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    Summary
    EudraCT Number:2022-001547-25
    Sponsor's Protocol Code Number:ZILO-301
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2023-01-31
    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 number2022-001547-25
    A.3Full title of the trial
    A Phase 3, Randomized, Double-Blind, Placebo-Controlled, Multicenter Study of Zilovertamab (an ROR1 Antibody) Plus Ibrutinib Versus Ibrutinib Plus Placebo in Subjects with Relapsed or Refractory Mantle Cell Lymphoma
    Estudio en fase III, aleatorizado, doble ciego, controlado con placebo y multicéntrico de zilovertamab (anticuerpo anti-ROR1) más ibrutinib frente a ibrutinib más placebo en pacientes con linfoma de células del manto recidivante o resistente al tratamiento
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 3 study of Zilovertamab in addition to Ibrutinib in Subjects with Relapsed or Refractory Mantle Cell Lymphoma
    Estudio en fase III de zilovertamab en combinación con ibrutinib en pacientes con linfoma de células del manto recidivante o resistente
    A.3.2Name or abbreviated title of the trial where available
    N/A
    N/A
    A.4.1Sponsor's protocol code numberZILO-301
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT05431179
    A.5.4Other Identifiers
    Name:INDNumber:133131
    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 SponsorOncternal 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 supportOncternal Therapeutics, Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationOncternal Therapeutics, Inc
    B.5.2Functional name of contact pointSusette Gorak
    B.5.3 Address:
    B.5.3.1Street Address12230 El Camino Real, Ste. 230
    B.5.3.2Town/ citySan Diego, CA
    B.5.3.3Post code92130
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1760 525 1134
    B.5.5Fax number+1858 408 3010
    B.5.6E-mailRegulatory@Oncternal.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 nameZilovertamab
    D.3.2Product code Zilovertamab
    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 INNZilovertamab
    D.3.9.1CAS number 1643432-38-5
    D.3.9.2Current sponsor codeZilovertamab
    D.3.9.3Other descriptive nameCirmtuzumab, UC-961
    D.3.9.4EV Substance CodeSUB194646
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    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) No
    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 Yes
    D.2.5.1Orphan drug designation numberEU/3/13/1115
    D.3 Description of the IMP
    D.3.1Product nameIbrutinib
    D.3.2Product code PCI-32765
    D.3.4Pharmaceutical form Capsule, hard
    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 INNIbrutinib
    D.3.9.1CAS number 936563-96-1
    D.3.9.2Current sponsor codePCI 32765
    D.3.9.3Other descriptive nameIBRUTINIB
    D.3.9.4EV Substance CodeSUB120863
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number140
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product 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
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Relapsed or Refractory Mantle Cell Lymphoma
    Linfoma de células del manto recidivante o resistente
    E.1.1.1Medical condition in easily understood language
    Mantle Cell Lymphoma
    Linfoma de células del manto
    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 PT
    E.1.2Classification code 10061275
    E.1.2Term Mantle cell lymphoma
    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 21.1
    E.1.2Level PT
    E.1.2Classification code 10026801
    E.1.2Term Mantle cell lymphoma refractory
    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 21.0
    E.1.2Level PT
    E.1.2Classification code 10026800
    E.1.2Term Mantle cell lymphoma recurrent
    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
    The primary objective is to determine if progression-free survival (PFS), as assessed by Blinded Independent Central Review (BICR) per Lugano Classification, is superior for ibrutinib plus zilovertamab compared to ibrutinib plus placebo among subjects with relapsed or refractory (R/R) mantle cell lymphoma (MCL) that had a PR or SD after 16 weeks of ibrutinib monotherapy.
    El objetivo principal es determinar si la supervivencia sin progresión (SSP), evaluada mediante revisión central independiente enmascarada (RCIE) según la clasificación de Lugano, es superior para ibrutinib más zilovertamab en comparación con ibrutinib más placebo en pacientes con linfoma de células del manto (LCM) recidivante o resistente (R/R) que tuvieron una respuesta parcial (RP) o enfermedad estable (EE) después de 16 semanas de ibrutinib en monoterapia.
    E.2.2Secondary objectives of the trial
    1. ORR and DOR, as assessed by BICR per Lugano Classification, among the subjects who received the combination of zilovertamab plus ibrutinib compared with the subjects who received ibrutinib plus placebo.
