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    Summary
    EudraCT Number:2018-003791-12
    Sponsor's Protocol Code Number:MK-7902-008
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-04-12
    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 number2018-003791-12
    A.3Full title of the trial
    A Phase 3, multicenter, randomized, open-label trial to compare the efficacy and safety of pembrolizumab (MK-3475) in combination with lenvatinib (E7080/MK-7902) versus docetaxel in previously treated participants with metastatic non-small cell lung cancer (NSCLC) and progressive disease (PD) after platinum doublet chemotherapy and immunotherapy (anti-PD-1/PD-L1 inhibitor) (LEAP-008)
    Ensayo de fase 3, multicéntrico, aleatorizado y abierto para comparar la eficacia y la seguridad de pembrolizumab (MK-3475) en combinación con lenvatinib (E7080/MK-7902) frente a docetaxel en participantes tratados previamente con cáncer de pulmón no microcítico (CPNM) metastásico y progresión de la enfermedad (PE) después de quimioterapia doble con platino e inmunoterapia (anti-PD-1/inhibidor de PD-L1) (LEAP-008)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Pembrolizumab with Lenvatinib versus Docetaxel for Metastatic NSCLC after Platinum Doublet Chemotherapy and Immunotherapy
    Pembrolizumab con lenvatinib frente a docetaxel en el CPNM metastásico tras quimioterapia doble con platino e inmunoterapia.
    A.4.1Sponsor's protocol code numberMK-7902-008
    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 AddressCalle Josefa Valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    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.IMP: 5
    D.1.2 and D.1.3IMP RoleComparator
    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 Docetaxel
    D.2.1.1.2Name of the Marketing Authorisation holderPUREN Pharma GmbH & Co. KG
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 Concentrate for 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 INNDOCETAXEL
    D.3.9.2Current sponsor codeDOCETAXEL
    D.3.9.4EV Substance CodeSUB12492MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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: 6
    D.1.2 and D.1.3IMP RoleComparator
    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 Docetaxel
    D.2.1.1.2Name of the Marketing Authorisation holderAmneal Pharma Europe Limited
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    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 Concentrate for 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 INNDOCETAXEL
    D.3.9.2Current sponsor codeDOCETAXEL
    D.3.9.4EV Substance CodeSUB12492MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    NSCLC with squamous or nonsquamous histology
    CPNM metastásico con histología epidermoide o no epidermoide
    E.1.1.1Medical condition in easily understood language
    Non-small cell lung cancer
    cáncer de pulmón no microcítico
    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 PT
    E.1.2Classification code 10061873
    E.1.2Term Non-small cell lung cancer
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    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 docetaxel with respect to overall survival (OS) [Cohort 1]
    2) To compare pembrolizumab + lenvatinib to docetaxel 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) [Cohort 1]
    1) Comparar pembrolizumab (MK-3475) + lenvatinib (MK-7902) con docetaxel en cuanto a la supervivencia global (SG) [cohorte 1].
    2) Comparar pembrolizumab + lenvatinib con docetaxel en cuanto a la SSP conforme a los criterios RECIST 1.1 según una revisión central independiente y enmascarada (RCIE) [cohorte 1].
    E.2.2Secondary objectives of the trial
    1. To compare pembrolizumab + lenvatinib to docetaxel with respect to objective response rate (ORR) per RECIST 1.1 by BICR [Cohort 1]
    2. To assess ORR with lenvatinib monotherapy per RECIST 1.1 by BICR [Cohort 2]
    3. To assess duration of response (DOR) with pembrolizumab + lenvatinib and docetaxel per RECIST 1.1 by BICR [Cohort 1]
    4. To assess the safety and tolerability of treatment with pembrolizumab + lenvatinib versus docetaxel [Cohort 1] and with lenvatinib monotherapy [Cohort 2]
    5. To compare pembrolizumab + lenvatinib to docetaxel with respect to the mean change from baseline in global health status/quality of life (QoL), cough, chest pain, dyspnea, and physical functioning [Cohort 1]
    6. To compare pembrolizumab + lenvatinib to docetaxel with respect to time to true deterioration (TTD) in global health status/QoL, cough, chest pain, dyspnea, and physical functioning scales [Cohort 1]
    1.Comparar pembrolizumab + lenvatinib con docetaxel en cuanto a la TRO conforme a los criterios RECIST 1.1 según una RCIE [cohorte 1].
