胃がん患者を対象として、ラムシルマブ及びパクリタキセル併用のTRK-950の有効性及び安全性の検討、TRK-950の薬物動態(PK)の検討、TRK-950の至適用量の特定並びにTRK-950に対する抗薬物抗体(ADA)及び中和抗体(NAb)の発現の検討を目的とする。 | |||
2 | |||
2023年09月01日 | |||
2023年10月04日 | |||
2023年07月14日 | |||
2025年08月31日 | |||
|
146 | ||
|
介入研究 | Interventional | |
Study Design |
|
無作為化比較 | randomized controlled trial |
|
非盲検 | open(masking not used) | |
|
実薬(治療)対照 | active control | |
|
並行群間比較 | parallel assignment | |
|
治療 | treatment purpose | |
|
なし | ||
|
なし | ||
|
あり | ||
|
|||
|
韓国/米国 | South Korea/the United States of America | |
|
|
- 組織学的又は細胞学的に確認された転移性又は局所進行、切除不能な胃又はGEJ腺がん。 - RAM + PTXの投与対象となる患者。 - 直近の抗がん治療の治療中又は治療後に、客観的な放射線画像による増悪又は臨床的増悪(例えば、超音波検査により記録された癌性体腔液の出現又は悪化)が記録され、必要に応じて病理学的基準(組織学及び/又は細胞学)により確認されている。治療歴について、以下基準の一つが合致しなければならない。 a. アジュバント/ネオアジュバント療法を受けることなく転移性又は局所進行がんに対する一次治療を受け、投与中又は最終投与後4ヵ月以内に増悪が認められた。 b. アジュバント/ネオアジュバント療法を受け、最終投与後6ヵ月を超えて増悪が認められ、さらに転移性又は局所進行がんに対する一次治療を受け、投与中又は最終投与後4ヵ月以内に増悪が認められた。 c. アジュバント/ネオアジュバント療法を受け、投与中又は最終投与後6ヵ月以内に増悪が認められた。 d. アジュバント/ネオアジュバント療法を受け、投与中又は最終投与後6ヵ月以内に増悪が認められ、さらに転移性又は局所進行がんに対する一次治療を受け、投与中又は最終投与後4ヵ月以内に増悪が認められた。 - CTスキャンでRECIST v1.1に従った測定可能な原発巣又は転移巣が存在する。 - 国東海岸がん臨床試験グループ(ECOG)パフォーマンスステータスが0又は1。 - 3ヵ月以上の生存が期待される。 - 18歳以上(米国及び日本)、19歳以上(韓国)。 - IRBが承認した書面での同意・説明文書に署名した。 - Day 1前14日以内に採取された検体で、十分な臓器機能を有している。 - 男性及び妊娠可能な女性の場合、治験中及びTRK-950の最終投与後6ヵ月間、有効な避妊法を使用する。 - すべての患者は、適格性を判断するために腫瘍組織を評価するプレスクリーニングの同意書に署名する必要がある。腫瘍組織は、CAPRIN-1染色がCLIA認定検査機関において評価可能であり、発現レベルの要件で定義されたカットオフ値(≥2+染色で30%)を満たす又は超える必要がある。 |
- Histologically or cytologically confirmed metastatic, or locally advanced and unresectable gastric or GEJ adenocarcinoma. - The patient is eligible to receive RAM + PTX. - Documented objective radiographic or clinical disease progression (e.g., any new or worsening malignant effusion documented by ultrasound examination) which may be confirmed by pathologic criteria (histology and/or cytology) if appropriate, during or after treatment. The prior treatment must meet one of the following criteria with the following treatment history: a. First treatment for metastatic disease or locally advanced disease without experiencing adjuvant / neo-adjuvant treatment, which progressed during treatment or within 4 months after the last dose of treatment b. Adjuvant / neo-adjuvant treatment which progressed more than 6 months after the last dose of treatment and first treatment for metastatic disease or locally advanced disease, which progressed during the treatment or within 4 months after the last dose of treatment c. Adjuvant / neo-adjuvant treatment which progressed during treatment or within 6 months after the last dose of treatment d. Adjuvant / neo-adjuvant treatment which progressed during treatment or within 6 months after the last dose of treatment and first treatment for metastatic disease or locally advanced disease, which progressed during treatment or within 4 months after the last dose of treatment - Presence of primary or metastatic disease, measurable per RECIST v1.1 on CT scan. - Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1. - Life expectancy of at least 3 months. - Age >= 18 years in the US and Japan, and >= 19 years of age in Korea. - Signed, written IRB-approved informed consent. - Adequate organ function from specimens collected within 14 days prior to Day 1. - For men and women of child-producing potential, the use of effective contraceptive methods during the study and for 6 months after the last dose of TRK-950. - All patients must sign a pre-screening consent to assess tumor tissue to determine eligibility. Tumor tissue must be evaluable for CAPRIN-1 staining at a CLIA certified laboratory and meet or exceed the cutoff value (30% at >= 2+ staining) as defined in the expression level requirements. |
