Pembrolizumab + Lenvatinib + Chemo for Esophageal Cancer

Recruiting at 216 trial locations

Overseen By Toll Free Number

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Waitlist Available

Sponsor: Merck Sharp & Dohme Corp.

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This trial tests a new combination of drugs and chemotherapy for advanced esophageal cancer. It targets patients whose cancer has spread and who need effective first-line treatment. The treatment works by enhancing the immune system, blocking cancer growth, and killing cancer cells.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, it mentions that you must have adequately controlled blood pressure with or without antihypertensive medications, and there are restrictions on certain treatments like immunosuppressive therapy and live vaccines. It's best to discuss your specific medications with the trial team.

What data supports the idea that Pembrolizumab + Lenvatinib + Chemo for Esophageal Cancer is an effective treatment?

The available research does not provide specific data on the effectiveness of Pembrolizumab + Lenvatinib + Chemo for Esophageal Cancer. However, it does mention that traditional treatments like cisplatin and 5-fluorouracil have a response rate of 25% to 35% in metastatic cases. Newer treatments, such as paclitaxel combined with cisplatin, show promise with less toxicity. Pembrolizumab has been compared to paclitaxel for gastro-esophageal junction cancer, suggesting it is a viable option, but specific data for the combination with Lenvatinib and chemotherapy in esophageal cancer is not provided. ^{1 2 3 4 5}

What safety data is available for the treatment of esophageal cancer with Pembrolizumab, Lenvatinib, and chemotherapy?

The provided research includes safety data on various chemotherapy regimens involving drugs like fluorouracil (5-FU), cisplatin, and paclitaxel, which are part of the treatment for esophageal cancer. These studies highlight the significant gastrointestinal toxicity associated with traditional cisplatin/5-FU regimens and explore alternative combinations to improve the therapeutic index. The studies also evaluate the toxicity and efficacy of paclitaxel combined with cisplatin and 5-FU, noting the potential for improved outcomes with different combinations. However, specific safety data for the combination of Pembrolizumab, Lenvatinib, and chemotherapy is not directly addressed in these studies. ^{1 3 6 7 8}

Is the drug combination of Pembrolizumab, Lenvatinib, and chemotherapy promising for esophageal cancer?

Yes, the combination of Pembrolizumab, Lenvatinib, and chemotherapy is promising for esophageal cancer. Pembrolizumab has shown superior effectiveness in improving survival rates when combined with chemotherapy for esophageal cancer. Lenvatinib, when used with Pembrolizumab, has been more effective than when used alone. This combination is approved for treating advanced esophageal cancer, indicating its potential benefits. ^{2 9 10 11 12}

Research Team

Medical Director

Principal Investigator

Merck Sharp & Dohme LLC

Eligibility Criteria

This trial is for adults with metastatic squamous cell carcinoma of the esophagus. Participants must have controlled blood pressure, adequate organ function, and agree to contraception if applicable. Exclusions include adenocarcinoma of the esophagus, significant bleeding risks, recent major surgery or radiotherapy, active infections like Hepatitis B/C or HIV, weight loss over 20% in last 3 months, and certain cardiovascular diseases.

Inclusion Criteria

My organs are functioning well.

My blood pressure is 150/90 or lower, and my medication hasn't changed in the last week.

I am not pregnant, breastfeeding, and if able to have children, I use effective birth control or practice abstinence.

Exclusion Criteria

I have received treatment for advanced esophageal cancer that cannot be surgically removed.

I have cancer that has spread to my brain or spinal cord.

I have had serious heart problems in the last year.

Treatment Details

Interventions

• 5-FU (Fluoropyrimidine-based Chemotherapy)
• Cisplatin (Platinum-based Chemotherapy)
• Lenvatinib (Tyrosine Kinase Inhibitor)
• Oxaliplatin (Platinum-based Chemotherapy)
• Paclitaxel (Taxane-based Chemotherapy)
• Pembrolizumab (Monoclonal Antibodies)

Trial Overview The study tests pembrolizumab plus lenvatinib with chemotherapy against pembrolizumab with chemotherapy alone in first-line treatment for metastatic esophageal cancer. The goal is to see which combination improves overall survival (OS) and progression-free survival (PFS) better.

