Ares, France

Retrospective Analysis of the Experience With Larotrectinib in Patients With Solid Neoplasms With NTRK Fusion in Spain (SPAINTRK)

1. Study title Retrospective analysis of the experience with Larotrectinib in patients with solid neoplasms with NTRK fusion in Spain (SPAINTRK) 2. .RATIONALE AND OBJECTIVES SPAINTRK aims to be the first trial in Spain to systematically collect data on outcomes of Spanish patients with solid neoplasms treated with Larotrectinib through the compassionate drug use program, during the time elapsed between the indication approval and the drug commercialization. This will contribute to selection of the best treatment for cancer patients with NTRK fusions, such as Trk inhibitors like Larotrectinib. Since the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved the use of Trk inhibitors, like Larotrectinib, there is a new and effective option of treatment for patients with NTRK fusions in solid neoplasms. This observational retrospective study will allow to analyze data of patients treated with Larotrectinib across the country and increase the knowledge on response to rare and different cancers 2.1 Main Objective Description of the effectiveness of Larotrectinib treatment in tumors with NTRK fusion in Spanish patients as a clinical series. 2.2. Secondary Objectives - Describe treatment duration, including dose reductions and interruptions occurred along the treatment with Larotrebtinib, as well as to study the reasons behind those decisions. - Study the effectiveness of Larotrebtinib and previous lines of therapy. Identified the line of treatment at which molecular testing for NTRK was performed. - Exploration of clinical and/or histological variables related to the effectiveness and tolerability of Larotrectinib treatment. 3. RESEARCH METHODS 3.1. Study design This is an observational retrospective study including thyroid cancer patients with solid neoplasms with NTRK fusions. The study will use secondary data retrieved from medical records from each patient. The medical records include all the clinical variables defined in order to perform the analysis and it is not necessary to access additional sources. The assignment of a patient to a specific therapeutic strategy has been already decided in advance by the usual clinical practice of medicine; the decision to prescribe a specific treatment was clearly dissociated from the decision to include a patient in the study. No intervention will be applied to patients, either diagnostic or follow-up, other than the usual clinical practice. Epidemiological methods will be used to analyze the data collected. 3.2. Setting and study population In total, 19 patients diagnosed with solid neoplasms that have been confirmed to bear NTRK fusions in their tumors will be included in the study. It is known that these patients have received the treatment with Larotrectinib in 14 centers in Spain, prior to treatment reimbursement in Spain. 3.3. Inclusion Criteria Infant and adult patients (all ages). Patients with confirmed diagnosis of solid neoplasms. Patients must have detected NTRK fusions by the following diagnostic methods NGS, fluorescence in situ hybridization (FISH) and/or Immunohistochemistry (IHC). Patients must be treated with Larotrectinib under the compassionate use program (before the commercialization) in order to be included in the study. Data should be available in order to evaluate effectiveness and consequent follow up. 3.4. Exclusion Criteria Patients with solid neoplasms treated with Larotrectinib in clinical trials or other settings different from clinical practice. Patients that initiated treatment with Larotrectinib after the obtention of prize-reimbursement and commercialization. 3.5. Study Size The sample size calculation is based on the actual number of patients known to be treated in Spain with Larotrectinib. At the moment 19 patients from 14 different healthcare centers have been localized that were treated in the Spanish territory with Larotrectinib. We expect to include and collect data from all of them. fusions, such as Trk inhibitors like Larotrectinib. Since the Food and Drug
 Administration (FDA) and the European Medicines Agency (EMA) approved the use of Trk
 inhibitors, like Larotrectinib, there is a new and effective option of treatment for
 patients with NTRK fusions in solid neoplasms. This observational retrospective
 study will allow to analyze data of patients treated with Larotrectinib across the
 country and increase the knowledge on response to rare and different cancers 2.1
 Main Objective Description of the effectiveness of Larotrectinib treatment in tumors
 with NTRK fusion in Spanish patients as a clinical series.
 
 2.2. Secondary Objectives
 
 - Describe treatment duration, including dose reductions and interruptions
 occurred along the treatment with Larotrebtinib, as well as to study the
 reasons behind those decisions.
 
