Clinical Trial Page

Summary
EudraCT Number:2021-003715-26
Sponsor's Protocol Code Number:C4221022
National Competent Authority:Spain - AEMPS
Clinical Trial Type:EEA CTA
Trial Status:Ongoing
Date on which this record was first entered in the EudraCT database:2022-03-08
Trial results
A. Protocol Information
A.1Member State ConcernedSpain - AEMPS
A.2EudraCT number2021-003715-26
A.3Full title of the trial
A PHASE 2, RANDOMIZED, OPEN-LABEL STUDY OF ENCORAFENIB AND CETUXIMAB PLUS PEMBROLIZUMAB VERSUS PEMBROLIZUMAB ALONE IN PARTICIPANTS WITH PREVIOUSLY UNTREATED BRAF V600E-MUTANT, MSI-H/DMMR METASTATIC COLORECTAL CANCER
ESTUDIO EN FASE II, ALEATORIZADO Y ABIERTO DE ENCORAFENIB Y CETUXIMAB MÁS PEMBROLIZUMAB EN COMPARACIÓN CON PEMBROLIZUMAB EN MONOTERAPIA EN PARTICIPANTES CON CÁNCER COLORRECTAL METASTÁSICO CON MSI-H/DMMR Y CON MUTACIÓN V600E EN BRAF NO TRATADO PREVIAMENTE
A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
The SEAMARK Study: Phase 2 Study of First-line Encorafenib and
Cetuximab Plus Pembrolizumab in Participants With BRAF V600E-mutant, MSIH/dMMR Metastatic Colorectal Cancer
El estudio SEAMARK: Estudio en fase II de encorafenib y cetuximab más pembrolizumab como tratamiento de primera línea en participantes con cáncer colorrectal metastásico con MSI-H/DMMR y con mutación V600E en BRAF
A.4.1Sponsor's protocol code numberC4221022
A.5.2US NCT (ClinicalTrials.gov registry) numberNCT05217446
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 SponsorPfizer Inc.
B.1.3.4CountryUnited States
B.3.1 and B.3.2Status of the sponsorCommercial
B.4 Source(s) of Monetary or Material Support for the clinical trial:
B.4.1Name of organisation providing supportPfizer Inc., 235 East 42nd Street, New York, NY 10017
B.4.2CountryUnited States
B.5 Contact point designated by the sponsor for further information on the trial
B.5.1Name of organisationPfizer Inc.
B.5.2Functional name of contact pointClinical Trials.gov Call Centre
B.5.3 Address:
B.5.3.1Street Address235 East 42nd Street
B.5.3.2Town/ cityNew York
B.5.3.3Post codeNY 10017
B.5.3.4CountryUnited States
B.5.4Telephone number+18007181021
B.5.6E-mailClinicalTrials.gov_Inquiries@pfizer.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 BRAFTOVI®
D.2.1.1.2Name of the Marketing Authorisation holderPierre Fabre Médicament
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 nameEncorafenib
D.3.2Product code PF-07263896
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 INNEncorafenib
D.3.9.1CAS number 1269440-17-6
D.3.9.2Current sponsor codePF-07263896
D.3.9.4EV Substance CodeSUB177218
D.3.10 Strength
D.3.10.1Concentration unit mg milligram(s)
D.3.10.2Concentration typeequal
D.3.10.3Concentration number75
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 Yes
D.2.1.1.1Trade name Erbitux
D.2.1.1.2Name of the Marketing Authorisation holderMerck Europe B.V.
