E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Renal Cell Carcinoma (Kidney Cancer) |
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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 | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10038409 |
E.1.2 | Term | Renal cell carcinoma NOS |
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. Safety Lead-in Phase: To assess the safety and tolerability, and to establish a recommended Phase 2 dose (RP2D) if applicable, of certain treatment combinations.
2. Efficacy Phase: To assess the safety and tolerability of each treatment arm based on the proportion of participants with adverse events (AEs)
3. Efficacy Phase: To evaluate objective response rate (ORR) of each treatment arm as assessed by Blinded Independent Central Review (BICR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) |
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E.2.2 | Secondary objectives of the trial |
1. Efficacy Phase: To evaluate the duration of response (DOR) as assessed by BICR per RECIST 1.1
2. Efficacy Phase: To evaluate progression-free survival (PFS) as assessed by BICR per RECIST 1.1
3. Efficacy Phase: To evaluate overall survival (OS)
4. Efficacy Phase: To evaluate clinical benefit rate (CBR) per RECIST 1.1 as assessed by BICR
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Has a histologically confirmed diagnosis of locally advanced/metastatic ccRCC (with or without sarcomatoid features), ie, Stage IV RCC per AJCC
2. Has received no prior systemic therapy for advanced RCC. [1L participants]
3. Has measurable disease per RECIST 1.1 as assessed by BICR. Lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions
4. Has a KPS ≥70% assessed ≤10 days prior to randomization/allocation.
5. Is able to swallow oral medication
6. Submits an archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated. FFPE tissue blocks are preferred to slides. Newly obtained biopsies are preferred to archived tissue
7. Has adequate organ function. Specimens must be collected within 10 days prior to the start of study intervention
8. Participants receiving bone resorptive therapy (including but not limited to bisphosphonate or RANK-L inhibitor) must have therapy initiated at least 2 weeks prior to randomization/allocation
9. If participants received major surgery or radiation therapy of >30 Gy, they must have recovered from the toxicity and/or complications from the intervention
10. Has adequately controlled BP with or without antihypertensive medications, defined as BP ≤150/90 mm Hg with no change in antihypertensive medications within 1 week prior to randomization/allocation
11. Is male or female, from 18 years to 120 years of age inclusive, at the time of signing the informed consent
12. Male participants are eligible to participate if they agree to the following during treatment with and for at least 5 days after the last dose of lenvatinib and/or MK-6482:
- 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 WOCBP who is not currently pregnant
- Contraceptive use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
13. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
- Is not a WOCBP
OR
- Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low 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 after the last dose of pembrolizumab, MK 1308A and MK-4280A or 30 days after the last dose of lenvatinib and MK-6482, whichever occurs last
- 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 (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive
- The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy
- Contraceptive use by women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
14. The participant (or legally acceptable representative ) has provided documented informed consent for the study |
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E.4 | Principal exclusion criteria |
1. Has clinically significant cardiac disease, including unstable angina, acute myocardial infarction within 12 months from Day 1 of study intervention administration, or New York Heart Association Class III or IV congestive heart failure, cerebral vascular accident, or cardiac arrhythmia associated with hemodynamic instability. Medically controlled arrhythmia stable on medication is permitted
2. Prolongation of QTcF interval to >480 ms
3. Has a LVEF below the institutional (or local laboratory) normal range as determined by MUGA or ECHO
4. Has had major surgery within 3 weeks prior to first dose of study interventions
5. Has urine protein ≥1 g/24 hours
6. Has a history of interstitial lung disease, history of (non-infectious) pneumonitis that required steroids, or has current pneumonitis
7. Has symptomatic pleural effusion (for example cough, dyspnea, pleuritic chest pain). A participant who is clinically stable following treatment for these conditions (including therapeutic thoraco- or paracentesis) is eligible
8. Has a history of inflammatory bowel disease
9. Has preexisting ≥Grade 3 GI or non-GI fistula
10. Has malabsorption due to prior GI surgery or GI disease
11. Has received prior radiotherapy within 2 weeks of start of study intervention. Participants must have recovered from all radiation related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤2 weeks of radiotherapy) to non-CNS disease
12. Has received a live or live attenuated vaccine within 30 days before the first dose of study drug.
13. Is currently participating in a study of an investigational agent or is currently using an investigational device
14. Participants who have been previously allocated/randomized to study intervention in any substudy of protocol MK-3475-U03
15. 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 the first dose of study drug
16. Has a known additional malignancy that is progressing or has required active treatment within the past 3 years
17. Has known active CNS metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases may participate provided they are radiologically stable, (ie, without evidence of progression) 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
18. Has radiographic evidence of encasement or invasion of a major blood vessel, or of intratumoral cavitation
19. Has a history of hypersensitivity reaction to any of the investigational agent(s) included in this study. For example, but not limited to:
- Has a severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients
- Has a history of severe hypersensitivity reaction (eg, generalized rash/erythema, hypotension, bronchospasm, angioedema, or anaphylaxis) to lenvatinib
20. 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). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed
21. Has an active infection requiring systemic therapy
22. Has a known history of HIV infection. No HIV testing is required unless mandated by local health authority
23. Has a known history of Hepatitis B (defined as HBsAg reactive) or known active Hepatitis C virus (defined as HCV RNA [qualitative] is detected) infection
24. Has any of the following:
- Hypoxia defined as a pulse oximeter reading <92% at rest, or
- Requires intermittent supplemental oxygen, or
- Requires chronic supplemental oxygen
25. 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
26. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study
27. Has had an allogenic tissue/solid organ transplant |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Safety Lead-in Phase: Number of participants who experience one or more dose-limiting toxicities (DLTs)
2. Safety Lead-in Phase: Number of participants who experience one or more adverse events (AEs)
3. Safety Lead-in Phase: Number of participants who discontinue study treatment due to an AE
4. Efficacy Phase: Number of participants who experience one or more AEs
5. Efficacy Phase: Number of participants who discontinue study treatment due to an AE
6. Efficacy Phase: Objective response rate (ORR) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1. Up to ~21 days
2. Up to ~21 days
3. Up to ~21 days
4. Up to ~41 months
5. Up to ~41 months
6. Up to ~41 months |
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E.5.2 | Secondary end point(s) |
1. Efficacy Phase: Duration of response (DOR)
2. Efficacy Phase: Progression-free survival (PFS)
3. Efficacy Phase: Overall survival (OS)
4. Efficacy Phase: Clinical benefit rate (CBR) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. Up to ~41 months
2. Up to ~41 months
3. Up to ~41 months
4. Up to ~41 months |
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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 | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | Yes |
E.7.1.3.1 | Other trial type description |
First administration of the investigational agents combination in the specified population |
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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 | No |
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 | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
rolling arm, adaptive design |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 4 |
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 | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 16 |
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 |
France |
Israel |
Korea, Republic of |
New Zealand |
Spain |
United Kingdom |
United States |
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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 | 5 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 5 |