Birkenhead, United Kingdom

A Prospective Natural History Study in Uveal Melanoma

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, accounting for 85% to 95% of ocular melanoma cases. However, UM represents only about 3% to 5% of all melanomas in the United States (US). UM most commonly arises from choroidal melanocytes (85-90%), but can also arise from the iris (3-5%) and ciliary body (5-8%). The median age of diagnosis is approximately 62; however, the peak range for diagnosis is between 70 and 79. Males have a 30% greater incidence than females. A variety of putative risk factors have been identified, including the presence of light eyes, fair skin, an inability to tan, ocular melanocytosis, dysplastic nevus syndrome, and germline BRCA1-associated protein 1 (BAP1) mutations. Importantly, there are no recent or on-going multi-center natural history studies being conducted in this disease, and this effort is the only one to be launched with the goal of capturing the complete course of this disease, from diagnosis, initial management, surveillance, and treatment of recurrent disease in a national and international setting. This registry is especially important in providing such needed data.

Pragmatic Randomised Trial of High Or Standard PHosphAte Targets in End-stage Kidney Disease (PHOSPHATE)

Hyperphosphataemia is highly prevalent in patients with end-stage kidney disease (ESKD) and associated with increased mortality risk. The Clinical Practice Guidelines suggest lowering elevated phosphate levels towards the normal range (level 2C suggestion). However, trial data demonstrating that treatments that lower serum phosphate will improve patient-centred outcomes are lacking. The primary objective is to test the hypothesis that compared to a liberal serum phosphate concentration target of 2.0 to 2.5 mmol/L, intensive lowering of serum phosphate towards the normal level (≤1.50 mmol/L) with phosphate binders reduces the risk of fatal or non-fatal major cardiovascular events in ESKD patients receiving dialysis. The secondary objectives are to test the hypothesis that intensive lowering of serum phosphate towards the normal level with phosphate binders would improve physical health, fatigue, health-related quality of life, patient satisfaction, and pruritus; and be cost-effective. In this pragmatic, multinational, randomised controlled large simple trial, a total of 3600 adult ESKD patients receiving dialysis will be randomised either to intensive (≤1.50 mmol/L) or liberalized (2.0-2.5 mmol/L) serum phosphate target. The choice and dose of phosphate binders will be at the treating physician's discretion and local practice to achieve and maintain serum phosphate concentration within the required target range according to randomisation. The primary endpoint is the composite endpoint of cardiovascular death, non-fatal major cardiovascular or peripheral arterial events. The secondary outcome measures will be individual components of the primary composite endpoint, all-cause death, and utility-based quality of life EQ5D-5L.

Tenecteplase in Wake-up Ischaemic Stroke Trial

Background: One in five strokes occur during sleep, but patients with "wake-up" stroke are not given thrombolytic therapy because time of stroke onset is unknown. On-going trials are testing alteplase, and use MRI techniques for selection of patients. Tenecteplase has many pharmacological advantages over alteplase: greater fibrin specificity, very rapid action, longer half-life, and single bolus administration. In addition, patient selection based on MRI findings risks excluding many patients that might otherwise benefit. TWIST will test tenecteplase and will not use MRI techniques for selection of patients. Plain CT and CT angiography (if possible) will be performed before randomisation, and CT perfusion will be performed at selected centres, as part of a sub-study. Study design: TWIST is an international, multi-centre, randomised, open-label, blinded-endpoint trial of tenecteplase for acute ischaemic 'wake-up' stroke. Study questions: 1. Can tenecteplase given <4.5 hours of awakening improve functional outcome at 3 months? 2. Can findings on cerebral plain CT and CT angiography (and CT perfusion, at selected centres) identify patients who benefit from such treatment, compared to other patients? Patients eligible for treatment who are able to receive tenecteplase within 4.5 hours of waking, will be randomly allocated to treatment with tenecteplase in addition to best standard treatment, versus best standard treatment. Randomisation and treatment: Central randomisation (over the internet) to tenecteplase 0.25 mg/mg i.v. (maximum dose 25 mg) plus best medical treatment vs. best medical treatment alone. Imaging: All patients will undergo CT and CT angiography (CTA, if possible) before randomisation and on day 2. CT perfusion (CTP) will be performed at selected centres, as part of a sub-study. Follow-up and primary effect variable: Centralised follow-up via telephone or mail at 3 months. The primary effect variable is functional outcome (modified Rankin Scale score). Study size and centers: 600 patients from centers in Norway, Sweden, Denmark, Finland, Estonia, Latvia, Lithuania, United Kingdom, Switzerland and New Zealand.

First-in-human Study of CRB-601-01 to Treat Patients with Advanced Solid Tumor.