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 nameCetuximab
D.3.4Pharmaceutical form Solution for infusion
D.3.4.1Specific paediatric formulation No
D.3.7Routes of administration for this IMPIntravenous use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8INN - Proposed INNCetuximab
D.3.9.1CAS number 205923-56-4
D.3.9.4EV Substance CodeSUB01178MIG
D.3.10 Strength
D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
D.3.10.2Concentration typeequal
D.3.10.3Concentration number5
D.3.11 The IMP contains an:
D.3.11.1Active substance of chemical origin No
D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
The IMP is a:
D.3.11.3Advanced Therapy IMP (ATIMP) No
D.3.11.3.1Somatic cell therapy medicinal product No
D.3.11.3.2Gene therapy medical product No
D.3.11.3.3Tissue Engineered Product No
D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
D.3.11.5Radiopharmaceutical medicinal product No
D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
D.3.11.7Plasma derived medicinal product No
D.3.11.8Extractive medicinal product No
D.3.11.9Recombinant medicinal product No
D.3.11.10Medicinal product containing genetically modified organisms No
D.3.11.11Herbal medicinal product No
D.3.11.12Homeopathic medicinal product No
D.3.11.13Another type of medicinal product No
D.IMP: 3
D.1.2 and D.1.3IMP RoleTest
D.2 Status of the IMP to be used in the clinical trial
D.2.1IMP to be used in the trial has a marketing authorisation Yes
D.2.1.1.1Trade name KEYTRUDA®
D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
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.3.4Pharmaceutical form Solution for infusion
D.3.4.1Specific paediatric formulation No
D.3.7Routes of administration for this IMPIntravenous use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8INN - Proposed INNPembrolizumab
D.3.9.1CAS number 1374853-91-4
D.3.9.4EV Substance CodeSUB167136
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 No
D.3.11.3.2Gene therapy medical product No
D.3.11.3.3Tissue Engineered Product No
D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
D.3.11.5Radiopharmaceutical medicinal product No
D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
D.3.11.7Plasma derived medicinal product No
D.3.11.8Extractive medicinal product No
D.3.11.9Recombinant medicinal product Yes
D.3.11.10Medicinal product containing genetically modified organisms No
D.3.11.11Herbal medicinal product No
D.3.11.12Homeopathic medicinal product No
D.3.11.13Another type of medicinal product No
D.IMP: 4
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 KEYTRUDA®
D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
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.3.4Pharmaceutical form Solution for infusion
D.3.4.1Specific paediatric formulation No
D.3.7Routes of administration for this IMPIntravenous use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8INN - Proposed INNPembrolizumab
D.3.9.1CAS number 1374853-91-4
D.3.9.4EV Substance CodeSUB167136
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 No
D.3.11.3.2Gene therapy medical product No
D.3.11.3.3Tissue Engineered Product No
D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
D.3.11.5Radiopharmaceutical medicinal product No
D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
D.3.11.7Plasma derived medicinal product No
D.3.11.8Extractive medicinal product No
D.3.11.9Recombinant medicinal product Yes
D.3.11.10Medicinal product containing genetically modified organisms No
D.3.11.11Herbal medicinal product No
D.3.11.12Homeopathic medicinal product No
D.3.11.13Another type of medicinal product No
D.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
MSI-H/dMMR metastatic colorectal cancer.
cáncer colorrectal metastásico MSI-H/DMMR
E.1.1.1Medical condition in easily understood language
BRAFV600E mutant, colorectal cancer
cáncer colorrectal con mutación V600E de BRAF
E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
MedDRA Classification
E.1.2 Medical condition or disease under investigation
E.1.2Version 21.0
E.1.2Level PT
E.1.2Classification code 10061451
E.1.2Term Colorectal 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 21.0
E.1.2Level PT
E.1.2Classification code 10052358
E.1.2Term Colorectal cancer metastatic
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 compare the efficacy of encorafenib and cetuximab plus pembrolizumab (Triplet Arm [Arm A]) vs pembrolizumab (Control Arm [Arm B])
Comparar la eficacia de encorafenib y cetuximab más pembrolizumab (grupo del triplete [grupo A]) frente a pembrolizumab (grupo de control [grupo B])
E.2.2Secondary objectives of the trial
- To assess the overall safety and tolerability of Arm A vs Arm B;
- To assess the efficacy of Arm A vs Arm B;
- To confirm the BRAF and MSI status in tumor tissue;
- To evaluate the effect on PROs of Arm A vs Arm B.
