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    Summary
    EudraCT Number:2022-002419-48
    Sponsor's Protocol Code Number:GETNE-T2216
    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:2023-01-16
    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 number2022-002419-48
    A.3Full title of the trial
    Biomarker Phase II Study Of Cabozantinib In Advanced Radioactive-Iodine Refractory Differentiated Thyroid Cancer.
    Estudio de fase II con biomarcadores de cabozantinib en cáncer de tiroides diferenciado avanzado refractario al yodo radiactivo.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Biomarker Phase II Study Of Cabozantinib In Advanced Radioactive-Iodine Refractory Differentiated Thyroid Cancer.
    Estudio de fase II con biomarcadores de cabozantinib en cáncer de tiroides diferenciado avanzado refractario al yodo radiactivo.
    A.3.2Name or abbreviated title of the trial where available
    CABOTHYROID
    A.4.1Sponsor's protocol code numberGETNE-T2216
    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 SponsorGrupo Español de Tumores Neuroendocrinos y Endocrinos (GETNE)
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportIPSEN
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMFAR Clinical Research
    B.5.2Functional name of contact pointFederico Nepote
    B.5.3 Address:
    B.5.3.1Street AddressC/ Balmes 243 Esc A 5º 1ª
    B.5.3.2Town/ cityBarcelona
    B.5.3.3Post code08006
    B.5.3.4CountrySpain
    B.5.4Telephone number003493 434 44 12
    B.5.6E-mailinvestigacion@mfar.net
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name CABOMETYX
    D.2.1.1.2Name of the Marketing Authorisation holderIPSEN PHARMA
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    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 Capsule
    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 INNCabozantinib
    D.3.9.1CAS number 849217-68-1
    D.3.9.4EV Substance CodeSUB93452
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number20 to 60
    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
    Patients with radioiodine-refractory differentiated thyroid cancer (DTC).
    Pacientes con cáncer diferenciado de tiroides (DTC) refractario al yodo radioactivo.
    E.1.1.1Medical condition in easily understood language
    Patients thyroids cancer
    Pacientes con cáncer de tiroides
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10016935
    E.1.2Term Follicular thyroid cancer
    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 24.0
    E.1.2Level PT
    E.1.2Classification code 10033701
    E.1.2Term Papillary thyroid cancer
    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 10066474
    E.1.2Term Thyroid cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective to be tested in this phase II, single-arm, hypothesis generator study is the utility of the cfChIP-seq (Sadeh et al. 2021) on isolated chromatin nucleosomes from blood samples as a biomarker to predict response using cabozantinib therapy for patients with DTC.
    El objetivo principal que se probará en este estudio generador de hipótesis de fase II, de un solo brazo, es la utilidad de cfChIP-seq (Sadeh et al. 2021) en nucleosomas de cromatina aislados de muestras de sangre como biomarcador para predecir la respuesta de cabozantinib en pacientes con DTC.
    E.2.2Secondary objectives of the trial
    To validate cfCHIP-sep in DTC.
    To determine potential associations of cfChIP-seq signature with cabozantinib treatment efficacy outcomes (i.e. ORR, PFS, OS) in DTC.
    To determine potential associations of cfChIP-seq signature with cabozantinib associated toxicities in DTC.
    To determine potential associations of cfChIP-seq signature with patient reported outcomes in patients with DTC treated with cabozantinib.
    Validar cfCHIP-sep en DTC.
    Determinar las asociaciones potenciales de la firma cfChIP-seq con los resultados de eficacia del tratamiento con cabozantinib (es decir, ORR, PFS, OS) en DTC.
    Determinar las asociaciones potenciales de la firma cfChIP-seq con las toxicidades asociadas a cabozantinib en DTC.
    Determinar las asociaciones potenciales de la firma cfChIP-seq con los resultados informados por los pacientes en pacientes con DTC tratados con cabozantinib.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Male or female subjects ≥ 18 years old.
    2. Written informed consent approved by the Independent Ethics Committee (IEC), prior to the performance of any trial activities.
    3. Histologically or cytologically confirmed diagnosis of DTC, including the following subtypes:

    a. Papillary thyroid carcinoma (PTC) including histological variants of PTC such as follicular variant, tall cell, columnar cell, cribriform-morular, solid, oxyphil, Warthin-like, trabecular, tumor with nodular fasciitis-like stroma, Hürthle cell variant of papillary carcinoma, poorly differentiated.

