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    Summary
    EudraCT Number:2018-004117-40
    Sponsor's Protocol Code Number:MK-3475-641
    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:2019-06-11
    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 number2018-004117-40
    A.3Full title of the trial
    A Phase 3, Randomized, Double-blind Trial of Pembrolizumab (MK-3475) Plus Enzalutamide Versus Placebo Plus Enzalutamide in Participants With Metastatic Castration-Resistant Prostate Cancer (mCRPC) (KEYNOTE-641)
    Ensayo de fase 3, aleatorizado y doble ciego de pembrolizumab (MK-3475) más enzalutamida frente a un placebo más enzalutamida en participantes con cáncer de próstata resistente a la castración metastásico (CPRCm) (KEYNOTE-641)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 3 Study of Pembrolizumab plus Enzalutamide in mCRPC
    Ensayo de fase 3,de pembrolizumab más enzalutamida en CPRCm
    A.4.1Sponsor's protocol code numberMK-3475-641
    A.5.4Other Identifiers
    Name:INDNumber:122753
    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.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España SA
    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 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 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: 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 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: 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 Yes
    D.2.1.1.1Trade name Xtandi (Enzalutamide)
    D.2.1.1.2Name of the Marketing Authorisation holderAstellas Pharma US, Inc.
    D.2.1.2Country which granted the Marketing AuthorisationUnited States
    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 Capsule
    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 INNENZALUTAMIDE
    D.3.9.1CAS number 915087-33-1
    D.3.9.4EV Substance CodeSUB77412
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    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 placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Metastatic Castration-Resistant Prostate Cancer
    Cáncer de próstata resistente a la castración metastásico
    E.1.1.1Medical condition in easily understood language
    Metastatic Castration-Resistant Prostate Cancer
    Cáncer de próstata resistente a la castración metastásico
    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 10036909
    E.1.2Term Prostate cancer metastatic
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10076506
    E.1.2Term Castration-resistant prostate 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 plus enzalutamide versus placebo plus enzalutamide with respect to overall survival (OS)
    2. To compare pembrolizumab plus enzalutamide versus placebo plus enzalutamide with respect to radiographic progression-free survival (rPFS) per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by blinded independent central review (BICR)
    1. Comparar pembrolizumab más enzalutamida con placebo más enzalutamida en lo que respecta a la supervivencia global (SG)
    2. Comparar pembrolizumab más enzalutamida con placebo más enzalutamida en lo que respecta a la supervivencia sin progresión radiológica (SSPr) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), según lo evaluado mediante una revisión central independiente y enmascarada (RCIE),
    E.2.2Secondary objectives of the trial
    1. To compare pembrolizumab plus enzalutamide versus placebo plus enzalutamide with respect to the time to initiation of the first subsequent anti-cancer therapy or death
    2. To compare pembrolizumab plus enzalutamide versus placebo plus enzalutamide with respect to the: prostate-specific antigen response rate; PSA undetectable rate; and the objective response rate and duration of response per PCWG-modified RECIST 1.1 as assessed by BICR
    3. To compare pembrolizumab plus enzalutamide versus placebo plus enzalutamide with respect to the: time to PSA progression; time to first symptomatic skeletal-related event; time to radiographic soft tissue progression per soft tissue rules of PCWG-modified RECIST 1.1, as assessed by BICR

    Read in the protocol
    1. Comparar pembrolizumab más enzalutamida con placebo más enzalutamida en lo que respecta al tiempo transcurrido hasta el inicio del primer tratamiento antineoplásico posterior o la muerte
    2. Comparar pembrolizumab más enzalutamida con placebo más enzalutamida en lo que respecta a: Tasa de respuesta por PSA (antígeno prostático específico); tasa de PSA indetectable; tasa de respuestas objetivas (TRO) y duración de la respuesta (DR) conforme a los criterios RECIST 1.1 modificados por el PCWG, según lo evaluado mediante una RCIE.