 - Study the effectiveness of Larotrebtinib and previous lines of therapy.
 Identified the line of treatment at which molecular testing for NTRK was
 performed.
 
 - Exploration of clinical and/or histological variables related to the
 effectiveness and tolerability of Larotrectinib treatment.
 
 3. RESEARCH METHODS 3.1. Study design This is an observational retrospective study
 including thyroid cancer patients with solid neoplasms with NTRK fusions.
 
 The study will use secondary data retrieved from medical records from each patient.
 The medical records include all the clinical variables defined in order to perform
 the analysis and it is not necessary to access additional sources.
 
 The assignment of a patient to a specific therapeutic strategy has been already
 decided in advance by the usual clinical practice of medicine; the decision to
 prescribe a specific treatment was clearly dissociated from the decision to include
 a patient in the study. No intervention will be applied to patients, either
 diagnostic or follow-up, other than the usual clinical practice. Epidemiological
 methods will be used to analyze the data collected.
 
 3.2. Setting and study population In total, 19 patients diagnosed with solid
 neoplasms that have been confirmed to bear NTRK fusions in their tumors will be
 included in the study. It is known that these patients have received the treatment
 with Larotrectinib in 14 centers in Spain, prior to treatment reimbursement in
 Spain.
 
 3.3. Inclusion Criteria Infant and adult patients (all ages). Patients with
 confirmed diagnosis of solid neoplasms. Patients must have detected NTRK fusions by
 the following diagnostic methods NGS, fluorescence in situ hybridization (FISH)
 and/or Immunohistochemistry (IHC).
 
 Patients must be treated with Larotrectinib under the compassionate use program
 (before the commercialization) in order to be included in the study.
 
 Data should be available in order to evaluate effectiveness and consequent follow
 up.
 
 3.4. Exclusion Criteria Patients with solid neoplasms treated with Larotrectinib in
 clinical trials or other settings different from clinical practice.
 
 Patients that initiated treatment with Larotrectinib after the obtention of
 prize-reimbursement and commercialization.
 