    b. Follicular thyroid carcinoma (FTC) including histological variants of FTC such as Hürthle cell, clear cell, insular, and poorly differentiated.

    4. Measurable disease according to RECIST 1.1 on computed tomography/magnetic resonance imaging (CT/MRI) performed within 28 days prior to first dose of study treatment.
    5. Must have been previously treated with or deemed ineligible for treatment with Iodine-131 for DTC.
    6. Must have been previously treated and experienced documented radiographic progression per RECIST 1.1 with one or two of the following VEGF-targeting TKI agents for DTC:
    a. Lenvatinib first-line or,
    b. Sorafenib first-line or,
    c. Two prior VEGFR TKIs.
    7. Recovery to baseline or ≤ Grade 1 (Common Terminology Criteria for Adverse Events Version 5 [CTCAE v 5.0]) from toxicities related to any prior treatments, unless AEs are clinically nonsignificant and/or stable on supportive therapy.
    Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1 (Appendix 4).
    Adequate organ and bone marrow function based upon meeting all of the following laboratory criteria within 10 days before first dose of study treatment:
    Absolute neutrophil count ≥ 1500/mm3 (≥ 1.5 GI/L) without receipt of granulocyte colony-stimulating factor support within 2 weeks before screening laboratory sample collection.
    Platelets ≥ 100,000/mm3 (≥ 100 GI/L) without receipt of transfusion within 2 weeks before screening laboratory sample collection
    Hemoglobin ≥ 9 g/dL (≥ 90 g/L) without receipt of transfusion within 2 weeks before screening laboratory sample collection
    Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) ≤ 3 × upper limit of normal (ULN). ALP ≤ 5 × ULN if the subject has documented bone metastases
    Bilirubin ≤ 1.5 × the upper limit of normal (ULN). For subjects with known Gilbert’s disease ≤ 3 × ULN
    Serum creatinine ≤ 2.0 × ULN or calculated creatinine clearance ≥ 30 mL/min (≥ 0.5 mL/sec) using the Cockcroft-Gault (see Table 13 for Cockcroft-Gault formula)
    Urine protein/creatinine ratio (UPCR) ≤ 1 mg/mg (≤ 113.2 mg/mmol)
    Female subjects of childbearing potential (WOCBP) must provide a negative urine pregnancy test at screening, and must agree to use a medically accepted and highly effective birth control method (i.e. those with a failure rate less than 1%; refer to Appendix 5) for the duration of the study treatment and for 4 months after the final dose of cabozantinib.
    A woman is considered of childbearing potential ( i.e. fertile) following menarche and until becoming post-menopausal unless permanently sterile. Women will be considered post-menopausal if they have been amenorrhoeic for 12 months without an alternative medical cause. The following age-specific requirements apply:
    Amenorrheic for ≥1 year in the absence of chemotherapy and/or hormonal treatments
    Luteinizing hormone (LH) and/or follicle stimulating hormone and/or estradiol levels in the post-menopausal range
    Radiation induced oophorectomy with last menses >1 year ago
    Chemotherapy induced menopause with >1 year interval since last menses
    Surgical sterilization (bilateral oophorectomy or hysterectomy)
    Women <50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy)
    Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).
    Non-sterile males must be willing to use a highly effective method of birth control for the duration of the study treatment and for 4 months after the final dose of cabozantinib.
    A sterile male is defined as:
    a.One for whom azoospermia has been previously demonstrated in a semen sample examination as definitive evidence of infertility.
    Males with known “low sperm counts” (consistent with “sub-fertility”) are not to be considered sterile for purposes of this study.
    b.Capable of understanding and complying with the protocol requirements and signed informed consent.
    1. Sujetos masculinos o femeninos ≥ 18 años.
    2. Consentimiento informado por escrito aprobado por el Comité de Ética Independiente (IEC), antes de la realización de cualquier actividad del ensayo.
    3. Diagnóstico de CDT confirmado histológica o citológicamente, incluidos los siguientes subtipos:
    a. Carcinoma papilar de tiroides (PTC), incluidas las variantes histológicas de PTC, como la variante folicular, de células altas, de células columnares, cribiforme-morular, sólido, oxófilo, similar a Warthin, trabecular, tumor con estroma similar a fascitis nodular, variante de carcinoma papilar de células de Hürthle , poco diferenciados.
    b. Carcinoma folicular de tiroides (FTC) que incluye variantes histológicas de FTC como células de Hürthle, células claras, insulares y pobremente diferenciadas.
