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    Summary
    EudraCT Number:2022-002816-22
    Sponsor's Protocol Code Number:CTL-002-002
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-11-08
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2022-002816-22
    A.3Full title of the trial
    A multi-center Phase 2 study of neoadjuvant immunotherapy in combination with the anti-GDF-15 antibody visugromab (CTL-002) for the treatment of muscle invasive bladder cancer
    Studio multicentrico di fase 2 sull’immunoterapia neoadiuvante in combinazione con l’anticorpo anti-GDF-15 visugromab (CTL-002) per il trattamento del carcinoma della vescica muscolo-invasivo
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study of Visugromab (CTL-002) in combination with immunotherapy, in patients with muscle invasive bladder cancer
    Uno studio di Visugromab (CTL-002) in combinazione con l'immunoterapia, in pazienti con tumore della vescica muscolo-invasivo
    A.3.2Name or abbreviated title of the trial where available
    NEO-GDFather
    NEO-GDFather
    A.4.1Sponsor's protocol code numberCTL-002-002
    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 SponsorCatalym GmbH
    B.1.3.4CountryGermany
    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 supportCatalYm GmbH
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCatalYm GmbH
    B.5.2Functional name of contact pointPetra Fettes
    B.5.3 Address:
    B.5.3.1Street AddressAm Klopferspitz 19
    B.5.3.2Town/ cityPlanegg-Martinsried
    B.5.3.3Post code82152
    B.5.3.4CountryGermany
    B.5.4Telephone number+4989200066451
    B.5.6E-mailpetra.fettes@catalym.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 Yes
    D.2.1.1.1Trade name Opdivo
    D.2.1.1.2Name of the Marketing Authorisation holderBristol-Myers Squibb Pharma EEIG
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameOPDIVO 10 mg/mL concentrate for solution for infusion
    D.3.2Product code [-]
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNIVOLUMAB
    D.3.9.1CAS number 946414-94-4
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB122750
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameVisugromab
    D.3.2Product code [CTL-002]
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVisugromab
    D.3.9.2Current sponsor codeCTL-002
    D.3.9.3Other descriptive nameVisugromab
    D.3.9.4EV Substance CodeSUB214927
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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.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
    Muscle invasive bladder cancer set to undergo radical cystectomy who cannot receive or refuse to receive cisplatin-based chemotherapy
    carcinoma vescicale muscolo-invasivo da sottoporre a cistectomia radicale, per chi non può ricevere o rifiuta la chemioterapia con cisplatino.
    E.1.1.1Medical condition in easily understood language
    A therapy for the muscle-invasive bladder cancer (which is a tumor grown into the muscle of the bladder) for people who cannot receive or refuse to receive chemotherapy based on cisplatin
    Una terapia per il tumore della vescica muscolo-invasivo (che è un tumore cresciuto nel muscolo della vescica) per chi non può ricevere o rifiuta la chemioterapia con cisplatino
    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 LLT
    E.1.2Classification code 10022877
    E.1.2Term Invasive bladder cancer
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To assess the anti-tumor activity of visugromab (CTL-002) administered in combination with an anti-programmed death receptor-1 (PD-1) checkpoint inhibitor, compared to an anti-PD-1 checkpoint inhibitor alone in the neoadjuvant setting in subjects with muscle-invasive bladder cancer (MIBC)
    Valutare l'attività antitumorale di visugromab (CTL-002) somministrato in combinazione con un inibitore del checkpoint del recettore della morte programmata-1 (PD-1), rispetto a un inibitore del checkpoint anti-PD-1 da solo, in fase neoadiuvante, in soggetti con carcinoma della vescica muscolo-invasivo (MIBC).