Participant Groups

Group I: Part 2: Pembrolizumab + Lenvatinib + Chemotherapy Experimental Treatment 8 Interventions

In the induction phase, participants receive pembrolizumab 400mg intravenously (IV) every 6 weeks (Q6W) for 2 cycles (each cycle length = 6 weeks) plus Lenvatinib 8 mg orally (PO) once daily (QD) plus chemotherapy with FP (cisplatin 80 mg/m\^2 and 5-FU 4000 mg/m\^2) or TP (paclitaxel 175 mg/m\^2 and cisplatin 75 mg/m\^2) IV every 3 weeks for 4 administrations or mFOLFOX6 (oxaliplatin 85 mg/m\^2, 5-FU 400 mg/m\^2 followed by 2400 mg/m\^2, and leucovorin 400 mg/m\^2 \[or levoleucovorin 200 mg/m\^2\] once every 2 weeks \[Q2W\] for 6 administrations at the investigator's discretion (approximately 12 weeks). In the consolidation phase, participants receive pembrolizumab 400 mg IV Q6W for 16 cycles (each cycle length = 6 weeks) and Lenvatinib 20 mg PO until progressive disease or discontinuation (approximately 96 weeks).

Group II: Part 1: Pembrolizumab + Lenvatinib + Chemotherapy Experimental Treatment 5 Interventions

In the induction phase, participants receive pembrolizumab 400mg intravenously (IV) every 6 weeks (Q6W) for 2 cycles (each cycle length = 6 weeks) plus Lenvatinib 8 mg orally (PO) once daily (QD) plus chemotherapy with FP (cisplatin 80 mg/m\^2 and 5-FU 400 mg/m\^2 followed by 2400 mg/m\^2) or TP (paclitaxel 175 mg/m\^2 and cisplatin 75 mg/m\^2) IV every 3 weeks for 4 administrations at the investigator's discretion (approximately 12 weeks). In the consolidation phase, participants receive pembrolizumab 400 mg IV Q6W for 16 cycles (each cycle length = 6 weeks) and Lenvatinib 20 mg PO until progressive disease or discontinuation (approximately 96 weeks).

Group III: Part 2: Pembrolizumab + Chemotherapy Active Control 6 Interventions

Participants receive pembrolizumab 400 mg IV every 6 weeks for 18 cycles (each cycle length = 6 weeks, approximately 2 years) plus chemotherapy with FP (cisplatin 80 mg/m\^2 IV Q3W for up to 6 administrations \[up to \~18 weeks\] and 5-FU 4000 mg/m\^2 IV Q3W for up to 35 administrations \[up to \~2 years\]) or TP (paclitaxel 175 mg/m\^2 and cisplatin 75 mg/m\^2 Q3W for up 6 administrations \[up to \~18 weeks\]) or in combination with mFOLFOX6 (oxaliplatin 85 mg/m\^2, 5-FU 400 mg/m\^2 followed by 2400 mg/m\^2 and leucovorin 400 mg/m\^2 \[or levoleucovorin 200 mg/m\^2\] IV Q2W for up to 52 administrations \[approximately 2 years\]).

5-FU is already approved in Canada, Japan for the following indications:

Approved in Canada as Fluorouracil for:

• Colorectal cancer
• Breast cancer
• Stomach cancer
• Pancreatic cancer

Approved in Japan as Fluorouracil for:

• Colorectal cancer
• Breast cancer
• Stomach cancer
• Pancreatic cancer

Who Is Running the Clinical Trial?

Merck Sharp & Dohme Corp.

Lead Sponsor

Trials

2,287

Recruited

4,582,000+

Chirfi Guindo

Merck Sharp & Dohme Corp.

Chief Medical Officer

Engineering degree from Ecole Centrale de Paris, MBA from New York University Stern School of Business

Robert M. Davis

Merck Sharp & Dohme Corp.

Chief Executive Officer since 2021

J.D. from Northwestern University Pritzker School of Law, MBA from Northwestern University Kellogg Graduate School of Management, Bachelor's in Finance from Miami University

Merck Sharp & Dohme LLC

Lead Sponsor

Trials

4,096

Recruited

5,232,000+

Chirfi Guindo

Merck Sharp & Dohme LLC

Chief Marketing Officer since 2022

Degree in Engineering from Ecole Centrale de Paris, MBA from New York University Stern School of Business

Robert M. Davis

Merck Sharp & Dohme LLC

Chief Executive Officer since 2021

JD from Northwestern University Pritzker School of Law, MBA from Northwestern University Kellogg Graduate School of Management, Bachelor's in Finance from Miami University

Eisai Inc.

Industry Sponsor

Trials

524

Recruited

161,000+

Founded

Eisai Inc. was established in 1995 as the U.S. subsidiary of Eisai Co., Ltd.

Headquarters

Woodcliff Lake, NJ, USA

Known For

Neurology and Oncology

Top Products

Aricept (donepezil), Lenvima (lenvatinib), Leqembi (lecanemab), Halaven (eribulin)

Lynn Kramer

Eisai Inc.