    3. Comparar pembrolizumab más enzalutamida con placebo más enzalutamida en lo que respecta a:
    tiempo transcurrido hasta la progresión del PSA; Tiempo transcurrido hasta la progresión radiológica en las partes blandas conforme a las normas sobre partes blandas de los criterios RECIST 1.1 modificados por el PCWG, según lo evaluado mediante una RCIE

    Leer en el protocolo
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Merck will conduct Future Biomedical Research on DNA (blood and/or tissue and/or others) specimens collected during this clinical trial. Such research is for biomarker testing to address emergent questions not described elsewhere in the protocol (as part of the main trial) and will only be conducted on specimens from appropriately consented subjects. The objective of collecting specimens for Future Biomedical Research is to explore and identify biomarkers that inform the scientific understanding of diseases and/or their therapeutic treatments. The overarching goal is to use such information to develop safer, more effective drugs, and/or to ensure that subjects receive the correct dose of the correct drug at the correct time.
    Meck llevará a cabo investigaciones biomédicas futuras (Sangre y/o tejido y/o otros) con las muestras obtenidas de forma sistemática y específica durante este ensayo clínico. Estas investigaciones tendrán por objeto el análisis de biomarcadores para abordar aspectos nuevos que no se describen en otras partes del protocolo (como parte del ensayo principal) y solo se llevarán a cabo en muestras de los sujetos que hayan
    otorgado el consentimiento correspondiente. El objetivo de la obtención de muestras para investigación biomédica futura consiste en estudiar e identificar biomarcadores que proporcionen información a los científicos sobre las enfermedades y sus tratamientos. El objetivo último es utilizar tal información para desarrollar fármacos más seguros y eficaces o para garantizar que los sujetos reciban la dosis correcta del fármaco adecuados en el momento preciso.
    E.3Principal inclusion criteria
    A participant will be eligible for inclusion in the study if the participant:
    1. Have histologically- or cytologically-confirmed (if acceptable according to local health authority regulations) adenocarcinoma of the prostate without small cell histology. Diagnosis must be stated in a pathology report and confirmed by the investigator.
    2. Have prostate cancer progression while on ADT (or post bilateral orchiectomy) within 6 months prior to screening, as determined by the investigator, by means of one of the following:
    a. PSA progression using local laboratory values as defined by a minimum of 2 consecutive rising PSA levels with an interval of ≥1 week between each
    assessment where the PSA value at screening should be ≥1 ng/mL.
    b. Radiographic disease progression in soft tissue based on RECIST 1.1 criteria with or without PSA progression.
    c. Radiographic disease progression in bone based on PCWG defined as the appearance of 2 or more new bone lesions on bone scan with or without PSA progression.
    3. Have progression under the following conditions if the participant received anti-androgen therapy prior to enrollment:
    a. Evidence of progression >4 weeks since last flutamide treatment.
    b. Evidence of progression >6 weeks since last bicalutamide or nilutamide treatment.
    4. Have current evidence of metastatic disease documented by either bone lesions on bone scan and/or soft tissue disease by CT/MRI. Participants whose disease spread is limited to regional pelvic lymph nodes are not eligible.
    5. Have met one of the following criteria with regards to abiraterone acetate exposure:
    a. not received prior abiraterone acetate (ie, abiraterone naïve)
    b. received prior abiraterone acetate for the treatment of mHSPC, for a minimum of 4 weeks and must not have progressed while on treatment.
    c. received prior abiraterone acetate for the treatment of mCRPC and either progressed on treatment after a minimum of 8 weeks treatment (minimum 14 weeks for those with bone progression) or become intolerant of the drug after a minimum of 4 weeks treatment.
    6. Have ongoing androgen deprivation with serum testosterone <50 ng/mL (<2.0 nM). If the participant is currently being treated with luteinizing hormone-releasing hormone agonists or antagonists (participants who have not undergone an orchiectomy) this therapy must have been initiated at least 4 weeks prior to randomization and treatment must be continued throughout the study.