    2.Evaluar la TRO con lenvatinib en monoterapia conforme a los criterios RECIST 1.1 según una RCIE [cohorte 2].
    3.Evaluar la DR con pembrolizumab + lenvatinib y con docetaxel conforme a los criterios RECIST 1.1 según una RCIE [cohorte 1].
    4.Evaluar la seguridad y la tolerabilidad del tratamiento con pembrolizumab + lenvatinib en comparación con docetaxel [cohortes 1] y lenvatinib en monoterapia [cohortes 2].
    5.Comparar pembrolizumab + lenvatinib con docetaxel en cuanto a la variación media con respecto al momento basal del estado de salud general/calidad de vida (CdV), tos, dolor torácico, disnea y función física [cohorte 1].
    6.Comparar pembrolizumab + lenvatinib con docetaxel en cuanto al tiempo hasta el deterioro real (THD) en las escalas de estado de salud general/CdV, tos, dolor torácico, disnea y función física [cohorte 1].
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Have a histologically or cytologically confirmed diagnosis of metastatic squamous or nonsquamous NSCLC
    2. Have PD on treatment with an anti-PD-1/PD-L1 mAb administered either as monotherapy or in combination with other checkpoint inhibitors or other therapies. Anti- PD-1/PD-L1 treatment progression is defined by meeting ALL of the following criteria:
    • Treatment with at least 2 doses of an anti-PD-1/PD-L1 mAb
    • PD after an anti-PD-1/PD-L1 mAb as defined by RECIST v1.1. The initial evidence of PD is confirmed by a second assessment no less than 4 weeks from the date of the first documented PD, in the absence of rapid clinical progression
    • PD documented within 12 weeks from the last dose of anti-PD-1/PD-L1 mAb
    3. Have PD during/after platinum doublet chemotherapy
    4. Have confirmation that EGFR-, ALK-, or ROS1-directed therapy is not indicated as primary therapy (documentation of absence of tumor-activating EGFR mutations [eg, DEL19 or L858R], and absence of ALK and ROS1 gene rearrangements OR presence of a K-ras mutation)
    5. Have submitted prestudy imaging that confirmed evidence of PD based on investigator review of at least 2 images per RECIST 1.1, following initiation of an anti-PD-1/PD-L1 inhibitor
    6. Have measurable disease based on RECIST 1.1 as determined by the local site assessment.
    • Have at least 1 measurable lesion by CT or MRI per RECIST 1.1
    7. Have provided tumor tissue for PD-L1 biomarker analysis from an archival sample (defined as: from initial diagnosis of NSCLC and prior to receiving immunotherapy [antiPD-1/PD-L1], from the primary lesion or a metastatic lesion)
    8. Have provided prior to allocation tissue from a newly obtained formalin-fixed sample from a new biopsy (defined as: after completion of immunotherapy [anti-PD-1/PD-L1] and before receiving an allocation number), of a tumor lesion not previously irradiated
    9. Be ≥18 years of age on the day of signing the ICF
    10. Have ECOG performance status of 0 or 1 within 3 days before the first dose of study intervention but before allocation
    11. Have a life expectancy of at least 3 months
    12. Male participants receiving pembrolizumab ± lenvatinib or lenvatinib are eligible to participate if they agree to the following during the intervention period and for at least 120 days after the last dose of study intervention:
    Male participants randomized to docetaxel are eligible to participate if they agree to the following during the intervention period and for at least 180 days after the last dose of docetaxel:
    • Refrain from donating sperm
    PLUS either:
    • Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis) and agree to remain abstinent.