CRB-601-01 is a three-part interventional study which aims to: - To determine the maximum tolerated dose (MTD) and pharmacologically active dose range (PADR) for CRB-601 administered as a monotherapy in patients with select relapsed/refractory solid tumors who have progressed after at least one line of therapy - To determine the optimized dose for CRB-601 when administered within the PADR in combination with anti-programmed (cell) death ligand 1 (anti-PD-(L)1) therapy ( in patients with select relapsed/refractory solid tumors who have progressed after at least one line of therapy - To determine the optimized dose for CRB-601 when administered within the PADR in combination with anti-PD(L)-1 therapy and single-lesion, immune-priming stereotactic body radiation therapy (SBRT) in patients with select relapsed/refractory solid tumors who have progressed after at least one line of therapy The study will be run in 3 parts (A-C), run sequentially. Part A Dose Escalation Part A is designed to evaluate the safety, tolerability, and determine the MTD of CRB-601 administered as monotherapy in participants with select relapsed/refractory solid tumors that are known to express avb8 integrin. All participants will have had disease progression (PD) after at least one line of therapy or have no other standard therapy of proven clinical benefit currently available or be recommended based on the investigator's individual risk-benefit assessment for the participant. In Part A, doses will be escalated following the standard Bayesian Optimal Interval Design (BOIN) to determine the MTD and PADR or CRB-601. Three (3) dose groups treated on a 28 cycle with dosing every 2 weeks (Q2W) are predetermined. The target toxicity level is 0.3, the maximum number of participants that can be enrolled at each dose level is 12 participants and the maximum sample size of the BOIN design is 36. Determination of dose-limiting toxicities (DLT) will be based on toxicities observed during the DLT observation period (first 28-days or Cycle 1). Dose escalation /de-escalation decisions are made on the basis of occurrence of DLT. Part B Combination Safety Lead-in and Signal Seeking Part B is designed to assess the safety and tolerability of CRB-601 combined with anti-PD(L)-1 therapy, with or without single-lesion, immune-priming SBRT. There will be two distinct phases to Part B, a safety lead-in phase with a two-step dose-escalation and an Expansion Phase to seek efficacy signals in select solid tumors. The following cohorts will be initiated: Safety Lead-in - A cohort of 20 participants with select tumor-types (10 participants at a low-dose, and 10 participants at a high-dose, as selected in Part A) in combination with anti-PD(L)-1 at the recommended dose and schedule. - A second cohort of 20 participants will be treated with CRB-601 (10 participants at a low dose and 10 participants at a high-dose), in combination with anti-PD(L)-1 at the recommended dose and schedule and single-lesion, immune-priming SBRT Additional participants with select tumor-types showing preliminary efficacy will be enrolled in an expansions phase. Part C Dose Optimization Part C will follow a time-to-event Bayesian optimal Phase 2 (TOP Bayesian) study design developed for cancer immunotherapy. The aim of dose optimization is to determine the recommended Phase 2 dose (RP2D) by evaluating the efficacy of CRB-601 in combination with anti-PD(L)-1, with or without single-lesion, immune-priming SBRT (in terms of objective response rate [ORR]) when administered at two dose levels in a tumor-type selected based on preliminary efficacy observed in Part A and B. Participants will be randomized into one of two dose levels (low-dose CRB-601 group and high-dose CRB- 601 group) of 12-20 participants. In each arm, eligible participants will receive CRB-601 in combination with anti-PD(L)-1, with or without single lesion, immune priming SBRT (should the risk/benefit of immune-priming be established in Part B) and be monitored for safety and efficacy. For all enrolled participants (Parts A to C), study intervention will continue until any of the pre-defined criteria for discontinuation of study intervention are met, including intolerable toxicity, death, withdrawal of consent for study intervention, start of a new anti-cancer therapy, or investigator determined PD according to RECIST 1.1 or symptomatic deterioration attributed to PD. General In all parts, tumor response will be evaluated by the investigator according to RECIST v1.. During the post-treatment follow-up period, only participants who had discontinued study intervention for reasons other than PD or start of a new anti-cancer therapy (e.g., due to toxicity) will undergo tumor assessments. In these participants, tumor assessments will continue until death, confirmed radiographic PD according to RECIST v1.1, symptomatic deterioration attributed to PD, initiation of a subsequent anti cancer therapy, withdrawal of consent for the study or any of the other pre defined criteria for withdrawal from the study are met, whichever occurs first. All discontinued participants (with the exception of the reason of death) will be followed for 3 months for immune-related adverse events (irAEs) unless consent is refused in writing by the participant. Lesions selected for single lesion, immune priming SBRT or on-treatment biopsy, will be omitted from tumor assessments by RECIST v1.1. Clinical and laboratory adverse events (AEs) will be reported and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0. Guidelines for dose interruptions (e.g., for toxicity) are included in the protocol. Biomarkers will also be measured. Collection of off- and on-treatment biopsies in Parts A to C are considered mandatory, unless agreed with the sponsor. Fresh tumor biopsies or archival tumor formalin fixed paraffin embedded (FFPE) samples are acceptable for baseline evaluation, and on-treatment samples will be collected on C2D15. Blood samples for biomarker and cytokine/chemokine assessments will also be collected.

LIVERAGE™ - Cirrhosis: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Cirrhosis

LIVERAGE™: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Moderate or Advanced Liver Fibrosis

An Open-Label Study to Evaluate the Safety, Tolerability and Pharmacodynamics of BPL-003 in Patients with Treatment Resistant Depression

Part 1: Up to 32 patients, across 2 parallel arms (Arms A and Arms B) will receive one of two single doses of BPL-003, given intranasally, with 12 weeks of follow-up assessments. Part 2: Up to 32 patients, across 2 parallel arms (Arms A and Arms B) will receive two doses of BPL-003, given intranasally, with 10 weeks of follow-up assessments. Psychological support will be given before, during and after dosing in Part 1 and Part 2.

