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    Clinical Trial Results:
    A Multicenter, Open-label, Phase 2 Trial to Assess the Efficacy and Safety of Lenvatinib (E7080/MK-7902) in Combination with Pembrolizumab (MK-3475) in Participants with Advanced Melanoma Previously Exposed to an Anti-PD-1/L1 Agent (LEAP-004)

    Summary
    EudraCT number
    2018-002518-10
    Trial protocol
    SE   ES  
    Global end of trial date
    11 Oct 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Oct 2024
    First version publication date
    06 Oct 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    7902-004
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03776136
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    MSD: LEAP-004, Eisai Protocol Number: E7080-G000-225
    Sponsors
    Sponsor organisation name
    Merck Sharp & Dohme LLC
    Sponsor organisation address
    126 East Lincoln Avenue, P.O. Box 2000, Rahway, NJ, United States, 07065
    Public contact
    Clinical Trials Disclosure, Merck Sharp & Dohme LLC, ClinicalTrialsDisclosure@msd.com
    Scientific contact
    Clinical Trials Disclosure, Merck Sharp & Dohme LLC, ClinicalTrialsDisclosure@msd.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    11 Oct 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    11 Oct 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    11 Oct 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    This study will evaluate the safety and efficacy of combination therapy of lenvatinib (E7080/MK-7902) and pembrolizumab following approximately 2 years of pembrolizumab therapy and approximately 2 years or more lenvatinib therapy in adult participants with unresectable or advanced melanoma who have been exposed to anti-programmed cell death ligand 1 (PD-1/L1) agents approved for unresectable or metastatic melanoma. No statistical hypothesis will be tested in this study.
    Protection of trial subjects
    This study was conducted in conformance with Good Clinical Practice standards and applicable country and/or local statutes and regulations regarding ethical committee review, informed consent, and the protection of human subjects participating in biomedical research.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Jan 2019
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Australia: 19
    Country: Number of subjects enrolled
    Canada: 21
    Country: Number of subjects enrolled
    Spain: 36
    Country: Number of subjects enrolled
    Sweden: 14
    Country: Number of subjects enrolled
    United States: 13
    Worldwide total number of subjects
    103
    EEA total number of subjects
    50
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    58
    From 65 to 84 years
    44
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    Participants with unresectable or metastatic melanoma previously exposed to an anti-PD-1/L1 agent were recruited into the study.

    Pre-assignment
    Screening details
    Of 139 participants screened, a total of 103 participants were allocated into the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Arm title
    Lenvatinib + Pembrolizumab
    Arm description
    Participants received lenvatinib 20 mg orally once a day (QD) plus pembrolizumab 200 mg by intravenous (IV) infusion on Day 1 of each 21-day cycle (Q3W). Pembrolizumab was administered for up to 35 cycles (approximately 24 months). Lenvatinib was administered until progressive disease or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Pembrolizumab
    Investigational medicinal product code
    Other name
    KEYTRUDA®, MK-3475
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    200 mg intravenously (IV) on Day 1 of each 21-day cycle (Q3W) for up to 35 cycles (up to ~2 years).

    Investigational medicinal product name
    Lenvatinib
    Investigational medicinal product code
    Other name
    MK-7902, E7080, LENVIMA™
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    20 mg orally once a day (QD) during each 21-day cycle.

    Number of subjects in period 1
    Lenvatinib + Pembrolizumab
    Started
    103
    Treated
    103
    Completed
    0
    Not completed
    103
         Consent withdrawn by subject
    3
         Death
    85
         Sponsor Decision
    15

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Lenvatinib + Pembrolizumab
    Reporting group description
    Participants received lenvatinib 20 mg orally once a day (QD) plus pembrolizumab 200 mg by intravenous (IV) infusion on Day 1 of each 21-day cycle (Q3W). Pembrolizumab was administered for up to 35 cycles (approximately 24 months). Lenvatinib was administered until progressive disease or unacceptable toxicity.

    Reporting group values
    Lenvatinib + Pembrolizumab Total
    Number of subjects
    103 103
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    58 58
        From 65-84 years
    44 44
        85 years and over
    1 1
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    60.7 ( 13.4 ) -
    Sex: Female, Male
    Units: Participants
        Female
    48 48
        Male
    55 55
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    0 0
        Asian
    3 3
        Native Hawaiian or Other Pacific Islander
    0 0
        Black or African American
    1 1
        White
    98 98
        More than one race
    1 1
        Unknown or Not Reported
    0 0
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    1 1
        Not Hispanic or Latino
    100 100
        Unknown or Not Reported
    2 2

    End points

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    End points reporting groups
    Reporting group title
    Lenvatinib + Pembrolizumab
    Reporting group description
    Participants received lenvatinib 20 mg orally once a day (QD) plus pembrolizumab 200 mg by intravenous (IV) infusion on Day 1 of each 21-day cycle (Q3W). Pembrolizumab was administered for up to 35 cycles (approximately 24 months). Lenvatinib was administered until progressive disease or unacceptable toxicity.

