A Study of Biomarker-Directed, Pembrolizumab (MK-3475) Based Combination Therapy for Advanced Non-Small Cell Lung Cancer (MK-3475-495/KEYNOTE-495)

Study Overview
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Brief Summary
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This study will investigate the utility of biomarker-based triage for study participants with advanced non-small cell lung cancer (NSCLC) without prior systemic therapy. Study participants within groups defined by a biomarker-based classifier (gene expression profile [GEP] and tumor mutational burden [TMB]) will be randomized to receive pembrolizumab in combination with quavonlimab (MK-1308), favezelimab (MK-4280), or lenvatinib. The primary hypotheses are as follows: In participants receiving pembrolizumab in combination with either quavonlimab, favezelimab, or lenvatinib, the Objective Response Rate (ORR) will be 1) greater than 5% among participants with low GEP and low TMB, 2) greater than 20% among participants with low GEP and high TMB, 3) greater than 20% among participants with high GEP and low TMB, and 4) greater than 45% among participants with high GEP and high TMB.

Detailed Description
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After Amendment 5, participants can receive 800 mg of favezelimab every 3 weeks (Q3W)

Official Title
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A Phase 2 Precision Oncology Study of Biomarker-Directed, Pembrolizumab-(MK-3475, SCH 900475) Based Combination Therapy for Advanced Non-Small Cell Lung Cancer (KEYNOTE-495; KeyImPaCT)

Conditions
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Advanced Non-Small Cell Lung Cancer

