Metastatic Esophageal Squamous Cell Carcinoma
Conditions
Keywords
programmed cell death 1 (PD-1, PD1), programmed cell death ligand 1 (PD-L1, PDL1)
Brief summary
The purpose of this study is to assess the efficacy and safety of pembrolizumab plus lenvatinib plus chemotherapy compared with pembrolizumab plus chemotherapy as first-line intervention in participants with metastatic esophageal carcinoma. The primary hypotheses are that pembrolizumab plus lenvatinib plus chemotherapy is superior to pembrolizumab plus chemotherapy with respect to overall survival (OS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) by blinded independent central review (BICR). As of Amendment 09, Study MK-7902-014 will begin close out activities. Any participant who discontinues study intervention for any reason will be discontinued from the study without further follow-up. Second Course and treatment beyond disease progression will no longer be offered. No safety concerns contributed to the termination of this study.
Detailed description
There will be 2 parts to the study: the cisplatin and 5-fluorouracil (5-FU) (FP) and paclitaxel and cisplatin (TP) Safety Run-in (Part 1) and the Main Study (Part 2). In Part 1 (FP and TP Safety Run-in), participants will be treated with pembrolizumab plus lenvatinib plus FP or TP. Dose-limiting toxicities, safety, and tolerability will be assessed. In Part 2 (Main Study), participants (not including those participating in Part 1) will be treated with pembrolizumab plus lenvatinib plus chemotherapy or pembrolizumab plus chemotherapy. Efficacy, safety, and tolerability will be assessed. The protocol-specified analysis of the primary outcome measures was completed with a data cut-off of 08-May-2025 (Primary Completion Date) and served as the final analysis of the primary outcome measures. At the time of the protocol-specified analysis, 368 participants were ongoing in the study and will be included in the End of Trial analysis.
Interventions
BIOLOGICALPembrolizumab
400 mg once every 6-week-cycle, via IV infusion.
DRUGLenvatinib
8 mg QD (Induction) or 20 mg QD (Consolidation) via oral capsule.
DRUGCisplatin
80 mg/m\^2 Q3W via IV infusion, as part of investigator's choice FP chemotherapy or 75 mg/m\^2 Q3W via infusion, as part of investigator's choice TP chemotherapy.
DRUG5-FU
4000 mg/m\^2 Q3W via IV infusion, as part of investigator's choice FP chemotherapy or 400 mg/m\^2 Q2W via bolus IV infusion followed by 2400 mg/m\^2 Q2W via continuous IV infusion, as part of investigator's choice mFOLFOX6 chemotherapy.
DRUGOxaliplatin
85 mg/m\^2 Q2W via IV infusion, as part of investigator's choice mFOLFOX6 chemotherapy.
DRUGLeucovorin
400 mg/m\^2 Q2W as part of investigator's choice mFOLFOX6 chemotherapy.
DRUGLevoleucovorin
200 mg/m\^2 Q2W as part of investigator's choice mFOLFOX6 chemotherapy.
DRUGPaclitaxel
175 mg/m\^2 Q3W via IV infusion, as part of investigator's choice TP chemotherapy.
Sponsors
Merck Sharp & Dohme LLC
Eisai Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Has a histologically or cytologically confirmed diagnosis of metastatic squamous cell carcinoma of the esophagus * Male participants are abstinent from heterosexual intercourse or agree to use contraception during the intervention period and for at least 7 days after the last dose of lenvatinib or 90 days after the last dose of chemotherapy, whichever comes last; 7 days after lenvatinib is stopped, if the participant is on pembrolizumab only and is greater than 90 days post chemotherapy, no male contraception is needed * Female participant is not pregnant or breastfeeding and is not a woman of childbearing potential (WOCBP) or is a WOCBP using a contraceptive method that is highly effective or is abstinent from heterosexual intercourse as their preferred and usual lifestyle during the intervention period and for at least 120 days after the last dose of pembrolizumab, 30 days after the last dose of lenvatinib, or 180 days after the last dose of chemotherapy, whichever occurs last, and agrees not to donate eggs during this period * Has adequately controlled blood pressure (BP) with or without antihypertensive medications, defined as BP≤150/90 millimeters of mercury (mm Hg) with no change in antihypertensive medications within 1 week prior to randomization * Has adequate organ function
Exclusion criteria
* Has had previous therapy for locally advanced unresectable or metastatic esophageal cancer * Has locally advanced esophageal carcinoma * Has metastatic adenocarcinoma of the esophagus * Has direct invasion into adjacent organs such as the aorta or trachea * Has radiographic evidence of encasement of a major blood vessel, or of intratumoral cavitation * Has perforation risks or significant gastrointestinal (GI) bleeding * Has had clinically significant hemoptysis within 3 weeks prior to the first dose of study drug or tumor bleeding within 2 weeks prior to the first dose of study intervention * Has uncontrollable pleural effusion, pericardial effusion, or ascites requiring frequent drainage or medical intervention * Has GI obstruction, poor oral intake, difficulty in taking oral medication, or existing esophageal stent * Has had major surgery, open