    7. Participants receiving bone resorptive therapy must have been on stable doses for ≥4 weeks prior to randomization.
    8. Demonstrate adequate organ function as defined in Protocol; all screening labs should be performed in central laboratory within 10 days of the first dose of study intervention.
    9. Participant is male.
    10. Participant is ≥18 years of age on day of signing the informed consent.
    11. Male participants 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:
    • 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), as detailed below:
    • Agree to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a woman of child-bearing potential (WOCBP) who is not currently pregnant.
    12. Male participants must agree to use male condom when engaging in any activity that allows for passage of ejaculate to another person of any sex.

    Read in the protocol
    Para poder participar en este estudio, un posible participante deberá:
    1. Tener un adenocarcinoma de próstata confirmado por métodos histológicos o citológicos (siempre que sea aceptable conforme a la normativa de las autoridades sanitarias locales), sin histología microcítica. El diagnóstico debe estar consignado en un informe anatomopatológico y ser confirmado por el investigador.
    2. Haber mostrado progresión del cáncer de próstata durante el tratamiento de privación androgénica (o después de una orquiectomía bilateral) en los seis meses previos a la selección, según lo determinado por el investigador, definida por una de las circunstancias siguientes:
    a. Progresión por PSA, según valores del laboratorio local, definida como un mínimo de dos concentraciones crecientes de PSA con un intervalo de al menos una semana entre cada determinación; el valor de PSA de selección debe ser ≥ 1 ng/ml. Para obtener más detalles, consulte la sección 8.2.2, Evaluación del antígeno prostático específico.
    b. Progresión radiológica de la enfermedad en las partes blandas conforme a los criterios RECIST 1.1, con o sin progresión por PSA.
    c. Mostrar progresión radiológica de la enfermedad en el hueso, según los criterios del PCWG, definida como la aparición de dos o más lesiones óseas nuevas en la gammagrafía ósea, con o sin progresión por PSA.
    3. Mostrar progresión en las circunstancias siguientes si el participante ha recibido tratamiento antiandrogénico antes de su reclutamiento:
    a. Signos de progresión más de cuatro semanas después del último tratamiento con flutamida.
    b. Signos de progresión más de seis semanas después del último tratamiento con bicalutamida o nilutamida.
    4. Presentar signos actuales de enfermedad metastásica, documentada por la existencia de lesiones óseas en la gammagrafía ósea o de afectación de partes blandas en la TC/RM. No podrán participar aquellos posibles participantes cuya diseminación de la enfermedad se encuentre limitada a los ganglios linfáticos pélvicos regionales.
    5. Haber cumplido uno de los criterios siguientes en relación con la exposición al acetato de abiraterona:
    a. No haber recibido tratamiento previo con acetato de abiraterona (es decir, sin tratamiento previo con abiraterona).
    b. Haber recibido tratamiento previo con acetato de abiraterona por CPHSm durante un mínimo de cuatro semanas y no haber presentado progresión durante el mismo.
    c. Haber recibido tratamiento previo con acetato de abiraterona por CPRCm y haber presentado progresión durante el mismo después de un mínimo de ocho semanas de tratamiento (mínimo de 14 semanas en los pacientes con progresión ósea) o intolerancia al fármaco después de un mínimo de cuatro semanas de tratamiento.
    6. Estar en situación de privación androgénica persistente con una concentración sérica de testosterona < 50 ng/ml (< 2,0 nM). Si el participante está recibiendo agonistas o antagonistas de la gonadoliberina (participantes que no se hayan sometido a una orquiectomía), este tratamiento deberá haberse empezado al menos cuatro semanas antes de la aleatorización y el tratamiento deberá mantenerse durante todo el estudio.
    7. Los participantes que se encuentren en tratamiento antirresortivo óseo (con bisfosfonatos o denosumab, entre otros) deberán haber recibido dosis estables durante al menos cuatro semanas antes de la aleatorización.
    8. Presentar una función orgánica adecuada, según se define en la Tabla 1; todos los análisis de selección deberán realizarse en el laboratorio central en los 10 días previos a la primera dosis de la intervención del estudio.