A Platform Study for solId orgaN CancERs

This is a platform tissue collection study to provide biosamples for specific research projects. These sub-studies will be proposed by interested researchers and undergo internal review by the PINCER steering committee. Following approval, each sub study will be delivered on this platform in line with this protocol. This study will not be used to generate biobanks, but to allow biosamples to be used for specific active sub studies. 1. Study Locations & Approval This platform will allow patients having surgery or biopsy for any solid organ cancer to consent to take part in the study. Any site wishing to do this will open as a site for the PINCER Study. Sub-studies using PINCER will require their own local study lead and SOP written by the local team and this will require approval by the PINCER steering committee. This will be to confirm alignment with the overarching PINCER protocol, define sampling requirements and assess the scientific validity of the study, as well as ensure regulatory oversight. 2. Fresh Tissue Collection Tissue will be obtained either through biopsy (an extra sample of tissue will be taken using the same needle at the time of original biopsy) or after surgical resection (where the tumour tissue would routinely be discarded after sampling for pathological assessment). In the case of tissue retrieved after surgery, a pathologist will ensure that excess tissue removed after resection will not compromise pathological assessment of the resected specimen. At the same time as biopsy or surgery, a small sample of blood (60ml) may be removed from the venous catheter which the patient has inserted as part of the routine care during their procedure. After the tissue has been retrieved, tissue and blood will be transported to a HTA approved facility. This will be performed under a locally arranged material transfer agreement (MTA) agreed by the local team between each individual site and the relevant partner organization. 3. Collection of historical FFPE tumour tissue Patients who have undergone biopsy or surgery for solid organ cancers will be identified from existing NHS clinical databases which track surgical activity by relevant clinical teams. Their tumour tissue samples will then be identified using local pathology systems, and their archived tissue blocks retrieved. In the case of patients who have had metastatic disease resected, both primary and metastatic tumour tissue will be accessed. A small amount of these tissue blocks will be sampled, and the remnant tissue block returned to the pathology archive. After the tissue has been retrieved, it will be transported to a HTA approved facility. This will be performed under a locally arranged material transfer agreement (MTA) between each individual site and the relevant partner organization. 4. Collection of post-treatment blood samples Up to 60mls of blood may be drawn from patients up to 12 months following treatment. After the blood has been retrieved, it will be transported to a HTA approved facility. This will be performed under a locally arranged material transfer agreement (MTA) between each individual site and the relevant partner organization. 5. Quality of Life Analysis Where appropriate, patients will be invited to complete EORTC Quality of Life assessment questionnaires up to 12 months following treatment. 6. Pseudoanonymised data & radiology collection Linked clinicopathological and radiological data will be retrieved where appropriate and stored on password protected computer systems. Local pseudoanonymisation will be required before these data are shared with other researchers not directly involved in the clinical care of patients. 7. Biosample analysis All analyses will be performed in HTA approved laboratories or equivalent. Pseudoanonymised samples may be shared with academic and commercial partner organisations within the UK and abroad, including the USA. All users of biosamples will be expected to have completed MRC HTA training.

Staphylococcus Aureus Network Adaptive Platform Trial

Infection of the bloodstream with the bacterium Staphylococcus aureus (Staphylococcus aureus bacteraemia, SAB) is a serious infection that results in 15-30% of affected patients dying within three months of acquiring the infection. Treatment of this infection requires patients to be hospitalised, treated with prolonged antibiotics through an intravenous line, and carefully examined for the occurrence of complications associated with this condition. At present, there are many treatment options in current use, with no clear agreement as to which of these is best. The SNAP trial aims to identify which treatment options for SAB results in the fewest patients dying within the first 90 days after an infection. In contrast to a conventional clinical trial, the SNAP trial will examine multiple different treatment options at once. Patients will be randomly assigned to different concurrent treatment options currently considered acceptable in routine medical care, but as the trial progresses, more patients will be assigned to treatments that appear to have better outcomes than those with worse outcomes. The trial will adapt to accumulating trial evidence, on a regular basis, by removing treatment options found to be inferior, incorporating new treatment options, and ensuring that all patients in the trial receive the best treatments once they have been identified. Over time, we hope to determine the best combination of treatment options for patients with SAB. The SNAP Trial infrastructure will also support a number of sub-studies. A list of all active sub-studies can be found on the SNAP website: https://www.snaptrial.com.au/substudies.

PRIMUS 001: A Study Looking at Two Different Chemotherapy Regimens in Patients With Metastatic Pancreatic Cancer

PRIMUS 001 is a multicentre, randomised, open label, two arm, phase II interventional trial with pre-clinical and translational work including in-depth molecular profiling and biomarker discovery/development. The primary objective is to look at the efficacy of FOLFOX-A compared to AG in all comers and in a biomarker positive group using progression free survival.