Chief Medical Officer since 2019

MD

Tatsuyuki Yasuno

Eisai Inc.

Chief Executive Officer since 2023

MBA from Kellogg School of Management, Northwestern University; Bachelor of Political Science from Waseda University

Findings from Research

Esophageal cancer is rapidly increasing in the U.S. and is aggressive, with poor survival rates from traditional treatments like surgery or chemoradiation alone.

New trials at Memorial Sloan-Kettering Cancer Center are exploring the use of weekly paclitaxel/cisplatin and irinotecan/cisplatin, which may reduce gastrointestinal toxicity while maintaining efficacy, compared to traditional cisplatin/5-FU regimens.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combined modality therapy in esophageal cancer: the Memorial experience. Anderson, SE., Minsky, BD., Bains, M., et al.[2018]

Esophageal cancer, particularly adenocarcinoma, is increasingly common, with over half of patients presenting with metastatic disease, making palliative chemotherapy a crucial treatment option.

Recent studies show that weekly irinotecan and cisplatin is a highly effective and less toxic regimen for treating both adenocarcinoma and squamous cell carcinoma, while paclitaxel also shows promise with minimal side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chemotherapy in esophageal cancer. Enzinger, PC., Ilson, DH., Kelsen, DP.[2022]

In a study of 28 patients with unresectable or recurrent esophageal squamous cell carcinoma (ESCC), the combination of S-1 and paclitaxel (S1/PTX) showed a response rate of 14.8%, with a median overall survival time of 306 days, indicating some clinical efficacy in this difficult-to-treat population.

While S1/PTX was generally well-tolerated, severe neutropenia occurred in 13 patients, highlighting the need for monitoring blood counts during treatment, although most non-hematological side effects were mild.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Trial of S-1 and Paclitaxel in Unresectable or Postoperative Recurrent Esophageal Squamous Cell Carcinoma Pretreated by Fluorouracil, Cisplatin, and Docetaxel Chemotherapy. Nakajima, Y., Kawada, K., Tokairin, Y., et al.[2019]

The combination of Nedaplatin and 5-fluorouracil (5FU) showed a response rate of 60% in assessable patients and 52.9% in all patients with advanced esophageal cancer, indicating significant efficacy in treating this condition.

The treatment was generally safe, with only three cases of grade 3 toxicity reported, suggesting that the combination therapy is well tolerated by patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A new combination chemotherapy with cis-diammine-glycolatoplatinum (Nedaplatin) and 5-fluorouracil for advanced esophageal cancers. Yoshioka, T., Gamoh, M., Shineha, R., et al.[2019]

In a meta-analysis of 1231 patients, pembrolizumab and paclitaxel showed no significant difference in effectiveness for treating advanced gastroesophageal cancer, with similar objective response rates.

Both treatments can be considered viable options for patients, as they provide comparable time to response and similar rates of partial response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pembrolizumab versus paclitaxel for previously treated, advanced gastro-esophageal junction cancer: A systematic review and meta-analysis of randomized clinical trials. Swed, S., Shaheen, N., Hafez, W., et al.[2022]

In a feasibility study involving 16 patients with oesophageal cancer, the combination of paclitaxel, cisplatin, and 5-fluorouracil (5-FU) showed significant activity, with 25% of patients achieving pathological complete remission after surgery.

However, the treatment regimen resulted in high levels of toxicity, with 62.5% of patients experiencing severe side effects, leading to the conclusion that this specific dosing schedule is not safe for routine clinical use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot study of preoperative combined modality treatment for locally advanced operable oesophageal carcinoma: toxicities and long-term outcome. Mukherjee, S., Abraham, J., Brewster, A., et al.[2019]

In a study of 22 patients with advanced esophageal squamous cell cancer, a chemotherapy regimen combining continuous infusional paclitaxel and 5-FU resulted in a promising overall response rate of 68.2%, with 2 complete responses and 9 partial responses.

The treatment was well-tolerated, with manageable side effects such as marrow depression, alopecia, and fatigue, indicating that this low-dose continuous infusion approach could be a safe option for patients who are not candidates for surgery or radiation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase II study on continuous infusional paclitaxel and 5-Fu as first-line chemotherapy for patients with advanced esophageal cancer. Gu, M., Li, SY., Huang, XE., et al.[2022]

In a phase II trial involving 61 patients with advanced esophageal cancer, the combination of paclitaxel, cisplatin, and fluorouracil (5-FU) demonstrated significant antitumor activity, achieving a 48% overall response rate and a notable 20% complete response rate in patients with squamous cell carcinoma.

