Étude avec IV NEPA (Fosnetupitant / Palonosetron) pour la prévention des nausées et des vomissements induits par la chimiothérapie chez des patients atteints de cancer pédiatrique subissant une chimiothérapie très émétogène (HEC)
Une étude multicentrique, multinationale, pharmacocinétique, de sécurité et d'efficacité avec IV NEPA (fosnetupitant / palonosétron) pour la prévention de la nausée induite par la chimiothérapie et des vomissements chez des patients atteints de cancer pédiatrique subissant une chimiothérapie hautement émétogène (HEC). A 2-part Study With Phase 2, Open-label, Randomised, Single-dose IV NEPA vs Fosaprepitant/Ondansetron in Single-day HEC and Repeated-dose IV NEPA in Multi-day HEC (Part I, Single Cycle) and With Phase 3, Double-blind, Randomised, Repeated-dose IV NEPA vs Fosaprepitant/Ondansetron in Multi-day HEC (Part II, Repeated Cycles)
Chemotherapy often causes nausea and vomiting (CINV), and this is a major problem for the children being treated for cancer. To prevent this, a combination of two substances in fixed proportion (IV NEPA) was developed. The two substances are: palonosetron, an antagonist of 5 HT3 receptors, and fosnetupitant, an antagonist of NK1 receptors that transforms into netupitant in the body. The medication is administered through intravenous injection (IV- drip).
This study is built from 2 parts:
Part 1: phase 2, open label Part 2: phase 3 double blind
The detailed description, study design, study milestones and eligibility criteria will reflect the Part 1 requirements
Aperçu de l'étude
Statut
Description détaillée
Part I of the study is a Phase 2, open-label, randomised (for Cohort 1 only), single chemotherapy cycle study which will compare single-dose of IV NEPA to another treatment (fosaprepitant/ondansetron) considered as a standard of care, in patients receiving single-day chemotherapy that has a high possibility to generate a vomiting episode (HEC) (Cohort 1) and assess repeated dose of IV NEPA in patients receiving multi day HEC chemotherapy (Cohort 2).
Because this will be the first study testing the IV NEPA in children, Part I will enroll patients from older to younger age groups with safety checks before moving to the next group.
Type d'étude
Inscription (Estimé)
Phase
- Phase 2
Contacts et emplacements
Coordonnées de l'étude
- Nom: Tulla Spinelli Head of Clinical Affairs, PharmD, PhD
- Numéro de téléphone: +41919852121
- E-mail: tulla.spinelli@helsinn.com
Lieux d'étude
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Athens, Grèce
- Recrutement
- Aghia Sophia Children's Hospital, Pediatric Hematology/ Oncology Unit (POHemU)
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Thessaloniki, Grèce
- Retiré
- "AHEPA" University General Hospital of Thessaloniki, 2nd Department of Pediatrics
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Bialystok, Pologne
- Retiré
- Department of Pediatrics, Oncology and Hematology University Children's Clinical Hospital them. Ludwik Zamenhof in Bialystok
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Bydgoszcz, Pologne, 85-667
- Recrutement
- Department of Paediatrics, Haematology, Oncology and Rheumatology Voivodship Children's Hospital them. J. Brudziński
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Lodz, Pologne
- Recrutement
- Clinic of Pediatrics, Oncology and Hematology University Pediatric Center them M. Konopnicka SP ZOZ Central Clinical Hospital Medical University of Lodz
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Lublin, Pologne, 20-093
- Pas encore de recrutement
- University Children'S Hospital in Lublin, Department of Pediatric Hematology, Oncology, and Transplantology
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Olsztyn, Pologne
- Retiré
- Clinical Department of Paediatric Oncology and Haematology VOIVODSHIP SPECIALIST CHILDREN'S HOSPITAL them. prof. dr. Stanisław Popowski in Olsztyn
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Poznan, Pologne
- Recrutement
- Department of Pediatric Oncology, Hematology and Transplantation Clinical Hospital them. Karol Jonscher Medical University them. Karol Marcinkowski in Poznań
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Szczecin, Pologne
- Retiré
- Department of Paediatrics and Paediatric Haemato-Oncology University Clinical Hospital No. 1 them. prof. Tadeusz Sokołowski Pomeranian Medical University
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Szczecin, Pologne
- Retiré
- Department of Paediatrics, Oncology and Paediatric Immunology, University Clinical Hospital No. 1 them. prof. Tadeusz Sokołowski Pomeranian Medical University in Szczecin
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Warsaw, Pologne
- Recrutement
- Department of Oncology and Surgical Oncology for Children and Youth Institute Mother and Child
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Warsaw, Pologne
- Recrutement
- Department of Oncology Institute "Monument - Child Health Center"
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Bucharest, Roumanie
- Recrutement