    OR
    • Must agree to use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause)
    • 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
    13. A female participant is eligible to participate if she is not pregnant or breastfeeding and at least 1 of the following conditions applies:
    • Is not a WOCBP
    OR
    • Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, or is abstinent from heterosexual intercourse as her preferred and usual lifestyle (abstinent on a long term and persistent basis),during the intervention period and for at least 120 days after the last dose of study intervention , and agrees not to donate eggs (ova, oocytes) to others or freeze/store these for her own use for the purpose of reproduction during this period
    • A WOCBP randomized to docetaxel is eligible to participate if she is using a contraceptive method that is highly effective with low user dependency or is abstinent from heterosexual intercourse as her preferred and usual lifestyle and agrees not to donate or freeze/store eggs during the intervention period and for at least 180 days after the last dose of docetaxel
    • A WOCBP must have a negative highly sensitive pregnancy test ([urine or serum] as required by local regulations) within 72 hours before the first dose of study intervention
    14. Provide (or legally acceptable representative must provide if applicable) written informed consent for the study
    1.Tener un diagnóstico confirmado histológica o citológicamente de CPNM epidermoide o no epidermoide metastásico.
    2. Presentar PE durante el tratamiento con un AcM anti-PD-1/PD-L1 administrado en monoterapia o en combinación con otros inhibidores de puntos de control inmunológico u otros tratamientos. La progresión con el tratamiento con anti-PD-1/PD-L1 se define por el cumplimiento de TODOS los criterios siguientes:
    • Tratamiento con al menos 2 dosis de un AcM anti-PD-1/PD-L1.
    • PE después de un AcM anti-PD-1/PD-L1 según lo definido por los criterios RECIST v1.1. Las pruebas iniciales de PE se deberán confirmar en una segunda evaluación, que se realizará no menos de 4 semanas después de la fecha de la primera PE documentada, en ausencia de progresión clínica rápida.
    • PE documentada en las 12 semanas siguientes a la última dosis del AcM anti-PD-1/PD-L1.
    3. Presentar PE durante o después de la quimioterapia doble con platino.
    4. Confirmar que el tratamiento dirigido a EGFR, ALK o ROS1no está indicado para el tratamiento primario (documentación de ausencia de mutaciones de EGFR activadoras e tumores [p. ej., DEL19 o L858R] y ausencia de reordenamientos de ALK y ROS1 O presencia de una mutación de K-ras).
    5. Haberse sometido a un estudio de imagen antes del estudio que confirmase la PE basándose en la revisión por el investigador de al menos 2 imágenes conforme a los criterios RECIST 1.1 tras el comienzo de un anti-PD-1/inhibidor de PD-L1.
    6. Presentar enfermedad mensurable conforme a los criterios RECIST 1.1, según la evaluación del centro local.
    • Presentar al menos una lesión mensurable mediante TC o RM conforme a los criterios RECIST 1.1.
    7. Haber proporcionado tejido tumoral para el análisis del biomarcador PD-L1 procedente de una muestra de archivo (definida como: a partir del diagnóstico inicial del CPNM y antes de recibir la inmunoterapia [antiPD-1/PD-L1], de la lesión primaria o una lesión metastásica).
    8. Haber proporcionado antes de la asignación tejido de una muestra fijada en formol procedente de una nueva biopsia recién obtenida (definida como: a partir del final de la inmunoterapia [anti-PD-1/PD-L1] y antes de recibir un número de asignación) de una lesión tumoral no irradiada previamente.
    9. Edad mínima de 18 años el día de firma del consentimiento informado.
    10. Estado funcional del ECOG de 0 o 1 en los 3 días previos a la primera dosis de la intervención del estudio pero antes de la asignación.