    4. Enfermedad medible según RECIST 1.1 en tomografía computarizada/resonancia magnética (CT/MRI) realizada dentro de los 28 días anteriores a la primera dosis del tratamiento del estudio.
    5. Debe haber sido tratado previamente o considerado no elegible para el tratamiento con yodo-131 para DTC.
    6. Debe haber sido tratado previamente y experimentado progresión radiográfica documentada según RECIST 1.1 con uno o dos de los siguientes agentes TKI dirigidos a VEGF para DTC: a. Lenvatinib de primera línea o, b. Sorafenib de primera línea o, c. Dos ITC VEGFR previos.
    7. Recuperación al valor inicial o ≤ Grado 1 (Criterios de terminología común para eventos adversos, versión 5 [CTCAE v 5.0]) de toxicidades relacionadas con cualquier tratamiento anterior, a menos que los AA no sean clínicamente significativos y/o sean estables con la terapia de apoyo.
    8. Estado funcional del Eastern Cooperative Oncology Group (ECOG PS) de 0 o 1.
    9. Función adecuada de órganos y médula ósea basada en el cumplimiento de todos los siguientes criterios de laboratorio dentro de los 10 días anteriores a la primera dosis del tratamiento del estudio:
    a. Recuento absoluto de neutrófilos ≥ 1500/mm3 (≥ 1,5 GI/L) sin haber recibido apoyo con factor estimulante de colonias de granulocitos en las 2 semanas anteriores a la recogida de muestras en el laboratorio de cribado.
    b. Plaquetas ≥ 100 000/mm3 (≥ 100 GI/L) sin recibir transfusión dentro de las 2 semanas anteriores a la recolección de muestras de laboratorio para la selección
    c. Hemoglobina ≥ 9 g/dL (≥ 90 g/L) sin haber recibido transfusión dentro de las 2 semanas anteriores a la recolección de muestras de laboratorio para la selección
    d. Alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y fosfatasa alcalina (ALP) ≤ 3 × límite superior normal (ULN). ALP ≤ 5 × ULN si el sujeto tiene metástasis óseas documentadas
    e. Bilirrubina ≤ 1,5 × el límite superior de la normalidad (LSN). Para sujetos con enfermedad de Gilbert conocida ≤ 3 × LSN
    f. Creatinina sérica ≤ 2,0 × LSN o aclaramiento de creatinina calculado ≥ 30 ml/min (≥ 0,5 ml/seg) usando la fórmula de Cockcroft-Gault (consulte la tabla 13 para la fórmula de Cockcroft-Gault)
    g. Proporción de proteína/creatinina en orina (UPCR) ≤ 1 mg/mg (≤ 113,2 mg/mmol)
    10. Las mujeres en edad fértil (WOCBP) deben proporcionar una prueba de embarazo en orina negativa en la selección y deben aceptar utilizar una prueba médicamente aceptada y altamente método anticonceptivo eficaz (es decir, aquellos con una tasa de fracaso inferior al 1 %; consulte la duración del tratamiento del estudio y durante los 4 meses posteriores a la dosis final de cabozantinib.
    Se considera que una mujer es fértil después de la menarquia y hasta la posmenopausia, a menos que esté permanentemente estéril Las mujeres se considerarán posmenopáusicas si han estado amenorreicas durante 12 meses sin una causa médica alternativa (para más detalles ver protocolo)
    11. Los varones no estériles deben estar dispuestos a utilizar un método anticonceptivo altamente eficaz durante el tratamiento del estudio y durante los 4 meses posteriores a la dosis final de cabozantinib. Un varón estéril se define como:
    a. Alguien para quien la azoospermia se ha demostrado previamente en un examen de muestra de semen como evidencia definitiva de infertilidad.
    Los varones con "recuento bajo de espermatozoides" conocido (congruente con "subfertilidad") no deben considerarse estériles para los fines de este estudio.
    b. Capaz de comprender y cumplir con los requisitos del protocolo y el consentimiento informado firmado.
    E.4Principal exclusion criteria
    1. Prior treatment with any of the following:
    a.Cabozantinib.
    b.Selective small-molecule BRAF kinase inhibitor (eg, vemurafenib, dabrafenib).
    c.Immune checkpoint inhibitor therapy (eg, PD-1 or PD-L1 targeting agent).
    d.Systemic chemotherapy regimen (given as a single agent or in combination with another chemotherapy agent).
