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    Summary
    EudraCT Number:2022-002616-24
    Sponsor's Protocol Code Number:MEDOPP485
    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:2023-01-20
    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 number2022-002616-24
    A.3Full title of the trial
    A proof of concept study to evaluate treatments’ efficacy by monitoring Minimal Residual Disease using ctDNA in HR-positive/HER2-negative early breast cancer population.
    Estudio preliminar de eficacia para evaluar la eficacia de los tratamientos mediante el control de la enfermedad residual mínima con ADNtc en población con cáncer de mama precoz RH positivo/HER2 negativo.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to evaluate treatments’ efficacy by monitoring Minimal Residual Disease in early breast cancer population.
    Estudio para evaluar la eficacia de los tratamientos mediante el control de la enfermedad residual mínima en población con cáncer de mama precoz.
    A.3.2Name or abbreviated title of the trial where available
    MIRADOR
    MIRADOR
    A.4.1Sponsor's protocol code numberMEDOPP485
    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 SponsorMedica Scientia Innovation Research, S.L. (MEDSIR)
    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 supportF. Hoffmann-La Roche Ltd.
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEvidenze Health España S.L.
    B.5.2Functional name of contact pointFátima González Hurtado
    B.5.3 Address:
    B.5.3.1Street AddressCalle Caléndula 93, Edificio K, Complejo Miniparc III
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28109
    B.5.3.4CountrySpain
    B.5.4Telephone number0034914561105
    B.5.5Fax number0034914561126
    B.5.6E-mailf.gonzalez@evidenze.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 nameGiredestrant
    D.3.2Product code RO7197597
    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 INNGiredestrant
    D.3.9.2Current sponsor codeRO7197597
    D.3.9.4EV Substance CodeSUB216524
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin 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 nameInavolisib
    D.3.2Product code RO7113755
    D.3.4Pharmaceutical form 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 INNInavolisib
    D.3.9.2Current sponsor codeRO7113755
    D.3.9.4EV Substance CodeSUB198571
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number9
    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 RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Verzenios
    D.2.1.1.2Name of the Marketing Authorisation holderEli Lilly Nederland B.V.
    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.3.1Product nameAbemaciclib
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    Iontophoresis
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAbemaciclib
    D.3.9.2Current sponsor codeAbemaciclib
    D.3.9.4EV Substance CodeSUB171907
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number300
    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
    Early breast cancer
    Cáncer de mama precoz
    E.1.1.1Medical condition in easily understood language
    Early breast cancer
    Cáncer de mama precoz
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 23.0
    E.1.2Level PT
    E.1.2Classification code 10083232
    E.1.2Term HER2 negative breast 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
    To evaluate the efficacy –in terms of rate of patients with a 90% decrease or clearance in baseline ctDNA at three months- of the different arms.
    Evaluar la eficacia, en términos de tasa de pacientes con una reducción del 90 % o eliminación del ADNtc inicial al cabo de tres meses, de los diferentes grupos.
    E.2.2Secondary objectives of the trial
    Surveillance phase:
    • To assess the incidence of ctDNA detection in patients with HRpositive/HER2-negative BC.

    Treatment phase
    • To evaluate the efficacy –in terms of:
    -A 90% decrease in baseline ctDNA at six, nine, and 12 months- of the experimental arms.
    -A 90% decrease in baseline ctDNA at three months and maintained at six months and 12months- of the different arms.
    -A50% and 70% decrease in baseline ctDNA at three, six, nine, and 12 months- of the different arms.
    -Time to rising ctDNA during the study follow-up- of the different arms.
    -Time with at least a 90% decrease in baseline ctDNA- of the different arms.
    • To evaluate the ctDNA decrease relative to baseline -at three, six, nine, and 12 months- of the different arms.
    • To evaluate the safety and tolerability of the different treatments
    Fase de vigilancia:
    • Evaluar la incidencia de detección de ADNtc en pacientes con CM RH positivo/HER2 negativo.