    Primary: Objective Response Rate (ORR)

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    End point title
    Objective Response Rate (ORR) [1]
    End point description
    ORR was defined as the percentage of participants in the analysis population who have a confirmed Complete Response (CR: disappearance of all lesions) or a Partial Response (PR: ≥30% decrease in the sum of target lesion diameters without progression in other lesions) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR). Per protocol, RECIST 1.1 was modified to allow up to 10 target lesions total (up to 5 per organ). ORR is reported here for all participants who received at least one dose of study intervention.
    End point type
    Primary
    End point timeframe
    Up to approximately 55 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Per protocol, no statistical analysis were planned for this endpoint.
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    103
    Units: Percentage of Participants
        number (confidence interval 95%)
    21.4 (13.9 to 30.5)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    OS was defined as the time from the first day of study intervention to death due to any cause. Participants without documented death at the time of the final analysis were censored at the date of the last follow-up. OS was calculated using the nonparametric Kaplan-Meier method. OS is reported here for all participants who received at least one dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Up to approximately 55 months
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    103
    Units: Months
        median (confidence interval 95%)
    14.0 (10.8 to 18.3)
    No statistical analyses for this end point

    Secondary: Progression-free Survival (PFS)

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    End point title
    Progression-free Survival (PFS)
    End point description
    PFS was defined as the time from first day of study intervention to the first documented progressive disease (PD) per RECIST 1.1 by BICR, or death from any cause, whichever occurred first. Per protocol, RECIST 1.1 was modified to allow up to 10 target lesions total (up to 5 per organ). PFS was calculated using the nonparametric Kaplan-Meier method; participants who did not experience a PFS event were censored at the last disease assessment, or the last assessment before new anticancer treatment if new treatment was initiated. PFS is reported here for all participants who received at least one dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Up to approximately 55 months
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    103
    Units: Months
        median (confidence interval 95%)
    4.2 (3.5 to 6.3)
    No statistical analyses for this end point

    Secondary: Duration of Response (DOR)

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    End point title
    Duration of Response (DOR)
    End point description
    For participants who demonstrated a confirmed Complete Response (CR: disappearance of all lesions) or Partial Response (PR: ≥30% decrease in the sum of target lesion diameters without progression in other lesions) per RECIST 1.1, DOR was defined as the time from first documented CR or PR until progressive disease (PD) or death from any cause, whichever occurs first. Per protocol, RECIST 1.1 was modified to allow up to 10 target lesions total (up to 5 per organ). DOR was calculated using the nonparametric Kaplan-Meier method for censored data. DOR is reported here for all participants who received at least one dose of study intervention, and who experienced a confirmed CR or PR.
    End point type
    Secondary
    End point timeframe
    Up to approximately 55 months
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    22
    Units: Months
        median (full range (min-max))
    8.5 (3.2 to 40.8)
    No statistical analyses for this end point

    Secondary: Area Under the Concentration Time Curve of Lenvatinib From Time 0 to Infinity (AUC 0-inf)

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    End point title
    Area Under the Concentration Time Curve of Lenvatinib From Time 0 to Infinity (AUC 0-inf)
    End point description
    AUC0-inf was defined as the area under the concentration-time curve from time zero extrapolated to infinity. Plasma blood samples collected at specified timepoints, were used to estimate AUC0-inf following Lenvatinib and Pembrolizumab administration. Based on the lenvatinib plasma concentration data obtained on Cycle 1 Day 1, Cycle 1 Day 15, and Cycle 2 Day 1, a protocol specified population PK analysis was performed to characterize the steady state AUC0-inf of lenvatinib when co-administered with pembrolizumab. AUC0-inf is reported here for all participants who received at least one dose of study intervention, and had data available for AUC0-inf.
    End point type
    Secondary
    End point timeframe
    Cycle 1 Day 1: 0.5 to 4 hours and 6 to 10 hours postdose; Cycle 1 Day 15: Predose and 2 to 12 hours postdose; Cycle 2 Day 1: Predose, 0.5 to 4 hours, and 6 to 10 hours post-dose (each cycle =21 days)
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    103
    Units: ng*hr/mL
        geometric mean (geometric coefficient of variation)
    3005 ( 39.5 )
    No statistical analyses for this end point

    Secondary: Number of Participants Who Experience At Least One Adverse Event (AE)