    2.Receipt of any type of small molecule kinase inhibitor (including investigational kinase inhibitor) within 2 weeks or 5 half-lives of the agent, whichever is longer, before first dose of study treatment.
    3. Receipt of any type of anticancer antibody (including investigational antibody) within 4 weeks before first dose of study treatment.
    4. Receipt of radiation therapy for bone metastasis within 2 weeks or any other radiation therapy within 4 weeks before first dose of study treatment. Patients with clinically relevant ongoing complications from prior radiation therapy that have not completely resolved are not eligible (eg, radiation esophagitis or other inflammation of the viscera).
    5.Known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks before first dose of study treatment. Eligible subjects must be neurologically asymptomatic and without corticosteroid treatment at the time of inclusion.
    6. Concomitant anticoagulation with oral anticoagulants (eg, warfarin, direct thrombin and Factor Xa inhibitors) or platelet inhibitors (eg, clopidogrel), except for the following allowed anticoagulants:
    a. Low-dose aspirin for cardioprotection and low-dose low molecular weight heparins.
    b. Anticoagulation with therapeutic doses of LMWH in subjects without known brain metastases who are on a stable dose of LMWH for at least 6 weeks before first dose of study treatment and who have had no clinically significant hemorrhagic complications from the anticoagulation regimen or the tumor.
    7. The subject has uncontrolled, significant intercurrent or recent illness including, but not limited to, the following conditions:
    a. Cardiovascular disorders (see details in protocol)
    b. Gastrointestinal disorders (eg, malabsorption syndrome or gastric outlet obstruction) including those associated with a high risk of perforation or fistula formulation (see details in protocol)
    c. Clinically significant hematemesis or hemoptysis of > 0.5 teaspoon (> 2.5 mL) of red blood or history of other significant bleeding within 3 months before the first dose of study treatment.
    d. Cavitating pulmonary lesion(s) or known endobronchial disease manifestation.
    e. Lesions invading major pulmonary blood vessels.
    f. Other clinically significant disorders such as:
    i.Active infection requiring systemic treatment, infection with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome-related illness, or chronic hepatitis B (HBV) or C (HCV) infection.
    ii.Serious non-healing wound/ulcer/bone fracture.
    iii. Malabsorption syndrome.
    iv. Moderate to severe hepatic impairment (Child-Pugh B or C).
    v. Requirement for hemodialysis or peritoneal dialysis.
    vi. Uncontrolled diabetes mellitus.
    vii.History of solid organ transplantation.
    8. Major surgery (eg, GI surgery, removal or biopsy of brain metastasis) within 8 weeks before the first dose of study treatment. Complete wound healing from major surgery must have occurred 4 weeks before the first dose of study treatment and from minor surgery (eg, simple excision, tooth extraction) at least 10 days before the first dose of study treatment. Patients with clinically relevant ongoing complications from prior surgery are not eligible.
    9. Corrected QT interval calculated by the Fridericia formula (QTcF) > 500 ms within 28 days before the first dose of study treatment.
    Note: If a single ECG shows a QTcF with an absolute value > 500 ms, two additional ECGs at intervals of approximately 3 min must be performed within 30 min after the initial ECG, and the average of these 3 consecutive results for QTcF will be used to determine eligibility.
    (see exclusion criteria 10-14 in the protocol)
    1. Tratamiento previo con alguno de los siguientes:
    a.Cabozantinib.
    b. Inhibidor selectivo de la quinasa BRAF (p. ej., vemurafenib, dabrafenib).
    c.Terapia con inhibidores de puntos de control inmunitarios (p. ej., agente dirigido a PD-1 o PD-L1).
    d. Régimen de quimioterapia sistémica (administrado como agente único o en combinación con otro agente de quimioterapia).
    2. Recibir cualquier tipo de inhibidor de quinasa de molécula pequeña (incluido el inhibidor de quinasa en investigación) dentro de las 2 semanas o 5 semividas del agente, lo que sea más largo, antes de la primera dosis del tratamiento del estudio.
    3. Recepción de cualquier tipo de anticuerpo contra el cáncer (incluido el anticuerpo en investigación) dentro de las 4 semanas anteriores a la primera dosis del tratamiento del estudio.