 3.5. Study Size The sample size calculation is based on the actual number of
 patients known to be treated in Spain with Larotrectinib. At the moment 19 patients
 from 14 different healthcare centers have been localized that were treated in the
 Spanish territory with Larotrectinib. We expect to include and collect data from all
 of them.
 3.6. Sampling and recruitment method Patients will be consecutively included, in compliance with the previously established inclusion criteria. According to the definition of study population and disease established in this scientific report, patients will be selected from cases diagnosed with solid neoplasms bearing NTRK fusions detected by any of these methods, NGS, FISH and/or IHC, and treated with Larotrectinib. The 19 patients treated with Larotrectinib in the Spanish territory are localized and belong to 14 different sites/healthcare centers. To prevent two or more reporting physicians from logging the same case, a coordinator, who controls the cases included in his or her center, is appointed in health centers with several reporting physicians, and preventive measures are implemented in the tool controlling duplications in variables (such as birth date, gender, center or diagnosis). 3.7. Case Definition A 'case' is defined as any patient, diagnosed, treated, or followed in the different health centers where reporting physicians authorized by the sponsor, who meets the inclusion criteria. A key point is that the patient was diagnosed with solid neoplasms that harbors a NTRK fusion and he/she was receiving treatment with Larotrectinib. Data from patient's treatment should have been recorded and be available at the centers. 3.8. Data Logging Once the patient is compliant with inclusion/exclusion criteria information on the clinical history will be collected to gather the necessary data and to complete the electronic forms of the study designed for this purpose. All data collected during treatment, as well as demographic data, will be provided for the purpose of this study and completed at the electronic Case Report Form (eCRF) to proceed to its analysis. 4. ENDPOINTS AND VARIABLES 4.1. Endpoints 4.1.1. Primary Endpoints Duration of response (DoR): is defined as the time from first confirmed response (complete (CR) or partial (PR) response), according to Objective response rate (ORR) defined below, to the date of the documented progression of the disease (PD) as determined using RECIST V1.1 criteria or death due to any cause, whichever occurs first. Those patients with response and without PD or death event will be censored on the date of their last tumor assessment. Results will be presented as individual cases, not compiled as the patients have different pathologies which may differ in prognosis. 4.1.2. Secondary Effectiveness Endpoints - Objective response rate (ORR): is assessed by the investigator analysis of tumor growth through imaging follow-up (CT scan/MRI), using a method to evaluate it as RECIST V1.1. This will be considered as the number of patients with confirmed complete response (CR) or partial response (PR) as their overall best response throughout the period of treatment with Larotrectinib. Tumor measurements that were assessed locally by the clinician according to RECIST, V1.1, should be recorded and indicate the change in size of tumors as compared with baseline, at the first dose of study treatment. - Progression free survival (PFS): Time from first dosing date to the date of confirmed PD according to RECIST 1.1. Patients alive and free of events at the date of the analysis will be censored at their last known tumor assessment. Patients who start a new treatment line without progression will be censored on the date of first dose of the subsequent anticancer treatment. - Overall survival (OS): defined as the time elapsed from the first dose of study treatment until death from any cause. Patients alive and free of events at the date of the analysis will be censored at their last known contact. Survival will be assessed by recording patients' status at each visit. Results will be presented as individual cases, not compiled as the patients have different pathologies which may differ in prognosis. 4.1.3. Secondary Safety Endpoints -Safety: All safety information will be collected retrospectively according to data available in the chart review. A descriptive analysis of adverse events collected in medical charts will be done taking into account: 1. The frequency of Adverse events (AEs) will be reported per patient by MedDRA System Organ Class (SOC) and Preferred Term (PT); 2. The maximum CTCAE grade will be reported per patient; 3. The causal relationship with the study drug will be assessed locally by the investigator - Larotrectinib interruptions / Delays: number of interruptions and delays of treatment reported per patient (frequency) and reason for dose interruption / delay. - Larotrectinib dose reductions or modifications: Number of reductions or modifications of doses reported per patient (frequency) and reason for dose reduction / modification. - Larotrectinib treatment duration: Time elapsed between first dose and permanent discontinuation of the study treatment. 4.2. Study Variables Investigators will provide information of each of the following variables: Variables for Demography: - Age at enrollment. - Sex (male, female). - Race (white, black, Asian, other) - Height (cm). - Weight (kg). - Body mass index. - Body surface area (BSA) - calculated from the reported height and weight using Mostseller's formula: BSA (m2)= (height (cm) x weight (kg) / 3600) 1/2 - Performance status.will be presented using the Eastern Cooperative Oncology - Group (ECOG) scale. Cancer history: - Primary cancer diagnosis. - Primary tumor type, histology and location - Stage of disease at initial diagnosis(I-IV). - Time since initial diagnosis. - Extent of disease at enrollment (metastatic, locally advanced, sites of disease, presence of at least one measurable lesion). Stage of the disease at inclusion - Time since diagnosis of metastatic or locally advanced disease (years). Prior anticancer treatments: -Prior systemic treatments type, start and end dates. -Number of prior systemic regimens or treatment courses. -Best overall response to the most recent prior systemic regimen or treatment course (CR, PR, stable disease, progressive disease, unknown or inevaluable or not applicable). -Prior radiotherapy. -Prior cancer-related surgery. NTRK fusions: -NTRK fusion gene: NTRK1, NTRK2, NTRK3. -NTRK fusion isoform (i.e ETV6-NTRK3). -Method of detection: NGS, FISH or IHC and dates of the determinations. - Other oncogenic alterations present. Treatment with Larotrectinib: -Dose of Larotrectinib. -Larotrectinib start and end date. Reasons for end of treatment -Data records of dose reductions and/or interruptions and their reason. -Best response and best response date -Progression date. -Frequency of AEs reported per patient by MedDRA System Organ Class (SOC) and Preferred Term (PT); the maximum CTCAE grade will be reported per patient. Causal relationship with the study treatment will be reported for all events. Survival: - Patient status (alive, death, lost to follow-up) - Reasons of death (if applicable) - Subsequent anticancer treatments (type, start and end dates, best response, progression dates)

Prospective Observational Study to Evaluate the Safety of Immunotherapy as a Treatment for Hymenoptera Venom Allergy

Observational study to evaluate the adverse reaction to immunotherapy as well as the allergic reaction to a spontaneous hymenoptera sting (safety evaluation), also it will be evulated the quality of life of the patient using one QoL questionnair before and after immunotherapy treatment. The patients aged equal or more than 14 years old, not gender differentiation, and sensitised to heminoptera venom. The total number of participants is expected to be 120. This study will be conducted in Spain (multicentric) and data will be collected prospectively.