    Fase de tratamiento
    • Evaluar la eficacia, en términos de:
    -Reducción del 90 % del ADNtc inicial a los seis, nueve y 12 meses, de los grupos experimentales.
    -Reducción del 90 % del ADNtc inicial a los tres meses y mantenido a los seis meses y a los 12 meses, de los diferentes grupos.
    -Reducción del 50 % y del 70 % en el ADNtc inicial a los tres, seis, nueve y 12 meses, de los diferentes grupos.
    -Tiempo hasta el aumento del ADNtc durante el seguimiento del estudio, de los diferentes grupos.
    • Evaluar la duración de la eficacia, en términos de tiempo con al menos una reducción del 90 % en el ADNtc inicial, de los diferentes grupos.
    • Evaluar la reducción del ADNtc con respecto al valor inicial a los tres, seis, nueve y 12 meses de los diferentes grupos.
    • Evaluar la seguridad y la tolerabilidad de los diferentes tratamientos.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Surveillance phase:
    1.Signed ICF prior to participation in any study-related activities.
    2.Male or female patients aged 18 years or older.
    3.ECOG 0 or 1.
    4.Histologically proven primary HR-positive according to the updated ASCO/ CAP 2020 guidelines and HER2-negative BC as per ASCO/CAP 2018 criteria based on local testing on the most recent analyzed biopsy.
    5.Patients with high-risk early-stage BC according to at least one of the following criteria:
    a. If no previous neoadjuvant chemotherapy:
    i. pN2/N3 or
    ii. pN1,
    1. pT3/T4
    and/or
    2. high genomic risk defined as Oncotype Dx Recurrence Score > 25 if postmenopausal;> 20 if pre-menopausal, Prosigna score ≥ 41, Mammaprint high risk category or similar
    and/or
    3.histological grade II/III and proliferation marker Ki67 (Ki67) >20%.
    b.If patients have received previous neoadjuvant chemotherapy, they must have had significant residual invasive disease defined as at least one of the following:
    i.Residual invasive disease in the breast ypT3 or ypT4.
    and/or
    ii.Any macroscopic, ≥ 2 mm, residual lymph node involvement regardless of primary tumor site involvement (includes no residual disease in the breast).
    6.On adjuvant treatment with ET for at least two years and no more than four years at the time of study enrolment with an additional three years of ET planned. At least 12 months prior to enrolment on the same ET treatment with AI or tamoxifen (LHRH for pre-menopausal women and men is required).
    Note: Male and pre-menopausal patients treated with tamoxifen alone are excluded.
    7.No prior treatment with CDK4/6 inhibitors.
    8.No prior treatment with fulvestrant.
    9.Willingness and ability to provide tissue from one archival tumor tissue sample (either from diagnostic biopsy, primary surgery, or where available from a residual disease post-neoadjuvant therapy).
    Note: Patients with multifocal BC may be enrolled, if archival tissue samples from at least two tumors are available and after histopathological examination, all tumors meet pathologic criteria for HRpositive and HER2-negative BC.
    10.Absence of metastatic disease by routine clinical assessment (computed tomography [CT] scan of
    the thorax and abdomen, and bone scan) confirmed no longer than three months prior to study
    inclusion.
    11.Patients must have had surgery for their primary BC with documented clear margins (as per local
    guidelines) within the past five years.
    12. Patients must be able and willing to adhere to study procedures.

    Treatment phase
    1. Signed ICF prior to study inclusion.
    2. ctDNA positivity with no evidence of clinical or radiologic recurrence by standard assessments (e.g.: breast ultrasound, staging scans, NMR).
    3. ECOG 0, 1 or 2.
    4. Patients must have received the same ET during at least the last 12 months. A temporary discontinuation of < 90 days during the surveillance phase is allowed.
    5. Receiving LHRH agonist therapy alongside the same ET treatment for at least 90 days prior to initiation of one of the available study treatments if male or pre-menopausal.
