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Efficacy and Safety Study of First-line Treatment With Pembrolizumab (MK-3475) Plus Chemotherapy Versus Placebo Plus Chemotherapy in Women With Persistent, Recurrent, or Metastatic Cervical Cancer (MK-3475-826/KEYNOTE-826)

NCT03635567

Description:

The purpose of this study is to assess the efficacy and safety of pembrolizumab (MK-3475) plus one of four platinum-based chemotherapy regimens compared to the efficacy and safety of placebo plus one of four platinum-based chemotherapy regimens in the treatment of adult women with persistent, recurrent, or metastatic cervical cancer. Possible chemotherapy regimens include: paclitaxel plus cisplatin with or without bevacizumab and paclitaxel plus carboplatin with or without bevacizumab. The primary study hypotheses are that the combination of pembrolizumab plus chemotherapy is superior to placebo plus chemotherapy with respect to: 1) Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) as assessed by blinded independent central review (BICR), or, 2) Overall Survival (OS).

Related Conditions:
  • Cervical Adenocarcinoma
  • Cervical Adenosquamous Carcinoma
  • Cervical Squamous Cell Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Efficacy and Safety Study of First-line Treatment With Pembrolizumab (MK-3475) Plus Chemotherapy Versus Placebo Plus Chemotherapy in Women With Persistent, Recurrent, or Metastatic Cervical Cancer (MK-3475-826/KEYNOTE-826)
  • Official Title: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Pembrolizumab (MK-3475) Plus Chemotherapy Versus Chemotherapy Plus Placebo for the First-Line Treatment of Persistent, Recurrent, or Metastatic Cervical Cancer (KEYNOTE-826)

Clinical Trial IDs

  • ORG STUDY ID: 3475-826
  • SECONDARY ID: 2018-001440-53
  • SECONDARY ID: MK-3475-826
  • SECONDARY ID: KEYNOTE-826
  • NCT ID: NCT03635567

Conditions

  • Cervical Cancer

Interventions

DrugSynonymsArms
PembrolizumabMK-3475, KEYTRUDA®Pembrolizumab+Chemotherapy
PaclitaxelTAXOL®Pembrolizumab+Chemotherapy
CisplatinPLATINOL®Pembrolizumab+Chemotherapy
CarboplatinPARAPLATIN®Pembrolizumab+Chemotherapy
BevacizumabAVASTIN®Pembrolizumab+Chemotherapy
Placebo to pembrolizumabNormal Saline or Dextrose solutionPlacebo+Chemotherapy

Purpose

The purpose of this study is to assess the efficacy and safety of pembrolizumab (MK-3475) plus one of four platinum-based chemotherapy regimens compared to the efficacy and safety of placebo plus one of four platinum-based chemotherapy regimens in the treatment of adult women with persistent, recurrent, or metastatic cervical cancer. Possible chemotherapy regimens include: paclitaxel plus cisplatin with or without bevacizumab and paclitaxel plus carboplatin with or without bevacizumab. The primary study hypotheses are that the combination of pembrolizumab plus chemotherapy is superior to placebo plus chemotherapy with respect to: 1) Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) as assessed by blinded independent central review (BICR), or, 2) Overall Survival (OS).

Trial Arms

NameTypeDescriptionInterventions
Pembrolizumab+ChemotherapyExperimentalOn Day 1 of each 21-day cycle, participants receive an intravenous (IV) infusion of pembrolizumab 200 mg PLUS Investigator choice of chemotherapy (paclitaxel 175 mg/m^2 PLUS cisplatin 50 mg/m^2 WITH or WITHOUT bevacizumab 15 mg/kg OR paclitaxel 175 mg/m^2 PLUS carboplatin Area Under the Curve (AUC) 5, WITH or WITHOUT bevacizumab 15 mg/kg). All treatments are administered until disease progression or toxicity, for up to 35 cycles (up to approximately 2 years).
  • Pembrolizumab
  • Paclitaxel
  • Cisplatin
  • Carboplatin
  • Bevacizumab
Placebo+ChemotherapyPlacebo ComparatorOn Day 1 of each 21-day cycle, participants receive an IV infusion of placebo (Normal Saline or Dextrose solution) PLUS Investigator choice of chemotherapy (paclitaxel 175 mg/m^2 PLUS cisplatin 50 mg/m^2 WITH or WITHOUT bevacizumab 15 mg/kg OR paclitaxel 175 mg/m^2 PLUS carboplatin AUC 5, WITH or WITHOUT bevacizumab 15 mg/kg). All treatments are administered until disease progression or toxicity, for up to 35 cycles (up to approximately 2 years).
  • Paclitaxel
  • Cisplatin
  • Carboplatin
  • Bevacizumab
  • Placebo to pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          -  Has persistent, recurrent, or metastatic squamous cell carcinoma, adenosquamous
             carcinoma, or adenocarcinoma of the cervix which has not been treated with systemic
             chemotherapy and is not amenable to curative treatment (such as with surgery and/or
             radiation)

