Safety and Tolerability of Pembrolizumab (MK-3475) + Pegylated Interferon Alfa-2b and Pembrolizumab+ Ipilimumab in Participants With Advanced Melanoma or Renal Cell Carcinoma (MK-3475-029/KEYNOTE-29)

Overview

This study is being done to analyze the safety, tolerability, and efficacy of treatment for advanced melanoma (MEL) and renal cell carcinoma (RCC) using combination regimens of pembrolizumab + pegylated interferon alfa-2b (PegIFN-2b) and pembrolizumab + ipilimumab (IPI). The primary hypothesis is that these combinations will be sufficiently well-tolerated to permit continued clinical investigation.

Full Title of Study: “A Phase 1/2 Clinical Trial to Study the Safety and Tolerability of MK-3475 + Pegylated Interferon Alfa-2b (PEG-IFN) and MK-3475 + Ipilimumab (IPI) in Subjects With Advanced Melanoma (MEL) and Renal Cell Carcinoma (RCC) (KEYNOTE 029)”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: January 6, 2021

Detailed Description

The trial is being done in three parts: Part 1A (MEL and RCC) will define the maximum tolerated dose (MTD)/maximum administered dose (MAD) for the drug combinations; a recommended Phase 2 dose (RP2D) for each combination will be identified. Part 1B (MEL-single arm expansion) will better characterize safety and efficacy and provide preliminary efficacy data for the penbrolizumab + IPI combination in participants with MEL. Part 2 (MEL and RCC) is a randomized portion of the trial and will evaluate preliminary efficacy of the drug combinations given in 6-week cycles for advanced MEL participants. Part 2 was removed from the study with Amendment 3 of the protocol. Part 1C (MEL) is added as the third part of the study with Amendment 3. Part 1C will evaluate safety and efficacy for different doses and dosing intervals for IPI in combination with pembrolizumab in participants with advanced MEL.

Interventions

  • Biological: Pembrolizumab
  • Biological: PegIFN-2b
  • Biological: Ipilimumab

Arms, Groups and Cohorts

  • Experimental: Pembrolizumab + PegIFN-2b
    • Participants in Part A receive pembrolizumab intravenously (IV) at assigned dose every 3 weeks + PegIFN-2b subcutaneously (SC) at assigned dose once a week in each 6-week cycle.
  • Experimental: Pembrolizumab + IPI Q3W
    • Participants in Parts 1A and 1B receive pembrolizumab IV at assigned dose every 3 weeks + IPI IV at 1 mg/kg every 3 weeks (Q3W) for a total of two 6-week cycles.
  • Experimental: Pembrolizumab + IPI Q6W
    • Participants in Part 1C receive pembrolizumab IV at assigned dose every 3 weeks + IPI IV at 50 mg every 6 weeks (Q6W) for a maximum of four 6-week cycles.
  • Experimental: Pembrolizumab + IPI Q12W
    • Participants in Part 1C receive pembrolizumab IV at assigned dose every 3 weeks + IPI IV at 100 mg every 12 weeks (Q12W) for a maximum of eight 6-week cycles.

Clinical Trial Outcome Measures

Primary Measures

  • Number of participants with dose-limiting toxicities (Part 1A)
    • Time Frame: Up to 6 weeks (Cycle 1)
  • Number of participants experiencing adverse events (AEs)
    • Time Frame: Up to 27 Months
  • Number of participants discontinuing study drug because of AEs
    • Time Frame: Up to 24 Months
  • Progression-free survival (PFS) (Part 2)
    • Time Frame: Up to 24 Months
  • Number of participants experiencing grade 3-5 drug-related AEs (Part 1C)
    • Time Frame: Up to 27 Months
  • Objective response rate (ORR) (Part 1C)
    • Time Frame: Up to 24 Months

Secondary Measures

  • ORR using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 (Part 1C)
    • Time Frame: Up to 24 Months
  • ORR (Part 2)
    • Time Frame: Up to 24 Months
  • Duration of Response (DOR) (Parts 1B, 1C)
    • Time Frame: Up to 24 Months
  • Overall Survival (OS) (Parts 1B, 1C)
    • Time Frame: Up to 24 Months
  • PFS (Parts 1B, 1C)
    • Time Frame: Up to 24 Months
  • Number of participants experiencing grade 3-4 AEs
    • Time Frame: Up to 27 Months
  • ORR using RECIST 1.1 (Part 1B)
    • Time Frame: Up to 24 Months

