Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Prescription costs wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Clinical trial wikipedia , lookup
Pharmacognosy wikipedia , lookup
Neuropharmacology wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Adherence (medicine) wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Polysubstance dependence wikipedia , lookup
***DELETE THIS PAGE FROM FINAL VERSION*** Protocol Template Instructions This template has been created to assist in the development of an investigator-initiated clinical trial protocol. It is not mandatory that you follow the exact order presented in this template (although this is the preferred format for studies that will utilize services of the Clinical Research Office). However, all the information contained in this template must be present, in some format, in your final protocol. The sections in BLACK are standard/required language for studies under the purview of the Robert H. Lurie Comprehensive Cancer Center and should be included in your protocol and/or revised as needed to reflect the specifics of your trial. In some cases, alternate language choices are included and may be more appropriate. Please note that a Letter of Intent (LOI) must be submitted to the Lurie Cancer Center’s Scientific Review Committee (SRC) for all Northwestern University interventional investigator-initiated trials [IITs] prior to full protocol submission. Please refer to additional instructions which may be included in the SRC approval letter for your LOI, as these may provide guidance as to what language is required in your protocol. The sections in BLUE provide examples and/or instructions, and details should be modified to fit your specific trial. You may RENAME sections (if appropriate) and/or DELETE any sections that do not apply. The final protocol document should not contain any BLUE text. NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Study Title Title should include study phase, design descriptors (e.g., randomized, double-blind, placebocontrolled, multi-center, etc.), the intervention(s), the target population (disease(s) or condition(s) and stage, if appropriate), and the setting (e.g. front-line, adjuvant, etc). Acronyms should be spelled out. Principal Investigator: Name/Credentials (One person only - may not be a resident/fellow) Institution/Department or Division Address City, State, Zip Phone: Fax: Email Sub-Investigator(s): For local sub-Is include: Name Department/Division (may group individuals together from same) For external sub-Is include (one per site): Name/Credentials Institution Address City, State, Zip Phone: Fax: Email Biostatistician: Name Email (May include other contact info if biostatistician is external) Study Intervention(s): Generic study drug name, followed by marketed name IND Number: May list “pending” or “TBD” or delete if N/A. IND Holder: Delete if N/A. Funding Source: List support (funding or investigational agent) from Industry or other sources (provide grant number, if applicable.) Version Date: Coordinating Center: Clinical Research Office Robert H. Lurie Comprehensive Cancer Center Northwestern University 676 N. St. Clair, Suite 1200 Chicago, IL 60611 http://cancer.northwestern.edu/CRO/index.cfm CONFIDENTIAL This material is the property of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Do not disclose or use except as authorized in writing by the study sponsor. NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) CONFIDENTIAL This material is the property of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Do not disclose or use except as authorized in writing by the study sponsor. NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) TABLE OF CONTENTS LIST OF ABBREVIATIONS............................................................................................................. 1 STUDY SCHEMA ............................................................................................................................ 2 1.0 STUDY SUMMARY ............................................................................................................. 2 1.0 INTRODUCTION – BACKGROUND & RATIONALE ......................................................... 4 1.1 Disease Background........................................................................................................ 4 1.2 Intervention Background & Overview .............................................................................. 4 1.3 Rationale for the Current Study ....................................................................................... 4 1.4 Exploratory Studies.......................................................................................................... 4 2.0 OBJECTIVES & ENDPOINTS ............................................................................................. 4 2.1 Primary Objective & Endpoint .......................................................................................... 5 2.2 Secondary Objectives & Endpoints ................................................................................. 5 2.3 Exploratory Objectives & Endpoints ................................................................................ 5 3.0 PATIENT ELIGIBILITY ........................................................................................................ 5 3.1 Inclusion Criteria .............................................................................................................. 6 3.2 Exclusion Criteria ............................................................................................................. 7 4.0 TREATMENT PLAN ............................................................................................................ 7 4.1 Overview .......................................................................................................................... 7 4.2 Treatment Administration ................................................................................................ 8 4.3 Phase I Dose Escalation Scheme ................................................................................... 8 4.4 Toxicity Management & Dose Delays/Modifications ..................................................... 10 4.5 Concomitant Medications/Treatments ........................................................................... 13 4.6 Other Modalities or Procedures ..................................................................................... 13 4.7 Duration of Therapy ....................................................................................................... 13 4.8 Duration of Follow Up .................................................................................................... 13 i NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 4.9 Removal of Subjects from Study Treatment and/or Study as a Whole ......................... 13 4.10 Patient Replacement ..................................................................................................... 14 5.0 STUDY PROCEDURES ..................................................................................................... 14 6.0 ENDPOINT ASSESSMENT ............................................................................................... 15 6.1 Definitions ...................................................................................................................... 15 6.2 Primary Endpoint ........................................................................................................... 15 6.3 Secondary Endpoints..................................................................................................... 16 7.0 ADVERSE EVENTS .......................................................................................................... 16 7.1 Adverse Event Monitoring ............................................................................................. 16 7.2 Definitions & Descriptions .............................................................................................. 16 7.3 Adverse Event Reporting ............................................................................................... 18 8.0 8.1 9.0 DRUG INFORMATION ...................................................................................................... 19 Agent XXX ..................................................................................................................... 19 CORRELATIVES/SPECIAL STUDIES .............................................................................. 21 9.1 Sample Collection Guidelines ........................................................................................ 21 9.2 Sample Processing, Storage, and Shipment ................................................................. 