- Evaluar la seguridad y tolerabilidad general del grupo A frente al grupo B
- Evaluar la eficacia del grupo A frente al grupo B
- Para confirmar el estado de BRAF y MSI en el tejido tumoral
- Evaluar el efecto en los RNP del grupo A frente al grupo B
E.2.3Trial contains a sub-study No
E.3Principal inclusion criteria
Participants are eligible to be included in the study only if all of the following criteria apply:
I. Molecular Prescreening Inclusion Criteria
1. Locally confirmed dMMR or MSI-H disease in tumor tissue or blood (eg. ctDNA genetic testing) as determined by a local laboratory assay in a CLIA- or similarly certified laboratory.
2. Locally confirmed BRAF V600E mutation in tumor tissue or blood (eg, ctDNA genetic testing) as determined by either PCR or NGS-based local laboratory assay in a CLIA- or similarly certified laboratory.

Screening Inclusion Criteria
3. Male or female participants age ≥16 years at the time of informed consent/assent (or the minimum country specific age of consent if >16). In countries or sites where enrollment of adolescents is not permitted (eg, Germany), male or female participants age ≥18 years at the time of informed consent.

Type of Participant and Disease Characteristics:
4. Participants who are willing and able to comply with all scheduled visits, treatment plan, laboratory tests, lifestyle considerations, and other study procedures.
5. Histologically or cytologically confirmed metastatic Stage IV colorectal adenocarcinoma.
Note: Patients with oligometastatic disease previously treated with curative intent are
eligible to participate in the study as long as they have baseline measurable disease
per RECIST 1.1.
6. Presence of measurable disease per RECIST v1.1, as assessed by investigator and evidenced by available baseline tumor scan.
Note: Baseline scan is defined as the last scan prior to the date of randomization (Section 10.10). Note: Baseline scans will be required to be available for subsequent submission to a central radiology vendor to be assessed by the BICR.
7. Availability of adequate tumor tissue (primary or metastatic; archival or newly obtained; block or slides; see Section 8.6.1). Whenever possible, the archival sample should be from the same tumor block that was used for local BRAF V600E mutation and MSI-H/dMMR testing. This tissue block should be obtained from a biopsy or surgery that was performed within 2 years prior to study enrollment. A newly obtained tumor tissue biopsy must be provided prior to randomization for participants unable to provide adequate archival tumor tissue. If a newly obtained biopsy is taken, the biopsy should be taken from a nontarget lesion when possible.
8. Have not received prior systemic regimens for metastatic disease. Note: Participants with early stage disease (eg, Stages I-III) treated with surgery
followed by chemotherapy (eg, treatment in the adjuvant setting) or have received prior systemic neoadjuvant therapy with or without radiation who present with new lesions or evidence of disease recurrence during or within 6 months of the last dose of chemotherapy would be considered as having received 1 prior systemic therapy in the metastatic setting.
9. ECOG performance status of ≤1.
10. Adequate bone marrow function characterized by the following at screening:
a. ANC ≥1.5 × 109/L
b. Platelets ≥100 × 109/L
c. Hemoglobin ≥9.0 g/dL (without blood transfusions 2 weeks prior to randomization)
11. Adequate hepatic and renal function characterized by the following at screening:
a. Serum Tbili ≤1.5 × ULN and < 2 mg/dL.
Note: Tbili >1.5 × ULN is allowed if direct (conjugated) ≤ 1.5 × ULN and indirect (unconjugated) bilirubin is ≤ 4.25 × ULN.
Note: Participants with documented Gilbert syndrome or hyperbilirubinemia due to non-hepatic cause (eg, hemolysis, hematoma) may be enrolled
following discussion and agreement with the sponsor or designee.
b. ALT and AST ≤ 2.5 × ULN, or ≤ 5 × ULN in the presence of liver metastases.