    E.2.2Secondary objectives of the trial
    • To assess the safety and tolerability of visugromab (CTL-002) administered in combination with an anti-PD-1 checkpoint inhibitor compared to an anti-PD-1 checkpoint inhibitor alone
    • To assess and further explore the pharmacokinetic (PK)/pharmacodynamics of visugromab (CTL-002) administered in combination with an anti-PD-1 checkpoint inhibitor, compared to an anti-
    PD-1 checkpoint inhibitor alone
    • To explore the clinical outcome of subjects treated with visugromab (CTL-002) administered in combination with an anti-PD-1 checkpoint inhibitor, compared to an anti-PD-1 checkpoint inhibitor alone in the neoadjuvant setting
    - Valutare la sicurezza e la tollerabilità di visugromab (CTL-002) somministrato in combinazione con un inibitore del checkpoint anti-PD-1 rispetto al solo inibitore del checkpoint anti-PD-1.
    - Valutare e approfondire la farmacocinetica (PK)/farmacodinamica di visugromab (CTL-002) somministrato in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo.
    - Esplorare l'esito clinico dei soggetti trattati con visugromab (CTL-002) somministrato in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo nel contesto neoadiuvante.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Able to understand the purpose of the study, provide signed and dated informed consent prior to performing any protocol-related procedures (including Screening evaluations), and comply with the study procedures.
    2. Age = 18 years.
    3. Histopathologically confirmed urothelial carcinoma. Subjects with mixed histologies are required to have a dominant (i.e., 50% at least) transitional cell pattern.
    4. Clinical stage T2-T4aN0M0 MIBC, as assessed by CT (mandatory), PET/CT, or mpMRI (both optional).
    5. Ineligible for cisplatin therapy per modified Galsky criteria (Eastern Cooperative Oncology Group [ECOG] Performance Status 2 subjects are excluded):
    a. Subjects with CTCAE v4 grade = 2 audiometric hearing loss (Galsky Criteria).
    b. Subjects with CTCAE v4 grade = 2 peripheral neuropathy (Galsky Criteria).
    c. Creatinine clearance of < 60 mL/min but = 30 mL/min (measured by the Cockcroft Gault formula or 24-hour urine).
    d. New York Heart Association (NYHA) Class III heart failure.
    Or, refuses cisplatin-based chemotherapy.
    6. Eligible for RC by the following:
    a. Fit and planned for RC according to local guidelines.
    b. Able to receive a minimum of 12 weeks of neoadjuvant treatment on study before date of scheduled RC.
    7. Pretreatment tumor material from TURBT (stored paraffin block) must be available for planned scientific analyses and stem from biopsy/removal of primary tumor within less than 3 months prior to study treatment initiation and contain at least 20% of tumor cells.
    8. ECOG performance status score of 0 or 1.
    9. Adequate organ function:
    a. Bone marrow function: hemoglobin = 10.0 g/dL (equal to 5.59 mmol/L); platelet count = 100×109/L; leukocyte count = 2.5×109/L.
    b. Hepatic function: AST and ALT = 2×upper limit of normal (ULN); bilirubin = 1.5×ULN (2×ULN in case of Gilbert's disease).
    c. Renal function: serum creatinine < 1.5×ULN and/or creatinine clearance = 50 mL/min (Cockcroft-Gault equation).
    d. Coagulation: no evidence for clinically relevant hypo- or hypercoagulability or presence of thrombosis/thrombotic event as per DDimer, antithrombin III (ATIII), prothrombin time /international
    normalized ratio, activated partial thromboplastin time analysis, and treating physician's assessment.
    10. If subject has Type II diabetes and receives metformin, metformin has to be replaced with other antidiabetic(s) prior to start of study treatment (at minimum 7 days prior to study baseline GDF-15 measurement) and for the whole study treatment duration.
    11. Women of childbearing potential must have a negative serum pregnancy test within 7 days prior to study treatment. Women of childbearing potential are defined as sexually mature women
    without prior hysterectomy or who have had any evidence of menses in the past 12 months. However, women who have been amenorrheic for 12 or more months are still considered to be of childbearing potential if the amenorrhea is possibly due to prior chemotherapy, anti-estrogens, or ovarian suppression.