|
- ラムシルマブ又はパクリタキセルによる治療歴がある。 - HER2陽性の胃又はGEJ腺がん - 無作為化前28日以内に大手術を受けた。 - Fridericiaの補正式で計算したベースラインの補正QT(QTc)間隔が、女性で> 470 msec、男性で> 450 msec。 - ニューヨーク心臓協会(NYHA)クラスII~IVの症候性うっ血性心不全、又は症候性若しくはコントロール不良の不整脈。 - 無作為化前3ヵ月以内に心筋梗塞、不安定狭心症、脳血管発作、一過性脳虚血発作などの動脈血栓性事象を経験した患者。 - ステロイドを必要とする(非感染性)肺臓炎の既往がある、又は現在肺臓炎を有する患者。 - 臨床的に症状のある静脈血栓塞栓症又は抗凝固薬による治療を受けている。(予防目的で低用量抗凝固療法を受けている患者は、選択基準9に規定されている凝固パラメータの基準を満たしている場合は適格とする。) - 標準的な医学的管理にもかかわらず、≥ 150 mmHg(収縮期)又は≥ 90 mmHg(拡張期)のコントロール不良の動脈性高血圧。 - 全身療法を必要とする活動的でコントロール不良の細菌、ウイルス、又は真菌感染症。 - 妊娠中又は授乳中の女性。 - 無作為化前2週間以内の放射線療法による治療、又は無作為化前4週間以内の化学療法、免疫療法、標的療法、治験薬による治療[経口FU(S1及びカペシタビン)については2週間以内]。 - 重大な出血性疾患、血管炎を有する、又は無作為化前3ヵ月以内に消化管からの重大な出血エピソードがあった患者。 - 臨床的に重大な腹水を有する、過去3ヵ月間の穿刺、又は穿刺を定期的に受けている。 - 無作為化前6ヵ月以内に消化管穿孔及び/又は消化管瘻の既往がある。 - 無作為化前28日以内に重篤な若しくは治癒しない創傷、消化性潰瘍、又は骨折を有する患者。 - 炎症性腸疾患又は広範な腸切除(例:慢性下痢による半結腸切除又は広範な小腸切除)の既往がある又は現在有する患者、腸閉塞、クローン病、潰瘍性大腸炎、慢性下痢を有する患者。 - 既知の活動性のHIV、B型肝炎又はC型肝炎の感染。B型肝炎又はC型肝炎の既往がある患者でも、HBV DNA又はHep C RNAが検出されない場合は、許可される。 - 治験薬若しくは医薬品の未承認使用を含む臨床試験に現在登録中の患者、又は本治験と科学的若しくは医学的に適合しないと判断される他の種類の医学研究に同時に登録されている患者。治験薬の投与を最近中止した患者は、その治験薬の最終投与が本治験参加のための無作為化から28日以上であれば、本治験に参加することができる。調査や観察研究に参加している患者は、本治験に参加することができる。 |
- Prior history of treatment with ramucirumab or paclitaxel. - HER2 positive gastric or GEJ adenocarcinoma. - Major surgery within 28 days prior to randomization. - Baseline corrected QT (QTc) interval of >= 470 msec for females and >= 450 msec for males calculated using Fridericia's formula. - New York Heart Association (NYHA) Class II - IV symptomatic congestive heart failure, or symptomatic or poorly controlled cardiac arrhythmia. - The patient has experienced any arterial thrombotic event, including myocardial infarction, unstable angina, cerebrovascular accident, or transient ischemic attack, within 3 months prior to randomization. - The patient has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis. - Clinically symptomatic venous thromboembolism or current treatment with anti-coagulants. (Patients receiving prophylactic and low-dose anticoagulation therapy are eligible provided that the coagulation parameter defined in the Inclusion Criterion 9 is met.) - Uncontrolled arterial hypertension >= 150 mmHg (systolic) or >= 90 mmHg (diastolic) despite standard medical management. - Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy. - Pregnant or nursing women. - Treatment with radiation therapy within 2 weeks, or treatment with chemotherapy, immunotherapy, targeted therapy, or investigational therapy within 4 weeks prior to randomization (within 2 weeks for Oral FU (S1 and capecitabine)). - The patient has significant bleeding disorders, vasculitis, or had a significant bleeding episode from the gastrointestinal tract within 3 months prior to randomization. - Clinically significant ascites, paracentesis in the last 3 months, or undergoes regular paracentesis procedures. - History of gastrointestinal perforation and/or fistulae within 6 months prior to randomization. - The patient has a serious or non-healing wound, peptic ulcer, or bone fracture within 28 days prior to randomization. - The patient has a bowel obstruction, history or presence of inflammatory enteropathy or extensive intestinal resection (e.g., hemicolectomy or extensive small intestine resection with chronic diarrhea), Crohn's disease, ulcerative colitis, or chronic diarrhea. - Known active infection with HIV, hepatitis B or hepatitis C. Patients with a history of hepatitis B or C are allowed if HBV DNA or Hep C RNA are undetectable. - The patient is currently enrolled in or discontinued within the last 28 days from a clinical trial involving an investigational product or non-approved use of a drug, or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study. Patients who have recently discontinued dosing of study drug are eligible to participate as long as the final dose of study drug was >= 28 days from randomization for participation in this study. Patients participating in surveys or observational studies are eligible to participate in this study. |