    6. Female of reproductive potential and male patients with female partners of childbearing potential, must remain abstinent and truly abstain from sexual activity (refrains from heterosexual intercourse) or use locally recognized adequate methods of contraception (described as that with a failure rate <1%) for the duration of trial treatment.
    7. Resolution of all acute toxic effects of prior anti-cancer therapy to Grade ≤1 as determined by the NCI-CTCAE v 5.0
    8. Adequate hematologic and organ function within 14 days before the first study treatment on Day 1 of Cycle 1, defined by the following:
    Hematological (without platelet, red blood cell (RBC) transfusion, and/or granulocyte colony-stimulating factor support within 7 days before first study treatment dose): White blood cell (WBC) count > 3.0 x 109/L, absolute neutrophil count (ANC) ≥ 1.5 x 109/L, platelet count ≥ 100.0 x109/L, and hemoglobin ≥ 9.0 g/dL (≥ 5.6 mmol/L).
    • Hepatic: Serum albumin ≥ 3 g/dL; Bilirubin ≤ 1.5 times the upper limit of normal (ULN) (≤3 x ULN in the case of Gilbert’s disease); aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 2.5 × ULN; alkaline phosphatase (ALP) ≤ 2 × ULN.
    • Renal: serum creatinine ≤ 1.5 x ULN or creatinine clearance ≥ 50 mL/min based on Cockcroft−Gault glomerular filtration rate estimation.
    9. Participants who are able and willing to swallow, retain, and absorb oral medication.
    Fase de vigilancia:
    1.CI firmado para la participación en cualquier actividad relacionada con el estudio.
    2.Pacientes de ambos sexos de 18 años o mayores.
    3.ECOG de 0 o 1.
    4.CM primario positivo para HER2 demostrado histológicamente según las directrices actualizadas de ASCO/CAP de 2020 y CM HER2 negativo según los criterios de la ASCO/CAP de 2018, basándose en el análisis local de la biopsia analizada más reciente.
    5.Pacientes con CM en estadio inicial de alto riesgo según al menos uno de los siguientes criterios:
    a.En caso de ausencia de quimioterapia neoadyuvante previa:
    i.pN2/N3
    o bien
    ii.pN1,
    1.pT3/T4
    y/o
    2.riesgo genómico alto definido como una puntuación de recurrencia Oncotype Dx >25 en mujeres posmenopáusicas; >20 en mujeres premenopáusicas, puntuación Prosigna ≥41, categoría de riesgo alto Mammaprint o similar
    y/o
    3.grado histológico II/III y Ki67 >20 %.
    b.Si los pacientes han recibido quimioterapia neoadyuvante previa, deben haber tenido enfermedad residual invasiva significativa definida como al menos uno de los siguientes:
    i.Enfermedad invasiva residual en la mama ypT3 o ypT4
    y/o
    ii.Cualquier afectación residual macroscópica, ≥2 mm, de los ganglios linfáticos, independientemente de la afectación del punto del tumor primario (incluye la ausencia de enfermedad residual en la mama).
    6.Tratamiento adyuvante con HT durante al menos dos años y no más de cuatro años en el momento de la inclusión en el estudio, con otros tres años de HT previstos. Al menos 12 meses antes de la inclusión en el mismo tratamiento con HT con IA o tamoxifeno (se requiere hormona liberadora de hormona luteinizante para mujeres premenopáusicas y varones).
    o haber recibido tratamiento previo con inhibidores de las cinasas 4/6 (CDK4/6) dependientes de ciclinas.
    8.No haber recibido tratamiento previo con fulvestrant.
    9.Voluntad y capacidad para proporcionar tejido de una muestra de tejido tumoral de archivo (ya sea de una biopsia diagnóstica, cirugía primaria o cuando esté disponible en una enfermedad residual después del tratamiento neoadyuvante).
    10. Ausencia de enfermedad metastásica mediante evaluación clínica rutinaria (tomografía computarizada [TC] de tórax y abdomen y gammagrafía ósea) confirmada como máximo tres meses antes de la inclusión en el estudio.