DRUG RELEASING BALL vs. PHARMACOACTIVE STENT IN LARGE VESSELS: MORPHOLOGICAL ANALYSIS AND FUNCTION VASOMOTOR (DEBORA STUDY) IN LARGE VESSELS: MORPHOLOGICAL ANALYSIS AND FUNCTION VASOMOTOR (DEBORA STUDY)

Randomized, controlled, open and multicenter study that analyzes the vasomotor function 8 months after use of the drug-eluting balloon (DCB) vs. drug-eluting stent (DES) in vessels ≥ 3.5 mm

Study of Treatment With Sacituzumab and Zimberelimab for Patients With Lung Cancer Confined to the Chest and Previously Operated on Who Were Not Disease-free.

This is an open-label, phase III, randomized, stratified (PDL1- vs PDL1+), 3 arms, multicenter clinical trial. Patients stage IB to IIIA-IIIB (T3N2) after surgical resection if they did not achieve a pathological com-plete response (pCR) will be randomized 1:1:1 to: - ARM 1: Observational Arm for 10 months - ARM 2: Immunotherapy (Zimberelimab) treatment for 13 cycles, Q3W - ARM 3: Sacituzumab Govitecan + Zimberelimab Q3W for 8 cycles + Zimberelimab Q3W for 5 cycles. Patients will receive 8 cycles of the combination and 5 cycles of Zimberelimab monotherapy. The primary objective is to evaluate the disease-free survival (DFS): defined as the length of time from randomization to the earliest event defined as disease recurrence, any new lung cancer (even in the opposite lung), or death from any cause at any known point in time. Disease Free survival (DFS): The time from random assignment to cancer recurrence or death from any cause. Secondary objectives: - Overall survival (OS): at 12, 24 and 36 months after the start of adjuvant treatment - Safety and tolerability of the combination of Sacituzumab Govitecan + Zimberelimab according to CTCAE v5.0. Exploratory objectives - To evaluate whether there is a significant association between change in levels of ctDNA between baseline and after adjuvant treatment and OS and DFS. The total trial duration will be 7 years approximately. Approval-start up: 4-6 months. Patient accrual is expected to be completed within 2 years. One year of treatment and 3 years of follow up, and close-out: 4-6 months. The study will end once survival follow-up has concluded

Study of Antitumor Immune Response After cCRT and IO Treatment in Non-resectable III Stage NSCLC Patients

The study is based on the collection of blood samples and tumor sample analysis, in real world NSCLC stage IIIA/B and IIIC; PD-L1>1%; non-resectable patients on treatment with IO after cCRT without progression. The patients participating in this study will not receive treatment in relation to the study, no drugs will be provided. Patients will be treated as per standard clinical practice. All data collected for this study will be collected retrospectively from patient clinical chart. Only secondary data collected will be analyzed together will samples analysis information.The duration of the study is expected to be 3 years.

Erdafitinib Monotherapy or in Combination With Cetrelimab in Muscle-invasive Bladder Cancer Patients With Fibroblast Growth Factor Receptor (FGFR ) Gene Alterations