biopsy, or significant traumatic injury within 3 weeks prior to first dose of study interventions * Has received prior radiotherapy within 2 weeks of start of study intervention or have had a history of radiation pneumonitis * Has received a live or live attenuated vaccine within 30 days prior to the first dose of study intervention; administration of killed vaccines is allowed * Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any form of immunosuppressive therapy within 7 days prior to the first dose of study intervention, or has a history of organ transplant, including allogeneic stem cell transplant * Has a known additional malignancy that is progressing or has required active treatment within the past 3 years * 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 is not considered a form of systemic treatment and is allowed * Has a history of non-infectious pneumonitis/interstitial lung disease that required steroids or current pneumonitis/interstitial lung disease * Has poorly controlled diarrhea * Has clinically significant cardiovascular disease within 12 months from first dose of study intervention * Has peripheral neuropathy ≥Grade 2 * Has a known history of human immunodeficiency virus (HIV) infection * Has a known history of Hepatitis B or know active Hepatitis C virus infection * Has a weight loss of \>20% within the last 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Part 1 (FP and TP Safety Run-in): Number of Participants With Dose Limiting Toxicities (DLTs) | Up to 21 days | A DLT is defined as a specific adverse event graded for toxicity using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Hematologic DLTs are defined as Grade 4 neutropenia lasting for ≥7 days, Grade 3 or Grade 4 febrile neutropenia, Grade 3 thrombocytopenia with bleeding, Grade 4 thrombocytopenia, or Grade 4 anemia. Other nonhematologic toxicities considered a DLT include any other Grade 4 or Grade 5 toxicity, Grade 3 toxicities lasting \>3 days (excluding nausea, vomiting, and diarrhea controlled by medical intervention within 72 hours, and Grade 3 rash in the absence of desquamation with no mucosal involvement), Grade 3 hypertension not able to be controlled by medication, ≥Grade 3 gastrointestinal perforation, ≥Grade 3 wound dehiscence requiring medical or surgical intervention, any grade thromboembolic event or any Grade 3 nonhematologic laboratory value requiring medical intervention or hospitalization. The number of participants in Part 1 with DLTs are presented. |
| Part 1 (FP and TP Safety Run-in): Number of Participants With Adverse Events (AEs) | Up to 43 months | An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. The number of participants in Part 1 with AEs will be presented. |
| Part 1 (FP and TP Safety Run-in): Number of Participants Who Discontinued Study Treatment Due to an AE | Up to 22 months | An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. The number of participants in Part 1 who discontinue study treatment due to an AE will be presented. |
| Part 2 (Main Study): Overall Survival (OS) in All Participants | Up to 42 months | OS is defined as the time from randomization to death due to any cause. OS in Part 2 for all randomized participants are presented based on the Kaplan-Meier method for censored data. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Part 2 (Main Study): 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) in All Participants | Up to 42 months | PFS is defined as the time from randomization to the first documented progressive disease (PD) per RECIST 1.1 by BICR or death due to any cause, whichever occurs first. Per RECIST 1.1, PD is 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. The appearance of one or more new lesions is also considered PD. RECIST 1.1 has been adjusted to include a maximum of 10 target lesions and a maximum of 5 target lesions per organ. PFS in Part 2 for all randomized participants are presented based on the Kaplan-Meier method for censored data. |
| Part 2 (Main Study): Objective Response Rate (ORR) Per RECIST 1.1 as Assessed by BICR in All Participants | Up to 42 months | ORR is defined as the percentage of participants with Complete Response (CR: disappearance of all target lesions) or Partial Response (PR: at least a 30% decrease in the sum of diameters of target lesions), per RECIST 1.1 adjusted to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ, as assessed by BICR. ORR in Part 2 for all randomized participants are presented. |
| Part 2 (Main Study): Duration of Response (DOR) Per RECIST 1.1 as Assessed by BICR in All Participants | Up to 42 months | For participants who demonstrate a confirmed CR (disappearance of all target lesions) or PR (at least a 30% decrease in the sum of diameters of target lesions), per RECIST 1.1 by BICR, DOR is defined as the time from first documented evidence of CR or PR until PD or death. Per RECIST 1.1, PD is defined as at least a 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 at least 5 mm. The appearance of one or more new lesions is also considered PD. RECIST 1.1 has been adjusted to include a maximum of 10 target lesions and a maximum of 5 target lesions per organ. DOR in Part 2 for all randomized participants are presented based on the Kaplan-Meier method for censored data. |