    11. Los pacientes deben haberse sometido a una intervención quirúrgica por su CM primario con márgenes limpios documentados (según las guías locales) en los últimos cinco años.
    12.Los pacientes deben ser capaces y estar dispuestos a cumplir los procedimientos del estudio

    Fase de tratamiento:
    1.Firma del CI antes de la inclusión en el estudio.
    2.Positividad para ADNtc, sin indicios de recidiva clínica o radiológica según las evaluaciones estándar (p. ej., ecografía de mama, exploraciones de estadificación, RM).
    3.ECOG 0, 1 o 2.
    4.Los pacientes deben haber recibido la misma HT durante al menos los últimos 12 meses. Se permite una interrupción temporal de <90 días durante la fase de vigilancia.
    5.Recibir tratamiento con un agonista de la LHRH junto con el mismo tratamiento de HT durante al menos 90 días antes del inicio de uno de los tratamientos del estudio disponibles en caso de ser varón o mujer premenopáusica.
    6.Las mujeres con capacidad de procrear y los varones con parejas femeninas con capacidad de procrear deben practicar la abstinencia sexual y abstenerse realmente de mantener relaciones sexuales (relaciones sexuales heterosexuales) o utilizar métodos anticonceptivos adecuados reconocidos localmente (descritos como que tienen una tasa de fallo <1 %) durante el tratamiento del estudio.
    7.Resolución de todos los efectos secundarios agudos de los tratamientos antineoplásicos previos a grado ≤1 según lo determinado por los criterios terminológicos comunes para acontecimientos adversos del CTCAE del NCI versión 5
    8.Función hematológica y orgánica adecuada en los 14 días anteriores al primer tratamiento del estudio en el día 1 del ciclo 1, definida por lo siguiente:
    •Valores hematológicos (sin transfusión de plaquetas, eritrocitos (ERI) y/o apoyo de factor estimulante de colonias de granulocitos en los 7 días anteriores a la primera dosis de tratamiento del estudio): recuento de leucocitos (LEU) >3,0 × 109/l, recuento absoluto de neutrófilos (RAN) ≥1,5 × 109/l, recuento de plaquetas ≥100,0 × 109/l, y hemoglobina ≥9,0 g/dl (≥5,6 mmol/l).
    •Valores hepáticos: albúmina sérica ≥3 g/dl; bilirrubina total ≤1,5xLSN (≤3 × LSN en el caso de la enfermedad de Gilbert); AST y ALT ≤2,5 veces el LSN, FA ≤2 veces el LSN.
    •Valores renales: creatinina sérica≤1,5xLSN o aclaramiento de creatinina ≥50 ml/min basándose en la estimación de la filtración glomerular de Cockcroft-Gault.
    9.Participantes capaces y dispuestos a tragar, retener y absorber la medicación oral.
    E.4Principal exclusion criteria
    Surveillance phase:
    Any concurrent or planned treatment for the current diagnosis of BC other than adjuvant ET.
    2. Diagnosis of an alternative cancer in the five years prior to primary BC diagnosis other than for nonmelanoma carcinoma of the skin or cervical carcinoma in situ. Other stage I tumors will be discussed case by case prior to inclusion with the Medical Monitor of the study.
    3. Active or prior documented inflammatory bowel disease (i.e. C’ohn's disease, ulcerative colitis, or a preexisting chronic condition resulting in baseline grade ≥1 diarrhea) that may significantly alter the absorption of oral drugs.
    4. Active cardiac disease or history of cardiac dysfunction including any of the following:
    f. History (within two years from screening) or presence of idiopathic bradycardia or resting heart rate <50 beats per minute at screening.
    g. History of angina pectoris or symptomatic coronary heart disease within 12 months prior to study entry.
    h. QT interval corrected through use of Fridericia’s formula (QTcF) > 450 ms for women and > 470 ms for men by at least three electrocardiograms (ECGs) > 30 minutes apart.
    i. History or presence of an abnormal ECG that is clinically significant in the investigator’s opinion,
    j. History of ventricular dysrhythmias or risk factors for ventricular dysrhythmias such as structural heart disease (e.g., severe left ventricular systolic dysfunction, left ventricular hypertrophy cardiomyopathy, infiltrative cardiomyopathy, moderate-to-severe valve disease), coronary heart disease (symptomatic or with ischemia demonstrated by diagnostic testing), clinically significant electrolyte abnormalities (e.g., hypokalemia, hypomagnesemia, hypocalcemia), or family history of long QT syndrome within 12 months.