Informed Consent:
12. Capable of giving signed informed consent as described in Appendix 1, which includes compliance with the requirements and restrictions listed in the ICD and in this protocol.
Please refer to the protocol to view the notes associated with inclusion criteria number 12.
Los participantes serán aptos para ser incluidos en el estudio solo si cumplen todos los criterios siguientes:
I. Criterios de inclusión de la preselección molecular
1. dMMR o MSI-H confirmada localmente en tejido tumoral o sangre (p. ej., análisis genéticos de ADNtc) según lo determinado por un análisis de laboratorio local en un laboratorio con certificado CLIA o similar.
2. Mutación V600E de BRAF confirmada localmente en tejido tumoral o sangre (p. ej., análisis genéticos de ADNtc) determinada mediante PCR o análisis de laboratorio local basado en NGS en un laboratorio con certificado CLIA o similar.

Criterios de inclusión de la selección
3. Participantes varones o mujeres de ≥16 años de edad en el momento del consentimiento/asentimiento informado (o la edad mínima específica del país de consentimiento si >16). En los países o centros en los que no se permite la inscripción de adolescentes (p. ej., Alemania), participantes de sexo masculino o femenino de ≥18 años de edad en el momento del consentimiento informado.

Tipo de participante y características de la enfermedad
4. Los participantes deben estar dispuestos y ser capaces de cumplir con todas las visitas programadas, el plan de tratamiento, las pruebas analíticas, las consideraciones sobre el estilo de vida y otros procedimientos del estudio.
5. Adenocarcinoma colorrectal metastásico en estadio IV confirmado histológica o citológicamente
Nota: los pacientes con enfermedad oligometastásica tratados previamente con intención curativa son aptos para participar en el estudio siempre que tengan enfermedad medible al inicio según RECIST 1.1.
6. Presencia de enfermedad medible según los criterios RECIST v1.1, evaluada por el investigador y demostrada por el escáner tumoral inicial disponible.
Nota: el escáner inicial se define como el último escáner antes de la fecha de aleatorización (Sección 10.10).
Nota: los escáneres iniciales deberán estar disponibles para su posterior envío a un proveedor central de radiología para que las evalúe la RCIE.
7. Disponibilidad de tejido tumoral adecuado (primario o metastásico; de archivo o recién obtenido; bloques o portaobjetos; véase la sección 8.6.1). Siempre que sea posible, la muestra de archivo debe ser del mismo bloque tumoral que se utilizó para la mutación VV600E de BRAF local y la prueba de MSI-H/dMMR. Este bloque de tejido debe obtenerse de una biopsia o cirugía realizada en los 2 años anteriores a la inscripción en el estudio. Se debe proporcionar una biopsia de tejido tumoral recién obtenida antes de la aleatorización para los participantes que no puedan proporcionar suficiente tejido tumoral de archivo. Si se toma una biopsia reciente, la biopsia debe obtenerse de una lesión no diana siempre que sea posible.
8. No haber recibido pautas sistémicas previas para la enfermedad metastásica.
Nota: los participantes con enfermedad en fase temprana (p. ej., estadios I-III) tratados con cirugía seguida de quimioterapia (p. ej., tratamiento en el contexto adyuvante) o que hayan recibido tratamiento neoadyuvante sistémico previo con o sin radiación que presenten nuevas lesiones o indicios de recurrencia de la enfermedad durante o en los 6 meses posteriores a la última dosis de quimioterapia se considerarían que han recibido 1 tratamiento sistémico previo en el contexto metastásico.
9. Estado funcional del ECOG ≤1.
10. Función adecuada de la médula ósea caracterizada por lo siguiente en la selección:
a. RAN ≥1.5 × 109/l
b. Plaquetas ≥100 × 109/l
c. Hemoglobina ≥9,0 g/dl (sin transfusiones de sangre 2 semanas antes de la aleatorización)
11. Funciones hepática y renal adecuadas caracterizadas por lo siguiente en la selección:
a. Tbili sérico ≤1,5 × LSN y <2 mg/dl.
