A Study Evaluating the Effect of Pembrolizumab (MK-3475) in Participants With Renal Cell Cancer (MK-3475-031)

Study Overview
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Brief Summary
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This study will examine the effect of treatment with the neoadjuvant antibody pembrolizumab (MK-3475) on tumors of participants with renal cell cancer (RCC). The primary hypotheses are that pembrolizumab is well tolerated in participants undergoing RCC tumor resection; and that pembrolizumab will stimulate a 2-fold or greater increase in intratumoral lymphocytic infiltration in at least 30% of participants with RCC.

Official Title
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A Clinical Trial to Evaluate the Effect of Neoadjuvant MK-3475 (Pembrolizumab) Therapy on Intratumoral Immune Infiltrates in Renal Cell Cancer (RCC) Patients Undergoing Surgical Resection

Conditions
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Renal Cell Cancer

Intervention / Treatment
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* Drug: Pembrolizumab Pre-Resection
* Procedure: Surgical Resection
* Drug: Pembrolizumab Post-Resection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Have a newly diagnosed RCC, with a primary tumor diameter of more than 4 cm (>= T1b), not previously treated, and be a candidate for operative tumor resection Be willing and able to undergo pre-treatment baseline image-guided core biopsy of their primary RCC Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale Demonstrate adequate organ function Female is not breast feeding, is postmenopausal or surgically sterile; demonstrates non-pregnant state, and agrees to use two acceptable methods of birth control throughout the trial, until 120 days after the last dose of treatment Male with female partner of childbearing potential agrees to use adequate method of contraception throughout study, until 120 days after last dose of treatment or last blood draw. Exclusion Criteria: Is currently participating in, or has participated in a study with an investigational agent or device within 4 weeks prior to first dose of study therapy Has a diagnosis of immunosuppression or has received systemic steroid therapy, or any other form of immunosuppressive therapy within 4 weeks prior to first dose of study therapy Has had prior chemotherapy, targeted small molecule, or radiation therapy for treatment of RCC Has a known additional (other than RCC) malignancy that is progressing or requires active treatment Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis Has an active, or documented history of autoimmune disease, with the exceptions of vitiligo or resolved childhood asthma/atopy Has a history of (non-infectious) pneumonitis that required treatment with steroids or current pneumonitis. Has an active infection requiring systematic therapy Is receiving anticoagulant therapy, with the exception of low dosage aspirin Has severe cardiovascular disease or symptomatic ischemic heart disease Has hepatic decompensation Has uncontrolled thyroid dysfunction Has uncontrolled diabetes mellitus Has known psychiatric or substance abuse disorders Female is pregnant or breastfeeding Is expecting to conceive children within the projected maximum duration of the trial, extending through 120 days after the last dose of treatment or the last blood draw Has received prior therapy with any antibody or drug (including ipilimumab) specifically targeting T-cell co-stimulation or checkpoint pathway Has a known history of human immunodeficiency virus (HIV) Has known active hepatitis B or C Has received a live vaccine within 30 days prior to screening