- Fundeni Clinical Institute, Pediatric Hematology and BMT
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Bucharest, Roumanie
- Recrutement
- Oncology Institute "Prof. Dr. Al. Trestioreanu", Pediatric Oncology
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Timișoara, Roumanie
- Recrutement
- Emergency Children's Hospital " Louis Turcanu, Oncology-Haematology and BMP department
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Ankara, Turquie (Türkiye)
- Recrutement
- Gazi University Gazi Hospital Children Hematology and Oncology
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Ankara, Turquie (Türkiye)
- Recrutement
- Hacettepe University Hospitals Oncology Hospital 2nd Floor Children Oncology
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Faith
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Istanbul, Faith, Turquie (Türkiye)
- Pas encore de recrutement
- Istanbul University Istanbul Faculty of Medicine Topkapı
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Mamak
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Ankara, Mamak, Turquie (Türkiye)
- Recrutement
- Ankara University Faculty of Medicine Children's Hospital, Department of Children Oncology and Hematology
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Melikgazi
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Kayseri, Melikgazi, Turquie (Türkiye)
- Recrutement
- Erciyes University Hospitals Kanka Children's Hematology Oncology and Bone Marrow Hospital
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
The following inclusion criteria must be checked prior to study inclusion:
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Signed written Informed Consent Form (ICF) by parent(s)/legal guardian of the paediatric patient in compliance with the local laws and regulations. In addition, the signed children's Assent Form according to local requirements.
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Male or female in- or out-patient from 0 months (newborns) to <18 years on the date of enrolment (Day 1).
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Cohort 1: Patient < 6 months weighing at least 4 kg or patient ≥ 6 months weighing at least 6 kg.
Cohort 2: Patient weighing at least 4 kg.
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Patient with a predicted life expectancy ≥3 months according to Investigator's opinion.
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Patient naïve or non-naïve to chemotherapy, with histologically and/or cytologically (or imaging in the case of brain tumours and nephroblastomas) confirmed malignant disease.
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Cohort 1: Patient scheduled and eligible to receive at least 1 cycle of single-day HEC.
Cohort 2: Patient scheduled and eligible to receive at least 1 cycle of multi-day HEC.
(For the level of emetogenicity of the chemotherapeutic agents, refer to the POGO January 2021 guideline).
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For patients aged ≥10 years: Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≤2.
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For patient with known hepatic impairment: the patient may be enrolled provided the serum ALT and AST are ≤2.5 ULN, the total bilirubin is ≤1.5 ULN, and in the Investigator's opinion the impairment is not expected to jeopardize the patient's safety during the study.
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For patient with known renal impairment: the patient may be enrolled provided the estimated glomerular filtration rate (eGFR) is ≥70 mL/min/1.73m2 (≥50 mL/min/1.73m2 for children <3 months old) (the eGFR should be calculated using the modified Schwartz equation) and in the Investigator's opinion the impairment is not expected to jeopardize the patient's safety during the study.
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For patient with known history or predisposition to cardiac abnormalities: as per the Investigator's opinion, the history/predisposition should not jeopardize patient's safety during the study.
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Patient with non-clinically significant abnormal laboratory values or with clinically relevant abnormal laboratory values may be enrolled if in the Investigator's opinion the patient's safety is not expected to be jeopardized.
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Female patient shall: a) not have attained menarche yet or b) have attained menarche and have a negative serum pregnancy test at the Screening Visit and a negative urine pregnancy test at Day 1.
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Male or female fertile patient using reliable contraceptive measures. Such measures, for patient and sexual partner, include: implants, injectables, combined oral contraceptives, intrauterine devices, vasectomized/sterilized partner, use of a double barrier method, or sexual abstinence. The patient and his/her parent(s)/legal guardian must be counselled on the importance of avoiding pregnancy before and during the study.
