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    Summary
    EudraCT Number:2018-003752-21
    Sponsor's Protocol Code Number:MK-7902-011/E7080-G000-317
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2019-05-24
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2018-003752-21
    A.3Full title of the trial
    A Phase 3, Randomized, Double-blind Study to Compare the Efficacy and Safety of Pembrolizumab (MK-3475) in Combination with Lenvatinib (E7080/MK-7902) Versus Pembrolizumab and Placebo as First Line Treatment for Locally Advanced or Metastatic Urothelial Carcinoma in Cisplatin-ineligible Participants Whose Tumors Express PD-L1, and in Participants Ineligible for Any Platinum-containing Chemotherapy Regardless of PD-L1 Expression (LEAP-011)
    Estudio de fase 3, aleatorizado y doble ciego para comparar la eficacia y la seguridad de pembrolizumab (MK-3475) en combinación con lenvatinib (E7080/MK-7902) frente a pembrolizumab y un placebo equivalente como tratamiento de primera línea del carcinoma urotelial localmente avanzado o metastásico en participantes que no pueden recibir cisplatino cuyos tumores expresan PD-L1 y en participantes que no pueden recibir ningún tipo de quimioterapia a base de platino con independencia de la expresión de PD-L1 (LEAP-011)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 3 Study of First-line Pembrolizumab With or Without Lenvatinib in Urothelial Carcinoma in Cisplatin-ineligible Participants Whose Tumors Express PD-L1 and Participants Ineligible for Any Platinum-containing Chemotherapy
    Estudio de fase 3 de pembrolizumab de primera línea, con o sin lenvatinib, en participantes con carcinoma urotelial no elegibles para recibir cisplatino cuyos tumores expresan PD-L1 y en participantes no elegibles para recibir quimioterapia a base de platino
    A.4.1Sponsor's protocol code numberMK-7902-011/E7080-G000-317
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.4.1Name of organisation providing supportEisai Limited
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España S.A.
    B.5.2Functional name of contact pointInvestigación Clínica
    B.5.3 Address:
    B.5.3.1Street AddressC/ Josefa Valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28037
    B.5.3.4CountrySpain
    B.5.4Telephone number+34913210600
    B.5.5Fax number+34913210590
    B.5.6E-mailensayos_clinicos@merck.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePEMBROLIZUMAB
    D.3.2Product code MK-3475
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA (pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib
    D.3.2Product code E7080
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLENVATINIB MESILATE
    D.3.9.1CAS number 857890-39-2
    D.3.9.3Other descriptive nameLENVATINIB MESILATE
    D.3.9.4EV Substance CodeSUB72971
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib
    D.3.2Product code E7080
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLENVATINIB MESILATE
    D.3.9.1CAS number 857890-39-2
    D.3.9.3Other descriptive nameLENVATINIB MESILATE
    D.3.9.4EV Substance CodeSUB72971
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboCapsule, hard
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Advanced/unresectable or metastatic urothelial carcinoma
    Carcinoma urotelial avanzado/irresecable o metastásico
    E.1.1.1Medical condition in easily understood language
    Urothelial cancer (also known as transition cell carcinoma of the bladder)
    Cáncer urotelial (también conocido como carcinoma de células de transición de la vejiga)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10064467
    E.1.2Term Urothelial carcinoma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To compare pembrolizumab (MK-3475) + lenvatinib (MK-7902) to pembrolizumab + placebo with respect to Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR)
    2. To compare pembrolizumab + lenvatinib to pembrolizumab + placebo with respect to Overall Survival (OS)
    1. Comparar pembrolizumab + lenvatinib con pembrolizumab + placebo en cuanto a la supervivencia sin progresión (SSP) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según una revisión central independiente y enmascarada (RCIE)
    2.Comparar pembrolizumab + lenvatinib con pembrolizumab + placebo en cuanto a la supervivencia global (SG).