Intervention / Treatment
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* Biological: Pembrolizumab
* Biological: Favezelimab
* Drug: Lenvatinib
* Drug: Quavonlimab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Has a histologically- or cytologically-confirmed diagnosis of Stage IV (American Joint Committee on Cancer [AJCC] v 8) NSCLC and has not had prior systemic therapy for advanced disease Has confirmation that epidermal growth factor receptor- (EGFR-), anaplastic lymphoma kinase- (ALK-), c-ros oncogene 1- (ROS1-), or B isoform of rapidly accelerated fibrosarcoma- (B-Raf-) directed therapy is not indicated as primary therapy (documentation of absence of tumor activating EGFR mutations, B-Raf mutations, ALK gene rearrangements, and ROS1 gene rearrangements) Has measurable disease per RECIST 1.1 as assessed by the local site investigator/radiology Male participants must agree to use contraception during the treatment period and for ≥120 days, after the last dose of study treatment and refrain from donating sperm during this period. Male participants with pregnant partners must agree to use a condom Female participants eligible to participate if not pregnant, not breastfeeding, and not a woman of childbearing potential (WOCBP) or is a WOCBP who agrees to follow contraceptive guidance during the treatment period and for ≥120 days after the last dose of study treatment Provided archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1 Has adequate organ function Exclusion Criteria: Has significant cardiovascular impairment within 12 months of the first dose of study drug: history of congestive heart failure greater than New York Heart Association (NYHA) Class II, unstable angina, myocardial infarction or cerebrovascular accident (CVA) stroke, or cardiac arrhythmia associated with hemodynamic instability, significant cardiovascular impairment, or a left ventricular ejection fraction (LVEF) below the institutional normal range as determined by multigated acquisition scan (MUGA) or echocardiogram Prolongation of QTc interval to >480 milliseconds (ms) Has symptomatic ascites or pleural effusion Has had an allogenic tissue/solid organ transplant WOCBP who has a positive urine pregnancy test within 24 hours before the first dose of study treatment Has not recovered adequately from any toxicity and/or complications from major surgery prior to starting therapy, or has had major surgery within 3 weeks prior to first dose of study intervention Has preexisting ≥Grade 3 gastrointestinal or non-gastrointestinal fistula, gastrointestinal malabsorption, gastrointestinal anastomosis, or any other condition that might affect the absorption of lenvatinib Radiographic evidence of major blood vessel invasion/infiltration Clinically significant hemoptysis or tumor bleeding within 2 weeks prior to the first dose of study drug Has received prior systemic chemotherapy treatment for metastatic/recurrent NSCLC Has current NSCLC disease that can be treated with curative intent with surgical resection, localized radiotherapy, or chemoradiation Is expected to require any other form of systemic or localized antineoplastic therapy while on study (including maintenance therapy with another agent for NSCLC, radiation therapy, and/or surgical resection) 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 Has received previous treatment with another agent targeting the Lymphocyte-activation gene 3 (LAG-3) receptor Has received previous treatment with another agent targeting vascular endothelial growth factor (VEGF) or the VEGF receptor Has received prior anticancer therapy including investigational agents within 4 weeks prior to randomization Has received prior radiotherapy within 2 weeks of start of study treatment or received lung radiation therapy of >30 Gy within 6 months prior to the first dose of study intervention Has received a live or live-attenuated vaccine within 30 days before the first dose of study treatment 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 treatment. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study treatment 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 severe hypersensitivity (≥Grade 3) to pembrolizumab, favezelimab, or lenvatinib and/or any of its excipients 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) Has a history of (noninfectious) 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 (defined as hepatitis B surface antigen [HBsAg] reactive) or known active hepatitis C virus (defined as HCV RNA [qualitative] is detected) infection Has a known history of active tuberculosis (TB; Bacillus tuberculosis) Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's 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 Has known psychiatric or substance abuse disorders that would interfere with cooperating with the requirements of the study 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 (females and males) after the last dose of study treatment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: GEP low TMB low: Pembrolizumab + Quavonlimab<br>Participants receive pembrolizumab 200 mg Q3W plus quavonlimab at the Recommended Phase 2 Dose ([RP2D], dose and schedule based on study NCT03179436) until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Quavonlimab<br>* Quavonlimab solution for IV infusion administered at the RP2D (dose and schedule based on study NCT03179436)<br>* Other names: MK-1308;|
| Experimental: GEP low TMB low: Pembrolizumab + Favezelimab<br>Participants receive pembrolizumab 200 mg Q3W plus favezelimab 200 mg or 800 mg Q3W until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Biological: Favezelimab<br>* 200 mg or 800 mg favezelimab solution for IV infusion administered Q3W<br>* Other names: MK-4280;|