    12. All subjects, male and female, who are not surgically sterilized or postmenopausal as defined below, and subjects' partners of childbearing potential must agree to use "highly effective methods of contraception" during the study and for at least 5 months (5 times the predicted half-life of visugromab [CTL-002] in humans) after the last dose of study drug. "Highly effective methods of contraception" are combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation, progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomized partner, or sexual abstinence. The double-barrier method (synthetic condoms, diaphragm, or cervical cap with spermicidal foam, cream, or gel), periodic abstinence (such as calendar, symptothermal, or method and spermicide only are NOT acceptable as "highly effective methods of contraception." Postmenopausal is defined as at least 12 months after last menstrual bleeding without an alternative medical cause (e.g., amenorrhea due to prior chemotherapy, anti-estrogens, or ovarian suppression).
    1. In grado di comprendere lo scopo dello studio, di fornire un consenso informato firmato e datato prima di eseguire qualsiasi procedura relativa al protocollo (comprese le valutazioni di screening) e di rispettare le procedure dello studio.
    2. Età = 18 anni.
    3. Carcinoma uroteliale confermato istopatologicamente. I soggetti con istologia mista devono avere un pattern a cellule transizionali dominante (cioè, almeno il 50%).
    4. MIBC in stadio clinico T2-T4aN0M0, valutato mediante TC (obbligatoria), PET/CT o mpMRI (entrambe facoltative).
    5. Non idoneo alla terapia con cisplatino secondo i criteri di Galsky modificato (sono esclusi i soggetti con Performance Status 2 dell'Eastern Cooperative Oncology Group [ECOG]):
    a. Soggetti con perdita uditiva audiometrica di grado CTCAE v4 = 2 (criteri Galsky).
    b. Soggetti con neuropatia periferica di grado CTCAE v4 = 2 (Criteri di Galsky).
    c. Clearance della creatinina < 60 mL/min ma = 30 mL/min (misurata con la formula di Cockcroft Gault o con le urine delle 24 ore).
    d. Insufficienza cardiaca di classe III della New York Heart Association (NYHA).
    Oppure, rifiuto della chemioterapia a base di cisplatino.
    6. Idoneità alla RC in base a quanto segue:
    a. Idoneità e pianificazione della RC secondo le linee guida locali.
    b. Capacità di ricevere un minimo di 12 settimane di trattamento neoadiuvante in studio prima della data di RC programmata.
    7. Il materiale tumorale pre-trattamento proveniente da TURBT (blocco di paraffina conservato) deve essere disponibile per le analisi scientifiche previste e deve provenire da una biopsia/rimozione del tumore primario effettuata meno di 3 mesi prima dell'inizio del trattamento dello studio e contenere almeno il 20% di cellule tumorali.
    8. Punteggio ECOG performance status pari a 0 o 1.
    9. Funzionalità d'organo adeguata:
    a. Funzione del midollo osseo: emoglobina = 10,0 g/dL (pari a 5,59 mmol/L); conta piastrinica = 100×109/L; conta leucocitaria = 2,5×109/L.
    b. Funzione epatica: AST e ALT = 2×limite superiore della norma (ULN); bilirubina = 1,5×ULN (2×ULN in caso di malattia di Gilbert).
    c. Funzione renale: creatinina sierica < 1,5×ULN e/o clearance della creatinina = 50 mL/min (equazione di Cockcroft-Gault).
    d. Coagulazione: nessuna evidenza di ipo- o ipercoagulabilità clinicamente rilevante o presenza di trombosi/evento trombotico secondo DDimer, antitrombina III (ATIII), tempo di protrombina/rapporto internazionale normalizzato, trombina parziale attivata (ATIII).
    normalizzato, analisi del tempo di tromboplastina parziale attivato e valutazione del medico curante.
    10. Se il soggetto è affetto da diabete di tipo II e riceve metformina, quest'ultima deve essere sostituita con un altro antidiabetico prima dell'inizio del trattamento dello studio (almeno 7 giorni prima della misurazione GDF-15 al basale dello studio) e per tutta la durata del trattamento dello studio.