    9. El participante es varón.
    10. El participante tiene 18 años o más de edad el día de firma del consentimiento informado.
    11. Podrán participar en el estudio los varones que se comprometan a todo lo siguiente durante el período de intervención y hasta, como mínimo, 120 días después de recibir la última dosis de la intervención del estudio:
    • 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 la existencia de azoospermia (por vasectomía o secundaria a una causa médica 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.
    12. Los varones participantes deberán comprometerse a utilizar preservativo masculino en cualquier actividad que permita el paso de eyaculado a otra persona de cualquier sexo.

    Leer en el protocolo
    E.4Principal exclusion criteria
    The participant must be excluded from the study if the participant:
    1. Has a known additional malignancy that is progressing or has required active treatment in the last 3 years. Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ that have undergone potentially curative therapy are not excluded.
    2. Has an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
    3. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of study intervention.
    4. 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.
    5. Has undergone major surgery including local prostate intervention (excluding prostate biopsy) within 28 days prior to randomization and not recovered adequately from the toxicities and/or complications.
    6. Has a gastrointestinal disorder affecting absorption (eg, gastrectomy, active peptic ulcer disease within last 3 months).
    7. Is unable to swallow tablets/capsules.
    8. Has an active infection (including tuberculosis) requiring systemic therapy.
    9. Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
    10. Has known active human immunodeficiency virus (HIV), hepatitis B virus or hepatitis C virus (HCV) (eg, HCV RNA. Testing is not required unless mandated by local regulation.
    11. Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least 4 weeks prior to randomization and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to randomization. This exception does not include carcinomatous meningitis, which is excluded regardless of clinical stability.
    12. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study.
    13. Has a history of seizure or any condition that may predispose to seizure.
    14. Has a history of loss of consciousness within 12 months of the Screening Visit.
    15. Has had myocardial infarction or uncontrolled angina within 6 months prior to randomization.
    16. Has a history of clinically significant ventricular arrhythmias.
    17. Has a history of Mobitz II second degree or third degree heart block without a permanent pacemaker in place.
    18. Has hypotension as indicated by systolic blood pressure <86 millimeters of mercury (mmHg) at the Screening Visit.
    19. Has bradycardia as indicated by a heart rate of <50 beats per minute on the Screening electrocardiogram (ECG).
    20. Has uncontrolled hypertension as indicated by systolic blood pressure >170 mmHg or diastolic blood pressure >105 mmHg at the Screening visit.
    21. Has severe hypersensitivity (Grade ≥3) to pembrolizumab and/or any of its excipients.
    22. Has history of prostate cancer progression on ketoconazole.
    23. Has had prior treatment with any second-generation androgen receptor inhibitor.

    Read in the protocol
    1. Presencia de otra neoplasia maligna conocida que está en progresión o ha precisado tratamiento activo en los últimos tres años. No se excluirá a los participantes con carcinoma basocelular o espinocelular de piel o carcinoma in situ que se hayan sometido a un tratamiento potencialmente curativo.
    2. Presencia de una enfermedad autoinmunitaria activa que ha precisado tratamiento sistémico (es decir, fármacos modificadores de la enfermedad, corticoides o inmunodepresores) en los dos últimos años. El tratamiento de reposición (es decir, tiroxina, insulina o corticoides en dosis fisiológicas por insuficiencia suprarrenal o hipofisaria, etc.) no se considera una forma de tratamiento sistémico.
    3. Diagnóstico de inmunodeficiencia o recepción de 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.
    4. Antecedentes o indicios existentes de cualquier proceso, tratamiento o anomalía analítica que, en opinión del investigador responsable del tratamiento, podrían 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.
    5. Práctica de una intervención de cirugía mayor, incluida una intervención prostática local (excepto biopsia de próstata), en los 28 días previos a la aleatorización sin recuperación adecuada de la toxicidad o complicaciones.
