E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Recurrent/metastatic head and neck squamous cell carcinoma |
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E.1.1.1 | Medical condition in easily understood language |
Recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) which has progressed after treatment with both platinum therapy and most recently immunotherapy |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 22.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10082179 |
E.1.2 | Term | Squamous cell carcinoma of head and neck metastatic |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
1. To compare pembrolizumab (MK-3475) + lenvatinib (MK-7902/E7080) combination therapy and standard of care (SOC) chemotherapy with respect to objective response rate (ORR) per modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1), as assessed by blinded independent central review. |
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E.2.2 | Secondary objectives of the trial |
1. To compare pembrolizumab + lenvatinib combination therapy and standard of care (SOC) chemotherapy with respect to progression-free survival (PFS) per modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1), as assessed by blinded independent central review. 2. To compare pembrolizumab + lenvatinib combination therapy and standard of care (SOC) chemotherapy with respect to overall survival (OS). 3. To compare pembrolizumab + lenvatinib combination therapy and standard of care (SOC) chemotherapy with respect to duration of response (DOR) per modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1), as assessed by blinded independent central review. 4. To assess the safety and tolerability of pembrolizumab + lenvatinib combination therapy, standard of care (SOC) chemotherapy, and lenvatinib monotherapy.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Be male or female and at least 18 years of age on the day of signing informed consent 2. Have histologically confirmed recurrent (not amenable to curative treatment with local and/or systemic therapies) or metastatic (disseminated) HNSCC of the oral cavity, oropharynx, hypopharynx, and/or larynx that is considered incurable by local therapies 3. Have experienced disease progression at any time during or after treatment with a platinum-containing (eg, carboplatin or cisplatin) regimen with or without cetuximab 4. Have disease progression on or after 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 the following criteria: - Most recent treatment with an anti-PD-1/PD-L1 mAb - Has received at least 2 doses of an anti-PD-1/PD-L1 mAb - Has demonstrated disease progression on or after an anti-PD-1/PD-L1 mAb as defined by RECIST 1.1 - Progressive disease has been documented within 12 weeks from the last dose of anti-PD-1/PD-L1 mAb 5. Have submitted pre-study imaging that demonstrates evidence of disease progression based on investigator review of at least 2 pre-study images per RECIST 1.1, following initiation of treatment with a PD-1/PD-L1 inhibitor 6. Have documentation of results from testing of HPV status for oropharyngeal cancer defined as p16 IHC testing using the CINtec® p16 Histology assay and a 70% cutoff point. If HPV status has previously been tested using this procedure, no retesting is required 7. Have provided tissue for PD-L1 biomarker analysis from a core or excisional biopsy (fine needle aspirate is not adequate) not previously irradiated. Repeat samples may be required if adequate tissue is not provided. A newly obtained biopsy (within 90 days prior to start of study treatment) is strongly preferred, but an archival sample is acceptable 8. Have measurable disease by CT or MRI based on RECIST 1.1 as verified by BICR. Tumor lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions 9. Have an ECOG performance status of 0 or 1 assessed within 7 days of the first dose of study intervention 10. Male participants are eligible to participate if they agree to the following during the intervention period and for at least: 1 week after the last dose of lenvatinib; 3 months after the last dose of capecitabine and paclitaxel; and 6 months after the last dose of docetaxel; no male contraception is needed for pembrolizumab and cetuximab. - 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 11. 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 randomized to pembrolizumab + lenvatinib (Arm 1) or lenvatinib monotherapy (Arm 3) and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with lower user dependency, or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis), during the intervention period and for at least 120 days post pembrolizumab or 1 month post lenvatinib, whichever occurs last. The investigator should evaluate the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention - A WOCBP randomized to SOC chemotherapy is eligible to participate if she is using a contraceptive method that is highly effective with low user dependency or 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 6 months after the last dose of capecitabine, docetaxel, paclitaxel; and 2 months after the last dose of cetuximab. - A WOCBP must have a negative highly sensitive pregnancy test (urine or serum; as required by local regulations) within 24 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 12. The participant (or legally acceptable representative if applicable) provides written informed consent for the study 13. Have adequately controlled BP with or without antihypertensive medications, defined as BP ≤150/90 mm Hg with no change in antihypertensive medications for at least 1 week prior to randomization 14. Have adequate organ function |
