Head and Neck Squamous Cell Carcinoma
Conditions
Keywords
head and neck squamous cell carcinoma, pembrolizumab, lenvatinib, PD-L1
Brief summary
This is a study of pembrolizumab (MK-3475) with or without lenvatinib (E7080/MK-7902) as a first line intervention in a PD-L1 selected population with participants with recurrent or metastatic head and neck squamous cell carcinoma. Hypotheses include: * Pembrolizumab + lenvatinib is superior to pembrolizumab + placebo with respect to Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by blinded independent central review (BICR). * Pembrolizumab + lenvatinib is superior to pembrolizumab + placebo with respect to Progression Free Survival (PFS) per RECIST 1.1 as assessed by BICR. * Pembrolizumab + lenvatinib is superior to pembrolizumab + placebo with respect to overall survival (OS).
Interventions
DRUGLenvatinib
Lenvatinib, 20 mg (two 10-mg oral capsules) administered QD
BIOLOGICALPembrolizumab
Pembrolizumab (MK-3475), 200 mg, every 3 weeks (Q3W) by intravenous (IV) infusion for up to 35 3-week cycles
DRUGPlacebo
Lenvatinib-matching placebo, oral capsules, administered once daily (QD)
Sponsors
Merck Sharp & Dohme LLC
Eisai Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Has histologically confirmed diagnosis of R/M HNSCC that is considered incurable by local therapies. Note: Participants with newly-diagnosed HNSCC must be M1/Stage IV. * Has a primary tumor location of oropharynx, oral cavity, hypopharynx, or larynx. Note: Primary tumor site of nasopharynx (any histology) or unknown primary tumor (including p16+ unknown primary) are not eligible. Contraceptive use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. If the contraception requirements in the local label for any of the study interventions is more stringent than the requirements above, the local label requirements are to be followed. * Male participants agree to use approved contraception during the treatment period for at least 7 days after the last dose of lenvatinib/placebo, or refrain from heterosexual intercourse during this period * Female participants are not pregnant or breastfeeding, and are not a woman of childbearing potential (WOCBP), OR are a WOCBP that agrees to use contraception during the treatment period (or 14 days prior to the initiation of study treatment for oral contraception) and for at least 120 days post pembrolizumab, or 30 days post lenvatinib/placebo, whichever occurs last * Has measurable disease per RECIST 1.1 as assessed by BICR. Note: Lesions situated in a previously irradiated area are considered measurable if progression has been shown in such lesions. * Participants with oropharyngeal cancer must have results from testing of human papillomavirus HPV status. * Has an Eastern Cooperative Oncology Group (ECOG) performance score of 0 to 1. * Have adequately controlled blood pressure with or without antihypertensive medications. * Has adequate organ function.
Exclusion criteria
* Has a history of any contraindication or has a severe hypersensitivity to any components of pembrolizumab (≥Grade 3) or lenvatinib. * Has pre-existing ≥Grade 3 gastrointestinal or non-gastrointestinal fistula. * Has a history of a gastrointestinal condition or procedure that, in the opinion of the investigator, may affect oral study drug absorption. * 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 (NYHA) Class II, unstable angina, myocardial infarction or cerebrovascular accident/transient ischemic attack (TIA)/stroke, cardiac revascularization, or cardiac arrhythmia associated with hemodynamic instability. * Has disease that is suitable for local therapy administered with curative intent. * Had PD within 6 months of completion of curatively intended systemic treatment for locoregionally advanced HNSCC. * Has had major surgery within 3 weeks before to first dose of study interventions. * Has difficulty swallowing capsules or ingesting a suspension orally or by a feeding tube. * Has received prior therapy with lenvatinib or pembrolizumab. * Received last dose of systemic therapy for locoregionally advanced disease less than 6 months before signing consent. * Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (e.g., CTLA-4, OX-40, CD137). * Has received prior systemic anticancer therapy including investigational agents within 4 weeks before randomization. * Has received prior radiotherapy within 2 weeks of start of study intervention. * Has received a live vaccine within 30 days before the first dose of study intervention. Administration of killed vaccines is allowed. * Received an investigational agent or has used an investigational device within 4 weeks prior to study intervention-administration. * 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 intervention. * Has a known additional malignancy that is progressing or has required active treatment within the past 3 years. Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (e.g., breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy are not excluded. * Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. * Has an active autoimmune disease that has required systemic treatment in past 2 years. Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid) is allowed. * Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis. * Has an active infection requiring systemic therapy. (e.g., tuberculosis, known viral or bacterial infections, etc.). * Has a known history of human immunodeficiency virus (HIV) infection. * Has a known history of hepatitis B (defined as HBsAg reactive) or known active hepatitis C virus (defined as HCV ribonucleic acid (RNA) \[qualitative\] is detected) infection. * Is pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of study intervention. * Has had an allogenic tissue/solid organ transplant. * Has a known psychiatric or substance abuse disorder that would interfere with the participant's ability to cooperate with the requirements of the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR) | Up to ~ 37 months | ORR is defined as the percentage of participants who had a Complete Response (CR: Disappearance of all target lesions) or a Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters) per RECIST 1.1 modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. The percentage of participants who experienced a CR or PR based on modified RECIST 1.1 is presented. |
| Progression Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR). | Up to ~ 37 months | PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, PD was defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. Note: The appearance of one or more new lesions is also considered PD. |
| Overall Survival (OS) | Up to ~ 37 months | OS is the time from randomization to death due to any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response (DOR) | Up to ~ 37 months | For participants who demonstrate a confirmed complete response (CR: Disappearance of all target lesions) or confirmed Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions) per RECIST 1.1, DOR is defined as the time from first documented evidence of CR or PR until disease progression or death. |
| Percentage of Participants Who Experienced an Adverse Event (AE) | Up to ~ 61 months | An adverse event (AE) is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure, that occurs during the course of the study. |
| Percentage of Participants Who Discontinued Study Drug Due to an AE | Up to ~ 46 months | An adverse event (AE) is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure, that occurs during the course of the study. |
Countries
Australia, Brazil, Canada, China, France, Germany, Hungary, Italy, Japan, Mexico, Peru, Poland, Russia, South Korea, Spain, Taiwan, Turkey (Türkiye), United Kingdom, United States
Contacts
STUDY_DIRECTORMedical Director
Merck Sharp & Dohme LLC
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pembrolizumab + Lenvatinib Participants were administered Pembrolizumab 200mg by intravenous IV infusion on Day 1 of each 21-day cycle (Q3W) plus Lenvatinib 20 mg orally once a day (QD) | 256 |
| Pembrolizumab + Placebo Participants were administered lenvatinib-matching placebo orally once a day (QD) plus pembrolizumab 200 mg by intravenous (IV) infusion on Day 1 of each 21-day cycle (Q3W). | 255 |
| Total | 511 |
Baseline characteristics
| Characteristic | Pembrolizumab + Lenvatinib | Pembrolizumab + Placebo | Total |
|---|---|---|---|
| Age, Continuous | 64.0 Years STANDARD_DEVIATION 8.8 | 62.7 Years STANDARD_DEVIATION 9.6 | 63.4 Years STANDARD_DEVIATION 9.2 |
| Eastern Cooperative Oncology Group (ECOG Status of 0 vs 1) ECOG 0 | 122 Participants | 115 Participants | 237 Participants |
| Eastern Cooperative Oncology Group (ECOG Status of 0 vs 1) ECOG 1 | 134 Participants | 140 Participants | 274 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 33 Participants | 42 Participants | 75 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 205 Participants | 199 Participants | 404 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 18 Participants | 14 Participants | 32 Participants |
| Human Papilloma Virus (HPV) Status Negative | 199 Participants | 197 Participants | 396 Participants |
| Human Papilloma Virus (HPV) Status Positive | 57 Participants | 58 Participants | 115 Participants |
| Programmed Cell Death Ligand 1 (PD-L1) Tumor Expression <50% | 192 Participants | 191 Participants | 383 Participants |
| Programmed Cell Death Ligand 1 (PD-L1) Tumor Expression >=50% | 64 Participants | 64 Participants | 128 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 2 Participants | 7 Participants | 9 Participants |
| Race (NIH/OMB) Asian | 67 Participants | 80 Participants | 147 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 17 Participants | 19 Participants | 36 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 168 Participants | 147 Participants | 315 Participants |
| Sex: Female, Male Female | 37 Participants | 42 Participants | 79 Participants |
| Sex: Female, Male Male | 219 Participants | 213 Participants | 432 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 185 / 256 | 167 / 255 | 1 / 3 | 0 / 3 |
| other Total, other adverse events | 245 / 254 | 222 / 253 | 3 / 3 | 2 / 3 |
| serious Total, serious adverse events | 155 / 254 | 92 / 253 | 1 / 3 | 2 / 3 |
Outcome results
Primary
Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR)
ORR is defined as the percentage of participants who had a Complete Response (CR: Disappearance of all target lesions) or a Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters) per RECIST 1.1 modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. The percentage of participants who experienced a CR or PR based on modified RECIST 1.1 is presented.