    2. CR rate as assessed by BICR per Lugano Classification, among the subjects who received the combination of zilovertamab plus ibrutinib compared with the subjects who received ibrutinib plus placebo.
    3. Proportion of subjects experiencing Grade 3 to 4 neutrophil count decrease among the subjects who received the combination of zilovertamab plus ibrutinib compared with the subjects who received ibrutinib plus placebo based on laboratory abnormalities.
    4. OS among the subjects who received the combination of zilovertamab plus ibrutinib compared with the subjects who received ibrutinib plus placebo.
    5. Overall safety profile among the subjects who received the combination of zilovertamab plus ibrutinib compared with the subjects who received ibrutinib plus placebo.
    1.TRO y DR, evaluadas mediante RCIE según la clasificación de Lugano, en los pacientes que recibieron la combinación de zilovertamab más ibrutinib en comparación con los que recibieron ibrutinib más placebo.
    2.Tasa de RC, evaluada mediante RCIE según la clasificación de Lugano, en pacientes que recibieron la combinación de zilovertamab más ibrutinib en comparación con los que recibieron ibrutinib más placebo.
    3.Proporción de pacientes que experimentan un descenso del recuento de neutrófilos de grado 3 o 4 en los pacientes que recibieron la combinación de zilovertamab más ibrutinib en comparación con los que recibieron ibrutinib más placebo, en función de las anomalías en el análisis.
    4.SG en pacientes que recibieron la combinación de zilovertamab más ibrutinib en comparación con los que recibieron ibrutinib más placebo.
    5.Perfil de seguridad general en pacientes que recibieron la combinación de zilovertamab más ibrutinib en comparación con los que recibieron ibrutinib más placebo.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Men and women of age >=18 years.
    2. Subject has histologically confirmed MCL with documented overexpression of cyclin D1, or t(11;14) translocation, or relevant immunophenotype (eg, CD5, CD19, CD20, SOX11).
    3. Subject has received at least one prior regimen for MCL.
    4. Subject has R/R disease, defined by the following:
    a. Relapse is defined as PD following an initial response to prior therapy, and
    b. Refractory disease is defined as PD as a best response to prior therapy or PD within a short period of time (< 6 months).
    5. Subject has at least 1 measurable site of disease that is >= 2.0 cm in the longest diameter and measurable in 2 perpendicular dimensions by computed tomography (CT).
    6. Subject must have a combined positron emission tomography (PET)-CT performed less than 28 days prior to study entry. If the subject’s MCL is non-fluorodeoxyglucose (FDG)-avid, subject must have a bone marrow biopsy performed less than 28 days prior to study entry.
    7. If a subject has toxicities due to prior therapy for the treatment of MCL, the subject must be stable and recovered to <= Grade 1 (except for clinically non-significant toxicities such as alopecia).
    8. Subject has an Eastern Cooperative Oncology Group performance status of 0 or 1.
    9. Subject must meet the following laboratory parameters:
    a. Absolute neutrophil count of > 1.0 × 10^9/L independent of growth factor support within 7 days of study entry.
    b. Platelet count > 75 × 10^9/L without transfusion support within 7 days of study entry.
    c. Hemoglobin >= 8.0 g/dL maintained without transfusion support within 7 days of study entry.
    d. Serum aspartate aminotransferase/serum glutamic-oxaloacetic transaminase (AST/SGOT) and alanine aminotransferase/serum glutamic-pyruvic transaminase (ALT/SGPT) <= 3.0 × upper limit of normal (ULN).
    e. Total bilirubin <= 1.5 × ULN.
    f. Estimated creatinine clearance (ie, estimated glomerular filtration rate using Cockcroft-Gault) >= 30 mL/min.
    g. International normalized ratio (INR) <= 1.5 and activated partial thromboplastin time <= 1.5 × ULN.
    10. For female subjects of childbearing potential, a negative urine or serum pregnancy test within 72 hours prior to the start of ibrutinib monotherapy.