Nota: se permite Tbili >1,5 × LSN si la bilirrubina directa (conjugada) ≤1,5 × LSN e indirecta (no conjugada) es ≤4,25 × LSN.
Nota: se podrá incluir a los participantes con síndrome de Gilbert documentado o hiperbilirrubinemia debida a una causa no hepática (p. ej., hemólisis, hematoma) tras comentarlo y acordarlo con el promotor o la persona designada.
b. ALT y AST ≤2,5 × LSN o ≤5 × LSN en presencia de metástasis hepáticas.
c. Función renal adecuada definida por un aclaramiento de creatinina estimado ≥50 ml/min según la fórmula de Cockcroft Gault o mediante la recogida de orina de 24 horas para el aclaramiento de creatinina, o de acuerdo con el método de referencia institucional local.
d. Electrolitos adecuados, definidos como niveles séricos de potasio y magnesio dentro de los límites normales institucionales. Nota: se permitirá el tratamiento sustitutivo para lograr electrolitos adecuados
12. Capacidad de otorgar consentimiento informado firmado, tal y como se describe en el Apéndice 1, lo que comprende el cumplimiento de los requisitos y las restricciones indicados en el formulario de consentimiento informado (FCI) y en este protocolo.
Consulte el protocolo para ver las notas asociadas al criterio de inclusión 12.
E.4Principal exclusion criteria
Participants are excluded from the study if any of the following criteria apply:

Screening Exclusion Criteria
Medical Conditions:
1. Colorectal adenocarcinoma that is RAS mutant or for which RAS mutation status is unknown.
2. Documented clinical disease progression (eg, worsening of performance status, clinical symptoms, or clinically significant laboratory parameters demonstrating worsening of disease) or radiographic disease progression during the screening period.
3. Has active CNS metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable, ie, without evidence of progression for at least 4 weeks by repeat imaging (note that the repeat imaging should be performed during study screening), clinically stable and without requirement of steroid treatment for at least 14 days prior to first dose of study intervention.
4. Leptomeningeal disease.
5. Diagnosis of immunodeficiency or an active autoimmune disease that required systemic treatment in the past 2 years (ie, with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Note: Participants with diabetes type I, vitiligo, psoriasis, controlled asthma,
Graves’ disease, Hashimoto’s disease or hypo- or hyperthyroid disease are exceptions and may participate. Note: Replacement and symptomatic therapies (eg, levothyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) are not considered a form of immunosuppressive agents and are permitted.
6. Presence of acute or chronic pancreatitis.
7. History of chronic inflammatory bowel disease requiring medical intervention (immunomodulatory or immunosuppressive medications or surgery) ≤ 12 months prior to randomization.
8. Unable to swallow, retain, and absorb oral medications.
9. Impaired gastrointestinal function (eg, uncontrolled nausea, vomiting or diarrhea, malabsorption syndrome, small bowel resection) or disease which may significantly alter the absorption of oral study intervention or recent changes in bowel function suggesting current or impending bowel obstruction.
10. Clinically significant cardiovascular diseases, including any of the following:
a. History of acute myocardial infarction, acute coronary syndromes (including unstable angina, coronary artery bypass graft, coronary angioplasty or
stenting) ≤ 6 months prior to randomization.
b. Congestive heart failure requiring treatment (New York Heart Association Grade ≥ 2).
c. Recent history (one year) or presence of clinically significant cardiac arrhythmias (including uncontrolled atrial fibrillation or uncontrolled
paroxysmal supraventricular tachycardia).
d. History of thromboembolic or cerebrovascular events ≤ 12 weeks prior to randomization. Examples include transient ischemic attacks, cerebrovascular accidents, hemodynamically significant (ie, massive or sub-massive) deep vein thrombosis or pulmonary emboli. Note: Participants with either deep vein thrombosis or pulmonary emboli that do not result in hemodynamic instability are allowed to enroll as long as they
are on a stable dose of anticoagulants for at least 4 weeks. Note: Participants with thromboembolic events related to indwelling catheters
(including PICC lines) or other procedures may be enrolled
e. Triplicate average QTcF interval ≥480 ms or a history of prolonged QT syndrome. Note: Participants with BBB or with an implanted cardiac pacemaker may enroll into the study upon agreement between the investigator and sponsor or designee.
f. Congenital LQTS.