    E.2.2Secondary objectives of the trial
    1. To compare pembrolizumab + lenvatinib to pembrolizumab + placebo with respect to Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR)
    2. To evaluate the safety and tolerability of treatment with pembrolizumab + lenvatinib versus pembrolizumab + placebo
    3. To evaluate pembrolizumab + lenvatinib and pembrolizumab + placebo with respect to Duration of Response (DOR) per RECIST 1.1 by Blinded Independent Central Review (BICR)
    4. To evaluate pembrolizumab + lenvatinib and pembrolizumab + placebo with respect to Disease Control Rate (DCR) per RECIST 1.1 by Blinded Independent Central Review (BICR)
    5. To evaluate changes in patient-reported outcomes (PROs) from Baseline and Time to Deterioration (TTD) in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status (Item 29)/Quality of Life (Item 30)
    1.Comparar pembrolizumab + lenvatinib con pembrolizumab + placebo en cuanto a la tasa de respuestas objetivas (TRO) conforme a los criterios RECIST 1.1, según una RCIE.
    2.Evaluar la seguridad y la tolerabilidad del tratamiento con pembrolizumab + lenvatinib en comparación con pembrolizumab + placebo.
    3.Comparar pembrolizumab + lenvatinib con pembrolizumab + placebo en cuanto a la duración de la respuesta (DR) conforme a los criterios RECIST 1.1, según una RCIE.
    4.Comparar pembrolizumab + lenvatinib con pembrolizumab + placebo en cuanto a la tasa de control de la enfermedad (TCE) conforme a los criterios RECIST 1.1, según una RCIE.
    Leer resto en el protocolo
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Have a histologically or cytologically confirmed diagnosis of advanced/unresectable or metastatic urothelial carcinoma of the renal pelvis, ureter, bladder, or urethra. Both transitional cell and mixed transitional/nontransitional cell histology are allowed, but transitional cell carcinoma must be the predominant histology
    2. Have at least 1 measurable target lesion per RECIST 1.1 as assessed by the local site investigator/radiologist, per the following criteria: 1) lymph node lesion measuring ≥15 mm in the short axis; 2) non-nodal lesion measuring ≥10 mm in the longest diameter; 3) lesion suitable for repeat measurement with CT/MRI imaging. Lesions in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions
    3. Have provided an archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated and adequate for PD-L1 evaluation. Formalin-fixed, paraffin-embedded tissue blocks are preferred to slides. Newly obtained biopsies are preferred to archived tissue. PD-L1 status (CPS ≥10 or CPS <10) must be obtained by the central laboratory during the screening period prior to enrollment
    4. Have received no prior systemic chemotherapy for advanced or metastatic UC with the following exceptions:
    - Neoadjuvant platinum-based chemotherapy for treatment of muscle-invasive bladder cancer with recurrence >12 months from completion of the therapy is permitted
    - Adjuvant platinum-based chemotherapy following radical cystectomy, with recurrence >12 months from completion of the therapy, is permitted
    5. Meet criteria for either option a or option b:
    a. Have a tumor(s) with PD-L1 CPS ≥10 and be considered ineligible to receive cisplatin-based combination therapy, based on 1 of the following:
    - ECOG PS 2 within 7 days prior to randomization
    - CrCl (calculated or measured using the institutional standard) ≥30 to ≤60 mL/min
    - NCI CTCAE Version 4.0 Grade≥2 audiometric hearing loss (25 dB in 2 consecutive frequency ranges)
    - NCI CTCAE Version 4.0 Grade≥2 peripheral neuropathy
    OR
    b. In the opinion of the investigator, be considered ineligible to receive any platinum-based chemotherapy (ie, ineligible for cisplatin and carboplatin) based on:
    - ECOG PS 2 within 7 days prior to randomization
    and at least 1 of the following:
    - Documented visceral metastatic disease
    - CrCl≥30 to ≤60 mL/min
    - NCI CTCAE Version 4.0 Grade≥2 audiometric hearing loss
    - NCI CTCAE Version 4.0 Grade≥2 peripheral neuropathy
    - Other reason, identified on the case report form, for the participant’s being unable to receive carboplatin safely. Additional criteria for platinum ineligibility will be considered and allowed on a case-by-case basis, following consultation with the Sponsor
    6. Be male or female and≥18 years of age and considered an adult per local regulations on the day of signing the informed consent
    7. Have ECOG PS 0, 1, or 2 within 7 days prior to randomization and a life expectancy of≥3 months
    8. Male participants are eligible to participate if they agree to the following during the intervention period and for at least 95 days after the last dose of pembrolizumab or lenvatinib/placebo and refrain from donating sperm during this period:
    - Be abstinent from heterosexual intercourse as their preferred and usual lifestyle and agree to remain abstinent
    OR
    - Must agree to use contraception unless confirmed to be azoospermic as detailed below:
    - Agree to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a WOCBP who is not currently pregnant
    9. A female participant is eligible to participate if she is not pregnant or breastfeeding and at least one of the following conditions applies:
    - Is not a WOCBP
    OR
    - Is a WOCBP and using a contraceptive method that is highly effective with low user dependency, or be abstinent from heterosexual intercourse as her preferred and usual lifestyle, during the intervention period and for at least 120 days after the last dose of pembrolizumab or lenvatinib/placebo
    - A WOCBP must have a negative highly sensitive pregnancy test within 72 hours before the first dose of study intervention
    - If a urine test cannot be confirmed as negative, a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive
    - The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk of including a woman with an early undetected pregnancy
    10. The participant (or legally acceptable representative if applicable) provides written informed consent for the study
    11. Have adequately controlled BP with or without antihypertensive medications, defined as BP≤140/90 mm Hg at screening and no change in antihypertensive medications within 1 week prior to randomization
    12. Have adequate organ function
    1.Tener un diagnóstico confirmado histológica o citológicamente de cáncer urotelial de pelvis renal, uréter (vías urinarias superiores), vejiga o uretra avanzado/irresecable (inoperable) o metastásico. Se permitirá la histología de células de transición y la histología mixta de células de transición/no de transición, aunque la histología predominante deberá ser de carcinoma de células de transición.
    2.Presentar al menos una lesión diana medible conforme a los criterios RECIST 1.1, según la evaluación del investigador o radiólogo del centro local, de conformidad con los criterios siguientes: 1) lesión ganglionar con un eje menor ≥ 15 mm; 2) lesión no ganglionar con un diámetro mayor ≥ 10 mm; 3) lesión adecuada para mediciones repetidas mediante TC/RM. Las lesiones ubicadas en una zona previamente irradiada se considerarán medibles siempre que se haya constatado progresión en dichas lesiones.
    3.Haber proporcionado una muestra de tejido tumoral de archivo o de una biopsia reciente, con aguja gruesa o por escisión, de una lesión tumoral no irradiada previamente que sea adecuada para un análisis de PD-L1. Se prefiere el uso de bloques de tejido fijados en formol e incluidos en parafina a los cortes para microscopio. Se prefiere el uso de biopsias recientes al tejido de archivo. La expresión de PD-L1 (PPC ≥ 10 o PPC < 10) deberá obtenerse en el laboratorio central durante el período de selección antes de la inclusión.
    4.No haber recibido quimioterapia sistémica previa contra el CU avanzado o metastásico, con las siguientes excepciones:
    -Se permitirá la quimioterapia neoadyuvante a base de platino para tratar un cáncer de vejiga con invasión muscular y recidiva más de 12 meses después de finalizar el tratamiento.
    -Se permitirá el uso de quimioterapia adyuvante a base de platino, tras una cistectomía radical, en caso de recidiva más de 12 meses después de finalizar el tratamiento.
    5.Cumplir los criterios correspondientes a la opción a u opción b (a continuación):
    a. Presencia de un tumor con una PPC de PD-L1 ≥ 10 y se considera que el participante no puede recibir tratamiento combinado a base de cisplatino debido a una de las circunstancias siguientes:
    -EF del ECOG de 2 (apéndice 9) en los 7 días previos a la aleatorización.
    -CrCl (calculado o medido según las normas del centro) ≥ 30 a ≤ 60 mL/min.
    -Hipoacusia audiométrica de grado ≥ 2 según los criterios CTCAE del NCI, versión 4.0 (25 dB en 2 intervalos de frecuencia consecutivos).
    -Neuropatía periférica de grado ≥ 2 según los criterios CTCAE del NCI, versión 4.0.
    O
    b. En opinión del investigador, se considera que el participante no puede recibir ningún tipo de quimioterapia a base de platino (es decir, no puede recibir cisplatino ni carboplatino) debido a:
    -EF del ECOG de 2 en los 7 días previos a la aleatorización.
    Y al menos una de las circunstancias siguientes:
    -Metástasis viscerales documentadas.
    -CrCl ≥ 30 a ≤ 60 mL/min.
    -Hipoacusia audiométrica de grado ≥ 2 según los criterios CTCAE del NCI, versión 4.