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: Neoadjuvant Pembrolizumab + RCC Resection<br>Participants received pembrolizumab, 200 mg intravenously (IV) once every 3-week cycle for up to 2 cycles followed by standard of care (SOC) renal cell carcinoma (RCC) surgical resection; and then received post-resection pembrolizumab 200 mg IV once every 3 week cycle for up to approximately 1 year (17 cycles). Post-resection pembrolizumab was only administered to participants who enrolled after Protocol Amendment 04. | Drug: Pembrolizumab Pre-Resection<br>* 200 mg administered by IV, once every 3-week cycle for a maximum of 2 cycles<br>* Other names: MK-3475;Procedure: Surgical Resection<br>* Standard of care surgical resection of RCC tumor<br>Drug: Pembrolizumab Post-Resection<br>* 200 mg administered by IV, once every 3-week cycle for a maximum of 17 cycles<br>* Other names: MK-3475;|
| Experimental: RCC Resection<br>Participants received SOC renal cell carcinoma (RCC) surgical resection; and then may have received post-resection pembrolizumab 200 mg IV once every 3 week cycle for up to approximately 1 year (17 cycles). Post-resection pembrolizumab was only administered to participants who enrolled under Protocol Amendment 04. | Procedure: Surgical Resection<br>* Standard of care surgical resection of RCC tumor<br>Drug: Pembrolizumab Post-Resection<br>* 200 mg administered by IV, once every 3-week cycle for a maximum of 17 cycles<br>* Other names: MK-3475;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With an Adverse Event (AE) During the Neoadjuvant Pembrolizumab Regimen | An AE was defined as any untoward medical occurrence in a participant administered study treatment and which did not necessarily have to have a causal relationship with this treatment. The number of participants who experienced an AE during their regimen of neoadjuvant pembrolizumab was presented. | Up to Week 16 | 
| Number of Participants Who Discontinued Treatment Due to an Adverse Event | An AE was defined as any untoward medical occurrence in a participant administered study treatment and which did not necessarily have to have a causal relationship with this treatment. The number of participants who discontinued study drug due to an adverse event is presented. | Up to 56 weeks | 
| Number of Participants Treated With Neoadjuvant Pembrolizumab With a 2-fold or Greater Change From Baseline in Intratumoral CD3+ Lymphocytic Infiltration | The number of participants who received neoadjuvant pembrolizumab and showed a 2-fold or greater change from baseline in intratumoral CD3+ lymphocytic infiltration is presented. Evaluations were based on pathologist score. | Baseline and Week 7 | 
| Number of Participants Treated With Neoadjuvant Pembrolizumab With a 2-fold or Greater Change From Baseline in Intratumoral CD8+ Lymphocytic Infiltration | The number of participants who received neoadjuvant pembrolizumab and showed a 2-fold or greater change from baseline in intratumoral CD8+ lymphocytic infiltration is presented. Evaluations were based on pathologist score. | Baseline and Week 7 | 
| Number of Participants Treated With Neoadjuvant Pembrolizumab With a 2-fold or Greater Change From Baseline in Intratumoral FoxP3+ Lymphocytic Infiltration | The number of participants who received neoadjuvant pembrolizumab and showed a 2-fold or greater change from baseline in intratumoral FoxP3+ (forkhead box protein P3 positive) lymphocytic infiltration is presented. Evaluations were based on pathologist score. | Baseline and Week 7 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline in Levels of Gene Expression of Immune Modulatory Receptors in Tumors of Participants Treated With Neoadjuvant Pembrolizumab | The change from baseline in levels of gene expression of immune modulatory receptors in tumors of participants treated with neoadjuvant pembrolizumab was presented. | Baseline and Week 7 | 
| Change From Baseline in Number of T Cells in Tumors of Participants Treated With Neoadjuvant Pembrolizumab | The change from baseline in number of T cells in tumors of participants treated with neoadjuvant pembrolizumab was presented. | Baseline and Week 7 | 
| Change From Baseline in Number of Activated T Cells in Peripheral Blood of Participants Treated With Neoadjuvant Pembrolizumab | The change from baseline in the number of activated T cells in peripheral blood of participants treated with neoadjuvant pembrolizumab was presented. | Baseline and Week 7 | 
| Change From Baseline in Levels of Programmed Cell Death 1 Ligand 1 (PD-L1) Protein in Tumors of Participants Treated With Neoadjuvant Pembrolizumab | The change from baseline in levels of programmed cell death 1 ligand 1 (PD-L1) protein in tumors of participants treated with neoadjuvant pembrolizumab in participants who received neoadjuvant pembrolizumab was presented. | Baseline and Week 7 | 
| Change From Baseline in Levels of Programmed Cell Death 1 Ligand 2 (PD-L2) Protein in Tumors of Participants Treated With Neoadjuvant Pembrolizumab | The change from baseline in levels of programmed cell death 1 ligand 2 (PD-L2) protein in tumors of participants treated with neoadjuvant pembrolizumab in participants who received neoadjuvant pembrolizumab was presented. | Baseline and Week 7 |