Exclusion Criteria:
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The patient and/or parent(s)/legal guardian are expected by the Investigator to be non compliant with the study procedures.
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Patient has received or is scheduled to receive total body irradiation; total nodal irradiation; upper abdomen radiotherapy; half or upper body irradiation; or radiotherapy of the cranium, craniospinal regions, head and neck, lower thorax region, or the pelvis within 1 week prior to study entry (Day 1) or within 120 h after start of chemotherapy on Day 1 (Cohort 1 patients) or within 168 h (for Cohort 2 patients receiving the last IV NEPA on Day 3) or 216 h (for Cohort 2 patients receiving the last IV NEPA on Day 5) from start of chemotherapy on Day 1.
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Known history of allergy to any component of the study treatments or other contraindications to any NK1-RAs or 5-HT3-RAs.
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Active infection.
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Any illness or condition that, in the opinion of the Investigator, may pose unwarranted risks in administering the investigational product to the patient.
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Uncontrolled medical condition (e.g., uncontrolled insulin-dependent diabetes mellitus).
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Patient experiencing ongoing vomiting from any organic aetiology (including patients with history of gastric outlet obstruction or intestinal obstruction due to adhesions or volvulus), or patient with hydrocephalus.
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Patient who experienced any vomiting, retching, or nausea within 24 h prior to the administration of the study treatment on Day 1 (Note: functional vomiting for infants, which is normally seen during the first 3 months of life, is not to be considered as vomiting).
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Patient who received any drug with potential antiemetic effect within 24 h prior to administration of study treatment on Day 1, including but not limited to the following:
- NK1-RAs (e.g., (fos)aprepitant or any other drug of this class)
- 5-HT3-RAs (e.g., ondansetron, granisetron, dolasetron, tropisetron, ramosetron)
- Benzamides (e.g., metoclopramide, alizapride)
- Phenothiazines (e.g., prochlorperazine, promethazine, perphenazine, fluphenazine, chlorpromazine, thiethylperazine)
- Benzodiazepines initiated 48 h prior to study treatment administration on Day 1 or expected to be administered within the efficacy assessment period, except for single doses of midazolam, temazepam, or triazolam
- Butyrophenones (e.g., droperidol, haloperidol)
- Anticholinergics (e.g., scopolamine, except the inhaled anticholinergics for respiratory disorders e.g., ipratropium bromide)
- Antihistamines (e.g., diphenhydramine, cyclizine, hydroxyzine, chlorphenhyramine, dimenhydrinate, meclizine)
- Domperidone
- Mirtazapine
- Olanzapine
- Prescribed cannabinoids (e.g., tetrahydrocannabinol, nabilone)
- Over-the-counter (OTC) antiemetics, OTC cold medications, or OTC allergy medications
- Herbal preparations containing ephedra or ginger
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Patient who received palonosetron within 1 week prior to administration of study treatment on Day 1.
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Patient receiving systemic corticosteroid therapy above 0.14mg/kg or >10 mg of prednisone daily or equivalent.
Exception:
Dexamethasone for the prevention of CINV is permitted in association with the study treatment (Test Treatment and Reference Treatment) as per standard of care and applicable guidelines, provided its dosage is reduced by 50% in consideration of known interactions with various NK1 RAs, including fosaprepitant and fosnetupitant.
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Patient aged <6 years who received any investigational drug (defined as a medication with no marketing authorization granted for any age or indication) within 90 days prior to Day 1, or patient aged ≥6 years who received any investigational drug within 30 days prior to Day 1, or patient any age who is expected to receive investigational drugs prior to study completion.
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Intake of alcohol, food, or beverages (e.g., grapefruit, cranberry, pomegranate, and aloe vera juices; German chamomile) known to interfere with CYP3A4 or CYP2D6 metabolic enzymes within 1 week prior to Day 1 and during the overall study period.
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Use of any drugs or substances known to be strong inhibitors of CYP3A4 or CYP2D6 enzymes within 1 week prior to Day 1 or planned to be used during the overall study period.
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Use of any drugs or substances known to be CYP3A4 substrates with narrow therapeutic range within 1 week prior to Day 1 or planned to be used during the overall study period.