    11. Le donne con potenziale fertile devono avere un test di gravidanza sierico negativo nei 7 giorni precedenti il trattamento dello studio. Le donne con potenziale fertile sono definite come donne sessualmente mature
    senza precedenti isterectomie o che hanno avuto qualsiasi evidenza di mestruazioni negli ultimi 12 mesi. Tuttavia, le donne che sono state amenorroiche per 12 o più mesi sono ancora considerate come donne con potenziale fertile se l'amenorrea è probabilmente dovuta a precedenti chemioterapie, anti-estrogeni o soppressione ovarica.
    12. Tutti i soggetti, maschi e femmine, che non sono sterilizzati chirurgicamente o in postmenopausa, come definito di seguito, e i partner dei soggetti con potenziale fertile devono accettare di utilizzare "metodi contraccettivi altamente efficaci" durante lo studio e per almeno 5 mesi (5 volte l'emivita prevista di visugromab [CTL-002] nell'uomo) dopo l'ultima dose di farmaco in studio. I "metodi contraccettivi altamente efficaci" sono la contraccezione ormonale combinata (contenente estrogeni e progestinici) associata all'inibizione dell'ovulazione, la contraccezione ormonale solo progestinica associata all'inibizione dell'ovulazione, il dispositivo intrauterino, il sistema intrauterino a rilascio di ormoni, l'occlusione tubarica bilaterale, il partner vasectomizzato o l'astinenza sessuale. Il metodo a doppia barriera (preservativo sintetico, diaframma o cappuccio cervicale con schiuma, crema o gel spermicida), l'astinenza periodica (come il calendario, il metodo sintotermico o il metodo e lo spermicida) NON sono accettabili come "metodi contraccettivi altamente efficaci". La postmenopausa è definita come almeno 12 mesi dopo l'ultimo sanguinamento mestruale senza una causa medica alternativa (ad esempio, amenorrea dovuta a precedenti chemioterapie, anti-estrogeni o soppressione ovarica).
    E.4Principal exclusion criteria
    1. Pregnant or breastfeeding.
    2. Has received prior radiotherapy on the bladder tumor.
    3. Has received a partial cystectomy.
    4. Primary refusal to undergo RC.
    5. Has received any prior systemic anti-cancer therapy including investigational agents and immunotherapy for bladder cancer.
    6. Prior anti-PD-1/PD-L1 therapy.
    7. Has a known additional malignancy that is progressing or has required active treatment within the past 3 years.
    8. Any acute or chronic major tissue injury that may require maintained GDF-15 function for tissue protection as per Investigator assessment (diagnosed with liver, kidney, myocardial infarction, or other major organ failure, all within < 3 months prior to Screening and with ongoing organ dysfunction as per clinical assessment).
    9. Pre-existing arrhythmia, uncontrolled angina pectoris, diagnosed with heart failure NYHA Grade IV, any myocardial infarction/coronary event as well as any central nervous system (CNS)-ischemic event and any thromboembolic event at any time < 6 months prior to Screening or presence of uncontrolled heart failure NYHA Grade III or higher.
    10. Left ventricular ejection fraction < 50% as measured by an echocardiogram (ECHO) or multigated acquisition scan if ECHO cannot be performed at site for any reason.
    11. QT interval corrected for heart rate using Fridericia's formula interval > 450 ms for men or > 470 ms for women.
    12. Any active autoimmune disease that requires systemic immunosuppressive treatments, for which (re-)activation may present a medical threat to the subject as per the Investigator's assessment.
    13. Any history of non-infectious pneumonitis < 6 months prior to Screening.
    14. Any active inflammatory bowel disease such as Crohn's disease or ulcerative colitis or active autoimmunthyroiditis, all present < 6 months prior to Screening.
    15. History of CNS disease such as stroke, seizure, encephalitis, or multiple sclerosis (< 6 months prior to Screening).
    16. Active allergy requiring systemic treatment (with the exception of histamine H1 receptor blocker treatment) or active infections requiring systemic anti-infectious therapy.
    17. History of or clinical evidence of CNS primary tumors or metastases including leptomeningeal metastases, unless they have been previously treated, demonstrated no progression at least for 3 months before Screening, are asymptomatic and have had no requirement for steroids or enzyme inducing anticonvulsants in the last 14 days before Screening
    – subjects with suspected brain metastases at Screening should undergo a CT/MRI of the brain prior to study entry.