    11. For female subjects of childbearing potential, willingness to use an effective method of contraception from the start of the Screening Phase until >= 3 months after the last dose of blinded infusion or >= 1 month after the last dose of ibrutinib, whichever is later. Note: A female subject is considered to be of childbearing potential unless she has had a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy; has medically documented ovarian failure (with serum estradiol and follicle-stimulating hormone levels within the institutional laboratory postmenopausal range and a negative serum or urine beta human chorionic gonadotropin [βHCG]); or is menopausal (age >= 50 years with amenorrhea for >= 6 months).
    12. For male subjects who can father a child with a female partner of childbearing potential, willingness to use an effective method of contraception and refrain from sperm donation from the start of ibrutinib monotherapy until >= 3 months after the last dose of ibrutinib or blinded infusion, whichever is later. Note: A male subject is considered able to father a child unless he has had a bilateral vasectomy with documented aspermia or a bilateral orchiectomy.
    1. Hombres y mujeres de >= 18 años de edad.
    2. El paciente tiene LCM confirmado histológicamente con sobreexpresión documentada de ciclina D1 o translocación t(11;14) o inmunofenotipo relevante (p. ej., CD5, CD19, CD20, SOX11).
    3. El paciente ha recibido al menos un tratamiento previo para el LCM.
    4. El paciente tiene enfermedad R/R, definida por lo siguiente:
    a. La recidiva se define como progresión de la enfermedad (PE) tras una respuesta inicial al tratamiento previo
    y
    b. La enfermedad resistente al tratamiento se define como PE como la mejor respuesta al tratamiento previo o PE en un periodo de tiempo corto (< 6 meses).
    5. El paciente tiene al menos 1 lugar de la enfermedad medible que es >= 2,0 cm en el diámetro más largo y medible en 2 dimensiones perpendiculares mediante tomografía axial computarizada (TAC).
    6. El paciente debe tener una tomografía por emisión de positrones (TEP) combinada con TAC realizada menos de 28 días antes de la entrada en el estudio. Si el LCM del paciente no tiene avidez por la fluorodesoxiglucosa (FDG), el paciente debe tener una biopsia de médula ósea realizada menos de 28 días antes de la entrada en el estudio.
    7. Si un paciente presenta toxicidades debidas al tratamiento previo para el LCM, el paciente debe estar estable y haberse recuperado hasta un grado <= 1 (excepto las toxicidades clínicamente no significativas, como la alopecia).
    8. El paciente tiene un estado funcional de 0 o 1, según el Grupo Oncológico Cooperativo del Este.
    9. El paciente debe cumplir los siguientes parámetros analíticos:
    a. Recuento absoluto de neutrófilos > 1,0 × 10^9/l independientemente del apoyo con factor de crecimiento en los 7 días previos a la entrada en el estudio.
    b. Recuento de plaquetas > 75 × 10^9/l sin apoyo con transfusión en los 7 días previos a la entrada en el estudio.
    c. Hemoglobina >= 8,0 g/dl mantenida sin apoyo con transfusión en los 7 días previos a la entrada en el estudio.
    d. Aspartato aminotransferasa/transaminasa glutámico-oxalacética (AST/SGOT) en suero y alanina aminotransferasa/ transaminasa glutámico-pirúvica (ALT/SGPT) en suero <= 3,0 × el límite superior de la normalidad (LSN).
    e. Bilirrubina total <= 1,5 × LSN.
    f. Aclaramiento de creatinina estimado (es decir, índice de filtración glomerular estimado
    mediante Cockcroft-Gault) >= 30 ml/min.
    g. Índice internacional normalizado (INR) <= 1,5 y tiempo de tromboplastina
    parcial activada <= 1,5 × LSN.
    10. Para mujeres en edad fértil, un resultado negativo en la prueba de embarazo en orina o suero en las 72 horas previas al inicio de ibrutinib en monoterapia.
    11. En el caso de las mujeres en edad fértil, disposición a utilizar un método anticonceptivo eficaz desde el inicio de la fase de selección hasta >= 3 meses después de la última dosis de la perfusión enmascarada o >= 1 mes después de la última dosis de ibrutinib, lo que ocurra más tarde. Nota: se considera que una paciente de sexo femenino tiene capacidad de concebir a menos que se haya sometido a una histerectomía, ligadura de trompas bilateral u ovariectomía bilateral; tenga insuficiencia ovárica documentada médicamente (con niveles en suero de estradiol y folitropina dentro del intervalo menopáusico institucional del laboratorio y un resultado negativo en suero u orina de la gonadotropina coriónica humana beta [βHCG]); o esté en la menopausia (edad >= 50 años con amenorrea durante >= 6 meses).