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    End point title
    Number of Participants Who Experience At Least One Adverse Event (AE)
    End point description
    An AE was any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE could therefore have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention. The number of participants who experienced an AE is presented here for all participants who received at least one dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Up to approximately 55 months
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    103
    Units: Participants
    102
    No statistical analyses for this end point

    Secondary: Number of Participants Who Discontinue Study Treatment Due to an AE

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    End point title
    Number of Participants Who Discontinue Study Treatment Due to an AE
    End point description
    An AE was any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE could therefore have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention. The number of participants who discontinued study treatment due to an AE is presented here for all participants who received at least one dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Up to approximately 48 months
    End point values
    Lenvatinib + Pembrolizumab
    Number of subjects analysed
    103
    Units: Participants
    15
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Up to approximately 55 months
    Adverse event reporting additional description
    All-cause mortality and adverse events (AEs): all participants who received ≥1 dose of treatment. Per protocol, disease progression was not considered an AE unless considered related to study drug. Thus MedDRA preferred terms Neoplasm progression, Malignant neoplasm progression and Disease progression not related to study drug are excluded as AEs.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.1
    Reporting groups
    Reporting group title
    Lenvatinib + Pembrolizumab
    Reporting group description
    -

    Serious adverse events
    Lenvatinib + Pembrolizumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    48 / 103 (46.60%)
         number of deaths (all causes)
    86
         number of deaths resulting from adverse events
    4
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumour haemorrhage
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Basal cell carcinoma
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cancer pain
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Malignant melanoma
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Malaise
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pneumothorax
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Disorientation
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Confusional state
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Platelet count decreased
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Injury, poisoning and procedural complications
    Wound secretion
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Muscle rupture
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Femoral neck fracture
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Supraventricular tachycardia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bradycardia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Acute coronary syndrome
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Horner's syndrome
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Syncope
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Immune thrombocytopenia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Melaena
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intra-abdominal haematoma
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Enteritis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    5 / 103 (4.85%)
         occurrences causally related to treatment / all
    4 / 5
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain upper
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Colitis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Proctitis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Proctalgia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Oesophagitis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholecystitis chronic
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cholecystitis acute
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Biliary obstruction
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Biliary colic
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin ulcer
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Renal impairment
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Acute kidney injury
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Urinary retention
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Fistula
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Biliary sepsis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Appendicitis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Escherichia bacteraemia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    2 / 103 (1.94%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Groin abscess
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pelvic abscess
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Viral upper respiratory tract infection
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    4 / 103 (3.88%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 2
    Pneumonia aspiration
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Hyperglycaemia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Failure to thrive
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diabetic ketoacidosis
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperkalaemia
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatraemia
         subjects affected / exposed
    3 / 103 (2.91%)
         occurrences causally related to treatment / all
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    Malnutrition
         subjects affected / exposed
    1 / 103 (0.97%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Lenvatinib + Pembrolizumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    101 / 103 (98.06%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    58 / 103 (56.31%)
         occurrences all number
    88
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    31 / 103 (30.10%)
         occurrences all number
    59
    Fatigue
         subjects affected / exposed
    36 / 103 (34.95%)
         occurrences all number
    44
    Mucosal inflammation
         subjects affected / exposed
    18 / 103 (17.48%)
         occurrences all number
    30
    Oedema peripheral
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    6
    Pyrexia
         subjects affected / exposed
    20 / 103 (19.42%)