    18. Systemic steroids at a daily dose of > 10 mg of prednisolone, > 2 mg of dexamethasone or equivalent, except non-systemic (inhaled, topical, nasal), for the last 28 days and ongoing.
    19. Major surgery within last 2 weeks prior to Screening (TURBT is not considered major surgery).
    20. Known/expected hypersensitivity against visugromab (CTL-002) and/or anti-PD-1/PD-L1 and/or anti-LAG-3 agents or their ingredients or previously had a severe hypersensitivity (= Grade 3) reaction to treatment with monoclonal antibodies (including pembrolizumab, nivolumab etc.) and/or any of their excipients.
    21. Evidence for active infection with human immunodeficiency virus, hepatitis B virus, hepatitis C virus, tuberculosis, or severe acute respiratory syndrome coronavirus 2 as per adequate testing performed.
    22. Dementia or altered mental status that would prohibit informed consent.
    23. Any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory abnormality giving reasonable suspicion of a disease or condition that in the opinion of the Investigator would contraindicate the use of an investigational drug or participation in a clinical study.
    24. Receipt of any organ transplantation, including hematopoietic cell transplantation, but with the exception of transplants that do not require immunosuppression (e.g., corneal transplant, hair transplant).
    25. Has a paraneoplastic syndrome (PNS) of autoimmune nature, requiring systemic treatment (systemic steroids or immunosuppressive agents) or has a clinical symptomatology suggesting worsening of PNS.
    26. Vaccine administration within 4 weeks of investigational drug administration (exception: coronavirus disease 2019 [COVID-19] vaccination). Vaccination with live vaccines while on study is prohibited. Administration of inactivated vaccines like inactivated influenza vaccines or RNA-vaccines is allowed, including COVID-19.
    27. Known active drug or alcohol abuse.
    1.Gravidanza o allattamento.
    2.Ha ricevuto una precedente radioterapia sul tumore della vescica.
    3.Ha subito una cistectomia parziale.
    4.Rifiuto primario di sottoporsi a RC.
    5.Ha ricevuto una precedente terapia antitumorale sistemica, compresi gli agenti sperimentali e l'immunoterapia per il cancro della vescica.
    6.Terapia precedente anti-PD-1/PD-L1.
    7.Ha un'altra neoplasia nota in progressione o che ha richiesto un trattamento attivo negli ultimi 3 anni.
    8.Lesioni tissutali acute o croniche importanti che potrebbero richiedere il mantenimento della funzione di GDF-15 per la protezione dei tessuti, secondo la valutaz dello sperimentatore (diagnosi di insuff epatica, renale, infarto del miocardio o altri organi importanti, tutti entro i 3 mesi precedenti lo screening e con disfunzione d'organo in corso secondo la valutazione clinica).
    9 Aritmia preesistente, angina pectoris non controllata, diagnosi di insufficienza cardiaca di grado NYHA IV, qualsiasi infarto miocardico/evento coronarico nonché qualsiasi evento ischemico del sistema nervoso centrale (SNC) e qualsiasi evento tromboembolico in qualsiasi momento <6 mesi prima dello screening o presenza di insuff cardiaca non controllata di grado NYHA III o superiore.
    10.Frazione di eiezione ventricolare sinistra < 50% misurata mediante ecocardiogramma (ECHO) o scansione ad acquisizione multipla se l'ECHO non può essere eseguita in sede per qualsiasi motivo.
    11.Intervallo QT corretto per la frequenza cardiaca mediante la formula di Fridericia >450 ms per gli uomini o >470 ms per le donne.
    12.Qualsiasi malattia autoimmune attiva che richieda trattamenti immunosoppressivi sistemici, per la quale la (ri)attivazione potrebbe rappresentare una minaccia medica per il soggetto, secondo la valutaz dello sperimentatore.
    13.Anamnesi di polmonite non infettiva < 6 mesi prima dello screening.
    14.Qualsiasi malattia infiammatoria intestinale attiva, come il morbo di Crohn o la colite ulcerosa, o autoimmunitiroidite attiva, tutte presenti < 6 mesi prima dello screening.
