Study to Evaluate the Safety of Pembrolizumab in Participants With Unresectable or Metastatic Melanoma or Non-small Cell Lung Cancer in India (MK-3475-593/KEYNOTE-593)

• ClinicalTrials.gov Identifier: NCT03715205
• Recruitment Status: Active, not recruiting
• First Posted: October 23, 2018
• Last Update Posted: October 12, 2022
• Sponsor: Merck Sharp & Dohme LLC
• Information provided by (Responsible Party): Merck Sharp & Dohme LLC

Study Description

Brief Summary:

This study has been designed to evaluate the safety of pembrolizumab in participants in India with unresectable or metastatic melanoma and participants with non-small cell lung cancer (NSCLC) who are either untreated (programmed cell death ligand 1 [PD-L1] ≥50%) or have experienced disease progression after a platinum-containing systemic therapy (PD-L1 ≥1%).

Condition or disease	Intervention/treatment	Phase
Carcinoma, Non-Small-Cell Lung; Melanoma	Drug: Pembrolizumab	Phase 4

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 150 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Prospective, Open-label, Phase 4 Study to Evaluate the Safety of Pembrolizumab (KEYTRUDA®) in Subjects With Unresectable or Metastatic Melanoma or PD-L1 Positive Non-small Cell Lung Cancer (NSCLC) in India (Keynote-593)
• Actual Study Start Date: January 31, 2019
• Estimated Primary Completion Date: July 22, 2024
• Estimated Study Completion Date: July 22, 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: Cohort A: Melanoma; Participants with unresectable or metastatic melanoma receive 200 mg of pembrolizumab as an intravenous (IV) infusion every 3 weeks (Q3W) for up to 35 cycles.	Drug: Pembrolizumab; Administered as an intravenous (IV) infusion every 3 weeks (Q3W); Other Names: KEYTRUDA®; MK-3475
Experimental: Cohort B: NSCLC; Participants with NSCLC who are either treatment naïve or have progressed after prior treatment receive 200 mg of pembrolizumab as an IV infusion every Q3W for up to 35 cycles.	Drug: Pembrolizumab; Administered as an intravenous (IV) infusion every 3 weeks (Q3W); Other Names: KEYTRUDA®; MK-3475

Outcome Measures

Primary Outcome Measures :

1. Incidence of Adverse Events (AEs) [ Time Frame: From time of signing the informed consent form (ICF) until the end of follow-up (up to approximately 25 months) ]
   Percentage of participants experiencing an AE defined as any unfavorable and unintended sign, symptom, disease, or worsening of preexisting condition temporally associated with study therapy and irrespective of causality to study therapy
2. Incidence of Drug-Related AEs [ Time Frame: From time of signing the ICF until the end of follow-up (up to approximately 25 months) ]
   Percentage of participants experiencing an AE that is determined by the investigator to be related to the treatment
3. Incidence of Serious Adverse Events (SAEs) [ Time Frame: From time of signing the ICF until the end of follow-up (up to approximately 27 months) ]
   Percentage of participants experiencing a SAE defined as an AE that did not necessarily have to have a causal relationship to the treatment, that was life-threatening; required inpatient hospitalization or prolongation of existing hospitalization; resulted in persistent or significant disability/incapacity; was a congenital anomaly/birth defect; was suggested to be significantly detrimental; was a cancer; overdose; or resulted in death
4. Incidence of Drug-Related SAEs [ Time Frame: From time of signing the ICF until the end of follow-up (up to approximately 27 months) ]
   Percentage of participants experiencing a SAE that is determined by the investigator to be related to the treatment
5. Incidence of Treatment Discontinuations [ Time Frame: From time of initiation of study treatment until the end of study treatment (up to approximately 24 months) ]
   Percentage of participants discontinuing study drug due to an AE
6. Incidence of Events of Clinical Interest (ECIs) [ Time Frame: From time of signing the ICF until the end of follow-up (up to approximately 27 months) ]
   Percentage of participants with ECIs including the following: 1) an overdose of pembrolizumab defined as any dose of ≥1000 mg or 2) an elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) lab value that is ≥3 times the upper limit of normal (ULN) and an elevated total bilirubin lab value that is ≥2 times ULN and, at the same time, an alkaline phosphatase lab value that is <2 times ULN, as determined by way of protocol-specified laboratory testing or unscheduled laboratory testing