21 9.3 Assay Methodology ....................................................................................................... 21 9.4 Specimen Banking ......................................................................................................... 21 10.0 STATISTICAL CONSIDERATIONS .................................................................................. 21 10.1 Study Design/Study Endpoints ...................................................................................... 21 10.2 Sample Size and Accrual .............................................................................................. 22 10.3 Data Analyses Plans...................................................................................................... 22 11.0 STUDY MANAGEMENT .................................................................................................... 22 11.1 Institutional Review Board (IRB) Approval and Consent ............................................... 22 11.2 Amendments .................................................................................................................. 22 11.3 Registration Procedures ................................................................................................ 22 ii NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 11.4 Instructions for Participating Sites ................................................................................. 23 11.5 Data Management and Monitoring/Auditing .................................................................. 24 11.6 Adherence to the Protocol ............................................................................................. 24 11.7 Investigator Obligations ................................................................................................. 24 11.8 Publication Policy........................................................................................................... 25 REFERENCES ............................................................................................................................... 26 APPENDICES ................................................................................................................................ 27 iii NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) LIST OF ABBREVIATIONS It may be helpful to include a list of frequently-used abbreviations. Some examples commonly used in oncology research include: AE Adverse Event ALT Alanine Aminotransferase ALC Absolute Lymphocyte Count AST Aspartate Aminotransferase BUN Blood Urea Nitrogen CBC Complete Blood Count CMP Comprehensive Metabolic Panel CR Complete Response CT Computed Tomography CTCAE Common Terminology Criteria for Adverse Events DLT Dose Limiting Toxicity DSMB Data and Safety Monitoring Board ECOG Eastern Cooperative Oncology Group H&PE History & Physical Exam IV (or iv) Intravenously MTD Maximum Tolerated Dose NCI National Cancer Institute ORR Overall Response Rate or Objective Response Rate OS Overall Survival PBMCs Peripheral Blood Mononuclear Cells PD Progressive Disease PFS Progression Free Survival PO (or p.o.) Per os/by mouth/orally PR Partial Response SAE Serious Adverse Event SD Stable Disease SGOT Serum Glutamic Oxaloacetic Transaminase SPGT WBC Serum Glutamic Pyruvic Transaminase White Blood Cells Version Date: 1 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) STUDY SCHEMA The schema should be a diagram or pictorial representation of your study design and general treatment plan. For example: Stage I/II Cancer A Randomize Arm A Drug 1 at dose # IV Day 1 each cycle + Drug 2 at dose # PO daily Arm B Drug 1 at dose # IV Day 1 each cycle + Placebo PO daily Response Assessment after 4 cycles CR/PR/SD continue treatment until POD PD proceed to surgery offstudy CR/PR/SD continue Drug 1 until POD Replace placebo with Drug 2 & reassess after 4 cycles Once off treatment continue follow-up q 6 months up to 3 years Version Date: 2 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) STUDY SUMMARY Title Full title of protocol Short Title Shortened title (match this to title used it ClinicalTrials.gov) Version Include date & amendment number. Study Design Study Center(s) Study phase & design attributes such as single blind, double blind or open label; randomized, placebo or active placebo control; cross-over design, Simon two-stage, etc. If multi-center, list all projected centers to be involved & indicate who the lead site will be. Objectives At a minimum list all primary & secondary objectives (can refer to body of protocol for any exploratory objectives). Sample Size Number of subjects projected for the entire study (may specify by phase if phase I/II trial). Diagnosis & Key Eligibility Criteria Note the main clinical disease state under study and some of the significant inclusion or exclusion criteria (do not list all criteria here) Treatment Plan Statistical Methodology Version Date: Brief overview of treatment plan including study intervention(s) and dose/route/regimen or other description of therapy (for non-drug or biologic). Also state overall treatment/intervention timeframe. NOTE: If name-brand agent is used in the study, may reference the marketed name in background or drug info section, but should use generic name throughout majority of the protocol. A very brief description of the main elements of the statistical methodology to be used in the study (sample size and power calculation, brief discussion of primary endpoint analysis). 3 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 1.0 2.0 INTRODUCTION – BACKGROUND & RATIONALE 1.1 Disease Background Please provide disease background information particularly relevant to your study, such as incidence, prognosis or current data corresponding to planned endpoints; be specific about the population being studied (e.g. relapsed/refractory disease or previously untreated or those possessing a particular genetic marker, etc). Questions to be addressed may include the current standard of care and any relevant treatment issues or controversies. Please justify why an investigational therapy or approach is warranted. 1.2 Intervention Background & Overview Please provide relevant background information about the study agent(s) or intervention(s) that you are planning to use in the study. Include the following for each intervention: FDA approval status (if applicable). A summary of findings from non-clinical in vitro/in vivo studies that have potential clinical significance including information on mechanism of action, pharmacokinetics and safety. NOTE: This is particularly important for investigational agents, and may not be necessary for commercially available drugs, and/or drugs with sufficient clinical data. A summary from relevant clinical studies (or current clinical use), with focus on those that provide background for your study. Important safety information, such as known toxicities and current or approved doses and regimens. If available (especially for early-phase or first-in-human trials): information on clinical pharmacokinetics, major route(s) of elimination, metabolism of the agent(s) in humans, and any potential for drug interactions. 1.3 Rationale for the Current Study Discuss the reasoning for conducting the study in light of the background information already presented. Specifically, provide rationale for each of the following: The study design being used, including the primary endpoints. The population being studied (particularly if focusing on a subset within the disease population, such as relapsed disease or elderly patients). The treatment plan (particularly if doses and/or regimens are not established or will not follow approved versions). 