    15.Storia di malattie del sistema nervoso centrale come ictus, convulsioni, encefalite o sclerosi multipla (< 6 mesi prima dello screening).
    16.Allergia attiva che richiede un tratt sistemico (ad eccezione del trattamento con bloccanti dei recettori H1 dell'istamina) o infezioni attive che richiedono una terapia anti-infettiva sistemica.
    17. Anamnesi o evidenza clinica di tumori primari o metastasi del SNC, comprese le metastasi leptomeningee, a meno che non siano stati precedentemente trattati, non abbiano dimostrato alcuna progressione per almeno 3 mesi prima dello screening, siano asintomatici e non abbiano richiesto l'uso di steroidi o anticonvulsivanti che inducono l'enzima negli ultimi 14gg prima dello screening.
    - i soggetti con sospette metastasi cerebrali allo screening devono sottoporsi a una TC/RM dell'encefalo prima dell'ingresso nello studio.
    18.Steroidi sistemici a una dose giornaliera di >10 mg di prednisolone, >2 mg di desametasone o equivalente, eccetto quelli non sistemici (inalati, topici, nasali), negli ultimi 28gg e in corso.
    19.Intervento chirurgico maggiore nelle ultime 2 settimane prima dello screening (la TURBT non è considerata un intervento chirurgico maggiore).
    20.Ipersensibilità nota/prevista nei confronti di visugromab (CTL-002) e/o degli agenti anti-PD-1/PD-L1 e/o anti-LAG-3 o dei loro componenti o precedente reazione di ipersensibilità grave (= grado 3) al trattamento con anticorpi monoclonali (compresi pembrolizumab, nivolumab ecc.) e/o uno qualsiasi dei loro eccipienti.
    21.Evidenza di infezione attiva da virus dell'immunodeficienza umana, virus dell'epatite B, virus dell'epatite C, tubercolosi o sindrome respirat acuta grave da coronavirus come da test adeguati effettuati.
    22.Demenza o alterazione dello stato mentale che impedisca il consenso informato.
    23.Qualsiasi altra malattia, disfunzione metabolica, reperto dell'esame fisico o anomalia clinica di laboratorio che dia il ragionevole sospetto di una malattia o condizione che, a giudizio dello sperimentatore, controindichi l'uso di un farmaco in sperimentazione o la partecipazione a uno studio clinico.
    24.Ricezione di un trapianto d'organo, compreso il trapianto di cellule ematopoietiche, ad eccez dei trapianti che non richiedono immunosoppressione (ad es. trapianto di cornea, trapianto di capelli).
    25.Ha una sindrome paraneoplastica (PNS) di natura autoimmune, che richiede un trattamento sistemico (steroidi sistemici o agenti immunosoppressivi) o ha una sintomatologia clinica che suggerisce un peggioramento della PNS.
    26.Somministrazione di vaccini entro 4 sett dalla somministrazione del farmaco in sperimentazione (eccezione: vaccinazione contro la malattia da coronavirus 2019 [COVID-19]). È vietata la vaccinaz con vaccini vivi durante lo studio. È consentita la somministrazione di vaccini inattivati, come i vaccini antinfluenzali inattivati o i vaccini a RNA, incluso il COVID-19.