    -Neuropatía periférica de grado ≥ 2 según los criterios CTCAE del NCI, versión 4.0.
    -Otro motivo, identificado en el cuaderno de recogida de datos (CRD), por el que la participante no pueda recibir carboplatino con seguridad. Se considerarán y permitirán otros criterios de imposibilidad de recibir platino de forma individualizada, previa consulta al promotor.
    6.Ser varón o mujer, tener una edad mínima de 18 años y ser considerado adulto, según la normativa local, el día de la firma del consentimiento informado.
    7.Tener un EF del ECOG de 0, 1 o 2 en los 7 días previos a la aleatorización y una esperanza de vida de tres meses, como mínimo.
    8.Podrán participar en el estudio los varones que se comprometan a todo lo siguiente durante el período de intervención y hasta, como mínimo, 95 días después de recibir la última dosis de pembrolizumab o lenvatinib/placebo y se abstengan de donar semen durante este período:
    - Abstenerse de mantener relaciones heterosexuales como modo de vida habitual y preferido (abstinencia a largo plazo y persistente) y compromiso de mantenerla.
    O
    - Utilizar métodos anticonceptivos a menos que se confirme que presentan azoospermia (por vasectomía o secundaria a una causa médica [apéndice 5]) tal como se detalla a continuación:
    -Comprometerse a utilizar preservativo masculino más uso por parte de la pareja de un método anticonceptivo adicional cuando mantengan relaciones sexuales con penetración vaginal con mujeres en edad fértil que no estén embarazadas.
    Leer resto en el protocolo
    E.4Principal exclusion criteria
    1. Has disease that is suitable for local therapy administered with curative intent
    2. Has tumor with any neuroendocrine or small cell component
    3. Has a history of a gastrointestinal condition or procedure (eg, gastric bypass, malabsorption) that, in the opinion of the investigator, may affect oral drug absorption
    4. Has had major surgery within 4 weeks prior to the first dose of study intervention
    5. Has a pre-existing Grade≥3 gastrointestinal or non-gastrointestinal fistula
    6. Has radiographic evidence of major blood vessel invasion/infiltration, or has had clinically significant hemoptysis (at least 0.5 teaspoon of bright red blood) or tumor bleeding within 2 weeks prior to the first dose of study intervention
    7. Has had significant cardiovascular impairment within 12 months of the first dose of study intervention
    8. Has known intolerance or severe hypersensitivity (Grade ≥3) to pembrolizumab or lenvatinib or any of their excipients
    9. Has received lenvatinib as monotherapy or in combination with a PD-1/PD-L1 inhibitor or has previously been enrolled in a clinical study evaluating lenvatinib for bladder cancer, regardless of the treatment received
    10. Is a WOCBP who has a positive urine pregnancy test within 72 hours before randomization
    11. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 inhibitor, indoleamine-pyrrole 2,3 dioxygenase (IDO1) inhibitor, or agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX 40, CD137), or any other antibody or drug targeting T-cell costimulatory pathways in the adjuvant or advanced/metastatic setting
    12. Has received prior radiotherapy to a metastatic site without the use of chemotherapy radiosensitization within 3 weeks of the first dose of study intervention, with the exception of palliative radiotherapy to bone lesions, which is allowed if completed 2 weeks before the start of study intervention. Participants must have recovered from all radiation-related toxicities, and must not require corticosteroids
    13. Has received a live vaccine within 30 days prior to the first dose of study intervention
    14. In the investigator’s judgment, has not recovered from toxicity or other complications from any major surgery prior to starting study intervention
    15. Is currently participating in or has participated in a trial of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study intervention
    16. Has an LVEF below the institutional normal range, as determined by MUGA or ECHO
    17. Has history or presence of an abnormal ECG that, in the investigator’s opinion, is clinically meaningful
    18. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy (at a dose exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to randomization
    19. Has had an active malignancy (except locally advanced or metastatic UC) within the past 36 months
    20. Has central nervous system (CNS) metastases, unless the participant has completed local therapy and has discontinued use of corticosteroids for this indication for at least 4 weeks before starting treatment in this study. Any signs or symptoms of CNS metastases must be stable for at least 4 weeks before starting study intervention