    5. History of pneumonitis, ILD, or pulmonary fibrosis.
    6. Known history of Human Immunodeficiency Virus (HIV) infection (testing not required as part of study screening).
    7. Clinically significant liver disease consistent with Child-Pugh C, including active hepatitis (e.g., hepatitis B virus [HBV] or hepatitis C virus [HCV]), current alcohol abuse, cirrhosis, or positive test for viral hepatitis
    8. Active bleeding diathesis venous thrombo-embolism, previous history of bleeding diathesis, or chronic anti-coagulation treatment, or any indications or history of Disseminated Intravascular Coagulation (DIC) or DVT. Low molecular weight heparin (LMWH), low dose aspirin or clopidogrel are permitted.
    9. Creatinine clearance < 30mL/min.
    10. Participants with renal dysfunction who require dialysis.
    11. Patient has any other concurrent severe and/or uncontrolled medical condition that would, in the Investigator’ opinion cause unacceptable safety risks, contraindicate patient participation in the clinical trial or compromise compliance with the protocol.
    12. Females who are known to be breastfeeding or pregnant as determined by a serum pregnancy test Human chorionic gonadotropin (β-HCG) prior to the administration of any trial treatment. Since β-HCG over expression can be also elevated in some tumor types, a positive result should be confirmed with a validated alternative test (e.g., ultrasound).
    13. Female or male participants planning a pregnancy.

    Treatment Phase:
    1. Known hypersensitivity reaction to any investigational or therapeutic compound or their incorporated substances.
    2. Undergoing any other simultaneous anti-cancer treatment since enrolling in the study, other than hormonal therapy or a bisphosphonate (or denosumab).
    3. Major surgery (defined as requiring general anesthesia) or significant traumatic injury within 28 days of start of study drug, or patients who have not recovered from the side effects of any major surgery.
    4. Treatment with strong Cytochrome P450 3A4 (CYP3A4) inhibitors or strong CYP3A4 inducers within 14 days or five drug-elimination half-lives, whichever is longer, prior to initiation of one of the available study reatments.
    5. Patient has a history of non-compliance to medical regimen
    Fase de vigilancia
    1. Cualquier tratamiento concomitante o previsto para el diagnóstico actual de CM distinto de HT adyuvante.
    2. Diagnóstico de un cáncer alternativo en los cinco años previos al diagnóstico del CM primario distinto de carcinoma de piel no melanocítico o carcinoma cervical in situ. Se comentarán con el monitor médico del estudio, caso por caso, otros tumores en estadio I antes de la inclusión.
    3. Enfermedad inflamatoria intestinal activa o previamente documentada (es decir, enfermedad de Crohn, colitis ulcerosa o una afección crónica preexistente que provoque diarrea de grado ≥1 al inicio) que pueda modificar de forma significativa la absorción de los fármacos orales.
    4. Cardiopatía activa o antecedentes de disfunción cardíaca, incluidos cualquiera de los siguientes:
    a. Antecedentes (en los dos años previos a la selección) o presencia de bradicardia idiopática o de frecuencia cardíaca en reposo <50 latidos por minuto en la selección.
    b. Antecedentes de angina de pecho o cardiopatía coronaria sintomática en los 12 meses anteriores a la inclusión en el estudio.
    c. Intervalo QT corregido mediante la fórmula de Fridericia (QTcF) >450 ms en las mujeres y >470 ms en los varones mediante al menos tres electrocardiogramas (ECG) con >30 minutos de diferencia.