    11. Esperanza de vida mínima de tres meses.
    12. Los varones que reciban pembrolizumab ± lenvatinib o lenvatinib podrán participar si aceptan lo siguiente durante el período de intervención y durante al menos 120 días después de la última dosis de la intervención del estudio:
    Los varones aleatorizados a docetaxel podrán participar si aceptan lo siguiente durante el período de intervención y durante al menos 180 días después de la última dosis de docetaxel:
    • Abstenerse de donar semen.
    MÁS:
    • 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)
    • 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.
    13. Una mujer podrá participar si no está embarazada, no está amamantando y cumple al menos una de las condiciones siguientes:
    • No es una MEF.
    O
    • Es una MEF y utiliza un método anticonceptivo muy eficaz (con un índice de fallos < 1 % anual), con baja dependencia de la usuaria, o que practica la abstinencia de relaciones heterosexuales como modo de vida preferido y habitual (abstinencia a largo plazo y persistente), durante el período de intervención y durante al menos 120 días después de la última dosis de la intervención del estudio, y se compromete a no donar óvulos (ovocitos) a otras personas ni congelarlos/conservarlos para su propio uso con fines de reproducción durante este periodo.
    • Las MEF aleatorizadas a docetaxel podrán participar si utilizan un método anticonceptivo muy eficaz con escasa dependencia de la usuaria o si practican la abstinencia de relaciones heterosexuales como modo de vida preferido y habitual y se comprometen a no donar o congelar/conservar óvulos durante el período de intervención y durante al menos 180 días después de la última dosis de docetaxel.
    •Las MEF deberán dar negativo en una prueba de embarazo de alta sensibilidad (en orina o suero, según exija la normativa local) en las 72 horas previas a la primera dosis de la intervención del estudio.
    14. Otorgar (el propio participante o su representante legal, si procede) el consentimiento informado por escrito para el estudio.
    E.4Principal exclusion criteria
    1. Has received docetaxel as monotherapy or in combination with other therapies
    2. Has received lenvatinib as monotherapy or in combination with an anti-PD-1/PD-L1 inhibitor
    3. Has received radiotherapy within 2 weeks before the first dose of study intervention or has received lung radiation therapy >30 Gy within 6 months before the first dose of study intervention
    4. Has received a live vaccine within 30 days before the first dose of study intervention
    5. Has clinically significant hemoptysis (at least 0.5 teaspoon of bright red blood) or tumor bleeding within 2 weeks before the first dose of study intervention
    6. Has radiographic evidence of major blood vessel invasion/infiltration
    7. Has clinically significant cardiovascular impairment within 12 months of the first dose of study intervention, such as history of congestive heart failure greater than New York Heart Association Class II, unstable angina, myocardial infarction or cerebrovascular accident/transient ischemic attack (TIA)/stroke, cardiac revascularization, or cardiac arrhythmia associated with hemodynamic instability
    8. Has a history of a gastrointestinal condition or procedure that, in the opinion of the investigator, may affect oral study intervention absorption
    9. Is a WOCBP who has a positive urine pregnancy test within 72 hours before allocation
    10. Is currently participating in a clinical trial and receiving study therapy or participated in a study of an investigational agent within 4 weeks of the first dose of study intervention
    11. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (exceeding 10 mg of prednisone or equivalent daily) or any other form of immunosuppressive therapy within 7 days before the first dose of study intervention
    12. Has a known history of an additional malignancy, except if the participant has undergone potentially curative therapy with no evidence of disease recurrence for 3 years since initiation of that therapy
    13. Has known active central nervous system metastases and/or carcinomatous meningitis
    14. Has severe hypersensitivity (Grade ≥3) to pembrolizumab and/or any of its excipients
    15. Has a sensitivity to any of the excipients contained in lenvatinib
    16. Has a sensitivity to any of the excipients contained in docetaxel