          -  Not pregnant or breastfeeding, and at least one of the following conditions applies:
             a.) Not a woman of childbearing potential (WOCBP), b.) A WOCBP must agree to use
             effective contraception during the treatment period and for at least 120 days after
             the last dose of pembrolizumab/placebo and 210 days after the last dose of
             chemotherapy/bevacizumab

          -  Has measurable disease per RECIST 1.1 as assessed by the local site
             investigator/radiology

          -  Has provided archival tumor tissue sample or newly obtained core or excisional biopsy
             of a tumor lesion not previously irradiated for prospective determination of
             Programmed Cell Death-Ligand 1 (PD-L1) status prior to randomization

          -  Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1 within
             14 days prior to randomization

          -  Has adequate organ function

        Exclusion Criteria:

          -  A WOCBP who has a positive urine pregnancy test within 72 hours prior to randomization

          -  Has known active central nervous system (CNS) metastases and/or carcinomatous
             meningitis. Participants with known brain metastases may participate provided that the
             brain metastases have been previously treated (except with chemotherapy) and are
             radiographically stable.

          -  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, transitional cell carcinoma of urothelial cancer,
             or carcinoma in situ (e.g. breast cancer) that have undergone potentially curative
             therapy are not excluded.

          -  Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
             (in doses exceeding 10 mg daily of prednisone equivalent) or any other form of
             immunosuppressive therapy within 7 days prior to randomization

          -  Has an active autoimmune disease that has required systemic treatment in past 2 years
             (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive
             drugs). Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid
             replacement therapy for adrenal or pituitary insufficiency) is not considered a form
             of systemic treatment and is allowed

          -  Has a history of (non-infectious) pneumonitis that required steroids or has current
             pneumonitis

          -  Has an active infection requiring systemic therapy

          -  Has a known history of human immunodeficiency virus (HIV) infection

          -  Has a known history of Hepatitis B or known active Hepatitis C virus infection

          -  Has a known history of active tuberculosis (TB; Bacillus tuberculosis)

          -  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.
             cytotoxic T-lymphocyte-associated protein 4 [CTLA-4], OX 40, CD137)

          -  Has received prior systemic chemotherapy for treatment of cervical cancer.

          -  Has not recovered adequately from toxicity and/or complications from major surgery
             prior to randomization

          -  Has received prior radiotherapy within 2 weeks prior to randomization. Participants
             must have recovered from all radiation-related toxicities, not require
             corticosteroids, and not have had radiation pneumonitis.

          -  Has received a live vaccine within 30 days prior to randomization

          -  Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients.

          -  Has a contraindication or hypersensitivity to any component of cisplatin, carboplatin,
             paclitaxel, or bevacizumab

          -  Is currently participating in or has participated in a study of an investigational
             agent or has used an investigational device within 4 weeks prior to randomization

          -  Is pregnant or breastfeeding or expecting to conceive within the projected duration of
             the study, starting with the screening visit through 120 days following last dose of
             pembrolizumab/placebo and 210 days following last dose of chemotherapy/bevacizumab

          -  Has had an allogeneic tissue/solid organ transplant
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure: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)
Time Frame:Up to approximately 2 years
Safety Issue:
Description: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 is defined as ≥ 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. 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 was also considered PD. The PFS per RECIST 1.1 as assessed by BICR will be presented.