1.4 Exploratory Studies If applicable, please provide background information to support any exploratory endpoints such as correlative studies; include the biological rationale and hypothesis (if applicable). OBJECTIVES & ENDPOINTS Please list all Primary, Secondary, and Exploratory objectives of the study (see below for definitions). Number objectives separately. In addition, it is strongly recommended that you have only one primary objective. An overall summary of the goal of the study is fine to include (e.g. “Establish the safety and efficacy of the combination of X and Y in the treatment of Z”), however specific objectives with measurable outcomes should be given to support this broad goal. For each objective please describe the corresponding endpoint, which is the outcome that is being measured. This includes what will be measured, how, and when. In addition, there are generally 4 levels of specificity that should be included: Level 1 – Domain or the type of health outcome measure. Level 2 – Specific tool to measure the domain. Level 3 – Specific metric to be measured. Version Date: 4 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Level 4 – Method of aggregation (continuous vs. categorical). An example of a clearly written objective and endpoint is the following: The primary objective will be to assess the efficacy of drug ABC on reducing symptoms of depression in patients undergoing chemotherapy. The endpoint will be a change in depression score on the Hamilton Anxiety Rating Scale of ≥ 5 points from baseline to end of treatment with drug ABC (6 weeks). Level 1: outcome/domain = depression Level 2: tool = Hamilton Anxiety Rating Scale Level 3: specific metric = change from baseline to post-treatment (6 week timeframe) Level 4: aggregation = categorical (will report proportion of patients who achieve a change in score of ≥ 5 points on the scale) Other examples of common endpoints and things to consider: Response – often a primary endpoint for phase II trials o Specify which criteria will be used (e.g. RECIST, Cheson, iwCLL2008, etc) o Specify how it will be reported: By response category (e.g. CR/PR/SD/PD or some combination of these) In terms of time or “duration of response” Survival – often used in phase II or III trials o Specify the type (e.g. progression-free or overall survival) and at what timepoint (e.g. indefinitely vs. at 2 years from start of treatment) Safety/toxicity – often used in phase I or II trials o Specify what criteria will be used (e.g. NCI CTCAE v 4.0) or if the focus will be on a specific list of adverse events of interest Quality of life – may be a secondary or even exploratory endpoint in any trial o Specify the subjective measure that will be used (if it is a tool or survey, briefly describe in background and indicate if it has been validated) Consider whether or not certain objectives are truly exploratory in nature (such as pharmacokinetics studies, tissue correlatives, etc). It is strongly encouraged to label objectives that are not associated with health outcomes as exploratory. 2.1 Primary Objective & Endpoint 2.2 Secondary Objectives & Endpoints 2.2.1 2.2.2 2.2.3 2.3 3.0 Exploratory Objectives & Endpoints Delete if not applicable. PATIENT ELIGIBILITY The target population for this study is patients with [insert description]. This will be a [multicenter or single-center] trial conducted at [insert name of site or clinic] of Northwestern University. Remove or revise the following as appropriate: Northwestern University will serve as the lead site and coordinating center for this study. Participating sites will include [list additional sites]. Version Date: 5 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) A total of ## subjects will be needed for this trial. Approximately # potentially eligible patients are seen per month, and it is anticipated that at least # per month will be accrued (once all sites are up and running). Potential patients may be referred to the Principal Investigator (PI) at Northwestern University, Dr. [insert name], at (###) ###-####, or to the local PI at each participating site. Eligibility will be evaluated by the study team according to the following criteria. Eligibility waivers are not permitted. Subjects must meet all of the inclusion and none of the exclusion criteria to be registered to the study. Study treatment may not begin until a subject is registered. Please refer to Section 11 for complete instructions regarding registration procedures. 3.1 Inclusion Criteria Each criterion should include its own number, e.g., 3.1.1, 3.1.2, etc. Inclusion criteria should not contain phrases that are actually meant to exclude patients (e.g. “patients must not have had prior radiation therapy” is actually an exclusion criteria and should be listed in section 3.2 accordingly). 3.1.1 Patients must have a [histologically/cytologically/confirmed by imaging or other means] diagnosis of [insert disease name and stage] 3.1.2 Patients must have [measurable or evaluable] disease. NOTE: include definition of measurable, if applicable. 3.1.3 Include allowed type(s) and amount(s) of prior therapy for this cancer, along with any required washout periods. 3.1.4 Patients must be age ≥ 18 years. 3.1.5 Patients must exhibit a/an [ECOG, Karnofsky, or other] performance status of [insert values]. 3.1.6 Patients must have adequate organ and bone marrow function within # days prior to registration, as defined below: (adjust values as appropriate) leukocytes ≥ 3,000/mcL absolute neutrophil count ≥ 1,500/mcL platelets ≥ 100,000/mcl total bilirubin within normal institutional limits AST(SGOT)/ALT(SPGT) ≤ 2.5 X institutional upper limit of normal (ULN) creatinine within normal institutional limits May add others… NOTE: Include any exceptions to the above (such as Gilbert’s Syndrome) and note whether nor not levels may be achieved with transfusion and/or growth factor support. 3.1.7 Females of child-bearing potential (FOCBP) and males must agree to use adequate contraception (give examples, e.g. hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for # days following completion of therapy. Should a female patient become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: Version Date: 6 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Has not undergone a hysterectomy or bilateral oophorectomy Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for > 12 months) 3.1.8 FOCBP must have a negative pregnancy test within # days prior to registration on study. 3.1.9 Other study-specific inclusion criteria or baseline parameters that are required for eligibility purposes (such as LVEF, QTc interval, disease-specific criteria, etc). 3.1.10 Patients must have the ability to understand and the willingness to sign a written informed consent prior to registration on study. 3.2 4.0 Exclusion Criteria Some examples might include… 3.2.1 Patients who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier are not eligible. 3.2.2 Patients may not be receiving any other investigational agents. 3.2.3 Patients who have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to [study agent(s)] are not eligible. AND/OR Patients who have had prior exposure to compounds of similar chemical or biologic composition to [study agent(s)] are not eligible. 3.2.4 Patients who have an uncontrolled intercurrent illness including, but not limited to any of the following, are not eligible: (edit/remove/add to list as needed) Hypertension (defined as ###/##) that is not controlled on medication Ongoing or active infection requiring systemic treatment Symptomatic congestive heart failure Unstable angina pectoris Cardiac arrhythmia Psychiatric illness/social situations that would limit compliance with study requirements Any other illness or condition that the treating investigator feels would interfere with study compliance or would compromise the patient’s safety or study endpoints 3.2.5 Female patients who are pregnant or nursing are not eligible. 3.2.6 Other study specific or disease criteria for exclusion (e.g. certain disease subtypes that are not eligible, patients who are unable to swallow oral medication if the study involves oral agents, etc). TREATMENT PLAN As with all sections of this template, please delete sub-sections that do not apply and/or re-name to fit the specifics of your study. 4.1 Version Date: Overview Give a brief (1-2 paragraphs at most) summary of the treatment plan, including intervention(s), doses/regimens, duration of treatment, and key study time-points 7 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) (response assessment, futility assessment, transition from phase I to II if a combination study, etc). 