11. Has a history of (non-infectious) pneumonitis / interstitial lung disease that required steroids or has current pneumonitis / interstitial lung disease.
12. Evidence of active and uncontrolled bacterial or viral infection, with certain exceptions, as noted below, for chronic infection with hepatitis B or hepatitis C, within 2 weeks prior to start of study intervention.

Further exclusion criteria are deatiled in the protocol.
Los participantes serán excluidos del estudio si cumplen alguno de los siguientes criterios:

Criterios de exclusión de la selección
Enfermedades:
1. Adenocarcinoma colorrectal con mutación RAS o para el que se desconoce el estado de mutación RAS.
2. Progresión clínica de la enfermedad documentada (p. ej., empeoramiento del estado funcional, síntomas clínicos o parámetros analíticos clínicamente significativos que demuestren empeoramiento de la enfermedad) o progresión radiográfica de la enfermedad durante la fase de selección.
3. Tiene metástasis activas en el SNC y/o meningitis carcinomatosa. Los participantes con metástasis cerebrales tratadas previamente pueden participar siempre que estén radiológicamente estables, es decir, sin signos de progresión durante al menos 4 semanas mediante la repetición de las pruebas de diagnóstico por imagen (tenga en cuenta que la repetición de las pruebas de diagnóstico por imagen debe realizarse durante la selección del estudio), clínicamente estables y sin necesidad de tratamiento con corticoesteroides durante al menos 14 días antes de la primera dosis de la intervención del estudio.
4. Enfermedad leptomeníngea.
5. Diagnóstico de inmunodeficiencia o enfermedad autoinmunitaria activa que haya requerido tratamiento sistémico en los últimos 2 años (es decir, con el uso de fármacos modificadores de la enfermedad, corticoesteroides o fármacos inmunosupresores).
Nota: los participantes con diabetes tipo I, vitíligo, psoriasis, asma controlada, enfermedad de Graves, enfermedad de Hashimoto o enfermedad hipotiroidea o hipertiroidea son excepciones y pueden participar.
Nota: los tratamientos sustitutivos y sintomáticos (p. ej., levotiroxina, insulina o tratamiento sustitutivo fisiológico con corticoesteroides para la insuficiencia suprarrenal o hipofisaria) no se consideran una forma de inmunodepresores y están permitidos.
6. Presencia de pancreatitis aguda o crónica.
7. Antecedentes de enfermedad intestinal inflamatoria crónica que requiera intervención médica (medicamentos inmunomoduladores o inmunosupresores o cirugía) ≤12 meses antes de la aleatorización.
8. Incapaz de tragar, retener y absorber medicamentos orales.
9. Deterioro de la función gastrointestinal (p. ej., náuseas, vómitos o diarrea no controlados, síndrome de malabsorción, resección del intestino delgado) o enfermedad que pueda alterar significativamente la absorción de la intervención oral del estudio o cambios recientes en la función intestinal que sugieran obstrucción intestinal actual o inminente.