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Use of any drugs or substances known to be strong inducers of CYP3A4 or CYP2D6 enzymes within 4 weeks prior to Day 1 or planned to be used during the overall study period.
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Lactating female patient.
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Enrolment in a previous study on netupitant (either administered alone or in combination with palonosetron).
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Marked baseline prolongation of QTc interval (QTcF>460 millisecond [msec]). At the discretion of the investigator, criterion may be based on automatic interpretation of results.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: La prévention
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: IV NEPA
The Test Treatment (IV NEPA) is planned to be administered in Cohort 1 and Cohort 2. IV NEPA Dosing Schedule
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In NEPA-22-01, different body weight-based dosages of IV NEPA will be applied to patients below and over 3 months of age: Formulation A (for patients ≥3 months of age; 235 mg fosnetupitant/1.5 mg palonosetron per vial) or Formulation B (for patients <3 months of age; 235 mg fosnetupitant/2.5 mg palonosetron per vial). |
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Comparateur actif: Reference Treatment
The Reference Treatment is planned to be administered in Cohort 1 only. The Reference Treatment includes fosaprepitant powder for solution for IV infusion and ondansetron liquid solution for IV infusion. |
IV Ondansetron Dosing Regimen
Fosaprepitant IV Dosing Regimen
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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COHORT 1 Neptupitant exposure parameter
Délai: From time zero ( start of IV NEPA infusion) to maximum 168 hours
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Maximum concentration (Cmax) |
From time zero ( start of IV NEPA infusion) to maximum 168 hours
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COHORT 1 Neptupitant exposure
Délai: From time zero ( start of IV NEPA infusion) to maximum 168 hours
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Area under the plasma concentration-time curve |
From time zero ( start of IV NEPA infusion) to maximum 168 hours
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COHORT 2 monitoring of AEs (safety and tolerability of IV NEPA)
Délai: Up to 31 days
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monitoring of AEs following repeated IV NEPA administration |
Up to 31 days
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
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COHORT 1: To assess the PK profile of netupitant.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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Cmax of netupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1: To assess the PK profile of fosnetupitant.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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Cmax of fosnetupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1: To assess the PK profile palonosetron.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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Cmax of palonosetron |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1: To assess the PK profile of netupitant
Délai: From Time zero ( start of IV NEPA infusion) until 48 hours
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AUC0-48 of netupitant |
From Time zero ( start of IV NEPA infusion) until 48 hours
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COHORT 1: To assess the PK profile of fosnetupitant.
Délai: From Time zero ( start of IV NEPA infusion) until 48 hours
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AUC0-48 of fosnetupitant |
From Time zero ( start of IV NEPA infusion) until 48 hours
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COHORT 1: To assess the PK profile palonosetron.
Délai: From Time zero ( start of IV NEPA infusion) until 48 hours
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AUC0-48 of palonosetron |
From Time zero ( start of IV NEPA infusion) until 48 hours
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COHORT 1: To assess the PK profile of netupitant
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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t1/2 of netupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1: To assess the PK profile of palonosetron.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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t1/2 of palonosetron |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1 and 2: To assess the population PK profile of fosnetupitant.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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Clearance (CL) of fosnetupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1 and 2: To assess the population PK profile of palonosetron.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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CL of palonosetron |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1 and 2: To assess the population PK profile of netupitant.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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CL/F of netupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
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COHORT 1 and 2: To assess the population PK profile of fosnetupitant
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
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Volume of compartments (V) for fosnetupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
|
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COHORT 1 and 2: To assess the population PK profile of palonosetron.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
|
V for palonosetron |
From Time zero ( start of IV NEPA infusion) until 168 hours
|
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COHORT 1 and 2: To assess the population PK profile of netupitant.
Délai: From Time zero ( start of IV NEPA infusion) until 168 hours
|
V/F for netupitant |
From Time zero ( start of IV NEPA infusion) until 168 hours
|
Collaborateurs et enquêteurs
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Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- NEPA-22-01
- 2024-514321-39 (Numéro EudraCT)
Plan pour les données individuelles des participants (IPD)
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Description du régime IPD
Only global trial data will be shared, not a single patient
Informations sur les médicaments et les dispositifs, documents d'étude
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