Participating in This Clinical Trial

Inclusion Criteria

  • Histologically- or cytologically-confirmed diagnosis of advanced/unresectable or metastatic MEL or RCC (Part 1A only) with predominantly clear cell elements
  • Previously untreated stage III/IV advanced or metastatic MEL (Part 1C only)
  • MEL subjects may be treatment naïve or may have received prior lines of therapy for metastatic disease (Parts 1A and 1B)
  • RCC subjects must have received ≥1 prior line of therapy for metastatic disease (Part 1A)
  • Measurable disease as defined by RECIST 1.1
  • Must provide a tumor sample (archival or newly obtained biopsy) that is adequate for determination of PD (programmed cell death)-Ligand 1 status by immunohistochemistry at a central pathology laboratory prior to enrollment. Note: Adequacy of the tumor sample for PD-Ligand 1 testing is not required prior to enrollment in Part 1C
  • Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1
  • Adequate organ function
  • Resolution of toxic effect(s) of the most recent prior chemotherapy to Grade 1 or less (Parts 1A and 1B) and/or recovered from major surgery or radiation therapy
  • Female participants of childbearing potential must be willing to use adequate contraception during the course of the study through 120 days after the last dose of study drug
  • Male participants must agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study drug

Exclusion Criteria

  • Uveal or ocular MEL
  • Diagnosis of immunodeficiency or receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug
  • Prior therapy with an anti-programmed cell death (anti-PD)-1, anti-PD-Ligand 1, anti-PD-Ligand 2 or with an agent directed to another co-inhibitory T-cell receptor or has previously participated in a pembrolizumab clinical trial. Note: In Part 1C, participants may have received anti-PD-1 and/or anti-Cytotoxic T-lymphocyte-associated antigen 4 (anti-CTLA-4) as part of their neo/adjuvant treatment.
  • Has received prior anti-cancer therapy, monoclonal antibody, chemotherapy, or an investigational agent or device within 4 weeks or 5 half-lives (whichever is longer) before first dose of trial drug or not recovered (≤ Grade 1 or at baseline) from AEs due to previously administered agents (Parts 1A and 1B)
  • Diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug
  • Known additional malignancy that is progressing or requires active treatment with the exception of early stage cancers (carcinoma in situ or Stage 1) treated with curative intent, basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer or in situ breast cancer that has undergone potentially curative therapy
  • Known active central nervous system (CNS) metastases and/or carcinomatous meningitis
  • Severe hypersensitivity to any pembrolizumab excipients
  • Active autoimmune disease requiring systemic treatment in the past 2 years
  • History of (non-infectious) pneumonitis that required steroids or has current pneumonitis
  • Active infection requiring systemic therapy
  • Pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial from screening through 120 days after the last dose of study drug
  • Prior therapy with interferon alfa (in neoadjuvant, adjuvant, or metastatic settings) (Part 1A only)
  • Uncontrolled thyroid dysfunction
  • Uncontrolled diabetes mellitus.
  • Known history of human immunodeficiency virus (HIV)
  • Known history of or is positive for Hepatitis B or Hepatitis C
  • Received a live vaccine within 30 days prior to first dose of study drug

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Merck Sharp & Dohme Corp.
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Medical Director, Study Director, Merck Sharp & Dohme Corp.

Citations Reporting on Results

Long GV, Atkinson V, Cebon JS, Jameson MB, Fitzharris BM, McNeil CM, Hill AG, Ribas A, Atkins MB, Thompson JA, Hwu WJ, Hodi FS, Menzies AM, Guminski AD, Kefford R, Kong BY, Tamjid B, Srivastava A, Lomax AJ, Islam M, Shu X, Ebbinghaus S, Ibrahim N, Carlino MS. Standard-dose pembrolizumab in combination with reduced-dose ipilimumab for patients with advanced melanoma (KEYNOTE-029): an open-label, phase 1b trial. Lancet Oncol. 2017 Sep;18(9):1202-1210. doi: 10.1016/S1470-2045(17)30428-X. Epub 2017 Jul 17.

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