Description:
The purpose of this study is to evaluate pembrolizumab (MK-3475) subcutaneous (SC)
administration as the first-line therapy in the treatment of metastatic squamous and
nonsquamous NSCLC by assessing the pharmacokinetics (PK), safety, and efficacy of
pembrolizumab SC injection in combination with standard-of-care chemotherapy. The primary
hypothesis of the study is Pembrolizumab SC is noninferior to pembrolizumab intravenous (IV)
for Cycle 1 Area Under Curve (AUC) and Cycle 6 minimal concentration (Ctrough) at steady
state.
Participants who discontinue study treatment after receiving the first course of 35
administrations of pembrolizumab (approximately up to 2 years) for reasons other than disease
progression or intolerability, may be eligible for a second course of pembrolizumab for up to
approximately 1 additional year if they have experienced radiographic disease progression per
RECIST 1.1 as assessed by BICR after stopping first course treatment.
Title
- Brief Title: Study of Pembrolizumab (MK-3475) Subcutaneous (SC) Versus Pembrolizumab Intravenous (IV) Administered With Platinum Doublet Chemotherapy in Participants With Metastatic Squamous or Nonsquamous Non-Small Cell Lung Cancer (NSCLC) (MK-3475-A86)
- Official Title: A Randomized, Phase 3, Open-label Study to Investigate the Pharmacokinetics and Safety of Subcutaneous Pembrolizumab Versus Intravenous Pembrolizumab, Administered With Platinum Doublet Chemotherapy, in the First-Line Treatment of Participants With Metastatic Squamous or Nonsquamous Non-Small-Cell Lung Cancer
Clinical Trial IDs
- ORG STUDY ID:
3475-A86
- SECONDARY ID:
MK-3475-A86
- SECONDARY ID:
2020-002729-27
- NCT ID:
NCT04956692
Conditions
- Non-Small Cell Lung Cancer
Interventions
Drug | Synonyms | Arms |
---|
Pembrolizumab SC | | Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy |
Pembrolizumab IV | MK-3475, KEYTRUDA®, SCH 900475 | Arm B: Pembrolizumab IV + Platinum Doublet Chemotherapy |
Paclitaxel | Nov-Onxol, Onxol, Paclitaxel Novaplus, Taxol | Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy |
Nab-Paclitaxel | Abraxane, Nanoparticle albumin-bound paclitaxel | Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy |
Carboplatin | Paraplatin, Paraplatin NovaPlus | Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy |
Cisplatin | Platinol-AQ | Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy |
Pemetrexed | LY231514, Alimta, Pemetrexed Disodium | Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy |
Purpose
The purpose of this study is to evaluate pembrolizumab (MK-3475) subcutaneous (SC)
administration as the first-line therapy in the treatment of metastatic squamous and
nonsquamous NSCLC by assessing the pharmacokinetics (PK), safety, and efficacy of
pembrolizumab SC injection in combination with standard-of-care chemotherapy. The primary
hypothesis of the study is Pembrolizumab SC is noninferior to pembrolizumab intravenous (IV)
for Cycle 1 Area Under Curve (AUC) and Cycle 6 minimal concentration (Ctrough) at steady
state.