The aim of the study is to assess the antitumor activity measured as ypT0 rate, defined as no evidence of residual disease based on pathological review of the surgical specimen (pCR) and tumour downstaging (<ypT2). Patients must have a MIBC (cT2-T4a N0/N1 M0) who harbour selected FGFR alterations stated in the protocol and are either ineligible for or refuse cisplatin-based neoadjuvant chemotherapy, as defined by consensus criteria (see 6.1 Inclusion criteria). Once it is confirmed that the subjects fulfil the eligibility criteria and have signed the informed consent form, they will receive erdafitinib alone (cohort 1) or erdafitinib in combination with cetrelimab (cohort 2). Patients will receive neoadjuvant treatment with erdafitinib alone (cohort 1) or erdafitinib plus cetrelimab (cohort 2) before proceeding to Radical Cystectomy (RC) (to be performed within 2 - 6 weeks after the last study drug treatment) Cohort 1: patients will receive erdafitinib Cohort 2: patients will receive erdafitinib in combination with cetrelimab intravenously (IV) Radiological assessment: A Computed Tomography /Magnetic Resonance Imaging and/or Positron Emission Tomography (per standard local imaging practices) will be scheduled as follow: - Basal assessment: during screening period (no more than 28 days before Cycle1, Day 1(C1D1) - Response assessment: At the end of treatment period allowing time for imaging review in advance of Radical cystectomy (RC). - Follow-up assessment: an image evaluation must be done at first follow-up visit and thereafter, it will be schedule according to local standards and as clinically indicated. A local pathological assessment will be done on specimens obtained during RC (for co-primary endpoints). Thereafter, during the follow-up period, pathological assessments will be scheduled according to local standards and as clinically indicated. Patients with disease progression during the treatment phase will be discontinued from the study and will receive their treatment according to the investigator's judgment and monitored to evaluate Overal Survival .

Registry of Patients in Shock Treated With Vasopressin

The main objective is to characterise the routine clinical practice of vasopressin use in the context of shock in a multicentre observational study. By collecting clinical, analytical and echocardiographic data in a uniform manner, describing the time sequence of vasopressin and/or noradrenaline use; how long vasopressin is used; and which vasoconstrictor is more frequently withdrawn earlier: vasopressin or noradrenaline. The secondary objectives are: - to assess what motivated the decision to initiate AVP: type of shock, perfusion parameters, noradrenaline dose; - to define the impact of initiating AVP on noradrenaline dose (whether the dose can be reduced or not), on cardiac function (whether echocardiographic data improve or worsen) and on perfusion data (whether laboratory and clinical data such as lactate, capillary refill time, mottling score or diuresis improve or worsen); - estimate what is the dose range of AVP used and what is the maximum dose used in routine clinical practice; - observe when AVP is stopped, how (abruptly or progressively); - describe the incidence of side effects of AVP, whether it is related to the dose of AVP and the comorbidities of the patients; - assess medium/long-term outcomes: 28- and 90-day mortality, ICU and hospital stay, days of vasopressor support, days of mechanical ventilation, days of renal replacement.

Study to Evaluate the Effect of Balcinrenone/Dapagliflozin in Patients With Heart Failure and Impaired Kidney Function

The purpose of this study is to investigate the effect of balcinrenone/dapagliflozin compared with dapagliflozin, on the risk of CV death, HF event with and without hospitalisation, in patients with chronic HF, impaired kidney function, and who have had a recent HF event. Eligible patients will randomly be assigned with a 1:1:1 ratio to receive once daily administration of one capsule and one tablet of one of the following treatments: 1. Balcinrenone/dapagliflozin 15 mg/10 mg capsule and matching placebo for dapagliflozin 10 mg tablet 2. Balcinrenone/dapagliflozin 40 mg/10 mg capsule and matching placebo for dapagliflozin 10 mg tablet 3. Dapagliflozin 10 mg tablet and matching placebo for balcinrenone/dapagliflozin capsule The study is event driven, and the average study duration for a participant is estimated to be 22 months including screening period, 20 months blinded treatment period and a one-month follow-up period on open-label dapagliflozin. The study will be conducted at approximately 700 sites in approximately 40 countries globally.

Hyperangulated vs Macintosh Blades for Intubation With Videolaryngoscopy in ICU

The purpose of this prospective multicenter randomized study is to compare successful intubation on the first attempt with the Macintosh videolaryngoscope vs the hyperangulated videolaryngoscope during tracheal intubation in ICU patients.The hypothesis of the study is that tracheal intubation using the hyperangulated videolaryngoscope will improve the frequency of successful intubation on the first attempt in ICU patients requiring intubation in the intensive care unit.

A Trial to Learn if Odronextamab Combined With Chemotherapy is Safe and Well-Tolerated and How Well it Works Compared to Rituximab Combined With Chemotherapy for Adult Participants With Follicular Lymphoma