios específicos de enfermedad (p. ej., lesión ósea) puede permitirse con aprobación por escrito del Monitor Médico del promotor.
    10. Paciente que recibió algún factor crecimiento hematopoyético (excepto eritropoyetina) dentro de los 14 días post biopsia de BM en selección, o requieren factor de crecimiento para mantener niveles adecua. de neutrófilos o plaquetas. Esta permitido pacientes mantenidos con dosis crónica de eritropoyetina, cuyo hemoglobina es estable y la dosis no ha cambiado en 28 días anteriores.
    11. Paciente que recibió más de un inhibidor selectivo previo de KIT.
    12. Pacientes que interrumpieron inhibidor selectivo previo de KIT debido a EA grave relacionado con el tratamiento no serán elegibles a participar.
    13. Paciente que requiere terapia con medic. concomitante que sea inhibidor fuerte, inductor fuerte o moderado de CYP3A4.
    14. Paciente con proced. quirúrgico mayor en 14 días previos a primera dosis fármaco de estudio. Proced. quirúrgicos menores: cirugía venosa central, colocación de catéter, biopsia de médula ósea y colocación de sonda alimentación, se pueden realizar en ventana de 14 días.
    15. Antecedentes de otra neoplasia maligna primaria diagnosticada o terapia requerida un 1 año antes de primera dosis del fármaco del estudio. Están exentos: cáncer de piel de células y células escamosas basal completamente resecado, cáncer de próstata localizado y curado, tumor del estroma gastrointestinal y carcinoma in situ completamente resecado en cualquier sitio.
    16. Triptasa <20 excepto en pacientes con LCM.
    17. Intervalo QT medio corregido en reposo con fórmula de Fridericia (QTcF) >480 mseg, antecedentes síndrome QT prolongado o Torsades de pointes, o antecedentes familiares de síndrome QT prolongado.
    18. Paciente con antecedentes de trastorno convulsivo (p. ej., epilepsia) o requerimiento de medicamentos anticonvulsivos
    19. Paciente con antecedentes de accidente cerebrovascular o ataques isquémicos transitorio en año antes primera dosis de fármaco de estudio.
    20. Paciente con un riesgo conocido de sangrado intracraneal, como
    aneurisma cerebral o anteced. de hemorragia subdural o subaracnoidea.
    21. Neoplasia maligna cerebral primaria o metástasis en cerebro.
    22. Enfermedad cardiovascular clínic. Signific., no controlada, incluyendo Insuficiencia cardíaca congestiva Grado III o IV según Clasificación Asociación New York Heart, infarto de miocardio o angina inestable en 6 meses antes, clínic. Signific., arritmias o hipertensión no controlada.

    Consulte el protocolo del estudio para obtener la lista completa.
    E.5 End points
    E.5.1Primary end point(s)
    Arm 1 - Dose escalation:
    1. The RD will be primarily determined by the number of dose-limiting toxicities (DLTs) in the first 28 days of treatment with BLU-263 monotherapy.
    Arm 1 - Dose Escalation & Dose Expansion:
    1. Safety profile of BLU-263, as assessed by the type, frequency, severity, timing, and relationship to study drug of any AEs or SAEs, and changes in vital signs, ECGs, and safety laboratory tests.
    2. PPR (CR + CRh + PR) rate for SM in selective KIT inhibitor-naïve patients.

    Arm2 - Dose Escalation:
    1. The RD will be primarily determined by the number of DLTs (during 28 days starting from Day 15 of C1 or Day 15 of C2) with BLU-263 in combination with azacitidine.
    2. Safety profile of BLU-263, as assessed by the type, frequency, severity, timing, and relationship to study drug of any AEs or SAEs, and changes in vital signs, ECGs, and safety laboratory tests.
    Arm 2 - Dose Expansion:
    1. Safety profile of BLU-263, as assessed by the type, frequency, severity, timing, and relationship to study drug of any AEs or SAEs, and changes in vital signs, ECGs, and safety laboratory tests.
    Brazo 1 - Aumento de dosis:
    1. La dosis recomendada (DR) estará determinada principalmente por el número de toxicidades de dosis limitantes (TDL) en los primeros 28 días de tratamiento en monoterapia con BLU-263
    Brazo 1 - Aumento de dosis y expansión de dosis:
    1. Perfil de seguridad de BLU-263, evaluado por el tipo, frecuencia, la gravedad, el momento y la relación con el fármaco del estudio de cualquier EA o SAE, y cambios en los signos vitales, ECG y pruebas de laboratorio de seguridad.
    2. Tasa de RAP (RC + RCh + RP) para MS en pacientes de novo con inhibidores selectivos de KIT
    Arm2 - Escalada de dosis:
    1. El DR estará determinado principalmente por el número de TDL (durante 28 días a partir del día 15 de C1 o el día 15 de C2) con BLU-263 en combinación con azacitidina.
    2. Perfil de seguridad de BLU-263, evaluado por el tipo, frecuencia, la gravedad, el momento y la relación con el fármaco del estudio de cualquier EA o SAE, y cambios en los signos vitales, ECG y pruebas de laboratorio de seguridad.
    Brazo 2 - Expansión de dosis:
    1. Perfil de seguridad de BLU-263, evaluado por el tipo, frecuencia,
    la gravedad, el momento y la relación con el fármaco del estudio de cualquier EA o SAE, y
    cambios en los signos vitales, ECG y pruebas de laboratorio de seguridad.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Arm 1 - Dose escalation:
    1. In the first 28 days of treatment with BLU-263 monotherapy.
    Arm 1 - Dose Escalation & Dose Expansion:
    1. Throughout the study
    2. C3D1, C7D1, C11D1 and C17D1 and then every 6 cycles (eg. C23, C29, C35 etc); EoT (14 days post last dose); every 6 Month (F/U for PFS)