    6. Presencia de un trastorno digestivo que afecte a la absorción (por ejemplo, gastrectomía o úlcera péptica activa en los tres últimos meses).
    7. Incapacidad de tragar comprimidos o cápsulas.
    8. Presencia de una infección activa (incluida la tuberculosis) con necesidad de tratamiento sistémico.
    9. Antecedentes de neumonitis (no infecciosa) que haya precisado la administración de esteroides o presencia de una neumonitis activa.
    10. Presencia de infección activa conocida por el virus de la inmunodeficiencia humana (VIH), el virus de la hepatitis B o el virus de la hepatitis C (VHC) (por ejemplo, detección [cualitativa] de ARN del VHC). No será necesario realizar pruebas a menos que lo exija la normativa local.
    11. Presencia de metástasis activas conocidas en el sistema nervioso central (SNC) o meningitis carcinomatosa. Los posibles participantes con metástasis cerebrales tratadas con anterioridad podrán participar siempre que se encuentren estables (sin signos de progresión en los estudios de imagen durante al menos cuatro semanas antes de la aleatorización y con regreso de todos los síntomas neurológicos a la situación basal), no presenten indicios de metástasis cerebrales nuevas o que estén aumentando de tamaño y no utilicen esteroides durante al menos 7 días antes de la aleatorización. Esta excepción no se aplica a la meningitis carcinomatosa, que será motivo de exclusión con independencia de la estabilidad clínica.
    12. Presencia de un trastorno psiquiátrico o por abuso de sustancias que pueda dificultar el cumplimiento de los requisitos del estudio.
    13. Antecedentes de convulsiones o cualquier trastorno que pueda predisponer a sufrirlas (entre otros, accidente cerebrovascular, accidente isquémico transitorio o malformación arteriovenosa cerebral previos o masas intracraneales, como un schwannoma o meningioma, que causan edema o efecto de masa).
    14. Antecedentes de pérdida del conocimiento en los 12 meses previos a la visita de selección.
    15. Infarto de miocardio o angina de pecho no controlada en los seis meses previos a la aleatorización.
    Nota: Se incluyen participantes con antecedentes recientes de revascularización por síndrome coronario agudo en los tres meses previos a la aleatorización.
    16. Antecedentes de arritmias ventriculares clínicamente significativas (por ejemplo, taquicardia ventricular, fibrilación ventricular o taquicardia helicoidal).
    17. Antecedentes de bloqueo cardíaco de segundo grado de tipo Mobitz II o de tercer grado sin implantación de un marcapasos permanente.
    18. Presencia de hipotensión, según lo indicado por una presión arterial sistólica < 86 milímetros de mercurio (mm Hg) en la visita de selección.
    19. Presencia de bradicardia, según lo indicado por una frecuencia cardíaca < 50 latidos por minuto en el electrocardiograma (ECG) de selección.
    20. Presencia de hipertensión no controlada, según lo indicado por una presión arterial sistólica > 170 mm Hg o una presión arterial diastólica > 105 mm Hg en la visita de selección.
    21. Presencia de hipersensibilidad grave (grado ≥ 3) a pembrolizumab o a cualquiera de sus excipientes.
    22. Antecedentes de progresión del cáncer de próstata durante el tratamiento con ketoconazol.
    23. Tratamiento previo con cualquier inhibidor de los receptores androgénicos de segunda generación (por ejemplo, enzalutamida, apalutamida o darolutamida).

    Leer en el protocolo
    E.5 End points
    E.5.1Primary end point(s)
    1. Overall Survival (OS)
    2. Radiographic Progression-free Survival (rPFS) per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by Blinded Independent Central Review (BICR)
    1. Supervivencia global (SG)
    2. Supervivencia sin progresión radiológica (SSPr) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), modificados por el Grupo de trabajo sobre el cáncer de próstata (PCWG), según lo evaluado mediante una revisión central independiente y enmascarada (RCIE).