4.2 Treatment Administration It may be useful to include a table that summarizes the various interventions prior to giving details: Treatment Administration Summary Agent Premedications Dose Route Schedule Drug X Acetaminophen 650 to 1000 mg every 4 to 6 hours for 3 days prior to Drug X 300 mg/m2 IV over 2 hours before Drug Y (day 1 only) Days 1, 8, and 15 of each cycle 150 mg/m2 IV 30 min after completion of Drug X (day 1 only) Day 1 of each cycle 50 mg tablet PO in the a.m. at least 1 hour before eating Daily x 3 weeks followed by 1 week break per cycle Drug Y Drug Z 4.3 n/a n/a Cycle Length Supportive Therapies Omeprazole or similar as needed 4 weeks (28 days) n/a Switch to taking 1 hour after eating if vomiting occurs 4.2.1 Intervention/Agent A Describe the intervention in detail, including the following: Dose/route/schedule (if using cycles, define “cycle” for your trial) Instructions for patients (if self-administered) or clinical staff (e.g. how to monitor) Any required or recommended supportive care medications (include dose(s), instructions for how/when to administer, criteria for administration, etc) Methods for tracking compliance (e.g. pill diary) Instructions regarding skipped or missed doses 4.2.2 Intervention/Agent B Phase I Dose Escalation Scheme Remove this section & re-number others if this does not apply to your trial. Key items to include in this section: State the starting dose(s) of the agent(s)/drug(s). Explain escalation/de-escalation rules for each agent/drug (or indicate if certain agents/drugs are kept constant). Please note that escalation of only one drug at each dose level is recommended. Describe the number of patients to be treated at each level and how a decision about dose escalation or expansion of cohort sizes will be made. Use tables to illustrate dose levels/cohorts. Use exact doses rather than percentages. Consult with your biostatistician when designing your dose escalation scheme and rules! The following language and table are provided as examples and may be modified as Version Date: 8 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) needed: Patients will be enrolled to dose level 1 initially (Drug A 75 mg/m 2 and Drug B 120 mg). Dose escalation will proceed first with Drug A up to 100 mg/m 2 for level 2; thereafter, Drug B will be escalated in 20 mg increments (up to a maximum of 160 mg) while Drug A remains constant. The table below summarizes the dose levels. A dose level -1 is included in the event that level 1 is determined to be too toxic. Dose Escalation Scheme Dose Level Drug A Drug B # of Patients^ Level -1 50 mg/m2 120 mg 3-6 Level 1* 75 mg/m2 120 mg 3-6 Level 2 100 mg/m2 120 mg 3-6 Level 3 100 mg/m2 140 mg 3-6 Level 4 100 mg/m2 160 mg 3-6 *Starting dose level ^A minimum of 3 patients will be treated per cohort; a total of 6 patients should be treated at whichever dose level is determined to be the MTD. A standard “3+3” dose escalation design will be utilized. Initially, 3 patients will be enrolled at the starting dose (level 1), after which enrollment will be temporarily suspended until all 3 patients complete the DLT evaluation period (defined as cycle 1 or the first 28 days of treatment). Once all 3 patients complete the DLT period and toxicity data has been submitted, the Data Monitoring Committee (DMC) will review the data and confirm the presence or absence of any DLTs (defined below). The following rules will be used at each dose level to determine whether or not to proceed to the next dose level: If 0 of 3 patients at a given dose level experience a DLT (defined below), then escalation will proceed to the next dose level. If 2 or 3 of 3 patients at a given dose level experience a DLT, then one of the following must occur: o If this happens at level 1, de-escalation to level -1 will occur. o If this happens at level 2 or beyond, the previous level will be declared the maximum tolerated dose (MTD). o If this happens at level -1, the study will be closed to further accrual and the regimen of Drug A + Drug B will be considered too toxic at any dose. If 1 of 3 patients at a given dose level experiences a DLT, then an additional 3 slots will be added (for a total of 6 patients at that level): o If 1 of 6 total experiences a DLT, then escalation will proceed to the next level. o If ≥ 2 of 6 total experience a DLT, the previous level will be declared the MTD. NOTE: Whichever dose level is declared the MTD must have 6 total patients treated at that level. For example, if 3 patients are treated at level 2 and 0 patients experience DLT, escalation would then proceed to level 3. However, if ≥ 2 patients at level 3 experience DLT, enrollment to level 2 would need to be re-opened to enroll an additional 3 patients at that level (with 0 or 1 DLT observed in 6 total patients) in order to declare level 2 the MTD. 4.3.1 Version Date: Definitions Tips to consider: o Define the period during which patients will be evaluating for dose-limiting toxicities (DLT period). o Describe how DLTs will be evaluated (e.g. per CTCAE v 4.0 criteria or other). 9 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) o o o o 4.4 Indicate whether or not toxicities must be related to study therapy to be labeled DLT (generally DLTs are defined as toxicities attributed to study therapy, but in some cases there may be exceptions to this). Provide an explicit definition of what constitutes a DLT: Types or categories of toxicities (e.g. hematologic vs. nonhematologic) Grades (e.g. “any ≥ Grade 4”) Duration of events (e.g. “persisting for ≥ 1 week”) Clearly list any exceptions to the DLT definition (e.g. “any ≥ Grade 3 nonhematologic toxicity except for alopecia any grade”). Clearly state the definition of MTD and (if appropriate) how this pertains to phase II (e.g. MTD will be the recommended phase II dose or RP2D). Toxicity Management & Dose Delays/Modifications This section should be included in all protocols, including phase I (note that for phase I trials, this usually pertains to management of toxicities that do not meet the criteria of DLT). Any patient who receives at least one dose of study therapy will be evaluable for toxicity endpoints. Each patient will be assessed for the development of toxicity according to the timeframe referenced in the Schedule of Events table). Toxicity will be assessed according to [insert name(s) of criteria]. Things to consider for this section: If more than one drug/agent is administered, provide a detailed description of toxicity grades and course of action for each agent separately. Also explain how to apply dose adjustments in the event that more than one study drug/agent could be responsible for a given toxicity, (e.g. “For non-hematologic toxicities, adjust Drug B before Drug A”). Indicate if and/or when treatment modifications are appropriate (if not permitted, please state when that is the case and reference the appropriate section for how to manage the patient once they are off study therapy) If dose modifications are anticipated/allowed, provide a dose de-escalation scheme (table) for intra-patient dose adjustments. Please also address whether and when reescalation is permitted, and in what fashion. For guidance, refer to the appropriate sections in the protocol that contain more detailed information on the known or potential toxicities associated with each drug/agent. Use tables rather than lengthy blocks of text! Dose adjustments should be expressed using exact doses rather than percentages. If dose delays are allowed: o Specify if/when study treatment may resume and at what dose (e.g. “Hold until resolved to ≤ Grade 1 or baseline and then resume at same dose level”). o Indicate how many days or doses/cycles of treatment may be missed before patient must be removed from the study. For ease of reading, dose modifications may be divided into hematological versus non-hematological criteria. For hematological toxicity, please address guidance on use of growth factor support. If applicable, include supportive care actions to be taken aside from holding therapy or adjusting doses (e.g. “administer Agent Y as needed and refer to cardiologist for evaluation”). The following tables are provided as examples and should be modified as appropriate: Version Date: 10 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Toxicity Grade/Description Drug A Drug B Hematologic Toxicities Grade 1 or 2 Thrombocytopenia Maintain dose level. 1st occurrence: Hold dose & follow CBC weekly. Once ≤ Grade 1 (platelets ≥ 75,000/mm3), resume at same dose. Grade 3 or 4 Grade 1 or 2 Neutropenia Grade 3 w/ fever or Grade 4 2nd occurrence: Hold dose & follow CBC weekly. Once ≤ Grade 1 (platelets ≥ 75,000/mm3), resume at 1 dose level lower. Maintain dose level. 1st occurrence: Hold dose & follow CBC weekly. Once resolved to > 1.0 x 109/L (if neutropenia was the only toxicity noted), resume at same dose. If other toxicity was noted, resume at 1 dose level lower. Maintain dose level. Hold Drug B if Drug A is held; resume Drug B at same dose once Drug A resumes (regardless of whether or not Drug A dose is changed). Maintain dose level. Maintain dose level. If Drug A is permanently discontinued but patient is receiving benefit, may consider continuing on single-agent Drug B, per treating investigator’s discretion. 2nd occurrence: Permanently discontinue Drug A. Non-hematologic Toxicities Allergic reaction or hypersensitivity ≤ Grade 3 Grade 4 Infection Herpes zoster or simplex Version Date: ≥ Grade 3 Any grade Hold dose until resolved to ≤ Grade 1 & then resume at same dose level. Permanently discontinue Drug A. Hold dose until systemic treatment for infection is complete. If no neutropenia, resume at same dose level. If neutropenic, follow instructions above (hematologic section). Hold dose until resolved to ≤ Grade 1 & then resume at same dose level. Permanently discontinue Drug B. Hold dose until systemic treatment for infection is complete. If no neutropenia, resume at same dose level. If neutropenic, follow instructions above (hematologic section). If no resolution after > 3 weeks: permanently discontinue Drug A. If no resolution after > 3 weeks: permanently discontinue Drug A. Hold dose until lesions are dry & then resume at same dose level. Maintain dose level. 