    12. En el caso de los hombres que puedan engendrar un hijo con una pareja femenina en edad fértil, disposición a utilizar un método anticonceptivo eficaz y abstenerse de donar esperma desde el inicio de ibrutinib en monoterapia hasta >= 3 meses después de la última dosis de ibrutinib o de la perfusión enmascarada, lo que ocurra más tarde. Nota: se considera que un paciente de sexo masculino es capaz de engendrar un hijo a menos que se haya sometido a una vasectomía bilateral con aspermia documentada o a una orquiectomía bilateral.
    E.4Principal exclusion criteria
    1. Subject has had more than one month of prior therapy with ibrutinib or any other BTK inhibitor or did not tolerate therapy with any BTK inhibitor.
    2. Subject has concurrent enrollment in another therapeutic investigational study.
    3. Subject has transfusion-dependent thrombocytopenia.
    4. Subject has received anticancer therapy, including chemotherapy, monoclonal antibody, or targeted agents within 21 days (or at least 5 drug half-lives, whichever is shorter) prior to the start of ibrutinib monotherapy.
    5. Subject has a history of other malignancy, with the exception of non-melanomatous skin cancer or carcinoma in situ (eg, cervix, bladder, breast), or indolent prostate cancer, unless disease free for at least 3 years prior to study entry.
    6. Subject has known active or prior central nervous system (CNS) involvement with lymphoma (eg, detectable cerebrospinal fluid malignant cells or brain metastases). Subjects with prior CNS involvement are eligible if they have had no evidence of active CNS disease for >= 12 months prior to study entry.
    7. Subject has a history or presence of CNS disorder (eg, as seizure disorder, cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, cerebral edema, posterior reversible encephalopathy syndrome, or any autoimmune disease with CNS involvement) within 6 months of study entry.
    8. Subject has a history of clinically significant cardiac disease within 6 months of study entry.
    9. Subject has active or prior cardiac (atrial or ventricular) lymphoma involvement.
    10. Subject has a history of atrial fibrillation or left or right bundle branch block.
    11. Subject has a history of symptomatic deep vein thrombosis or pulmonary embolism <= 6 months of study entry.
    12. Subject has chronic liver disease with hepatic impairment, Child-Pugh class B or C.
    13. Subject has a known bleeding disorder.
    14. Subject has had a prior stem cell transplant that requires ongoing immunosuppressive therapy or active clinical graft versus host disease.
    15. Subject has primary severe immunodeficiency.
    16. Subject has a history of human immunodeficiency virus infection or has active hepatitis B or C infection.
    17. Subjects may not have any active infection requiring IV antimicrobial (anti-viral, antibiotic, anti-fungal) therapy at the time of study entry. Subjects with an infection requiring IV antimicrobial therapy must have completed all antimicrobial therapy <= 14 days of study entry. Subjects with a recent self-limited infection that has clinically resolved may complete a prescribed course of antimicrobial therapy after study entry as long as they are asymptomatic with no clinical evidence of infection for >= 7 days prior to study entry.
    18. Subject has been vaccinated with a live, attenuated vaccine <= 4 weeks of the first dose of ibrutinib.
    19. Subject has a history of hypersensitivity reaction to any of the agents used in this study.
    20. Subject requires treatment with a strong CYP3A inhibitor/inducer.
    21. Subject is unable to swallow capsules or tablets, or has malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, symptomatic inflammatory bowel disease or ulcerative colitis, or partial or complete bowel obstruction.
    22. Subject has had major surgery <= 4 weeks of the first dose of ibrutinib.
    23. Subject has any medical condition likely to interfere with assessment of safety or efficacy of the study drug.
    24. Subject is unlikely to complete all protocol-required study visits or procedures, including follow-up visits, or comply with the study requirements for participation in the Investigator’s opinion.
    25. Subject is not willing to practice contraception.
    26. Subject is pregnant.
    27. Subject is breastfeeding (unless the subject agrees to discontinue breastfeeding during protocol therapy and for >= 3 months after the last infusion and for >= 1 month after the last dose of ibrutinib, whichever is later).