Time frame: Up to ~ 37 months
Population: All randomized participants were included from the intention to treat (ITT) participants. Participants were included in the treatment group to which they were randomized.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pembrolizumab + Lenvatinib | Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR) | 46.9 Percentage of participants |
| Pembrolizumab + Placebo | Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR) | 27.5 Percentage of participants |
p-value: 0.000001995% CI: [11.2, 27.3]Miettinen and Nurminen method
Primary
Overall Survival (OS)
OS is the time from randomization to death due to any cause.
Time frame: Up to ~ 37 months
Population: All randomized participants included in the ITT participants. Participants were included in the treatment group to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pembrolizumab + Lenvatinib | Overall Survival (OS) | 15.0 Months |
| Pembrolizumab + Placebo | Overall Survival (OS) | 17.9 Months |
p-value: 0.881958495% CI: [0.91, 1.45]Regression, Cox
Primary
Progression Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR).
PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, PD was defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. Note: The appearance of one or more new lesions is also considered PD.
Time frame: Up to ~ 37 months
Population: All randomized participants included in the ITT participants. Participants were included in the treatment group to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pembrolizumab + Lenvatinib | Progression Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR). | 7.0 Months |
| Pembrolizumab + Placebo | Progression Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR). | 2.8 Months |
p-value: 0.000112995% CI: [0.55, 0.83]Regression, Cox
Secondary
Duration of Response (DOR)
For participants who demonstrate a confirmed complete response (CR: Disappearance of all target lesions) or confirmed Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions) per RECIST 1.1, DOR is defined as the time from first documented evidence of CR or PR until disease progression or death.
Time frame: Up to ~ 37 months
Population: All randomized participants included in the ITT participants who demonstrated at least a partial response. Participants were included in the treatment group to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pembrolizumab + Lenvatinib | Duration of Response (DOR) | 10.1 Months |
| Pembrolizumab + Placebo | Duration of Response (DOR) | NA Months |
Secondary
Percentage of Participants Who Discontinued Study Drug Due to an AE
An adverse event (AE) is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure, that occurs during the course of the study.
Time frame: Up to ~ 34 months
Population: Safety analyses was conducted in the APaT population, which consisted of all randomized participants who received at least one dose of study treatment. Participants were included in the treatment group corresponding to the study treatment they actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pembrolizumab + Lenvatinib | Percentage of Participants Who Discontinued Study Drug Due to an AE | 43.7 Percentage of Participants |
| Pembrolizumab + Placebo | Percentage of Participants Who Discontinued Study Drug Due to an AE | 15.02 Percentage of Participants |
Secondary
Percentage of Participants Who Experienced an Adverse Event (AE)
An adverse event (AE) is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure, that occurs during the course of the study.
Time frame: Up to ~ 37 months
Population: Safety analyses was conducted in the all-participants-as-treated (APaT) population, which consisted of all randomized participants who received at least one dose of study treatment. Participants were included in the treatment group corresponding to the study treatment they actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pembrolizumab + Lenvatinib | Percentage of Participants Who Experienced an Adverse Event (AE) | 99.21 Percentage of Participants |
| Pembrolizumab + Placebo | Percentage of Participants Who Experienced an Adverse Event (AE) | 96.84 Percentage of Participants |