11 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Grade 2 w/ pain or Grade 3 Initially, maintain dose level. If neuropathy persists for > 2 weeks, hold dose until resolved to ≤ Grade 2 or baseline then resume at 1 dose level lower. Neuropathy Grade 4 Renal dysfunction CrCl ≤ 15 mL/min Grade 1 or 2 Other Version Date: Grade ≥ 3 May continue on singleagent Drug B (per treating investigator’s discretion) if Drug A is held. Maintain dose level. Hold dose until CrCl > 15 mL/min & then resume at 1 dose level lower. Maintain dose level. Hold dose until resolved to ≤ Grade 1 or baseline. Once resolved, resume at same dose level. If patient is receiving benefit, may continue on single-agent Drug B (per treating investigator’s discretion) if Drug A is discontinued. Maintain dose level. Hold dose until CrCl > 15 mL/min & then resume at 1 dose level lower. Maintain dose level. Hold dose until resolved to ≤ Grade 1 or baseline. Once resolved, resume at same dose level. Unresolved (persisting > 2 weeks) or recurrent event: permanently discontinue Drug A. Unresolved (persistent > 2 weeks) or recurrent event: permanently discontinue Drug B. Permanently discontinue Drug A. 12 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 4.5 Concomitant Medications/Treatments Please list all relevant concomitant drugs and/or treatments that are required, allowed, or prohibited (sub-sections should be used). This section should be consistent with the medications restrictions in the inclusion/exclusion criteria, as well as any premedications that are required or recommended. If any medications may be used, but only with caution, please clearly address that in this section. 4.6 Other Modalities or Procedures If applicable, please provide a description of any other modalities (e.g., surgery, radiotherapy) or procedures (e.g., hematopoietic stem cell transplantation) used in the protocol treatment. Please distinguish between those modalities that comprise standard of care, and those under investigation within your protocol (if standard of care, the description does not have to be lengthy but should include information relevant to the study, such as timing or other requirements). 4.7 Duration of Therapy This section should clearly define the “end of protocol therapy.” This may be a clearly defined number of cycles or doses, or it may be opened-ended with specific criteria to determine when treatment will conclude. For example: Patients may continue to receive cycles of treatment until any of the following occur: Disease progression Development of an inter-current illness that prevents further administration of treatment Unacceptable adverse event(s) Patient decides to withdraw from either study treatment or the as a whole study The treating investigator determines that the patient should be taken off treatment for any reason (i.e. changes in condition, inability to comply with study treatment or procedures) 4.8 Duration of Follow Up This section should clearly define the protocol-specific follow-up period and nature. Things to consider: All studies should have an end of treatment visit (which may or may not also be end of study) approximately 30 days after the last dose of study drug for the purposes of adverse event assessment. Patients removed from treatment for unacceptable adverse events will be followed until resolution or stabilization of the adverse event. Follow-up behind the 30-day post-last-dose visit will depend on study endpoints; patients may need to be followed to document disease progression or start of next therapy or survival. If there are no long-term endpoints, it is not necessary to state when and how patients will be followed clinically for disease management behind the end of study visit. This section pertains only to the period during which data is still to be collected for patients on this study for study purposes. Please think this through carefully as following patients until death may require considerable resources, and may not be necessary (although if this will definitely be the case, please clearly state such). Include the nature and frequency of follow-up (e.g., visits every 3 months, by phone call every 6 months, etc.). 4.9 Version Date: Removal of Subjects from Study Treatment and/or Study as a Whole The language below is somewhat standard and should be modified as appropriate for the study under development: 13 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Patients can be taken off the study treatment and/or study as a whole at any time at their own request, or they may be withdrawn at the discretion of the investigator for safety, behavioral or administrative reasons. The reason(s) for discontinuation must be clearly documented on the appropriate eCRF and may include: 4.10 Patient voluntarily withdraws from treatment (follow-up permitted) Patient withdraws consent (no follow-up permitted) Patient is unable to comply with protocol requirements Patient demonstrates disease progression Patient experiences unacceptable toxicity Treating physician determines that continuation on the study would not be in the patient’s best interest Patient becomes pregnant Patient develops a second malignancy that requires treatment which would interfere with this study Patient becomes lost to follow-up (LTF) Patient Replacement If appropriate, include guidelines describing when and how enrolled patients may be replaced in the study. For example: “Three patients within a dose level must be observed for one cycle (28 days) before accrual to the next higher dose level may begin. If a patient is withdrawn from the study prior to completing 22 days of therapy without experiencing a DLT prior to withdrawal, an additional patient may be added to that dose level. Patients missing 7 or more doses due to toxicity will not be replaced since these patients will be considered to have experienced a dose limiting toxicity.” 5.0 STUDY PROCEDURES The table below is provided as an example only and should be modified as appropriate to fit the study under development. Column headings can be changed, added, removed, or combined. Procedures and activities should be listed in the far left column. Use of footnotes to provide clarity and detail is strongly encouraged. ***Formatting tip: highlight all of section 5 (including table) and select landscape under page layout for “selected text only” to create more space in order to fit on one page if possible*** Version Date: 14 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) On Treatment7 Screening Time Period Baseline Cycle 1 Cycle 2+ Every 3 cycles Off Treatment End of FollowTreatment up8 Assessment or Activity Informed X Consent Medical history X X Physical exam1 X X X X ECOG status X X X X Toxicity X X X assessment Tumor X X X Measurements2 Chest x-ray X X CBC with diff X X X X Chemistry panel X X X X 3 Pregnancy test X Echo or MUGA4 X Drug A X X administration5 Drug B X administration6 Survival status X 1 Includes vital signs (pulse, respirations, blood pressure) and height (baseline only) and weight. 2 By CT or MRI (per treating investigator’s discretion); the same modality used at baseline should be used throughout. 3 Serum or urine test for females of child-bearing potential. 4 Required for all patients at baseline and then only as clinically indicated thereafter. 5 Drug A will be administered IV at the assigned dose for the cohort for cycles 1 and 2 only. 6 Drug B will be self-administered orally by patients at a fixed dose daily on days 1-14 of each cycle. 7 A cycle is defined as 21 days (+/- 2 days). 8 Patients will be followed (either by routine clinic visit or by phone call) every 3 months for 2 years and then every 6 months up to 5 years total from start of study treatment to document survival and disease progression. 6.0 ENDPOINT ASSESSMENT 6.1 Definitions Define/describe any terminology that is used in study endpoints or to address the objectives of the study (i.e. MTD, response categories, PFS/OS, etc). Include definitions (if applicable) of measurable vs. evaluable disease. 6.2 Version Date: Primary Endpoint Describe the primary endpoint, including how (what methods) and when (specifically) it will be assessed. For example, if response rate is an endpoint, note at what timepoint(s) this is assessed for all patients (i.e. after every 2 cycles or at 6 months post-end of therapy). 