    Exclusion Criteria for Randomized Double-Blind Treatment Phase

    • Best response of CR.
    • Progressive disease at any time during the 16-week Open-Label Ibrutinib Monotherapy Treatment Phase.
    • More than 2 ibrutinib dose reductions and/or 2 interruptions with a duration of >7 days each.
    • Atrial fibrillation of grade 1 or 2 unresolved at the time of randomization. Occurrence of atrial fibrillation of grade 3 or 4 any time prior to randomization.
    • An unacceptable safety profile deemed by the Investigator as related to ibrutinib therapy.
    • Any non-hematological >= Grade 3 toxicity unresolved at the time of randomization.
    • Any hematological Grade 4 toxicity unresolved at the time of randomization.
    • Other Investigator concerns (eg, inadequate compliance with therapy or study assessments).
    1.El paciente ha recibido más de 1 mes de tratamiento previo con ibrutinib o cualquier otro inhibidor de BTK o no toleró el tratamiento con ningún inhibidor de BTK.2.Está incluido a la vez en otro estudio de investigación.3.Tiene trombocitopenia dependiente de transfusión.4.Ha recibido tratamiento contra el cáncer, lo que incluye quimioterapia, anticuerpo monoclonal o agentes dirigidos, en los 21 días (o al menos 5 semividas del fármaco, lo que sea más corto) previos al inicio de ibrutinib en monoterapia.5.Tiene antecedentes de otras neoplasias malignas, a excepción del cáncer de piel no melanoma, carcinoma in situ o cáncer de próstata indolente, a menos que esté libre de enfermedad durante al menos 3 años antes de la entrada en el estudio.6.Presenta afectación activa o previa conocida del SNC por el linfoma. Los pacientes con afectación previa del SNC son aptos si no han presentado indicios de enfermedad activa del SNC durante >=12 meses antes de la entrada en el estudio.7.Tiene antecedentes o presencia de trastorno del SNC en los 6 meses previos a la entrada en el estudio.8.Tiene antecedentes de cardiopatía clínicamente significativa en los 6 meses previos a la entrada en el estudio.9.Presenta afectación cardíaca (auricular o ventricular) activa o previa por el linfoma.10.Tiene antecedentes de fibrilación auricular o bloqueo de la rama izquierda o derecha.11.Tiene antecedentes de trombosis venosa profunda sintomática o embolia pulmonar <=6 meses antes de la entrada en el estudio.12.El paciente tiene hepatopatía crónica con insuficiencia hepática, clase B o C de Child-Pugh.13.Tiene un trastorno hemorrágico conocido.14.Ha recibido previamente un trasplante de células madre que requiere tratamiento inmunosupresor en curso o tiene enfermedad de injerto contra huésped clínica activa.15.Tiene inmunodeficiencia primaria grave.16.Tiene antecedentes de infección por el virus de la inmunodeficiencia humana o tiene infección activa por el virus de la hepatitis B o C. 17.Los pacientes no pueden tener ninguna infección activa que requiera tratamiento antimicrobiano intravenoso (antivírico, antibiótico, antifúngico) en el momento de la entrada en el estudio. Los pacientes con infección que requiera tratamiento antimicrobiano intravenoso deben haber finalizado todo el tratamiento antimicrobiano <=14 días antes de la entrada en el estudio. Los pacientes con infección autolimitada reciente que se haya resuelto clínicamente podrán realizar un ciclo de tratamiento antimicrobiano recetado, después de entrar en el estudio, siempre y cuando estén asintomáticos y sin indicios clínicos de infección durante >=7 días antes de la entrada en el estudio.18.El paciente ha sido vacunado con una vacuna con microorganismos vivos atenuados <=4 semanas antes de la primera dosis de ibrutinib.19.Tiene antecedentes de reacción de hipersensibilidad a cualquiera de los fármacos utilizados en este estudio.20.Requiere tratamiento con inhibidor/inductor potente de CYP3A.21.No puede tragar cápsulas o comprimidos, o tiene síndrome de malabsorción, una enfermedad que afecta de forma significativa a la función digestiva, tiene resección del estómago o del intestino delgado, tiene enfermedad inflamatoria intestinal o colitis ulcerosa sintomática, o tiene una obstrucción intestinal parcial o completa.22.Se ha sometido a cirugía mayor <=4 semanas antes de la primera dosis de ibrutinib.23.Tiene alguna enfermedad que posiblemente pueda interferir en la evaluación de la seguridad o la eficacia del fármaco del estudio.24.Tiene, según el investigador, pocas probabilidades de realizar todas las visitas o procedimientos del estudio requeridos por el protocolo, incluidas las visitas de seguimiento, o de cumplir con los requisitos del estudio para la participación.25.No está dispuesto a utilizar métodos anticonceptivos.26.La paciente está embarazada. 