Participants who discontinue study treatment after receiving the first course of 35
administrations of pembrolizumab (approximately up to 2 years) for reasons other than disease
progression or intolerability, may be eligible for a second course of pembrolizumab for up to
approximately 1 additional year if they have experienced radiographic disease progression per
RECIST 1.1 as assessed by BICR after stopping first course treatment.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm A: Pembrolizumab SC + Platinum Doublet Chemotherapy | Experimental | Participants receive pembrolizumab subcutaneous (SC) administration on Day 1 of each cycle (cycle length = 3 weeks) for up to 35 cycles (up to ~2 years) PLUS paclitaxel IV (on Day 1 of each cycle) OR nab-paclitaxel IV (on Days 1, 8, and 15 of each cycle) and carboplatin IV (on Day 1 of each cycle) for 4 cycles for Squamous NSCLC; PLUS carboplatin IV (on Day 1 of each cycle) Or cisplatin IV (on Day 1 of each cycle) for 4 cycles and pemetrexed IV (on Day 1 of each cycle) until progression, intolerable adverse events, or participant/physician decision for Non-squamous NSCLC. | - Pembrolizumab SC
- Paclitaxel
- Nab-Paclitaxel
- Carboplatin
- Cisplatin
- Pemetrexed
|
Arm B: Pembrolizumab IV + Platinum Doublet Chemotherapy | Active Comparator | Participants receive pembrolizumab intravenous (IV) administration on Day 1 of each cycle (cycle length = 3 weeks) for up to 35 cycles (up to ~2 years) PLUS paclitaxel IV (on Day 1 of each cycle) OR nab-paclitaxel IV (on Days 1, 8, and 15 of each cycle) and carboplatin IV (on Day 1 of each cycle) for 4 cycles for Squamous NSCLC; PLUS carboplatin IV (on Day 1 of each cycle) Or cisplatin IV (on Day 1 of each cycle) for 4 cycles and pemetrexed IV (on Day 1 of each cycle) until progression, intolerable adverse events, or participant/physician decision for Non-squamous NSCLC. | - Pembrolizumab IV
- Paclitaxel
- Nab-Paclitaxel
- Carboplatin
- Cisplatin
- Pemetrexed
|
Eligibility Criteria
Inclusion Criteria:
- Has pathologically (histologically or cytologically) confirmed diagnosis of squamous
or nonsquamous non-small cell lung cancer (NSCLC)
- Has Stage IV (T any, N any, M1a, M1b, or M1c - American Joint Committee on Cancer 8th
Edition) squamous or nonsquamous NSCLC
- Has confirmation that epidermal growth factor receptor (EGFR), Anaplastic lymphoma
kinase (ALK), or ROS Proto-Oncogene 1, Receptor Tyrosine Kinase (ROS1)-directed
therapy is not indicated in nonsquamous NSCLC as well as mixed nonsquamous/squamous
NSCLC. Participants with purely squamous NSCLC do not require testing
- Has not received prior systemic treatment for their metastatic NSCLC. Participants who
received adjuvant or neoadjuvant therapy are eligible if the adjuvant/neoadjuvant
therapy was completed at least 12 months prior to the development of metastatic
disease
- Has an Eastern Cooperative Oncology Group (ECOG) performance score (PS) of 0 or 1
- Male participants are eligible to participate if they agree to use contraception as
per protocol unless confirmed to be azoospermic
- 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 woman of
childbearing potential (WOCBP) or is a WOCBP who agrees of using a contraceptive
method per protocol
- Has measurable disease per Response Evaluation Criteria in Solid Tumors Version 1.1
(RECIST 1.1) as assessed by the local site investigator/radiology
- Submit an archival tumor tissue sample or newly obtained core or incisional biopsy of
a tumor lesion not previously irradiated for PD-L1 status determination prior to
randomization
- Has adequate organ function
Exclusion Criteria:
- Has a known additional malignancy that is progressing or has required active treatment
within the past 3 years
- Has known central nervous system (ie, brain and/or spinal cord) metastases and/or
carcinomatous meningitis. Participants with treated brain metastases may participate
only if they satisfy all of the following: a) Have no evidence of new or enlarging
brain metastases confirmed by post-treatment repeat brain imaging performed at least 4
weeks after pretreatment brain imaging, and b) Are neurologically stable without the
need for steroids for at least 14 days before first dose of trial treatment as per
local site assessment
- Has severe hypersensitivity to study intervention and/or any of its excipients
- Has an active autoimmune disease that has required systemic treatment in past 2 years
- Has a history of (noninfectious) pneumonitis/interstitial lung disease that required
steroids or has current pneumonitis/interstitial lung disease
- Has an active infection requiring systemic therapy
- Has a known history of human immunodeficiency virus (HIV) infection and/or Hepatitis B
infection or known active Hepatitis C infection
- Has a known psychiatric or substance abuse disorder that would interfere with the
participant's ability to cooperate with the requirements of the study
- Has symptomatic ascites or pleural effusion. A participant who is clinically stable
after treatment for these conditions is eligible
- Before the first dose of study intervention: a) Has received prior systemic cytotoxic
chemotherapy for metastatic NSCLC b) Has received antineoplastic biological therapy