| Part 2 (Main Study): OS in Participants With Programmed Cell Death-Ligand 1 (PD-L1) Combined Positive Score (CPS) ≥10 | Up to 42 months | OS is defined as the time from randomization to death due to any cause. OS in Part 2 for randomized participants with PD-L1 CPS ≥10 are presented based on the Kaplan-Meier method for censored data. |
| Part 2 (Main Study): PFS Per RECIST 1.1 as Assessed by BICR in Participants With PD-L1 CPS ≥10 | Up to 42 months | PFS is defined as the time from randomization to the first documented PD per RECIST 1.1 by BICR or death due to any cause, whichever occurs first. Per RECIST 1.1, PD is 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. The appearance of one or more new lesions is also considered PD. RECIST 1.1 has been adjusted to include a maximum of 10 target lesions and a maximum of 5 target lesions per organ. PFS in Part 2 for randomized participants with PD-L1 CPS ≥10 are presented based on the Kaplan-Meier method for censored data. |
| Part 2 (Main Study): ORR Per RECIST 1.1 as Assessed by BICR in Participants With PD-L1 CPS ≥10 | Up to 42 months | ORR is defined as the percentage of participants with CR (disappearance of all target lesions) or PR (at least a 30% decrease in the sum of diameters of target lesions), per RECIST 1.1 adjusted to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ, as assessed by BICR. ORR in Part 2 for randomized participants with PD-L1 CPS ≥10 are presented. |
| Part 2 (Main Study): DOR Per RECIST 1.1 as Assessed by BICR in Participants With PD-L1 CPS ≥10 | Up to 42 months | For participants who demonstrate a confirmed CR (disappearance of all target lesions) or PR (at least a 30% decrease in the sum of diameters of target lesions), per RECIST 1.1 by BICR, DOR is defined as the time from first documented evidence of CR or PR until PD or death. Per RECIST 1.1, PD is defined as at least a 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 at least 5 mm. The appearance of one or more new lesions is also considered PD. RECIST 1.1 has been adjusted to include a maximum of 10 target lesions and a maximum of 5 target lesions per organ. DOR in Part 2 for randomized participants with PD-L1 CPS ≥10 are presented based on the Kaplan-Meier method for censored data. |
| Part 2 (Main Study): Number of Participants With AEs | Up to 43 months | An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. The number of participants in Part 2 with AEs are presented. |
| Part 2 (Main Study): Number of Participants Who Discontinued Study Treatment Due to an AE | Up to 22 months | An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. The number of participants in Part 2 who discontinue study treatment due to an AE are presented. |
Countries
Argentina, Canada, Chile, China, Costa Rica, Denmark, France, Guatemala, Hong Kong, Hungary, Italy, Japan, Malaysia, Romania, Russia, Singapore, South Africa, South Korea, Spain, Taiwan, Thailand, Turkey (Türkiye), Ukraine, United Kingdom, United States
Contacts
STUDY_DIRECTORMedical Director
Merck Sharp & Dohme LLC
Participant flow
Recruitment details
Participants with the following conditions were included in the study: if they had a confirmed diagnosis of metastatic squamous cell carcinoma of the esophagus and measurable disease; Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1; submitted a tumor tissue sample; had adequately controlled blood pressure; and had adequate organ function.
Pre-assignment details
Protocol-specified final analysis for the following results, including the participant flow, was performed with 368 participants ongoing in the study at the time of primary completion data cut-off. All remaining analysis of the 368 ongoing participants will be included in the End of Trial analysis.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 63.5 Years STANDARD_DEVIATION 9 |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG 0 | 3 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG 1 | 10 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status Missing | 2 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 96 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 758 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 9 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 14 Participants |
| Race (NIH/OMB) Asian | 11 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants |
| Race (NIH/OMB) More than one race | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 3 Participants |
| Race (NIH/OMB) White | 263 Participants |
| Region of Enrolling Site East Asia | 570 Participants |
| Region of Enrolling Site North America +Western Europe | 69 Participants |
| Region of Enrolling Site Rest of World | 157 Participants |
| Sex: Female, Male Female | 92 Participants |
| Sex: Female, Male Male | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 12 / 13 | 236 / 423 | 246 / 427 | 0 / 1 | 0 / 0 |
| other Total, other adverse events | 13 / 13 | 412 / 421 | 417 / 426 | 1 / 1 | 0 / 0 |
| serious Total, serious adverse events | 7 / 13 | 224 / 421 | 201 / 426 | 0 / 1 | 0 / 0 |
Outcome results
None listed