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

Melanoma Participant:

• Has a histologically confirmed diagnosis of unresectable Stage III or metastatic melanoma (Stage IV) not amenable to local therapy
• Has received no more than 1 line of prior systemic therapy for unresectable Stage III or Stage IV melanoma including mitogen activated protein kinase inhibitors
• Has a Lactate Dehydrogenase (LDH) ≤1.5 times ULN

NSCLC Participant-First Line Treatment:

• Has a histologically or cytologically confirmed diagnosis of Stage IV NSCLC
• Has a tumor that demonstrate PD-L1 strong expression (PD-L1 ≥50%)
• Do not have an EGFR sensitizing mutation AND are anaplastic lymphoma kinase (ALK) translocation negative
• Has received no systemic anti-cancer therapy for their metastatic NSCLC

NSCLC Participant-Second Line Treatment and Beyond:

• Has a histologically or cytologically confirmed diagnosis of stage IIIB//IIIC/IV (including any future updates to the American Joint Committee on Cancer [AJCC] guideline) or recurrent NSCLC
• Has a tumor that expresses programmed cell death ligand 1 (PD-L1) ≥1%
• Has received prior treatment with at least two cycles of a platinum-containing doublet for Stage IIIB/IV or recurrent disease
• Has received an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (either erlotinib, gefitinib, or afatinib) if they have an EGFR sensitizing mutation
• Has received crizotinib if they have an ALK translocation

NSCLC participants must also meet the following requirements:

• Have a life expectancy of at ≥3 months
• Provide a formalin fixed tumor tissue sample for PD-L1 biomarker analysis from a recent biopsy of a tumor lesion not previously irradiated; For first line, biopsies obtained PRIOR to the administration of any systemic therapy administered for the treatment of a tumor (such as neoadjuvant/adjuvant/definitive therapy) will not be permitted for analysis. For second line treatment and beyond, no systemic antineoplastic therapy may be administered between the PD-L1 biopsy and initiating study medication
• Have documented evidence of the EGFR mutation status or ALK translocation status. If unable to provide documentation of these molecular changes, formalin-fixed paraffin-embedded tumor tissue of any age should be submitted for testing
• Have measurable disease per Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST 1.1) as assessed by the local site investigator/radiologist
• Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1
• Women of childbearing potential (WOCP) must have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of trial treatment. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
• WOCP must be willing to use an adequate method of contraception for the course of the study through 120 days after the last dose of trial treatment
• Men of childbearing potential 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 therapy

Exclusion Criteria:

• For NSCLC Participant only: Has a tumor specimen that is not evaluable for PD-L1 expression by the laboratory
• Is currently participating in or has participated in a trial of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of trial treatment
• Has received prior therapy with an anti- programmed cell death 1 (PD-1), anti-PD-L1, or anti- programmed cell death ligand 2 (PD-L2) agent or with an agent directed to another T-cell receptor (i.e., cytotoxic T-lymphocyte antigen-4 [CTLA-4], OX-40, CD137) or has previously participated in a clinical trial for pembrolizumab (MK-3475)
• Has received prior anti-cancer therapy including investigational agent or device within 4 weeks, or completed palliative radiotherapy within 7 days, prior to enrollment
• Has recovered from all AEs due to previous therapies to ≤ Grade 1 or baseline
• Has recovered adequately from the toxicity and/or complications from major surgery prior to starting trial treatment
• Is expected to require any other form of antineoplastic therapy while participating in the trial
• Is on systemic corticosteroid therapy within 7 days before the planned date for first dose of treatment or any other form of immunosuppressive medication
• Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (exceeding 10 mg daily dose of prednisone or equivalent) or any other form of immunosuppressive therapy within 7 days before the first dose of trial treatment
• Has an active autoimmune disease that has required systemic treatment in the past 2 years
• Has a known additional malignancy that is progressing or requires active treatment with the exception of basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (e.g., cervical cancer in situ, breast carcinoma) that have undergone potentially curative therapy
• Has had an allogeneic tissue/solid organ transplant
• Has a history of or current radiographically detectable central nervous system metastases and/or carcinomatous meningitis
• Has a severe hypersensitivity (≥ Grade 3) to any excipients in pembrolizumab
• Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or current pneumonitis/interstitial lung disease
• Has an active infection requiring systemic therapy including known history of active tuberculosis (Bacillus tuberculosis)
• Has a known history of human immunodeficiency virus (HIV) infection
• Has a known history of or is positive for hepatitis B (hepatitis B surface antigen [HbsAg] reactive) or hepatitis C (HCV) ribonucleic acid (RNA) [qualitative] is detected
• Has a known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the trial
• If participant received prior radiation therapy to a symptomatic metastatic lesion, has recovered to Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 Grade 1 or Grade 0 AEs due to radiation therapy
• Is a regular user of any illicit drug or has a recent history (within the last 3 months) of substance abuse including alcohol
• 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 trial treatment
• Has received a live vaccine within 30 days before the first dose of trial treatment
• Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator

Contacts and Locations

Locations

India

Nizam's Institute of Medical Sciences ( Site 0011)

Hyderabad, Andhra Pradesh, India, 500082

All India Institute of Medical Sciences ( Site 0012)

New Delhi, Delhi, India, 110029

Indraprastha Apollo Hospitals ( Site 0008)

New Delhi, Delhi, India, 110076

Artemis Health Institute ( Site 0007)

Gurgaon, Haryana, India, 122001

Tata Memorial Hospital [M] ( Site 0005)

Mumbai, Maharashtra, India, 400012

Kokilaben Ben Dhirubhai Ambani Hosp & Med Res Inst. ( Site 0001)

Mumbai, Maharashtra, India, 400053

Deenanath Mangeshkar Hospital and Research Center ( Site 0009)

Pune, Maharashtra, India, 411004

Rajiv Gandhi Cancer Institute and Research Centre ( Site 0003)

Delhi, India, 110085

Sponsors and Collaborators

Merck Sharp & Dohme LLC

Investigators

• Study Director: Medical Director; Merck Sharp & Dohme LLC

More Information

Additional Information:

Merck Oncology Clinical Trials Information 

• Responsible Party: Merck Sharp & Dohme LLC
• ClinicalTrials.gov Identifier: NCT03715205
• Other Study ID Numbers: 3475-593; MK-3475-593 ( Other Identifier: Merck Protocol Number ); KEYNOTE 593 ( Other Identifier: Merck )
• First Posted: October 23, 2018
• Last Update Posted: October 12, 2022
• Last Verified: October 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
• URL: http://engagezone.msd.com/ds_documentation.php

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Merck Sharp & Dohme LLC:

programmed cell death 1 (PD-1, PD1 ); programmed cell death ligand 1 (PD-L1, PDL1); programmed cell death ligand 2 (PD-L2, PDL2)

Additional relevant MeSH terms:

Carcinoma, Non-Small-Cell Lung; Melanoma; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Neoplasms; Lung Diseases; Respiratory Tract Diseases; Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms, Nerve Tissue; Nevi and Melanomas; Pembrolizumab; Antineoplastic Agents, Immunological; Antineoplastic Agents; Immune Checkpoint Inhibitors; Molecular Mechanisms of Pharmacological Action