Secondary Outcome Measures

Measure:Objective Response Rate (ORR) Per RECIST 1.1 as Assessed by BICR
Time Frame:Up to approximately 2 years
Safety Issue:
Description:ORR is defined as the percentage of the participants in the analysis population who have 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). The ORR per RECIST 1.1 as assessed by BICR will be presented.
Measure:Duration of Response (DOR) Per RECIST 1.1 as Assessed by BICR
Time Frame:Up to approximately 2 years
Safety Issue:
Description:For participants who demonstrate CR or PR, DOR is defined as the time from first documented evidence of CR or PR until disease progression or death. The DOR per RECIST 1.1 as assessed by BICR will be presented.
Measure:Month 12 PFS Rate Per RECIST 1.1 as Assessed by BICR
Time Frame:Month 12
Safety Issue:
Description: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 is defined as ≥ 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. 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 was also considered PD. The PFS Rate per RECIST 1.1 as assessed by BICR at Month 12 will be presented
Measure:Number of Participants Who Experience an Adverse Event (AE)
Time Frame:From randomization through 30 days after last dose of study treatment (Up to approximately 25 months)
Safety Issue:
Description: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 who experience an AE will be presented.
Measure:Number of Participants Who Experience a Serious AE (SAE)
Time Frame:From randomization through 90 days after last dose of study treatment (Up to approximately 27 months)
Safety Issue:
Description:An SAE is defined as any untoward medical occurrence that, at any dose: a.) Results in death; b.) Is life-threatening; c.) Requires inpatient hospitalization or prolongation of existing hospitalization; d.) Results in persistent or significant disability/incapacity; e.) Is a congenital anomaly/birth defect; f.) Other important medical events; h.) Is a new cancer (that is not a condition of the study) or i.) Is associated with an overdose. The number of participants who experience an SAE will be presented.
Measure:Number of Participants Who Experience an Immune-related AE (irAE)
Time Frame:From randomization through 90 days after last dose of study treatment for serious irAEs (Up to approximately 27 months); From randomization through 30 days after last dose of study treatment for nonserious irAEs (Up to approximately 25 months)
Safety Issue:
Description:AEs associated with pembrolizumab exposure may be a result of an immune response. These irAEs may occur shortly after the first dose or several months after the last dose of pembrolizumab treatment and may affect more than one body system simultaneously. For this study irAEs include, but are not limited to: -Pneumonitis; Diarrhea/Colitis; Aspartate transaminase (AST)/Alanine transaminase (ALT) elevation or Increased bilirubin; Type 1 diabetes mellitus or Hyperglycemia; Hypophysitis; Hyperthyroidism; Hypothyroidism; Nephritis and Renal dysfunction; and Myocarditis. The number of participants who experience an irAE will be presented.
Measure:Number of Participants Who Discontinue Study Treatment Due to an AE
Time Frame:Up to approximately 2 years
Safety Issue:
Description:The number of participants who discontinue study treatment due to an AE will be presented.
Measure:Number of Participants with a 10-point Change from Baseline in Quality of Life (QoL) Based on the European Organisation for the Research & Treatment of Cancer (EORTC) QoL Questionnaire-30 (QLQ-C30) Global Score
Time Frame:Baseline (Cycle 1 Day 1: Predose) and up to 30 days after last dose of study treatment (Up to approximately 25 months)
Safety Issue:
Description:The EORTC QLQ-C30 is a 30-item questionnaire developed to assess the QoL of cancer patients. It incorporates 5 functional scales (physical, role, cognitive, emotional & social), 3 symptom scales (fatigue, pain, & nausea & vomiting), a global health status/QoL scale, & single items assessing additional symptoms commonly reported by cancer patients (dyspnoea, loss of appetite, insomnia, constipation & diarrhoea) & perceived financial impact of the disease. All of the scales & single-item measures range in score from 0 to 100. A 10-point change in the EORTC QLQ-C30 score is perceived to be clinically meaningful. Participant post-baseline EORTC QLQ-C30 scores will be classified as "improvement", "stable", or "deterioration" according to a 10-point or greater change for EORTC QLQ-C30 global score. The number of participants with "improved", "stable", or "deteriorated" symptoms/scales will be presented.

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Merck Sharp & Dohme Corp.

Trial Keywords

  • Programmed Cell Death 1
  • PD1
  • PD-1
  • Programmed Cell Death Ligand 1
  • PDL1
  • PD-L1

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