15 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) If there is published criteria to be utilized (iwCLL, RANO, RECIST, others) describe the criteria and include descriptions or refer to table representations in the appendices. Clearly state which patients will be considered evaluable for this endpoint! 6.3 7.0 Secondary Endpoints Same as with primary endpoints: Define Explain how and when each will be assessed Note the relevant criteria (or tools, such as FACT-Fatigue questionnaire) Clearly state who will be evaluable for each endpoint ADVERSE EVENTS This study will be conducted in compliance with the Data Safety Monitoring Plan (DSMP) of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University (please refer to Appendices for additional information). The level of risk attributed to this study requires [insert monitoring level as specific in SRC approval letter for LOI], as outlined in the DSMP. In addition, the study will abide by all safety reporting regulations, as set forth in the Code of Federal Regulations. 7.1 Adverse Event Monitoring Adverse event data collection and reporting, which are required as part of every clinical trial, are done to ensure the safety of subjects enrolled in the studies as well as those who will enroll in future studies using similar agents. Adverse events are reported in a routine manner at scheduled times during a trial (see Section 5 for timepoints). In addition, certain adverse events must be reported in an expedited manner to allow for optimal monitoring and patient safety and care. All patients experiencing an adverse event, regardless of its relationship to study drug, will be followed until: 7.2 the adverse event resolves or the symptoms or signs that constitute the adverse event return to baseline; any abnormal laboratory values have returned to baseline; there is a satisfactory explanation other than the study drug for the changes observed; or death. Definitions & Descriptions 7.2.1 Adverse Event An adverse event (AE) is any untoward medical occurrence in a patient receiving study treatment and which does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of an experimental intervention, whether or not related to the intervention. Recording of AEs should be done in a concise manner using standard, acceptable medical terms. In general, AEs are not procedures or measurements, but should reflect the reason for the procedure or the diagnosis based on the abnormal measurement. Preexisting conditions that worsen in severity or frequency during the study should also be recorded (a preexisting condition that does not worsen is not an AE). Further, a procedure or surgery is not an AE; rather, the event leading to the procedure or surgery is considered an AE. Version Date: 16 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) If a specific medical diagnosis has been made, that diagnosis or syndrome should be recorded as the AE whenever possible. However, a complete description of the signs, symptoms and investigations which led to the diagnosis should be provided. For example, if clinically significant elevations of liver function tests are known to be secondary to hepatitis, “hepatitis” and not “elevated liver function tests” should be recorded. If the cause is not known, the abnormal test or finding should be recorded as an AE, using appropriate medical terminology (e/g/ thrombocytopenia, peripheral edema, QT prolongation). 7.2.2 Severity of AEs Note, some hematology studies may choose to grade toxicity using alternatives to the CTCAE v4.0 (e.g., iwCLL criteria). When an alternative is used, please modify this section as needed. If using the CTCAE state: All non-hematologic adverse events will be graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. The CTCAE v4 is available at http://ctep.cancer.gov/reporting/ctc.html If no CTCAE grading is available, the severity of an AE is graded as follows: 7.2.3 Version Date: Mild (grade 1): the event causes discomfort without disruption of normal daily activities. Moderate (grade 2): the event causes discomfort that affects normal daily activities. Severe (grade 3): the event makes the patient unable to perform normal daily activities or significantly affects his/her clinical status. Life-threatening (grade 4): the patient was at risk of death at the time of the event. Fatal (grade 5): the event caused death. Serious Adverse Events (SAEs) All SAEs, regardless of attribution, occurring from time of signed informed consent, through 30 days after the last administration of study drug, must be reported upon discovery or occurrence. An SAE is defined in regulatory terminology as any untoward medical occurrence that: Results in death. If death results from (progression of) the disease, the disease should be reported as event (SAE) itself. Is life-threatening. The patient was at risk of death at the time of the event; it does not refer to an event that hypothetically might have caused death if it were more severe. Requires in-patient hospitalization or prolongation of existing hospitalization for ≥ 24 hours. Results in persistent or significant disability or incapacity. Is a congenital anomaly/birth defect. Is an important medical event. Any event that does not meet the above criteria, but that in the judgment of the investigator jeopardizes the patient, may be considered for reporting as a serious adverse event. The event may require medical or surgical intervention to prevent one of the outcomes listed in the definition of “Serious Adverse Event“. 17 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) For example: allergic bronchospasm requiring intensive treatment in an emergency room or at home; convulsions that may not result in hospitalization; development of drug abuse or drug dependency. 7.2.4 7.3 Unanticipated Problems Involving Risks to Subject or Others A UPIRSO is a type of SAE that includes events that meet ALL of the following criteria: Is unanticipated in terms of nature, severity, or frequency Places the research subject or others at a different or greater risk of harm Is deemed to be at least possibly related to participation in the study. Adverse Event Reporting 7.3.1 Routine Reporting All routine adverse events, such as those that are expected, or are unlikely or definitely not related to study participation, are to be reported on the appropriate eCRF . Routine AEs will be reviewed by the Data Monitoring Committee (DMC) according to the study’s phase and risk level, as outlined in the DSMP. 7.3.2 Determining if Expedited Reporting is Required This includes all events that occur within 30 days of the last dose of protocol treatment. Any event that occurs more than 30 days after the last dose of treatment and is attributed (possibly, probably, or definitely) to the agent(s) must also be reported accordingly. 1) Identify the type of adverse event using the NCI CTCAE v 4.03. 2) Grade the adverse event using the NCI CTCAE v 4.03. 3) Determine whether the adverse event is related to the protocol therapy. Attribution categories are as follows: Definite: AE is clearly related to the study treatment. Probable: AE is likely related to the study treatment. Possible: AE may be related to the study treatment. Unlikely: AE not likely to be related to the study treatment. Unrelated: AE is clearly NOT related to the study treatment. 4) Determine the prior experience of the adverse event. Expected events are those that have been previously identified as resulting from administration of the agent. An adverse event is considered unexpected, for expedited reporting purposes only, when either the type of event or the severity of the event is not listed in: the current protocol the drug package insert the current Investigator’s Brochure 7.3.3 Expedited Reporting of SAEs/Other Events 7.3.3.1 Reporting to the Northwestern University QAM/DMC All SAEs must be reported to the assigned QAM within 24 hours of becoming aware of the event. Completion of the NU CRO SAE Form, provided as a separate document, is required. The completed form should assess whether or not the event qualifies as a UPIRSO. The report should also include: Protocol description and number(s) The patient’s identification number A description of the event, severity, treatment, and outcome (if known) Supportive laboratory results and diagnostics Version Date: 18 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) The hospital discharge summary (if available/applicable) All SAEs will be reported to, and reviewed by, the DMC at their next meeting. 