    d. Antecedentes o presencia de un ECG anómalo que sea clínicamente significativo en opinión del investigador.
    e. Antecedentes de arritmias ventriculares o factores de riesgo de arritmias ventriculares como cardiopatía estructural (p. ej., disfunción sistólica del ventrículo izquierdo grave, miocardiopatía de hipertrofia ventricular izquierda, miocardiopatía infiltrativa, valvulopatía moderada o grave), cardiopatía coronaria (sintomática o con isquemia demostrada por pruebas diagnósticas), anomalías electrolíticas clínicamente significativas (p. ej., hipopotasemia, hipomagnesemia, hipocalcemia) o antecedentes familiares de síndrome del intervalo QT prolongado en los 12 meses previos.
    5. Antecedentes de neumonitis, enfermedad pulmonar intersticial (EPI) o fibrosis pulmonar.
    6. Antecedentes conocidos de infección por el virus de la inmunodeficiencia humana (VIH) (análisis no necesario como parte de la selección del estudio).
    7. Hepatopatía clínicamente significativa compatible con clase C de Child-Pugh, incluyendo hepatitis activa (p. ej., virus de la hepatitis B [VHB] o virus de la hepatitis C [VHC]), alcoholismo actual, cirrosis o prueba positiva de hepatitis vírica.
    8. Diátesis hemorrágica activa, tromboembolia venosa, antecedentes de diátesis hemorrágica o tratamiento anticoagulante crónico, o cualquier indicación o antecedentes de coagulación intravascular diseminada (CID) o trombosis venosa profunda (TVP). Se permite la heparina de bajo peso molecular (HBPM), el ácido acetilsalicílico en dosis bajas o el clopidogrel.
    9. Aclaramiento de creatinina <30 ml/min.
    10. Participantes con disfunción renal que requieren diálisis.
    11. El paciente tiene otra enfermedad concurrente grave y/o no controlada que, en opinión del investigador, pudiera provocar riesgos de seguridad inaceptables, contraindicar la participación del paciente en el ensayo clínico o comprometer el cumplimiento del protocolo.
    12. Mujeres en periodo de lactancia o embarazadas, determinado mediante una prueba de embarazo en suero, gonadotropina coriónica humana (β-HCG), antes de la administración de cualquier tratamiento del estudio. Dado que la sobreexpresión de β-HCG puede ser también elevada en algunos tipos de tumores, un resultado positivo debe confirmarse con una prueba alternativa validada (p. ej., ecografía).
    13. Mujeres o participantes varones que planeen un embarazo.

    Fase de tratamiento:
    1. Reacción de hipersensibilidad conocida a cualquier compuesto en investigación o terapéutico o sus sustancias incorporadas.
    2. Someterse a cualquier otro tratamiento antineoplásico simultáneo desde la inclusión en el estudio, aparte de la hormonoterapia o un bisfosfonato (o denosumab).
    3. Cirugía mayor (definida como la que precisa anestesia general) o lesión traumática significativa en los 28 días previos al inicio de la administración del fármaco del estudio, o pacientes que no se hayan recuperado de los efectos secundarios de alguna cirugía mayor.
    4. Tratamiento con inhibidores potentes del citocromo P450 3A4 (CYP3A4) o inductores potentes del CYP3A4 en los 14 días o cinco semividas de eliminación del fármaco, lo que sea más largo, antes de iniciar uno de los tratamientos del estudio disponibles.
    5. El paciente tiene antecedentes de incumplimiento del tratamiento médico.
    E.5 End points
    E.5.1Primary end point(s)
    Proportion of patients with at least a 90% decrease or clearance in baseline ctDNA at three months after initiation of study treatment.
    Tasa de pacientes con una reducción del 90 % o eliminación del ADNtc inicial al cabo de tres meses, de los diferentes grupos.
    E.5.1.1Timepoint(s) of evaluation of this end point
    at three months after initiation of study treatment
    Al cabo de tres meses, tras el inicio del tratamiento de estudio
    E.5.2Secondary end point(s)
    Surveillance Phase
    Total ctDNA detection and breakdown by incidence at first ctDNA test versus incidence at subsequent ctDNA tests.