10. Enfermedad cardiovascular clínicamente significativa, incluidas cualquiera de las siguientes:
a. Antecedentes de infarto agudo de miocardio, síndromes coronarios agudos (incluida angina inestable, injerto de derivación de la arteria coronaria, angioplastia coronaria o colocación de stent) ≤6 meses antes de la aleatorización.
b. Insuficiencia cardiaca congestiva que requiere tratamiento (grado ≥2 de la Asociación de Cardiología de Nueva York).
c. Antecedentes recientes (un año) o presencia de arritmias cardiacas clínicamente significativas (incluida fibrilación auricular no controlada o taquicardia supraventricular paroxística no controlada).
d. Antecedentes de acontecimientos tromboembólicos o cerebrovasculares ≤12 semanas antes de la aleatorización. Los ejemplos incluyen ataques isquémicos transitorios, accidentes cerebrovasculares, trombosis venosa profunda hemodinámicamente significativa (es decir, masiva o submasiva) o émbolos pulmonares.
Nota: se puede incluir a los participantes con trombosis venosa profunda o émbolos pulmonares que no provoquen inestabilidad hemodinámica siempre que estén recibiendo una dosis estable de anticoagulantes durante al menos 4 semanas.
Nota: pueden incluirse participantes con acontecimientos tromboembólicos relacionados con catéteres permanentes (incluidas líneas PICC) u otros procedimientos.
e. Intervalo QTcF medio por triplicado ≥480 ms o antecedentes de síndrome de QT prolongado.
Nota: se puede incluir en el estudio a los participantes con BHE o con un marcapasos cardiaco implantado tras el acuerdo entre el investigador y el promotor o la persona designada.
f. Síndrome de QT largo congénito.
11. Tiene antecedentes de neumonitis/neumopatía intersticial (no infecciosa) que requirió corticoesteroides o tiene neumonitis/neumopatía intersticial actualmente.
12. Evidencia de infección bacteriana o vírica activa y no controlada, con ciertas excepciones, como se indica a continuación, por infección crónica con hepatitis B o hepatitis C, en las 2 semanas previas al inicio de la intervención del estudio.

Se detallan más criterios de exclusión en el protocolo.
E.5 End points
E.5.1Primary end point(s)
PFS per investigator, defined as the time from randomization until PD based on investigator assessment per RECIST v1.1 or death due to any cause, whichever occurs first.
La SSP según el investigador se define como el tiempo transcurrido desde la aleatorización hasta la PE según la evaluación de RECIST v1.1 o la muerte por cualquier causa, lo que ocurra primero.
E.5.1.1Timepoint(s) of evaluation of this end point
The primary efficacy analysis of the trial will be the comparison of PFS per investigator assessment between the 2 treatment arms using a stratified log-rank test at 1-sided α = 0.15 and is anticipated to occur approximately 45 months after the first participant is randomized.
El análisis principal del estudio será la comparación de la SSP según la evaluación del investigador entre los dos grupos de tratamiento utilizando una prueba del orden logarítmico estratificada alfa unilateral = 0,15 y se prevé que ocurra aproximadamente 45 meses después de la aleatorización del primer participante.
E.5.2Secondary end point(s)
- Incidence and severity of AEs graded according to the NCI CTCAE v4.03 and changes in clinical laboratory test parameters, vital signs and ECGs
- Incidence of dosing interruptions, dose modifications and permanent discontinuations associated with AEs
- OS, defined as the time from the date of randomization to the date of death due to any cause
- Objective response, defined as confirmed CR or confirmed PR based on investigator assessment per RECIST v1.1, from the date of randomization until
the date of the first documentation of PD, death or start of new anticancer therapy
- DOR, defined as the time from the first response, until PD based on investigator assessment per RECIST v1.1 or death due to any cause, whichever
occurs first
- BRAF and MSI-status as determined by retrospective central testing of baseline tumor tissue;
- EORTC QLQ-C30: change from baseline in the global health status/QoL, functional and symptom scales, and single items
- EQ-5D-5L: change from baseline in the index score and VAS
- PGIS score: change from baseline in the score
- PGIC score
• Incidencia e intensidad de los AA clasificados según los CTCAE del NCI v4.03 y cambios en los parámetros de las pruebas analíticas clínicas, las constantes vitales y los ECG
• Incidencia de interrupciones de la administración de la dosis, modificaciones de la dosis e interrupciones permanentes asociadas a AA
• SG, se define como el tiempo desde la aleatorización hasta la fecha de muerte por cualquier causa.