    17. Has an active autoimmune disease that has required systemic treatment in the past 2 years (ie, with use of disease-modifying agents, corticosteroids, or immunosuppressive drugs)
    18. Has a history of (noninfectious) pneumonitis that required systemic steroids or current pneumonitis/interstitial lung disease
    19. Has an active infection requiring systemic therapy
    20. Has a known history of human immunodeficiency virus (HIV) infection
    21. Has a known history of hepatitis B (defined as hepatitis B surface antigen (HBsAg) reactive or known active hepatitis C virus (HCV) (defined as HCV RNA [qualitative] is detected) infection
    22. Has a known history of active tuberculosis
    23. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study or interfere with the participant's participation for the full duration of the study, or it is not in the best interest of the participant to participate, in the opinion of the treating investigator
    24. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study
    25. Has a left ventricular ejection fraction (LVEF) below the institutional normal range, as determined by multigated acquisition (MUGA) or echocardiogram (ECHO)
    26. Has QT interval corrected with Fridericia’s formula (QTcF) prolongation to >480 ms
    27. Has urinary protein ≥1 g/24 hours after having >1+ proteinuria on urine dipstick testing
    28. Is pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through at least 120 days after the last dose of pembrolizumab or lenvatinib, or 180 days after the last dose of docetaxel
    29. Has had an allogeneic tissue/solid organ transplant
    1. Ha recibido docetaxel en monoterapia o en combinación con otros tratamientos.
    2. Ha recibido lenvatinib en monoterapia o en combinación con un anti-PD-1/inhibidor de PD-L1.
    3. Ha recibido radioterapia en las 2 semanas anteriores a la primera dosis de la intervención del estudio o ha recibido radioterapia pulmonar > 30 Gy en los 6 meses previos a la primera dosis de la intervención del estudio.
    4. Ha recibido una vacuna de microorganismos vivos en los 30 días previos a la primera dosis de la intervención del estudio.
    5. Presenta hemoptisis clínicamente significativa (al menos 2,5 ml de sangre roja brillante) o hemorragia tumoral en las 2 semanas previas a la primera dosis de la intervención del estudio.
    6. Signos radiológicos de invasión/infiltración de vasos sanguíneos importantes.
    7. Presenta insuficiencia cardiovascular clínicamente significativa en los 12 meses anteriores a la primera dosis de la intervención del estudio, como antecedentes de insuficiencia cardíaca congestiva de clase superior a la II según la New York Heart Association (NYHA), angina inestable, infarto de miocardio, accidente cerebrovascular/accidente isquémico transitorio (AIT), revascularización cardiaca o arritmia cardíaca asociada a inestabilidad hemodinámica.
    8. Presenta antecedentes de un trastorno o procedimiento gastrointestinal que, en opinión del investigador, podría afectar a la absorción oral de la intervención del estudio.
    9. Es una mujer en edad fértil que da positivo en una prueba de embarazo en orina realizada en las 72 horas previas a la asignación
    10. Está participando en un ensayo clínico y recibiendo el tratamiento del estudio o ha participado en un estudio de un fármaco en investigación en las 4 semanas previas a la primera dosis de la intervención del estudio.
    11. Tiene un diagnóstico de inmunodeficiencia o está recibiendo tratamiento sistémico crónico con esteroides (en dosis superiores a 10 mg diarios de prednisona o equivalente) o cualquier otra forma de tratamiento inmunodepresor en los siete días previos a la primera dosis de la intervención del estudio.
    12. Tiene antecedentes conocidos de otra neoplasia maligna, salvo si el participante se ha sometido a un tratamiento potencialmente curativo y no ha habido signos de recidiva de la enfermedad durante tres años desde el comienzo de ese tratamiento.
    13. Presenta metástasis activas conocidas en el sistema nervioso central y/o meningitis carcinomatosa.
    14. Tiene hipersensibilidad grave (grado ≥ 3) al pembrolizumab y/o a alguno de sus excipientes.
    15. Tiene sensibilidad a alguno de los excipientes contenidos en lenvatinib.
    16. Tiene sensibilidad a alguno de los excipientes contenidos en docetaxel.
    17. Presenta una enfermedad autoinmunitaria activa que ha precisado tratamiento sistémico (es decir, fármacos modificadores de la enfermedad, corticosteroides o inmunodepresores) en los dos últimos años.