    Treatment phase
    • Proportion of patients with at least a 90% decrease in baseline ctDNA at six, nine, and 12 months after initiation of study treatment.
    • Proportion of patients with at least a 90% decrease in baseline ctDNA at three months maintained at six months and 12 months after initiation of study treatment.
    • Proportion of patients with 50% and 70% decrease in baseline ctDNA at three, six, nine, and 12 months after initiation of study treatment.
    • Time to rising ctDNA defined as time to first ctDNA increase compared to baseline
    • Duration of at least a 90% decrease in baseline ctDNA after initiation of study treatment.
    • Best percentage of ctDNA decrease relative to baseline at six, nine, and 12 months after initiation of study treatment.
    • Safety and toxicity profile according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events Version 5.0 (NCI-CTCAE v.5.0).
    Fase de Vigilancia:
    Detección de ctDNA total y desglose por incidencia en la primera prueba de ADNtc versus incidencia en las pruebas de ADNtc posteriores.

    Fase de Tratamiento:
    • Tasa de pacientes con una reducción al menos del 90 % del ADNtc inicial a los seis, nueve y 12 meses, de los grupos experimentales.
    • Tasa de pacientes con una reducción al menos del 90 % del ADNtc inicial a los tres meses y mantenido a los seis meses y a los 12 meses, de los diferentes grupos.
    • Tasa de pacientes con una reducción al menos del 50 % y del 70 % en el ADNtc inicial a los tres, seis, nueve y 12 meses, de los diferentes grupos.
    • Tiempo hasta el aumento del ADNtc como tiempo hasta el primer aumento de ADNtc con respecto al valor inicial-
    • Duración de la reducción al menos del 90 % en el ADNtc inicial tras el inicio del tratamiento de estudio
    • Mejor porcentaje de reducción del ADNtc con respecto al valor inicial a los tres, seis, nueve y 12 meses tras el inicio del tratamiento de estudio
    • Seguridad y la tolerabilidad de los diferentes tratamientos.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Surveillance Phase
    Total ctDNA detection at 12 months after initiation of study treatment.

    Treatment phase
    • 90% decrease in baseline ctDNA at six, nine, and 12 months after initiation of study treatment.
    • 90% decrease in baseline ctDNA at three months maintained at six months and 12 months after initiation of study treatment.
    • 50% and 70% decrease in baseline ctDNA at three, six, nine, and 12 months after initiation of study treatment.
    • Time to rising ctDNA at 12 months
    • Duration of at least a 90% decrease in baseline ctDNA 12 months after initiation of study treatment.
    • Best percentage of ctDNA decrease relative to baseline at six, nine, and 12 months after initiation of study treatment.
    • Safety and toxicity profile at 12 months
    Fase de Vigilancia:
    Detección de ctDNA total a los 12 meses.

    Fase de Tratamiento:
    • Reducción al menos del 90 % del ADNtc inicial a los seis, nueve y 12 meses
    • Reducción al menos del 90 % del ADNtc inicial a los tres meses y mantenido a los seis meses y a los 12 meses
    • Reducción al menos del 50 % y del 70 % en el ADNtc inicial a los tres, seis, nueve y 12 meses
    • Tiempo hasta el aumento del ADNtc a los 12 meses
    • Duración de la reducción al menos del 90 % en el ADNtc inicial a los 12 meses
    • Mejor porcentaje de reducción del ADNtc a los tres, seis, nueve y 12 meses
    • Seguridad y la tolerabilidad a los 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 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 No
    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 No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other 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 trial4
    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 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
    Last patient 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 years5
    E.8.9.1In the Member State concerned months
    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: 84
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 85
    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 state169
    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)
    Clinical routine preactice
    Practica clínica habitual
    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 Decision2023-04-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-04-20
    P. End of Trial
    P.End of Trial StatusOngoing
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