While the treatment showed substantial efficacy, it also resulted in severe but manageable toxicity, with 46% of patients requiring dose adjustments and 48% needing hospitalization due to side effects, highlighting the need for further optimization of dosing and scheduling.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase II trial of paclitaxel, fluorouracil, and cisplatin in patients with advanced carcinoma of the esophagus. Ilson, DH., Ajani, J., Bhalla, K., et al.[2022]

Nivolumab and pembrolizumab, both PD-1 inhibitors, have shown improved overall survival in patients with esophageal cancer, particularly in trials like ATTRACTION-3 and KEYNOTE-181, which involved patients with esophageal squamous cell carcinoma and those with high PD-L1 expression, respectively.

Ongoing trials are exploring the effectiveness of combining immune checkpoint inhibitors with traditional chemotherapy and radiotherapy, which may lead to better treatment options and outcomes for esophageal cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immuno-oncology for esophageal cancer. Yamamoto, S., Kato, K.[2021]

In a phase III trial (KEYNOTE-590), pembrolizumab combined with cisplatin and fluorouracil (FP) showed superior efficacy compared to FP alone for treating advanced esophageal cancer, resulting in a mean gain of 0.86 life-years and 0.77 quality-adjusted life-years (QALYs).

The cost-effectiveness analysis indicated that pembrolizumab plus FP is a viable treatment option, with an incremental cost-effectiveness ratio of $147,097 per QALY, which is acceptable given the willingness-to-pay threshold of $150,000 per QALY in the US healthcare system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cost Effectiveness of Adding Pembrolizumab to Platinum and Fluoropyrimidine-Based Chemotherapy as First-Line Treatment for Advanced Esophageal Cancer: A US Healthcare Payer's Perspective. Qu, T., Zhang, S., Zhong, Y., et al.[2022]

Pembrolizumab (Keytruda) is an approved treatment for metastatic or locally advanced esophageal and gastroesophageal junction cancer, indicating its efficacy in targeting these specific cancer types.

It is used in combination with platinum- and fluoropyrimidine-based chemotherapy, suggesting a synergistic approach to enhance treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pembrolizumab Approved for Esophageal or Gastroesophageal Cancer. Aschenbrenner, DS.[2023]

A 65-year-old female patient with metastatic endometrial cancer developed grade 2 esophagitis likely related to lenvatinib treatment, which was characterized by dysphagia and mucosal lacerations in the esophagus.

The patient's symptoms improved significantly after stopping lenvatinib and starting a proton pump inhibitor (PPI), allowing for a successful resumption of lenvatinib at a reduced dose without recurrence of esophagitis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Esophagitis as a complication of the combination of lenvatinib and pembrolizumab for advanced endometrial cancer: A case report. Fellouah, M., Auclair, MH., Fortin, S., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Combined modality therapy in esophageal cancer: the Memorial experience. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Chemotherapy in esophageal cancer. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

A Pilot Trial of S-1 and Paclitaxel in Unresectable or Postoperative Recurrent Esophageal Squamous Cell Carcinoma Pretreated by Fluorouracil, Cisplatin, and Docetaxel Chemotherapy. [2019]

4. Japan pubmed.ncbi.nlm.nih.gov

A new combination chemotherapy with cis-diammine-glycolatoplatinum (Nedaplatin) and 5-fluorouracil for advanced esophageal cancers. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Pembrolizumab versus paclitaxel for previously treated, advanced gastro-esophageal junction cancer: A systematic review and meta-analysis of randomized clinical trials. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Pilot study of preoperative combined modality treatment for locally advanced operable oesophageal carcinoma: toxicities and long-term outcome. [2019]

7. Thailand pubmed.ncbi.nlm.nih.gov

A phase II study on continuous infusional paclitaxel and 5-Fu as first-line chemotherapy for patients with advanced esophageal cancer. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Phase II trial of paclitaxel, fluorouracil, and cisplatin in patients with advanced carcinoma of the esophagus. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Immuno-oncology for esophageal cancer. [2021]

10. New Zealand pubmed.ncbi.nlm.nih.gov

Cost Effectiveness of Adding Pembrolizumab to Platinum and Fluoropyrimidine-Based Chemotherapy as First-Line Treatment for Advanced Esophageal Cancer: A US Healthcare Payer's Perspective. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Pembrolizumab Approved for Esophageal or Gastroesophageal Cancer. [2023]

12. Netherlands pubmed.ncbi.nlm.nih.gov

Esophagitis as a complication of the combination of lenvatinib and pembrolizumab for advanced endometrial cancer: A case report. [2023]