    21. Has an active autoimmune disease that has required systemic treatment in the past 2 years.
    22. Has a history of (non-infectious) pneumonitis that required systemic steroids, or current pneumonitis
    23. Has an active infection requiring systemic therapy
    24. Has a known history of human immunodeficiency virus (HIV) infection
    25. Has a known history of or is positive for active hepatitis B or has active hepatitis C
    26. Has active tuberculosis
    27. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant’s participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator
    28. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study
    29. Is receiving hemodialysis
    30. A participant with urine protein ≥1 g/24 h will be excluded
    31. Is pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of pembrolizumab and lenvatinib/placebo
    32. Has had an allogeneic tissue/solid organ transplan
    1.Enfermedad apta para recibir tratamiento local con intención curativa.
    2.Tumor con cualquier componente neuroendocrino o microcítico.
    3.Antecedentes de un trastorno o procedimiento gastrointestinal (por ejemplo, derivación gástrica o malabsorción) que, en opinión del investigador, podría afectar a la absorción oral de fármacos.
    4.Intervención de cirugía mayor en las cuatro semanas previas a la primera dosis de la intervención del estudio.
    5.Presencia de una fístula gastrointestinal o no gastrointestinal de grado ≥ 3.
    6.Presencia de signos radiológicos de invasión/infiltración de vasos sanguíneos importantes o antecedentes de hemoptisis clínicamente significativa (mínimo de 2,5 ml de sangre roja brillante) o hemorragia tumoral en las dos semanas previas a la primera dosis de la intervención del estudio.
    7.Antecedentes de deterioro cardiovascular importante en los 12 meses previos a la primera dosis de la intervención del estudio.
    8.Intolerancia conocida o hipersensibilidad grave (grado ≥ 3) a pembrolizumab o lenvatinib o a cualquiera de sus excipientes.
    9.Recepción de lenvatinib en monoterapia o en combinación con un inhibidor de PD-1/PD-L1 o participación previa en un estudio clínico para evaluar el uso de lenvatinib en el cáncer de vejiga, con independencia del tratamiento recibido.
    10.Mujer en edad fértil que dé positivo en una prueba de embarazo en orina realizada en las 72 horas previas a la aleatorización.
    11.Tratamiento previo con un fármaco anti-PD-1, anti-PD-L1, anti-PD-L2, inhibidor de la indolamina-pirrol 2,3 dioxigenasa (IDO1) o dirigido contra otro receptor estimulador o coinhibidor de los linfocitos T (por ejemplo, CTLA-4, OX 40, CD137) o cualquier otro anticuerpo o fármaco dirigido contra las vías coestimuladoras de los linfocitos T en el contexto adyuvante o avanzado/metastásico.
    12.Recepción de radioterapia previa en un foco metastásico sin uso de radiosensibilización a la quimioterapia en las tres semanas previas a la primera dosis de la intervención del estudio, con la excepción de radioterapia paliativa sobre lesiones óseas, que se permitirá siempre que se complete en las dos semanas previas al comienzo de la intervención del estudio. Los participantes deberán haberse recuperado de toda la toxicidad relacionada con la radioterapia y no precisar corticoides.
    13.Recepción de una vacuna de microorganismos vivos en los 30 días previos a la administración de la primera dosis de la intervención del estudio.
    14.En opinión del investigador, ausencia de recuperación de la toxicidad o de otras complicaciones de cualquier intervención de cirugía mayor antes de iniciarse la intervención del estudio.
    15.Participación activa o pasada en un ensayo de un fármaco en investigación o uso de un dispositivo en investigación en las cuatro semanas previas a la administración de la primera dosis de la intervención del estudio.
    16.FEVI por debajo del intervalo normal del centro, determinada mediante MUGA o ecocardiograma.
    17.Antecedentes o presencia de un electrocardiograma (ECG) anómalo que, en opinión del investigador, es clínicamente significativo.
    18.Diagnóstico de inmunodeficiencia o recepción de tratamiento sistémico con esteroides (en dosis superiores a 10 mg diarios de prednisona o un equivalente) o cualquier otra forma de tratamiento inmunodepresor en los siete días previos a la aleatorización.
    19.Antecedentes de neoplasia maligna activa (excepto CU localmente avanzado o metastásico) en los últimos 36 meses.