|
|
18歳 以上 | 18age old over | |
|
上限なし | No limit | |
|
男性・女性 | Both | |
|
|||
|
胃腺がん, 胃食道接合部(GEJ)腺がん | Gastric Adenocarcinoma, Gastroesophageal Junction (GEJ) Adenocarcinoma | |
|
|||
|
|||
|
あり | ||
|
- 投与群A:TRK-950 5 mg/kgを1週間に1回静脈内投与。ラムシルマブ8 mg/kgを28日を1サイクルとして1日目及び15日目に静脈内投与。パクリタキセル80 mg/m^2を28日を1サイクルとして1日目、8日目及び15日目に静脈内投与。 - 投与群B:TRK-950 10 mg/kgを1週間に1回静脈内投与。ラムシルマブ8 mg/kgを28日を1サイクルとして1日目及び15日目に静脈内投与。パクリタキセル80 mg/m^2を28日を1サイクルとして1日目、8日目及び15日目に静脈内投与。 - 投与群C:ラムシルマブ8 mg/kgを28日を1サイクルとして1日目及び15日目に静脈内投与。パクリタキセル80 mg/m^2を28日を1サイクルとして1日目、8日目及び15日目に静脈内投与。 |
- Experimental: Arm A: TRK-950(5 mg/kg)+Ramucirumab+Paclitaxel Participants who will be randomized to receive a 5 mg/kg intravenous(IV) dose of TRK-950 on days 1, 8, 15 and 22 in combination with 8 mg/kg IV dose of ramucirumab on days 1 and 15 and 80 mg/m^2 IV dose of paclitaxel on Days 1, 8, and 15 of a 28-day cycle. - Experimental: Arm B: TRK-950(10 mg/kg)+Ramucirumab+Paclitaxel Participants who will be randomized to receive a 10 mg/kg IV dose of TRK-950 on days 1, 8, 15 and 22 in combination with 8 mg/kg IV dose of ramucirumab on days 1 and 15 and 80 mg/m^2 IV dose of paclitaxel on Days 1, 8, and 15 of a 28-day cycle. - Active Comparator: Arm C: Ramucirumab+Paclitaxel Participants who will be randomized to receive a 8 mg/kg IV dose of ramucirumab on Days 1 and 15 in combination with 80 mg/m^2 IV dose of paclitaxel on Days 1, 8, and 15 of a 28-day cycle. |
|
|
|||
|
|||
|
- RECIST v1.1による独立中央判定(ICR)評価に基づく無増悪生存期間(PFS) | - Progression free Survival (PFS) Progression free Survival (PFS) is defined as time from the date of randomization to the date of progressive disease or death due to any cause based on Independent Central Review. |
|
|
- 全生存期間(OS) - RECIST v1.1によるICRに基づく客観的奏効率(ORR) - RECIST v1.1による治験担当医師評価に基づくPFS - RECIST v1.1による治験担当医師評価に基づくORR - RECIST v1.1によるICRに基づく最良総合効果(BOR) - RECIST v1.1による治験担当医師評価に基づくBOR - RECIST v1.1によるICRに基づく病勢コントロール率(DCR) - RECIST v1.1による治験担当医師評価に基づくDCR - RECIST v1.1によるICRに基づく奏効期間(DoR) - RECIST v1.1による治験担当医師評価に基づくDoR - RAM + PTX併用投与時のTRK-950の安全性 - 治験薬投与下で発現した有害事象(TEAE) - 重篤な有害事象(SAE) - 特に注目すべきAE(AESI) - AEによる中止 - 身体検査所見 - バイタルサイン測定 - 標準的な臨床検査項目 - 心電図パラメータ - TRK-950の薬物動態 - CEOI - Ctrough - AUC - ラムシルマブの薬物動態 - CEOI - Ctrough - AUC - パクリタキセルの薬物動態 - CEOI - Ctrough - AUC - ラムシルマブ及びパクリタキセルと併用時のTRK-950の免疫原性 - 抗薬物抗体(ADA)及び中和抗体(NAb) - QOL(生活の質)評価 |
- Overall survival (OS) Overall survival is defined as the time from the date of randomization to the date of death due to any cause. - Objective response rate (ORR) Objective response rate (ORR) is defined as the proportion of participants who achieve a best overall response of complete response (CR) or partial response (PR) using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria as assessed by Independent Central Review. - Progression free Survival (PFS) Progression free Survival (PFS) is defined as time from the date of randomization to the date of progressive disease or death due to any cause based on investigator assessment. - Objective response rate (ORR) Objective response rate (ORR) is defined as the proportion of participants who achieve a best overall response of complete response (CR) or partial response (PR) using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria as assessed by investigator. - Best overall response (BOR) The best overall response is defined as the best overall