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E.4 | Principal exclusion criteria |
1. Has carcinoma of the nasopharynx, salivary gland, unknown primary origin, or nonsquamous histologies as primary tumors 2. Has a history of re-irradiation to any head and neck sites of disease including the cervical, infraclavicular or supraclavicular lymph nodes for head and neck cancer 3. Has disease that is suitable for local therapy administered with curative intent 4. Has a life expectancy of less than 3 months and/or has rapidly progressing disease, in the opinion of the treating investigator 5. Has any evidence of symptoms or signs of active tumor bleeding within 6 months prior to randomization 6. Has ulceration and/or fungation of disease onto the skin surface 7. Has radiographic evidence of major blood vessel invasion/infiltration or tumor demonstrates >90 degree abutment or encasement of a major blood vessel 8. Has a history of (noninfectious) pneumonitis that required systemic steroids, or current pneumonitis/interstitial lung disease 9. Has an active infection requiring systemic therapy 10. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug 11. Has known active CNS metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable for at least 4 weeks by repeat imaging, clinically stable and without requirement of steroid treatment for at least 14 days prior to first dose of study intervention 12. Has a known additional malignancy that is progressing or has required active systemic treatment within the past 3 years 13. Has an active autoimmune disease that has required systemic treatment in the past 2 years 14. Has had an allogeneic tissue/solid organ transplant 15. Has a known history of HIV infection 16. Has a known history of hepatitis B or known active hepatitis C virus infection 17. Has a history of any contraindication or has a severe hypersensitivity to any components of pembrolizumab (≥Grade 3), lenvatinib or SOC chemotherapy 18. Has pre-existing ≥Grade 3 gastrointestinal or non-gastrointestinal fistula 19. Has a history of a gastrointestinal condition or procedure that, in the opinion of the investigator, may affect oral study drug absorption 20. Has had major surgery within 3 weeks prior to first dose of study interventions 21. Has clinically significant cardiovascular impairment within 12 months of the first dose of study drug, such as history of congestive heart failure greater than NYHA Class II, unstable angina, myocardial infarction or cerebrovascular accident /transient ischemic attack /stroke, cardiac revascularization, or cardiac arrhythmia associated with hemodynamic instability 22. Has active tuberculosis 23. Has difficulty swallowing capsules or ingesting a suspension either orally, by a nasogastric tube, or by a gastrostomy tube 24. Patients previously treated to one of the 4 SOC agents in this trialmay not receive the same agent if randomized to the SOC chemotherapy arm 25. Has had prior treatment with lenvatinib as monotherapy or in combination with an PD-1/PD-L1 inhibitor or other therapies 26. Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to Study Day 1 or has not recovered from AEs due to a previously administered agent 27. Has received a live vaccine within 30 days of planned start of study intervention 28. Was previously treated with 4 or more systemic regimens given for R/M disease 29. Is currently participating in or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks prior to the first dose of study intervention 30. Has urine protein ≥1 g/24 hours 31. Has prolongation of QTc interval to >480 msec 32. Has a left ventricular ejection fraction below the institutional normal range, as determined by multigated acquisition or echocardiogram 33. Has a history or current evidence of any condition, therapy, or laboratory abnormality that may 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, in the opinion of the treating investigator 34. Has a known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Objective Response Rate (ORR) per modified Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 as Assessed by Blinded Independent Central Review |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1. Up to approximately 4 years |
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E.5.2 | Secondary end point(s) |
1. Progression-Free Survival (PFS) per modified Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 as Assessed by Blinded Independent Central Review 2. Overall Survival (OS) 3. Duration of Response (DOR) per modified Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 as Assessed by Blinded Independent Central Review 4. Number of Participants Who Experienced One or More Adverse Events (AEs) 5. Number of Participants Who Discontinued Study Intervention Due to an Adverse Event (AE) |
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E.5.2.1 | Timepoint(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
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 10 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Canada |
Israel |
Korea, Republic of |
Taiwan |
United States |
Denmark |
France |
Portugal |
Romania |
Spain |
United Kingdom |
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E.8.7 | Trial 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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 48 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 48 |