    20.Presencia de metástasis en el sistema nervioso central (SNC), a menos que el participante haya completado el tratamiento local (por ejemplo, radioterapia panencefálica, cirugía o radiocirugía) y suspensión del uso de corticoides por esta indicación durante al menos cuatro semanas antes de iniciar el tratamiento del estudio.
    21.Presencia de una enfermedad autoinmunitaria activa que ha precisado tratamiento sistémico en los dos últimos años.
    22.Antecedentes de neumonitis (no infecciosa) que haya precisado la administración de esteroides sistémicos o presencia de una neumonitis activa.
    23.Infección activa con necesidad de tratamiento sistémico.
    24.Antecedentes de infección por el virus de la inmunodeficiencia humana (VIH).
    25.Antecedentes o presencia activa de hepatitis B o C.
    26.Tuberculosis activa.
    27.Antecedentes o indicios existentes de cualquier proceso, tratamiento o anomalía analítica que, en opinión del investigador responsable del tratamiento, podría confundir los resultados del estudio, dificultar la participación durante la totalidad del estudio o motivar que la participación no sea lo más conveniente para el posible participante.
    28.Presencia de un trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante para colaborar en el cumplimiento de los requisitos del estudio.
    29.Recepción de hemodiálisis.
    30.Los participantes con una proteinuria ≥ 1 g/24 h quedarán excluidos.
    Leer resto en el Protocolo
    E.5 End points
    E.5.1Primary end point(s)
    1. Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR)
    2. Overall Survival (OS)
    1. supervivencia sin progresión (SSP) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según una revisión central independiente y enmascarada (RCIE).
    2. supervivencia global (SG).
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 4 years
    2. Up to approximately 4 years
    1. Hasta aproximadamente 4 años.
    2. Hasta aproximadamente 4 años.
    E.5.2Secondary end point(s)
    1. Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR)
    2. Number of Participants Who Experience an Adverse Event (AE)
    3. Number of Participants Who Discontinue Study Treatment Due to an Adverse Event (AE)
    4. Duration of Response (DOR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR)
    5. Disease Control Rate (DCR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by Blinded Independent Central Review (BICR)
    6. Change from Baseline in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status (Item 29) and Quality of Life (Item 30) Combined Score
    7. Time to Deterioration (TTD) in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status (Item 29) and Quality of Life (Item 30) Combined Score
    1. Ratio de respuesta objetiva (RRO) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según una revisión central independiente y enmascarada (RCIE).
    2. Número de participantes que presentan acontecimientos adversos (AA)
    3. Número de participantes que discontinúan del tratamiento del esanyo debido a un acontecimiento adverso (AA)
    4. Duración de la respuesta (DR) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según una revisión central independiente y enmascarada (RCIE).
    5. Ratio de control de enfermedad (RCE) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según una revisión central independiente y enmascarada (RCIE).
    6. Variaciones respecto al momento basal de la puntuación combinada del cuestionario de la Organización Europea para la Investigación y el Tratamiento del Cáncer (EORTC) de calidad de vida C30 (QLQ-C30) de estado de salud general (Módulo 29) y calidad de vida (Módulo 30)
    7. Tiempo al deterioro basado en la puntuación combinada del cuestionario de la Organización Europea para la Investigación y el Tratamiento del Cáncer (EORTC) de calidad de vida C30 (QLQ-C30) de estado de salud general (Módulo 29) y calidad de vida (Módulo 30)
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 4 years
    2. Up to approximately 4 years
    3. Up to approximately 4 years
    4. Up to approximately 4 years
    5. Up to approximately 4 years
    6. Baseline and up to approximately 4 years
    7. Up to approximately 4 years
    1. Hasta aproximadamente 4 años.
    2. Hasta aproximadamente 4 años.
    3. Hasta aproximadamente 4 años.
    4. Hasta aproximadamente 4 años.
    5. Hasta aproximadamente 4 años.
    6. Línea de base y hasta aproximadamente 4 años.
    7. Hasta aproximadamente 4 años.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic Yes
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA75
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Australia
    Canada
    Denmark
    France
    Germany
    Hungary
    Israel
    Italy
    Japan
    Korea, Republic of
    Netherlands
    Poland
    Russian Federation
    Spain
    Taiwan
    Turkey
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years5
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 174
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 520
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state35
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 332
    F.4.2.2In the whole clinical trial 694
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2019-05-06
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-04-26
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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