27.Está en periodo de lactancia (a menos que la paciente acepte interrumpir la lactancia materna durante el tratamiento del protocolo y durante >=3 meses después de la última perfusión y durante >=1 mes después de la última dosis de ibrutinib, lo que ocurra más tarde).Criterios de exclusión para el periodo de tratamiento aleatorizado doble ciego:•Mejor respuesta de RC.•Progresión de la enfermedad en cualquier momento durante el periodo de tratamiento abierto con ibrutinib en monoterapia de 16 semanas.•Más de 2 reducciones de la dosis de ibrutinib o 2 interrupciones con una duración de >7 días cada una.•Fibrilación auricular de grado 1 o 2 sin resolver en el momento de la aleatorización. Aparición de fibrilación auricular de grado 3 o 4 en cualquier momento antes de la aleatorización.•Perfil de seguridad inaceptable que el investigador considere relacionado con el tratamiento con ibrutinib.•Cualquier toxicidad no hematológica de grado >=3 sin resolver en el momento de la aleatorización.•Cualquier toxicidad hematológica de grado 4 sin resolver en el momento de la aleatorización.•Otras preocupaciones del investigador.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint is Progression Free Survival (PFS), assessed by BICR per Lugano Classification
    El criterio de valoración principal de la eficacia es la supervivencia sin progresión (SSP), evaluada mediante RCIE según la clasificación de Lugano
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the study
    Durante todo el estudio
    E.5.2Secondary end point(s)
    Key secondary endpoints include:

    • ORR and DOR assessed by BICR per Lugano Classification.
    • CR rate, DOCR, and time to CR assessed by BICR per Lugano Classification.
    • Proportion of Grade 3 to 4 neutrophil count decrease.
    • OS.
    Los criterios de valoración secundarios clave son:

    • TRO y DR evaluadas mediante RCIE según la clasificación de Lugano.
    • Tasa de RC, duración de la respuesta completa (DRC) y tiempo hasta la RC evaluadas mediante RCIE según la clasificación de Lugano.
    • Proporción de disminución del recuento de neutrófilos de grado 3 a 4.
    • SG.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Throughout the study
    Durante todo el estudio
    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 No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Immunogenicity and biomarker assessments
    Evaluaciones de inmunogenicidad y biomarcadores.
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    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
    Periodo de tratamiento abierto con ibrutinib en monoterapia inicial
    Initial Open-Label Ibrutinib Monotherapy Treatment Phase
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    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 concerned9
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA70
    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
    Israel
    Korea, Republic of
    United States
    France
    Poland
    Spain
    Germany
    Italy
    Belgium
    Hungary
    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

    The study will be considered complete when the last subject has completed their final follow-up visit or procedure (per Table 1) or has experienced a PFS event or death.
    UVUP

    Se considerará que el estudio se ha completado cuando el último paciente haya completado su visita o procedimiento de seguimiento final (según la tabla 1) o haya experimentado un acontecimiento de SSP o muerte.
    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 months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    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: 274
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 91
    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 state35
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 179
    F.4.2.2In the whole clinical trial 365
    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

    If a subject exhibits PR or CR at the end of the Randomized Double-Blind Treatment Phase, combination treatment may be available after discussion with the Sponsor or designee until there is an occurrence of PD, unacceptable toxicity, or the study ends.
    Ninguno

    Si un paciente muestra RP o RC al final del periodo de tratamiento doble ciego aleatorizado, el tratamiento combinado podría estar disponible después de comentarlo con el promotor o la persona designada hasta que se produzca una PE, toxicidad inaceptable o la finalización del estudio.
    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 Decision2023-03-30
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-02-20
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2023-04-06
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