    4. Recibir radioterapia para la metástasis ósea dentro de las 2 semanas o cualquier otra radioterapia dentro de las 4 semanas anteriores a la primera dosis del tratamiento del estudio. Los pacientes con complicaciones en curso clínicamente relevantes de la radioterapia previa que no se hayan resuelto por completo no son elegibles (p. ej., esofagitis por radiación u otra inflamación de las vísceras).
    5. Metástasis cerebrales conocidas o enfermedad epidural craneal a menos que se trate adecuadamente con radioterapia y/o cirugía (incluida la radiocirugía) y permanezca estable durante al menos 4 semanas antes de la primera dosis del tratamiento del estudio. Los sujetos elegibles deben estar neurológicamente asintomáticos y sin tratamiento con corticosteroides en el momento de la inclusión.
    6. Anticoagulación concomitante con anticoagulantes orales (p. ej., warfarina, trombina directa e inhibidores del factor Xa) o inhibidores plaquetarios (p. ej., clopidogrel), excepto los siguientes anticoagulantes permitidos:
    a. dosis bajas de aspirina para cardioprotección (según las pautas locales aplicables) y dosis bajas de heparinas de peso molecular (HBPM).
    b. Anticoagulación con dosis terapéuticas de HBPM en sujetos sin metástasis cerebrales conocidas que reciben una dosis estable de HBPM durante al menos 6 semanas antes de la primera dosis del tratamiento del estudio y que no han tenido complicaciones hemorrágicas clínicamente significativas por el régimen de anticoagulación o el tumor.
    7. El sujeto tiene una enfermedad intercurrente significativa o reciente no controlada que incluye, entre otras, las siguientes condiciones:
    a. Trastornos cardiovasculares (ver detalles protocolo)
    b. Trastornos gastrointestinales (p. ej., síndrome de malabsorción u obstrucción de la salida gástrica), incluidos los asociados con un alto riesgo de perforación o formación de fístula (ver detalles protocolo)
    c. Hematemesis clínicamente significativa o hemoptisis de > 0,5 cucharaditas (> 2,5 ml) de sangre roja o antecedentes de otro sangrado significativo en los 3 meses anteriores a la primera dosis del tratamiento del estudio.
    d. Lesión(es) pulmonar(es) cavitante(s) o manifestación conocida de enfermedad endobronquial.
    e. Lesiones que invaden los principales vasos sanguíneos pulmonares.
    f. Otros trastornos clínicamente significativos como:
    i. Infección activa que requiere tratamiento sistémico, infección por el virus de la inmunodeficiencia humana (VIH) o enfermedad relacionada con el síndrome de inmunodeficiencia adquirida, o infección crónica por hepatitis B (VHB) o C (VHC).
    ii.Herida/úlcera/fractura ósea grave que no cicatriza.
    iii. Síndrome de malabsorción.
    iv. Insuficiencia hepática de moderada a grave (Child-Pugh B o C).
    v. Requerimiento de hemodiálisis o diálisis peritoneal.
    vi.Diabetes mellitus no controlada.
    vii. Historia del trasplante de órgano sólido.
    8. Cirugía mayor (p. ej., cirugía GI, extirpación o biopsia de metástasis cerebral) dentro de las 8 semanas anteriores a la primera dosis del tratamiento del estudio. La cicatrización completa de la herida de una cirugía mayor debe haber ocurrido 4 semanas antes de la primera dosis del tratamiento del estudio y de una cirugía menor (p. ej., escisión simple, extracción dental) al menos 10 días antes de la primera dosis del tratamiento del estudio. Los pacientes con complicaciones en curso clínicamente relevantes de una cirugía previa no son elegibles.
    9. Intervalo QT corregido calculado mediante la fórmula de Fridericia (QTcF) > 500 ms dentro de los 28 días anteriores a la primera dosis del tratamiento del estudio.
    Nota: Si un solo ECG muestra un QTcF con un valor absoluto > 500 ms, se deben realizar dos ECG adicionales a intervalos de aproximadamente 3 min dentro de los 30 min posteriores al ECG inicial, y se utilizará el promedio de estos 3 resultados consecutivos para QTcF para determinar la elegibilidad.