7.3.3.2 Reporting to the Northwestern University IRB The following information pertains to the responsibilities of the lead site (Northwestern University). Additional participating sites should follow their local IRB guidelines for reporting to their local IRBs. Any death of an NU subject that is unanticipated in nature and at least possibly related to study participation will be promptly reported to the NU IRB within 24 hours of notification. Any death of an NU subject that is actively on study treatment (regardless of whether or not the event is possibly related to study treatment) Any death of a non-NU subject that is unanticipated and at least possibly related and any other UPIRSOs will be reported to the NU IRB within 5 working days of notification. All other deaths of NU subjects not previously reported, other nonNU subject deaths that were unanticipated and unrelated, and any other SAEs that were not previously reported as UPIRSOs will be reported to the NU IRB at the time of annual continuing review. 7.3.3.3 Reporting to the FDA In the event that an IND is granted for this study, the following notifications will be handled by the NU QAM (if the protocol is determined to be IND exempt, this section will not apply): The FDA will be notified within 7 calendar days of any SAE that is associated with study treatment, is unexpected, and is fatal or lifethreatening. The FDA will be notified within 15 calendar days of any SAE that is associated with the study treatment, unexpected, and serious but not fatal or life-threatening. This includes any previous SAEs that were not initially deemed reportable, but are later determined to meet the criteria for reporting (i.e. by the DMC). All other SAEs will be reported on an annual basis as part of the annual FDA report. 7.3.3.4 Reporting to [insert name of funding source(s)] Most drug companies and other funding sources have established procedures and policies for what events must be reported to them and when. It is NU Cancer Center Policy to utilize our CRO SAE Form for all reporting (companies may review and ask for additional items or forms if absolutely necessary). At a minimum, this section should state what events are to be reported, in what timeframe(s), and the contact person or method for reporting (i.e. phone, fax, email). 8.0 DRUG INFORMATION The details in this section should be repeated for each agent administered (including standard of care therapies). 8.1 Agent XXX 8.1.1 Other names Version Date: 19 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 8.1.2 Classification - type of agent 8.1.3 Mode of action 8.1.4 Storage and stability 8.1.5 Protocol dose specifics If a drug is given at different doses at different points in the treatment cycle, all doses should be indicated. Even if standard/approved dosing is used, please specify what that is here (may not simply state “refer to package insert”). 8.1.6 Preparation Whether investigational or not, include preparation instructions (may not simply state “refer to package insert”). If oral, it is acceptable to state that no preparation is required. 8.1.7 Route of administration for this study 8.1.8 Incompatibilities 8.1.9 Availability & Supply Specify if commercially available and not supplied by study or if provided by sponsor (if provided but will be commercial supply, state this as it affects the IND). Include contact information and instructions for ordering drug (may refer to order for in appendices). For multi-center trials, specify if drug is shipped directly to each site or if all will come to NU and then be shipped out. 8.1.10 Side effects List adverse events by category (i.e. “Most Likely” vs. “Less Likely” vs. “Rare or Serious” or use percentage cut-offs). This must be done by the PI and he/she should verify that this reflects the IB or package insert for each drug. This will be the basis for the consent form risk section so it is essential that this be correct. 8.1.11 Nursing implications 8.1.12 Return and Retention of Study Drug Version Date: 20 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 9.0 CORRELATIVES/SPECIAL STUDIES Summarize the goal/rationale of the planned laboratory correlative studies. In addition, please list each correlative study in the table below with the required information. The Protocol Development Coordinator will format the information as needed in the subsequent sections of the protocol as well as a separate lab manual. If there are no correlative/special studies, remove this section entirely and renumber remaining sections. Correlative Samples - Details for Lab Manual please add additional rows as needed or mark “n/a” where information does not apply Correlative study (sample type) e.g. Pharmacokinetics (blood) Mandatory or Optional Timing (+/- windows) Volume Needed (blood only) Tube type needed (blood only) Tissue thickness and/or # slides (tissue only) Processing center (e.g. PCFCTU) Sample handling/processing instructions Shipping/delivery info Storage needs Analysis center Assay methodology 10.0 9.1 Sample Collection Guidelines 9.2 Sample Processing, Storage, and Shipment 9.3 Assay Methodology 9.4 Specimen Banking STATISTICAL CONSIDERATIONS Here is where you describe the statistical aspects of the protocol in detail. This section must be written in coordination with the study statistician. It should precisely describe what results will be reported and how those results were calculated. 10.1 Study Design/Study Endpoints Please specify the study design. Clearly state design aspects (i.e. retrospective or prospective, blinded, randomized, single or multi-centered). Define all study endpoints. If there are stopping rules for either safety or efficacy, describe the reasoning behind them, and how they might cause a suspension of study enrollment until a safety review has been convened. Version Date: 21 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) 11.0 10.2 Sample Size and Accrual Justification for the number of patients to be used in the study must be given. Please state precisely what the statistical power and sample size considerations are for the proposed study, and which objective they address. The total sample size, the total accrual, the expected accrual rate, and all relevant assumptions should be stated explicitly. How these numbers were calculated, including the software used, should be included. A reviewer should be able to duplicate the calculations given the information provided. 10.3 Data Analyses Plans Please describe in detail how each objective will be addressed by a particular data analysis plan. This is where the details of each data analysis plan (for each objective) are given – stating what statistical methods will be used, and under which assumptions. Every objective/study endpoint should have a plan associated with it. STUDY MANAGEMENT 11.1 Institutional Review Board (IRB) Approval and Consent It is expected that the IRB will have the proper representation and function in accordance with federally mandated regulations. The IRB should approve the consent form and protocol. In obtaining and documenting informed consent, the investigator should comply with the applicable regulatory requirement(s), and should adhere to Good Clinical Practice (GCP) and to ethical principles that have their origin in the Declaration of Helsinki. Before recruitment and enrollment onto this study, the patient will be given a full explanation of the study and will be given the opportunity to review the consent form. Each consent form must include all the relevant elements currently required by the FDA Regulations and local or state regulations. Once this essential information has been provided to the patient and the investigator is assured that the patient understands the implications of participating in the study, the patient will be asked to give consent to participate in the study by signing an IRB approved consent form. Prior to a patient’s participation in the trial, the written informed consent form should be signed and personally dated by the patient and by the person who conducted the informed consent discussion. 