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 52 months
    2. Up to approximately 52 months
    1. Hasta 52 meses aproximadamente
    2. Hasta 52 meses aproximadamente
    E.5.2Secondary end point(s)
    1. Time to Initiation of the First Subsequent Anti-Cancer Therapy or Death (TFST)
    2. Prostate-specific Antigen (PSA) Response Rate
    3. Prostate-specific Antigen (PSA) Undetectable Rate
    4. Objective Response Rate (ORR) per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by Blinded Independent Central Review (BICR)
    5. Duration of Response (DOR) per Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by Blinded Independent Central Review (BICR)
    6. Time to Prostate-specific Antigen (PSA) Progression
    7. Time to Radiographic Soft Tissue Progression per Soft Tissue Rules of Prostate Cancer Working Group (PCWG)-modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as assessed by Blinded Independent Central Review (BICR)
    8. Time to Pain Progression (TTPP)
    9. Time to First Symptomatic Skeletal-Related Event (SSRE)
    10. Number of Participants Who Experienced At Least One Adverse Event (AE)
    11.Number of Participants Who Discontinued Study Treatment Due to an Adverse Event (AE)
    1. Tiempo hasta el inicio del primer tratamiento antineoplásico posterior (TPTP) o hasta la muerte.
    2. Tasa de respuesta del PSA (antígeno prostático específico).
    3. Tasa de PSA (antígeno prostático específico) indetectable.
    4. Tasa de respuestas objetivas (TRO) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), modificados por el Grupo de trabajo sobre el cáncer de próstata (PCWG), evaluada mediante una revisión central independiente y enmascarada (RCIE).
    5. Duración de la respuesta (DR) conforme a los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), modificados por el Grupo de trabajo sobre el cáncer de próstata (PCWG), evaluada mediante una revisión central independiente y enmascarada (RCIE).
    6. Tiempo hasta la progresión del antígeno prostático específico (PSA).
    7. Tiempo hasta la progresión radiológica en los tejidos blandos, conforme a las normas para tejidos blandos de los Criterios de evaluación de la respuesta en tumores sólidos, versión 1.1 (RECIST 1.1), modificados por el Grupo de trabajo sobre el cáncer de próstata (PCWG), evaluado mediante una revisión central independiente y enmascarada (RCIE).
    8. Tiempo hasta la progresión del dolor (THPD).
    9. Tiempo hasta el primer episodio óseo sintomático (EOS).
    10. Número de participantes que presentaron al menos un acontecimiento adverso (AA).
    11. Número de participantes que suspendieron el tratamiento del estudio por un acontecimiento adverso (AA).
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 52 months
    2. Up to approximately 52 months
    3. Up to approximately 52 months
    4. Up to approximately 52 months
    5. Up to approximately 52 months
    6. Up to approximately 52 months
    7. Up to approximately 52 months
    8. Up to approximately 52 months
    9. Up to approximately 52 months
    10. Up to approximately 52 months
    11. Up to approximately 52 months
    1. Hasta 52 meses aproximadamente
    2. Hasta 52 meses aproximadamente
    3. Hasta 52 meses aproximadamente
    4. Hasta 52 meses aproximadamente
    5. Hasta 52 meses aproximadamente
    6. Hasta 52 meses aproximadamente
    7. Hasta 52 meses aproximadamente
    8. Hasta 52 meses aproximadamente
    9. Hasta 52 meses aproximadamente
    10. Hasta 52 meses aproximadamente
    11. Hasta 52 meses aproximadamente
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis Yes
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    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 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 concerned13
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA109
    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
    Austria
    Brazil
    Canada
    Chile
    Colombia
    France
    Germany
    Israel
    Italy
    Japan
    Korea, Republic of
    Netherlands
    New Zealand
    Poland
    Russian Federation
    Spain
    Taiwan
    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
    LPLV
    LPLV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months4
    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: 300
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 900
    F.2 Gender
    F.2.1Female No
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    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 state64
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 600
    F.4.2.2In the whole clinical trial 1200
    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 Decision2019-07-04
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-06-26
    P. End of Trial
    P.End of Trial StatusOngoing
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