    (ver criterios de exclusión 10-14 en protocolo)
    E.5 End points
    E.5.1Primary end point(s)
    Primary endpoint:
    The primary endpoint for this biomarker-focused trial is the determination of cfCHIP-seq (Sadeh et al. 2021) on isolated chromatin nucleosomes from blood samples extracted to patients with DTC at baseline, before any dose of study treatment, and at progression of the disease. The results from the molecular determinations will be crossed with clinical outcomes to identify potential prognostic value for response to cabozantinib in terms of ORR (confirmed).
    Assessed by the investigator through imaging follow-up (CT scan/MRI) using RECIST 1.1. This will be considered as the percentage/proportion of patients with confirmed complete response (CR) or partial response (PR) as their overall best response throughout the study.
    Valoración principal:
    El criterio de valoración principal de este ensayo centrado en biomarcadores es la determinación de cfCHIP-seq (Sadeh et al. 2021) en nucleosomas de cromatina aislados de muestras de sangre extraídas de pacientes con DTC al inicio del estudio, antes de cualquier dosis del tratamiento del estudio y la progresión de la enfermedad. Los resultados de las determinaciones moleculares se cruzarán con los resultados clínicos para identificar el valor pronóstico potencial de la respuesta a cabozantinib en términos de ORR (confirmado).
    Evaluado por el investigador a través de un seguimiento por imágenes (tomografía computarizada/resonancia magnética) utilizando RECIST 1.1. Esto se considerará como el porcentaje/proporción de pacientes con respuesta completa (RC) o respuesta parcial (PR) confirmada como su mejor respuesta general a lo largo del estudio.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the study period (approximately 12 months)
    A lo largo de todo el periodo de estudio (aproximadamente 12 meses)
    E.5.2Secondary end point(s)
    Secondary efficacy endpoints
    The molecular biomarkers at baseline will be crossed with the following endpoints to find potential prognostic value for cabozantinib efficacy:
    Disease control rate (DCR)
    Duration of Response (DoR)
    Progression-free Survival (PFS)
    Overall Survival (OS)

    Secondary safety endpoints
    The molecular biomarkers at baseline will be crossed with the following endpoints to find potential prognostic value for cabozantinib safety:
    Frequency and severity of adverse events and Treatment-related adverse events (TRAEs) assessed by NCI CTCAE v5.0.
    Frequency of AEs leading to treatment discontinuation.
    Health-related quality of life (HRQoL), assessed through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) version 3.
    Valoración de eficacia secundarios
    Los biomarcadores moleculares al inicio del estudio se cruzarán con los siguientes criterios de valoración para encontrar un valor pronóstico potencial para la eficacia de cabozantinib:
    Tasa de control de la enfermedad (DCR)
    Duración de la respuesta (DoR)
    Supervivencia libre de progresión (PFS)
    Supervivencia general (OS)

    Valoración Seguridad secundaria
    Los biomarcadores moleculares al inicio del estudio se cruzarán con los siguientes criterios de valoración para encontrar un valor pronóstico potencial para la seguridad de cabozantinib:
    frecuencia y gravedad de los eventos adversos y eventos adversos relacionados con el tratamiento (TRAE) evaluados por NCI CTCAE v5.0.
    Frecuencia de eventos adversos que conducen a la interrupción del tratamiento.
    Calidad de vida relacionada con la salud (HRQoL), evaluada a través del Cuestionario de calidad de vida C30 de la Organización Europea para la Investigación y el Tratamiento del Cáncer (EORTC QLQ-C30) versión 3.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Throughout the study period (approximately 12 months)
    A lo largo de todo el periodo de estudio (aproximadamente 12 meses)
    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 No
    E.6.7Pharmacodynamic Yes
    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
    Evaluation of biomarkers' impact on clinical outcome
    Evaluación del impacto de los biomarcadores en la evolución clínica
    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) 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 trial1
    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 concerned10
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.7Trial has a data monitoring committee No
    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
    Last subject's last visit
    Última visita del último paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days
    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: 30
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 11
    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 Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    The investigator or qualified designee must obtain documented consent from each potential subject or each subject’s legally acceptable representative prior to participating in this clinical trial
    El investigador o un delegado cualificado deberá obtener el consentimiento de cada sujeto o un representante legalmente aceptable previo a iniciar la participación en el ensayo.
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state41
    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)
    As per local clinical practice
    Tratamiento de la práctica clínica habitual local.
    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 Decision2023-03-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-03-10
    P. End of Trial
    P.End of Trial StatusOngoing
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