for metastatic NSCLC c) Has had major surgery (<3 weeks prior to first dose) d) Has
received prior therapy with an anti-programmed cell death 1 (anti-PD-1),
anti-programmed cell death ligand 1 (anti-PD-L1), or anti-programmed cell death ligand
2 (anti-PD-L2) agent or with an agent directed to another stimulatory or coinhibitory
T-cell receptor
- Received radiation therapy to the lung that is >30 Gray within 6 months of the first
dose of study intervention
- Is expected to require any other form of antineoplastic therapy while on study
- For participants with nonsquamous histology: Is unable to interrupt aspirin or other
Non-steroidal anti-inflammatory drugs (NSAIDs), other than an aspirin dose ≤1.3 g/day,
for a 5-day period
- For participants with nonsquamous histology: Is unable or unwilling to take folic acid
or vitamin B12 supplementation
- 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
- Has received a live or live attenuated vaccine within 30 days prior to the first dose
of study intervention
- 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 the first dose of
study intervention
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
or any other form of immunosuppressive therapy within 7 days prior the first dose of
study intervention
- Has had an allogenic tissue/solid organ transplant
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Area Under The Curve From 0-3 Weeks (AUC 0-3wks) of Pembrolizumab at Cycle 1 |
Time Frame: | Pharmacokinetic (PK) collection at designated timepoints in Cycle 1 (Up to approximately 3 weeks; cycle length = 3 weeks) |
Safety Issue: | |
Description: | AUC0-3wks at Cycle 1 is defined as the area under curve exposure parameter over a 3-week dosing interval in Cycle 1. |
Secondary Outcome Measures
Measure: | Objective Response (OR) 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 5 years |
Safety Issue: | |
Description: | The OR rate is defined as the percentage of participants who achieve a confirmed 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 as assessed by BICR. |
Measure: | Ctrough of Pembrolizumab at the End of Cycle 1 |
Time Frame: | PK collection at end of Cycle 1 (approximately at end of Week 3; cycle length = 3 weeks) |
Safety Issue: | |
Description: | Ctrough of Cycle 1 is defined as the observed trough concentration at the end of the dosing interval in Cycle 1. |
Measure: | Maximum Concentration (Cmax) of Pembrolizumab at Cycle 1 |
Time Frame: | PK collection at designated timepoints in Cycle 1 (Up to approximately 3 weeks; cycle length = 3 weeks) |
Safety Issue: | |
Description: | Cmax at Cycle 1 is defined as the observed peak concentration over the dosing interval in Cycle 1. |
Measure: | AUC 0-3wks of Pembrolizumab at Cycle 6 |
Time Frame: | PK collection at designated timepoints in Cycle 6 (Up to approximately 3 weeks; cycle length = 3 weeks) |
Safety Issue: | |
Description: | AUC0-3wks at Cycle 6 is defined as the area under curve exposure parameter over a 3-week dosing interval in Cycle 6. |
Measure: | Cmax of Pembrolizumab at Cycle 6 |
Time Frame: | PK collection at designated timepoints in Cycle 6 (Up to approximately 3 weeks; cycle length = 3 weeks) |
Safety Issue: | |
Description: | Cmax at Cycle 6 is defined as the observed peak concentration over the dosing interval in Cycle 6. |
Measure: | Number of Participants Who Experienced an Adverse Event (AE) |
Time Frame: | Up to approximately 28 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. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention. The number of participants who experience an AE will be reported. |
Measure: | Number of Participants Who Discontinued Study Treatment Due to an AE |
Time Frame: | 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. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study intervention. The number of participants who discontinue study treatment due to an AE will be presented. |
Measure: | Progression-Free Survival (PFS) per RECIST 1.1 as Assessed by BICR |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | 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. 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. |
Measure: | Overall Survival (OS) |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | OS is defined as the time from randomization to death due to any cause. |
Measure: | Duration of Response (DOR) per RECIST 1.1 as Assessed by BICR |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | For participants who show 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, duration of response is defined as the time from the first documented evidence of CR or PR until disease progression (PD) per RECIST 1.1 by BICR or death due to any cause, whichever occurs first. 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. |
Measure: | Anti-Drug Antibodies (ADAs) Incidence After Administration of Pembrolizumab |
Time Frame: | Up to approximately 26 months |
Safety Issue: | |
Description: | ADA incidence will be assessed by analyzing the development of ADAs following administration of pembrolizumab SC and pembrolizumab IV. |
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)
- Programmed Cell Death-Ligand 2 (PDL2, PD-L2)
Last Updated
August 23, 2021