         occurrences all number
    23
    Respiratory, thoracic and mediastinal disorders
    Aphonia
         subjects affected / exposed
    7 / 103 (6.80%)
         occurrences all number
    10
    Oropharyngeal pain
         subjects affected / exposed
    9 / 103 (8.74%)
         occurrences all number
    9
    Epistaxis
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    8
    Dyspnoea
         subjects affected / exposed
    8 / 103 (7.77%)
         occurrences all number
    8
    Dysphonia
         subjects affected / exposed
    22 / 103 (21.36%)
         occurrences all number
    24
    Cough
         subjects affected / exposed
    12 / 103 (11.65%)
         occurrences all number
    14
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    11 / 103 (10.68%)
         occurrences all number
    12
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    16 / 103 (15.53%)
         occurrences all number
    19
    Lipase increased
         subjects affected / exposed
    14 / 103 (13.59%)
         occurrences all number
    14
    Haemoglobin decreased
         subjects affected / exposed
    7 / 103 (6.80%)
         occurrences all number
    10
    Blood thyroid stimulating hormone increased
         subjects affected / exposed
    9 / 103 (8.74%)
         occurrences all number
    12
    Blood magnesium decreased
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    18
    Blood alkaline phosphatase increased
         subjects affected / exposed
    7 / 103 (6.80%)
         occurrences all number
    9
    Aspartate aminotransferase increased
         subjects affected / exposed
    13 / 103 (12.62%)
         occurrences all number
    18
    Amylase increased
         subjects affected / exposed
    10 / 103 (9.71%)
         occurrences all number
    15
    Neutrophil count decreased
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    6
    Weight decreased
         subjects affected / exposed
    23 / 103 (22.33%)
         occurrences all number
    25
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    12 / 103 (11.65%)
         occurrences all number
    15
    Headache
         subjects affected / exposed
    29 / 103 (28.16%)
         occurrences all number
    56
    Dizziness
         subjects affected / exposed
    18 / 103 (17.48%)
         occurrences all number
    22
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    14 / 103 (13.59%)
         occurrences all number
    15
    Neutropenia
         subjects affected / exposed
    7 / 103 (6.80%)
         occurrences all number
    9
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    19 / 103 (18.45%)
         occurrences all number
    27
    Gastrooesophageal reflux disease
         subjects affected / exposed
    12 / 103 (11.65%)
         occurrences all number
    13
    Nausea
         subjects affected / exposed
    46 / 103 (44.66%)
         occurrences all number
    64
    Stomatitis
         subjects affected / exposed
    14 / 103 (13.59%)
         occurrences all number
    15
    Toothache
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    6
    Vomiting
         subjects affected / exposed
    28 / 103 (27.18%)
         occurrences all number
    51
    Dry mouth
         subjects affected / exposed
    15 / 103 (14.56%)
         occurrences all number
    18
    Abdominal pain upper
         subjects affected / exposed
    9 / 103 (8.74%)
         occurrences all number
    13
    Diarrhoea
         subjects affected / exposed
    50 / 103 (48.54%)
         occurrences all number
    123
    Constipation
         subjects affected / exposed
    32 / 103 (31.07%)
         occurrences all number
    39
    Skin and subcutaneous tissue disorders
    Vitiligo
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    6
    Rash
         subjects affected / exposed
    12 / 103 (11.65%)
         occurrences all number
    15
    Pruritus
         subjects affected / exposed
    18 / 103 (17.48%)
         occurrences all number
    19
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    7 / 103 (6.80%)
         occurrences all number
    8
    Dry skin
         subjects affected / exposed
    11 / 103 (10.68%)
         occurrences all number
    11
    Renal and urinary disorders
    Proteinuria
         subjects affected / exposed
    23 / 103 (22.33%)
         occurrences all number
    34
    Endocrine disorders
    Hypothyroidism
         subjects affected / exposed
    37 / 103 (35.92%)
         occurrences all number
    39
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    15 / 103 (14.56%)
         occurrences all number
    18
    Muscular weakness
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    6
    Back pain
         subjects affected / exposed
    20 / 103 (19.42%)
         occurrences all number
    24
    Arthralgia
         subjects affected / exposed
    27 / 103 (26.21%)
         occurrences all number
    39
    Pain in extremity
         subjects affected / exposed
    11 / 103 (10.68%)
         occurrences all number
    12
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    6
    Urinary tract infection
         subjects affected / exposed
    15 / 103 (14.56%)
         occurrences all number
    17
    Metabolism and nutrition disorders
    Hypophosphataemia
         subjects affected / exposed
    6 / 103 (5.83%)
         occurrences all number
    7
    Hyponatraemia
         subjects affected / exposed
    9 / 103 (8.74%)
         occurrences all number
    9
    Hypomagnesaemia
         subjects affected / exposed
    13 / 103 (12.62%)
         occurrences all number
    23
    Hypokalaemia
         subjects affected / exposed
    10 / 103 (9.71%)
         occurrences all number
    15
    Decreased appetite
         subjects affected / exposed
    42 / 103 (40.78%)
         occurrences all number
    58

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    21 Jan 2019
    Amendment 1: To address agency comments associated with the potential for a clinical hold; amendment required to proceed with first site-ready milestone.
    05 Jun 2019
    Amendment 2: To address feedback from regulatory authority and add MK-7902 program-level updates.
    17 Jun 2020
    Amendment 3: To clarify Adverse Event Safety Follow-up timelines, to clarify allowed concomitant medications, and to add MK-7902 program-level updates.
    05 Oct 2021
    Amendment 4: To update the pembrolizumab dose modification and toxicity management guidelines for immune-related adverse events (irAEs) and table, to add MK-7902 program-level updates.
    29 Sep 2022
    Amendment 5: Sponsor underwent an entity name change and update to the address. Merck Sharp & Dohme Corp. underwent an entity name and address change to Merck Sharp & Dohme LLC, Rahway, NJ, USA.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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