    18. Tiene antecedentes de neumonitis (no infecciosa) que precisara la administración de esteroides sistémicos o presencia de una neumonitis o neumopatía intersticial activa.
    19. Tiene una infección activa con necesidad de tratamiento sistémico.
    20. Tiene antecedentes conocidos de infección por el virus de la inmunodeficiencia humana (VIH).
    21. Tiene antecedentes de infección por el virus de la hepatitis B (reactividad del antígeno de superficie del virus de la hepatitis B [HBsAg]) o infección activa por el virus de la hepatitis C (definida como detección de ARN del virus de la hepatitis C [VHC] [cualitativo]).
    22. Tiene antecedentes conocidos de tuberculosis activa.
    23. Tiene antecedentes o datos actuales de cualquier enfermedad, 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 hacer que la participación no sea lo más conveniente para el posible participante.
    24. Tiene 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.
    25. Presenta una fracción de eyección del ventrículo izquierdo (FEVI) por debajo del intervalo normal del centro, determinada mediante ventriculografía isotópica en equilibrio (MUGA) o ecocardiografía.
    26. Tiene prolongación del intervalo QT corregido por la fórmula de Fridericia (QTcF) > 480 ms.
    27. Presenta proteinuria ≥ 1 g/24 horas después de un valor > 1+ en el análisis de orina con tira reactiva.
    28. Está embarazada o en período de lactancia o espera concebir o engendrar un hijo durante el período previsto del estudio, desde la visita de selección hasta al menos 120 días después de la última dosis de pembrolizumab o lenvatinib o 180 días después de la última dosis de docetaxel.
    29. Ha recibido un alotrasplante de órgano sólido o tejidos.
    E.5 End points
    E.5.1Primary end point(s)
    1. Cohort 1: Overall Survival (OS)
    2. Cohort 1: Progression-free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    1. Cohorte 1: Supervivencia global (SG)
    2. Cohorte 1: Supervivencia sin progresión (SSP) según los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to ~52 months
    2. Up to ~37 months
    1. Hasta ~ 52 meses
    2. Hasta ~ 37 meses
    E.5.2Secondary end point(s)
    1. Cohorts 1 and 2: Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    2. Cohort 1: Duration of Response (DOR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
    3. Cohorts 1 and 2: Number of Participants Experiencing an Adverse Event (AE)
    4. Cohorts 1 and 2: Number of Participants Discontinuing Study Treatment Due to an Adverse Event (AE)
    5. Cohort 1: Change from Baseline in European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status / Quality of Life (Items 29 & 30) Scale Score
    6. Cohort 1: Change from Baseline in EORTC Quality of Life Questionnaire Lung Cancer Module 13 (QLQ-LC13) Cough (Item 31) Scale Score
    7. Cohort 1: Change from Baseline in EORTC QLQ-LC13 Chest Pain (Item 40) Scale Score
    8. Cohort 1: Change from Baseline in EORTC QLQ-C30 Dyspnea (Item 8) Scale Score
    9. Cohort 1: Change from Baseline in EORTC QLQ-C30 Physical Functioning (Items 1 to 5) Scale Score
    10. Cohort 1: Time to True Deterioration (TTD) in EORTC QLQ-C30 Global Health Status / Quality of Life (Items 29 & 30) Scale Score
    11. Cohort 1: Time to True Deterioration (TTD) in EORTC QLQ-LC13 Cough (Item 31) Scale Score
    12. Cohort 1: Time to True Deterioration (TTD) in EORTC QLQ-LC13 Chest Pain (Item 40) Scale Score
    13. Cohort 1: Time to True Deterioration (TTD) in EORTC QLQ-C30 Dyspnea (Item 8) Scale Score
    14. Cohort 1: Time to True Deterioration (TTD) in EORTC QLQ-C30 Physical Functioning (Items 1 to 5) Scale Score
    1. Cohortes 1 y 2: Tasa de respuesta objetiva (TRO) según los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1)
    2. Cohorte 1: Duración de la respuesta (DR) según los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1)