    Arm2 - Dose Escalation:
    1. During 28 days starting from Day 15 of C1 or Day 15 of C2.
    2. Throughout the study.
    Arm 2 - Dose Expansion:
    1. Throughout the study
    Brazo 1 - Aumento de dosis:
    1. En los primeros 28 días de tratamiento con monoterapia BLU-263.
    Brazo 1 - Aumento de dosis y expansión de dosis:
    1. A lo largo del estudio
    2. C3D1, C7D1, C11D1 y C17D1 y luego cada 6 ciclos (por ejemplo, C23, C29,
    C35, etc.); fin de tratamiento (14 días después de la última dosis); cada 6 meses (seguimiento para supervivencia libre de progresión )
    Arm2 - Escalada de dosis:
    1. Durante 28 días a partir del Día 15 de C1 o Día 15 de C2.
    2. A lo largo del estudio.
    Brazo 2 - Expansión de dosis:
    1. A lo largo del estudio
    E.5.2Secondary end point(s)
    Arm 1 - Dose Escalation & Dose Expansion:
    1. ORR (CR + CRh + PR + Clinical Improvement) for AdvSM, using modified IWG-MRT-ECNM
    2. PK parameters of BLU-263 including: Cmax, Tmax, AUC0-24, Vz/F, t½, CL/F, and accumulation ratio
    3. OS
    4. Time-to-response, DOR, and PFS.
    5. Proportion of patients pursuing stem cell transplant.

    Arm 2:
    1. ORR for SM, using modified IWG-MRT-ECNM
    2. PPR rate for SM
    3. PK parameters of BLU-263 and azacitidine including: Cmax, Tmax, AUC0-24, Vz/F, t½, CL/F, and accumulation ratio
    Brazo 1 - Aumento de dosis y expansión de dosis:
    1. Tasa de respuesta global (TRG) (RC + RCh + RP + Mejoría clínica) para MSAv, usando
    modificado IWG-MRT-ECNM
    2. Parámetros FC de BLU-263 que incluyen: Cmax, Tmax, AUC0-24, Vz/F, t½,
    CL/F, y relación de acumulación
    3. Supervivencia global
    4. Tiempo de respuesta, Duración de respuesta y supervivencia libre de progresión.
    5. Proporción de pacientes que solicitan un trasplante de células madre.
    Brazo 2:
    1. TRG para MS, utilizando IWG-MRT-ECNM modificado
    2. Tasa RAP para MS
    3. Parámetros farmacocinéticos de BLU-263 y azacitidina, incluidos: Cmax, Tmax,
    AUC0-24, Vz/F, t½, CL/F y relación de acumulación
    E.5.2.1Timepoint(s) of evaluation of this end point
    Arm 1 - Dose Escalation & Dose Expansion:
    1. C3D1, C7D1, C11D1 and C17D1 and then every 6 cycles; EoT; every 6 Month
    2. PK: Escalation (C1 D1, 2, 15, 16, C2D1, C3D1, C4D1); Expansion (C1D1, 15, C2D1, C3D1, C4D1)
    3. Throughout the study
    4. Throughout the study
    5. Throughout the study

    Arm 2:
    1. C3D1, C7D1, C11D1 and C17D1 and then every 6 cycles; EoT; every 6 Month
    2. C3D1, C7D1, C11D1 and C17D1 and then every 6 cycles; EoT; every 6 Month
    3. PK: Dose escalation(C1D1, 2, 15, 16, 28, C2D1, C3D1, C4D1); Dose Expansion (C1D1, 15, C2D1, C3D1).
    Brazo 1 - Aumento de dosis y expansión de dosis:
    1. C3D1, C7D1, C11D1 y C17D1 y luego cada 6 ciclos; fin de ttro; cada 6 meses
    2. PK: Escalada (C1 D1, 2, 15, 16, C2D1, C3D1, C4D1); Expansión (C1D1, 15, C2D1, C3D1, C4D1)
    3. A lo largo del estudio
    4. A lo largo del estudio
    5. A lo largo del estudio

    Brazo 2:
    1. C3D1, C7D1, C11D1 y C17D1 y luego cada 6 ciclos; fin de ttro; cada 6 meses
    2. C3D1, C7D1, C11D1 y C17D1 y luego cada 6 ciclos; fin de ttro; cada 6 meses
    3. PK: escalada de dosis (C1D1, 2, 15, 16, 28, C2D1, C3D1, C4D1); Expansión de dosis (C1D1, 15, C2D1, C3D1)
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    2 arms, dose escalation - dose expansion study
    2 brazos, estudio aumento de dosis-expansión de dosis
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA11
    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
    Korea, Republic of
    Taiwan
    United States
    France
    Netherlands
    Spain
    Germany
    Belgium
    Norway
    Portugal
    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
    LPLV
    Ultimo paciente, útima visita
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years7
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years7
    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: 80
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 28
    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 state5
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 108
    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)
    There are no plans for continuing study drug access following the end of the study. Patients will receive standard care following disease progression or other criteria for discontinuation of treatment
    No hay planes para continuar con el acceso al fármaco del estudio después de la finalización del estudio. Los pacientes recibirán tratamiento estándar después de la progresión de la enfermedad u otros criterios para la interrupción del tratamiento.
    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 Decision2023-05-12
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-01-17
    P. End of Trial
    P.End of Trial StatusOngoing
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