    27.Abuso attivo e noto di droghe o alcol
    E.5 End points
    E.5.1Primary end point(s)
    • Pathologic complete response (pCR) rate of visugromab (CTL-002) in combination with an anti-PD-1 checkpoint inhibitor, versus an anti-PD-1 checkpoint inhibitor alone
    • Radiologic response rate according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 of visugromab (CTL-002) in combination with an anti-PD-1 checkpoint inhibitor, versus an anti-PD-1 checkpoint inhibitor alone
    - Tasso di risposta patologica completa (pCR) di visugromab (CTL-002) in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo
    - Tasso di risposta radiologica secondo i criteri di valutazione della risposta nei tumori solidi (RECIST) v1.1 di visugromab (CTL-002) in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the course of the study
    Nel corso dello studio
    E.5.2Secondary end point(s)
    • Evaluation of the number of subjects with adverse events (AEs) including serious adverse events (SAEs), abnormal clinical laboratory data, and physical findings of visugromab (CTL-002) in combination with an anti-PD-1 checkpoint inhibitor, versus an anti-PD-1 checkpoint inhibitor alone
    • Evaluation of number of subjects with treatment-related delay of surgery
    • Evaluation of PK parameters of visugromab (CTL-002; e.g., maximum concentration [Cmax], area under the curve [AUC], and half-life [t1/2])
    • Evaluation of GDF-15 baseline serum levels and their correlation with pharmacodynamics and clinical activity
    • Evaluation of pathologic response of visugromab (CTL-002) in combination with an anti-PD-1 checkpoint inhibitor, versus an anti-PD-1 checkpoint inhibitor alone
    • Evaluation of radiologic response according to RECIST v1.1 of visugromab (CTL-002) in combination with an anti-PD-1 checkpoint inhibitor, versus an anti-PD-1 checkpoint inhibitor alone
    • Evaluation of tumor stage downgrading from baseline assessment to assessment prior to radical cystectomy (RC)
    • Evaluation of EFS, time to relapse (TTR), and overall survival (OS)
    • Positron emission tomography (PET)-computed tomography (CT) and/or multiparametric (mp) magnetic resonance imaging (MRI) assessed response of visugromab (CTL-002) in combination with an antiPD-1 checkpoint inhibitor, versus an anti-PD-1 checkpoint inhibitor alone
    - Valutazione del numero di soggetti con eventi avversi (AEs), inclusi eventi avversi gravi (SAEs), dati clinici di laboratorio anormali e reperti fisici di visugromab (CTL-002) in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo
    - Valutazione del numero di soggetti con ritardo dell'intervento chirurgico correlato al trattamento.
    - Valutazione dei parametri PK di visugromab (CTL-002; ad esempio, concentrazione massima [Cmax], area sotto la curva [AUC] ed emivita [t1/2]).
    - Valutazione dei livelli sierici basali di GDF-15 e della loro correlazione con la farmacodinamica e l'attività clinica.
    - Valutazione della risposta patologica di visugromab (CTL-002) in combinazione con un inibitore del checkpoint anti-PD-1, rispetto al solo inibitore del checkpoint anti-PD-1.
    - Valutazione della risposta radiologica secondo RECIST v1.1 di visugromab (CTL-002) in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo
    - Valutazione del declassamento dello stadio tumorale dalla valutazione al basale alla valutazione prima della cistectomia radicale (RC)
    - Valutazione dell'EFS, del tempo alla recidiva (TTR) e della sopravvivenza globale (OS).
    - La tomografia a emissione di positroni (PET) e la tomografia computerizzata (TC) e/o la risonanza magnetica multiparametrica (MRI) hanno valutato la risposta di visugromab (CTL-002) in combinazione con un inibitore del checkpoint anti-PD-1, rispetto a un inibitore del checkpoint anti-PD-1 da solo.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Throughout the course of the study
    Nel corso dello studio
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response 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 Yes
    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 Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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 concerned4
    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 Information not present in EudraCT
    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
    The End of Study is defined as the time point when the last Follow-up Visit has taken place.
    La fine dello studio è definita come il momento in cui si svolge l'ultima visita di follow-up.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months6
    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: 15
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 15
    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 state30
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 30
    F.4.2.2In the whole clinical trial 30
    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)
    Subjects will be followed until death, withdrawal of consent, or 12 months after the RC, whichever occurs first, to monitor safety and long-term outcome (efficacy and survival), as well as to document
    adjuvant treatment
    I soggetti saranno seguiti fino al decesso, alla revoca del consenso o 12 mesi dopo la RC, a seconda di quale evento si verifichi per primo, per monitorare la sicurezza e gli esiti a lungo termine (efficacia e sopravvivenza), nonché per documentare il trattamento adiuvante.
    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 Decision2023-03-09
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-11-09
    P. End of Trial
    P.End of Trial StatusOngoing
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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