    3. Cohortes 1 y 2: Número de participantes que presentan un acontecimiento adverso (AA)
    4. Cohortes 1 y 2: Número de participantes que suspenden el tratamiento del estudio por un acontecimiento adverso (AA)
    5. Cohorte 1: Variación con respecto al momento basal en el Cuestionario de calidad de vida-módulo básico 30 de la Organización Europea para la Investigación y el Tratamiento (EORTC)
    (QLQ-C30) Puntuación en la escala de estado de salud general/calidad de vida (apartados 29 y 30)
    6. Cohorte 1: Variación con respecto al momento basal de la puntuación en la escala de tos (apartado 31) del módulo 13 del cáncer de pulmón del Cuestionario de calidad de vida de la EORTC (QLQ-LC13)
    7. Cohorte 1: Variación con respecto al valor basal de la puntuación en la escala de dolor torácico del QLQ-LC13 de la EORTC (apartado 40)
    8. Cohorte 1: Variación con respecto al valor basal de la puntuación en la escala de disnea del QLQ-C30 de la EORTC (apartado 8)
    9. Cohorte 1: Variación con respecto al momento basal de la puntuación de la escala de función física del QLQ-C30 de la EORTC (apartados 1 a 5).
    10. Cohorte 1: Tiempo hasta el deterioro real (THD) en la puntuación de la escala QLQ-C30 de la EORTC para el estado general de salud/calidad de vida (apartados 29 y 30)
    11. Cohorte 1: Tiempo hasta el deterioro real (THD) en la puntuación de la escala de tos del QLQ-LC13 de la EORTC (apartado 31)
    12. Cohorte 1: Tiempo hasta el deterioro real (THD) en la puntuación de la escala de dolor torácico QLQ-LC13 de la EORTC (apartado 40)
    13. Cohorte 1: Tiempo hasta el deterioro real (THD) en la puntuación de la escala de disnea QLQ-C30 de la EORTC (apartado 8)
    14. Cohorte 1: Tiempo hasta el deterioro real (THD) en la puntuación de la escala de funcionamiento físico del QLQ-C30 de la EORTC (apartados 1 a 5)
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to ~5 years
    2. Up to ~5 years
    3. Up to ~5 years
    4. Up to ~5 years
    5. Baseline and Week 12
    6. Baseline and Week 12
    7. Baseline and Week 12
    8. Baseline and Week 12
    9. Baseline and Week 12
    10. Up to ~5 years
    11. Up to ~5 years
    12. Up to ~5 years
    13. Up to ~5 years
    14. Up to ~5 years
    1.Hasta ~ 5 años
    2.Hasta ~ 5 años
    3.Hasta ~ 5 años
    4.Hasta ~ 5 años
    5.Visita basal y semana 12
    6.Visita basal y semana 12
    7.Visita basal y semana 12
    8.Visita basal y semana 12
    9.Visita basal y semana 12
    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 No
    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 Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    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) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    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 concerned10
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA35
    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
    Australia
    Canada
    Colombia
    France
    Israel
    Italy
    Japan
    Korea, Republic of
    Russian Federation
    Spain
    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 months9
    E.8.9.1In the Member State concerned days14
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    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: 235
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 156
    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 state46
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 161
    F.4.2.2In the whole clinical trial 391
    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. Particpants will we followed for survival.
    Ninguno. Seguimiento de supervivencia a los pacientes
    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 Decision2019-04-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-02-19
    P. End of Trial
    P.End of Trial StatusOngoing
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