response (BOR) recorded from the start of treatment until the end of treatment and includes CR, PR, stable disease (SD), progressive disease (PD) and not evaluable (NE) using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria as assessed by Independent Central Review based. - Best overall response (BOR) The best overall response is defined as the best overall response (BOR) recorded from the start of treatment until the end of treatment and includes CR, PR, stable disease (SD), progressive disease (PD) and not evaluable (NE) using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria as assessed by investigator. - Disease control rate (DCR) Disease control rate (DCR) is defined as the proportion of participants who achieve a best overall response of complete response (CR), partial response (PR) or stable disease (SD) for a minimum of 6 weeks using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria as assessed by Independent Central Review based. - Disease control rate (DCR) Disease control rate (DCR) is defined as the proportion of participants who achieve a best overall response of complete response (CR), partial response (PR) or stable disease (SD) for a minimum of 6 weeks using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria as assessed by investigator. - Duration of response (DoR) Duration of response (DoR) is defined as the time from the initial response (CR or PR) until documented tumor progression or death from any cause based on Independent Central Review based. - Duration of response (DoR) Duration of response (DoR) is defined as the time from the initial response (CR or PR) until documented tumor progression or death from any cause based on investigator assessment. - Incidence of Treatment-emergent Adverse Events (TEAE) Adverse events will be graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events Version 5.0. - Serious Adverse Events (SAEs) Adverse events will be graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events Version 5.0. - Adverse Events of Special Interest (AESI) Adverse events will be graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events Version 5.0. - Incidence of Discontinuation due to AE Adverse events will be graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events Version 5.0. - Incidence of Physical Examination Findings, Vital sign measurements, Standard clinical laboratory parameters, ECG parameters - Pharmacokinetic Parameter of Concentration of drug at the end of infusion (CEOI), Trough Serum Concentration (Ctrough) and Area Under the Curve (AUC) of TRK-950 - Pharmacokinetic Parameter of Concentration of drug at the end of infusion (CEOI), Trough Serum Concentration (Ctrough) and Area Under the Curve (AUC) of Ramucirumab - Pharmacokinetic Parameter of Concentration of drug at the end of infusion (CEOI), Trough Serum Concentration (Ctrough) and Area Under the Curve (AUC) of Paclitaxel - Percentage of participants who are Anti-drug antibody (ADA)-Positive and Neutralizing antibodies (NAbs) - Patient Reported Quality of Life Outcomes |
|
医薬品 | ||
---|---|---|---|
|
未承認 | ||
|
|
|
TRK-950 |
|
なし | ||
|
なし | ||
|
|
||
|
|
---|
|
||
---|---|---|
|
募集中 |
Recruiting |
|
|
||
---|---|---|
|
|
|
|
||
|
|
東レ株式会社 |
---|---|
|
Toray Industries, Inc. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
なし | |
---|---|---|
|
||
|
|
国立研究開発法人 国立がん研究センター治験審査委員会(本試験の治験実施可否について最初に審議された治験審査委員会) | National Cancer Ctr IRB#2-j |
---|---|---|
|
東京都中央区築地5丁目1番1号 | 5-1-1 Tsukiji, Chuo-ku, Tokyo |
|
||
|
||
|
||
|
承認 |
|
NCT06038578 |
---|---|
|
ClinicalTrials.gov |
|
ClinicalTrials.gov |
|
|
|
---|---|---|
|
||
|
||
|
|
無 | No |
---|---|---|
|
|
|
---|---|
|
|
|
|
設定されていません |
---|---|
|
設定されていません |