• Respuesta objetiva, definida como RC confirmada o RP confirmada según la evaluación del investigador de acuerdo con los criterios RECIST v1.1, desde la fecha de aleatorización hasta la fecha de la primera documentación de PE, muerte o inicio de un nuevo tratamiento antineoplásico
• DR, definida como el tiempo transcurrido desde la primera respuesta hasta la PE según la evaluación del investigador de acuerdo con los criterios RECIST v1.1 o la muerte por cualquier causa, lo que ocurra primero
• Estado de BRAF y MSI determinado por análisis central retrospectivo de tejido tumoral inicial
• EORTC QLQ-C30: Cambio desde el inicio en el estado de salud global/CdV, escalas funcionales y de síntomas, y elementos individuales
• EQ-5D-5L: Cambio con respecto al inicio en la puntuación del índice y la EVA.
• PGIS: Cambio desde el inicio en la puntuación
• Puntuación PGIC
E.5.2.1Timepoint(s) of evaluation of this end point
throughout the study
a lo largo del estudio
E.6 and E.7 Scope of the trial
E.6Scope of the trial
E.6.1Diagnosis No
E.6.2Prophylaxis No
E.6.3Therapy No
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 Yes
E.6.11Pharmacogenomic No
E.6.12Pharmacoeconomic No
E.6.13Others Yes
E.6.13.1Other scope of the trial description
tolerability
tolerabilidad
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 Yes
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) 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 concerned11
E.8.5The trial involves multiple Member States Yes
E.8.5.1Number of sites anticipated in the EEA65
E.8.6 Trial involving sites outside the EEA
E.8.6.1Trial being conducted both within and outside the EEA Yes
E.8.6.2Trial being conducted completely outside of the EEA No
E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
Australia
Canada
United States
Belgium
Czechia
Denmark
France
Germany
Italy
Netherlands
Norway
Poland
Slovakia
Spain
Sweden
United Kingdom
E.8.7Trial has a data monitoring committee Yes
E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
LVLS
último paciente última visita
E.8.9 Initial estimate of the duration of the trial
E.8.9.1In the Member State concerned years4
E.8.9.1In the Member State concerned months6
E.8.9.1In the Member State concerned days0
E.8.9.2In all countries concerned by the trial years5
E.8.9.2In all countries concerned by the trial months0
E.8.9.2In all countries concerned by the trial days0
F. Population of Trial Subjects
F.1 Age Range
F.1.1Trial has subjects under 18 Yes
F.1.1Number of subjects for this age range: 5
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) Yes
F.1.1.6.1Number of subjects for this age range: 5
F.1.2Adults (18-64 years) Yes
F.1.2.1Number of subjects for this age range: 95
F.1.3Elderly (>=65 years) Yes
F.1.3.1Number of subjects for this age range: 4
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 state13
F.4.2 For a multinational trial
F.4.2.1In the EEA 75
F.4.2.2In the whole clinical trial 104
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)
Continuing treatment beyond first radiologic evidence of PD is to be considered under special circumstances when it is believed that the participant may clinically benefit from continued treatment beyond progression. At the discretion of the investigator and with consultation with Sponsor, clinically stable participants with initial evidence of investigator-assessed PD are permitted to continue study intervention.
Se considerará la continuación del tratamiento tras la primera evidencia radiológica de PE en circunstancias especiales en las que se considere que el participante puede obtener un beneficio clínico por el tratamiento continuado desde la progresión. Se permitirá continuar con la intervención del estudio a los participantes estables clínicamente con evidencia inicial de PE evaluada por el investigador, según el criterio del investigador y tras consultarlo con el promotor.
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 Decision2022-06-06
N.Ethics Committee Opinion of the trial applicationFavourable
N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
N.Date of Ethics Committee Opinion2022-04-28
P. End of Trial
P.End of Trial StatusOngoing
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