11.2 Amendments The Principal Investigator will formally initiate all amendments to the protocol and/or informed consent. All amendments will be subject to the review and approval of the appropriate local, institutional, and governmental regulatory bodies, as well as by [insert sponsor name if applicable]. Amendments will be distributed by the lead institution (Northwestern) to all affiliate sites upon approval by the Northwestern University IRB. 11.3 Registration Procedures 11.3.1 Registering a Patient for the Phase I Portion of the Study For potential patients for the phase I portion of this study, study teams are asked to inform the QAM of the date and time that the patient will need to be registered ([email protected]). BEFORE a patient can be treated on study, please complete and submit the following items to confirm eligibility and receive an identification number: Patient’s signed and dated informed consent form (upload to NOTIS and keep original hard copy in a secure location/study chart) Eligibility checklist (signed and dated by the treating physician – upload to NOTIS) Version Date: 22 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Eligibility eCRF (complete in NOTIS) Copy of the pathology report (upload to NOTIS) The QAM will review all source documentation required to confirm eligibility that is readily available in the patient’s electronic medical record (EMR). Any information that is not available in the EMR must be de-identified and emailed to the QAM. Once the QAM confirms the patient is eligible, he or she will register the patient, assign a subject identification number, provide a cohort assignment, and send a confirmation of registration to involved personnel. Registration will then be complete and the patient may begin study treatment. 11.3.2 Registering a Patient to the Phase II Portion of the Study For potential patients for the phase II portion of this study, study teams are asked to inform the QAM of the date and time that the patient will need to be registered ([email protected]). BEFORE a patient can be treated on study, please complete and submit the following items to confirm eligibility and receive a subject identification number: • Eligibility eCRF (complete in NOTIS) • Eligibility checklist (signed and dated by the treating physician – upload in NOTIS) • Signed and dated informed consent document (upload in NOTIS) • Pathology Report (upload in NOTIS) The QAM will review the registration, register the patient, assign an identification number, and send a confirmation of registration to involved personnel. Registration will then be complete and the patient may begin study treatment. 11.4 Data Submission Once a subject is confirmed and registered to the study, eCRFs should be submitted according to the detailed data submission guidelines (provided in a separate document). Generally, all data for phase I patients during the time period patients are evaluated for Dose Limiting Toxicities (DLTs) must be submitted on a weekly basis. Generally, for all phase II patients, data are due at the end of every cycle. This is a general template. Data Submission language can be revised as make sense for each protocol. A detailed data submission guideline must be included as a separate document for all NU IITs determined to require high or moderate level intensity monitoring. To develop your data submission guideline, contact [email protected]. 11.5 Version Date: Instructions for Participating Sites Remove this language if no additional sites are planned. Before the study can be initiated at any site, the following documentation must be provided to the Clinical Research Office at Northwestern University: Signed and completed Letter of Invitation to participate in the study. Signed copy of Northwestern University’s Data Monitoring Committee policy pertaining to data submission. Draft informed consent form should for review/approval prior to submission to the local IRB A copy of the official IRB approval letter for the protocol and informed consent. CVs and medical licensure for the local PI and any sub-investigators who will be involved in the study at the site. 23 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) Form FDA 1572 appropriately filled out and signed with appropriate documentation. Additional activities may be required prior to site activation (i.e. contract execution, studyspecific training). Full requirements will be outlined in a memo upon receipt of the signed Letter of Invitation. 11.6 Data Management and Monitoring/Auditing This study will be conducted in compliance with the Data Safety Monitoring Plan (DSMP) of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University (please refer to NOTIS for additional information). The level of risk attributed to this study requires {insert risk level from SRC approval letter for LOI}, as outlined in the DSMP. The assigned QAM, with oversight from the Data Monitoring Committee, will monitor this study in accordance with the study phase and risk level. Please refer to the NOTIS for additional data submission instructions. 11.7 Adherence to the Protocol Except for an emergency situation in which proper care for the protection, safety, and well-being of the study patient requires alternative treatment, the study shall be conducted exactly as described in the approved protocol. 11.6.1 Emergency Modifications Investigators may implement a deviation from, or a change of, the protocol to eliminate an immediate hazard(s) to trial subjects without prior IRB approval. For any such emergency modification implemented, an IRB modification form must be completed within 5 business days of making the change, and the QAM must be notified within 24 hours of such change. 11.6.2 Other Protocol Deviations All other deviations from the protocol must be reported to the assigned QAM using the appropriate form. A protocol deviation is any unplanned variance from an IRB approved protocol that: Is generally noted or recognized after it occurs. Has no substantive effect on the risks to research participants. Has no substantive effect on the scientific integrity of the research plan or the value of the data collected. Did not result from willful or knowing misconduct on the part of the investigator(s). A protocol deviation may be considered an instance of Promptly Reportable NonCompliance (PRNC) if it: Has harmed or increased the risk of harm to one or more research participants. Has damaged the scientific integrity of the data collected for the study. Results from willful or knowing misconduct on the part of the investigator(s). Demonstrates serious or continuing noncompliance with federal regulations, State laws, or University policies. 11.8 Version Date: Investigator Obligations The Principal Investigator is responsible for the conduct of the clinical trial at the site in accordance with Title 21 of the Code of Federal Regulations and/or the Declaration of Helsinki. The PI is responsible for personally overseeing the treatment of all study patients. The PI must assure that all study site personnel, including sub-investigators and 24 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) other study staff members, adhere to the study protocol and all FDA/GCP/NCI regulations and guidelines regarding clinical trials both during and after study completion. The Principal Investigator at each institution or site will be responsible for assuring that all the required data will be collected, entered onto the appropriate eCRFs, and submitted within the study-specific timeframes. Periodically, monitoring visits may be conducted and the Principal Investigator will provide access to his/her original records to permit verification of proper entry of data. The study may also be subject to routine audits by the Audit Committee, as outlined in the DSMP. 11.9 Publication Policy This section should be removed if the trial is not rated as a high intensity trial. All potential publications and/or data for potential publications (e.g. manuscripts, abstracts, posters, clinicaltrials.gov releases) must be approved in accordance with the policies and processes set forth in the Lurie Cancer Center DSMP. For trials that require high intensity monitoring, the assigned QAM will prepare a preliminary data summary (to be approved by the DMC) no later than 3 months after the study reaches its primary completion date (the date that the final subject is examined or receives an intervention for the purposes of final data collection for the primary endpoint). If the investigator’s wish to obtain DMC-approved data prior to this point (or prior to the point dictated by study design), the PI must send a written request for data to the QAM which includes justification. If the request is approved, data will be provided no later than 4 weeks after this request approval. The data will be presented to the DMC at their next available meeting, and a final, DMC-approved dataset will be released along with any DMC decisions regarding publication. The investigators are expected to use only DMCapproved data in future publications. The investigators should submit a copy of the manuscript to the biostatistician to confirm that the DMC-approved data are used appropriately. Once the biostatistician gives final approval, the manuscript may be submitted to external publishers. Version Date: 25 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) REFERENCES Version Date: 26 NU Study Number: Will be assigned by SRC Coordinator Other Study Number: Other reference numbers used by external collaborators (if applicable) APPENDICES Version Date: 27