| Experimental: GEP low TMB low: Pembrolizumab + Lenvatinib<br>Participants receive pembrolizumab 200 mg Q3W plus lenvatinib 20 mg once daily until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). Participants completing 35 infusions of pembrolizumab may continue with lenvatinib alone until disease progression or toxicity. | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Lenvatinib<br>* 20 mg lenvatinib capsules administered orally once daily<br>* Other names: MK-7902;|
| Experimental: GEP low TMB hi: Pembrolizumab + Quavonlimab<br>Participants receive pembrolizumab 200 mg Q3W plus quavonlimab at the RP2D (dose and schedule based on study NCT03179436) until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Quavonlimab<br>* Quavonlimab solution for IV infusion administered at the RP2D (dose and schedule based on study NCT03179436)<br>* Other names: MK-1308;|
| Experimental: GEP low TMB hi: Pembrolizumab + Favezelimab<br>Participants receive pembrolizumab 200 mg Q3W plus favezelimab 200 mg or 800 mg Q3W until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Biological: Favezelimab<br>* 200 mg or 800 mg favezelimab solution for IV infusion administered Q3W<br>* Other names: MK-4280;|
| Experimental: GEP low TMB hi: Pembrolizumab + Lenvatinib<br>Participants receive pembrolizumab 200 mg Q3W plus lenvatinib 20 mg once daily until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). Participants completing 35 infusions of pembrolizumab may continue with lenvatinib alone until disease progression or toxicity. | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Lenvatinib<br>* 20 mg lenvatinib capsules administered orally once daily<br>* Other names: MK-7902;|
| Experimental: GEP hi TMB low: Pembrolizumab + Quavonlimab<br>Participants receive pembrolizumab 200 mg Q3W plus quavonlimab at the RP2D (dose and schedule based on study NCT03179436) until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Quavonlimab<br>* Quavonlimab solution for IV infusion administered at the RP2D (dose and schedule based on study NCT03179436)<br>* Other names: MK-1308;|
| Experimental: GEP hi TMB low: Pembrolizumab + Favezelimab<br>Participants receive pembrolizumab 200 mg Q3W plus favezelimab 200 mg or 800 mg Q3W until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Biological: Favezelimab<br>* 200 mg or 800 mg favezelimab solution for IV infusion administered Q3W<br>* Other names: MK-4280;|
| Experimental: GEP hi TMB low: Pembrolizumab + Lenvatinib<br>Participants receive pembrolizumab 200 mg Q3W plus lenvatinib 20 mg once daily until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). Participants completing 35 infusions of pembrolizumab may continue with lenvatinib alone until disease progression or toxicity. | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Lenvatinib<br>* 20 mg lenvatinib capsules administered orally once daily<br>* Other names: MK-7902;|
| Experimental: GEP hi TMB hi: Pembrolizumab + Quavonlimab<br>Participants receive pembrolizumab 200 mg Q3W plus quavonlimab at the RP2D (dose and schedule based on study NCT03179436) until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Quavonlimab<br>* Quavonlimab solution for IV infusion administered at the RP2D (dose and schedule based on study NCT03179436)<br>* Other names: MK-1308;|
| Experimental: GEP hi TMB hi: Pembrolizumab + Favezelimab<br>Participants receive pembrolizumab 200 mg Q3W plus favezelimab 200 mg or 800 mg Q3W until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Biological: Favezelimab<br>* 200 mg or 800 mg favezelimab solution for IV infusion administered Q3W<br>* Other names: MK-4280;|
| Experimental: GEP hi TMB hi: Pembrolizumab + Lenvatinib<br>Participants receive pembrolizumab 200 mg Q3W plus lenvatinib 20 mg once daily until disease progression, or until the participant has received 35 administrations of pembrolizumab (approximately 2 years). Participants completing 35 infusions of pembrolizumab may continue with lenvatinib alone until disease progression or toxicity. | Biological: Pembrolizumab<br>* 200 mg pembrolizumab solution for intravenous (IV) infusion administered Q3W<br>* Other names: MK-3475;Drug: Lenvatinib<br>* 20 mg lenvatinib capsules administered orally once daily<br>* Other names: MK-7902;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) | ORR was defined as the percentage of participants who have a confirmed complete response (CR: disappearance of all target lesions) or partial response (PR: At least a 30% decrease in the sum of diameters [SOD] of target lesions, taking as reference the baseline sum diameters) per Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) as assessed by local site. | Up to  2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression Free Survival (PFS) per RECIST 1.1 | PFS is defined as the time from randomization to the first documented disease progression or death due to any cause, whichever occurs first. Responses are according to RECIST 1.1 as assessed by local site. | Up to  2 years | 
| Overall Survival (OS) | OS is defined as the time from randomization to death due to any cause. | Up to  2 years | 
| Number of Participants Experiencing Adverse Events (AEs) | An AE is any untoward medical occurrence in participant that is temporally associated with the use of study treatment, whether or not considered related to the study treatment. 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 treatment. The number of participants in each treatment arm experiencing an AE will be reported. | Up to  2 years | 
| Number of Participants Discontinuing Study Drug Due to AEs | An AE is any untoward medical occurrence in participant that is temporally associated with the use of study treatment, whether or not considered related to the study treatment. 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 treatment. The number of participants in each treatment arm that discontinued study drug due to an AE will be reported. | Up to  2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Programmed Cell Death-1 (PD1, PD-1), Programmed Death-Ligand 1 (PDL1, PD-L1)