Efficacy and Safety of Pembrolizumab (MK-3475) Plus Enzalutamide Plus Androgen Deprivation Therapy (ADT) Versus Placebo Plus Enzalutamide Plus ADT in Participants With Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) (MK-3475-991/KEYNOTE-991)
Metastatic Hormone-Sensitive Prostate Cancer
About this trial
This is an interventional treatment trial for Metastatic Hormone-Sensitive Prostate Cancer focused on measuring Programmed Cell Death-1 (PD1, PD-1),, Programmed Death-Ligand 1 (PDL1, PD-L1)
Eligibility Criteria
Inclusion Criteria:
- Male participants with histologically- or cytologically-confirmed adenocarcinoma of the prostate without small cell histology
- Has metastatic disease assessed by investigator and verified by BICR by either ≥2 bone lesions on bone scan and/or visceral disease by computed tomography/magnetic resonance imaging (CT/MRI)
- Willing to maintain continuous ADT with a LHRH agonists or antagonists during study treatment or have a history of bilateral orchiectomy
- Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 assessed within 10 days of randomization
- Participants receiving bone resorptive therapy (including, but not limited to, bisphosphonate or denosumab) must have been on stable doses prior to randomization
- Has adequate organ function
- Has provided newly obtained core or excisional biopsy (obtained within 12 months of screening) from soft tissue not previously irradiated (samples from tumors progressing in a prior site of radiation are allowed). Participants with bone only or bone predominant disease may provide a bone biopsy sample
- Male participants must agree to the following during the intervention period and for at least 120 days after the last dose of study intervention: Refrain from donating sperm PLUS either be abstinent from heterosexual intercourse and agree to remain abstinent OR agree to use contraception, unless confirmed to be azoospermic
- Male participants must agree to use male condom when engaging in any activity that allows for passage of ejaculate to another person of any sex
Exclusion Criteria:
- Has a known additional malignancy that is progressing or has required active treatment in the last 3 years
- Has an active autoimmune disease that has required systemic treatment in past 2 years
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
- Has undergone major surgery including local prostate intervention (excluding prostate biopsy) within 28 days prior to randomization and not recovered adequately from the toxicities and/or complications
- Has a gastrointestinal disorder affecting absorption or is unable to swallow tablets/capsules
- Has an active infection (including tuberculosis) requiring systemic therapy
- Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis
- Has known active human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) infection
- Has known or suspected central nervous system (CNS) metastases and/or carcinomatous meningitis
- Has a history of seizure or any condition that may predispose to seizure
- Has a history of loss of consciousness within 12 months of screening
- Has had myocardial infarction or uncontrolled angina within 6 months prior to randomization, or has New York Heart Association class III or IV congestive heart failure or a history of New York Heart Association class III or IV congestive heart failure
- Has hypotension (systolic blood pressure <86 millimeters of mercury [mmHg]) or uncontrolled hypertension (systolic blood pressure >170 mmHg or diastolic blood pressure >105 mmHg) at the screening visit
- Has a history of clinically significant ventricular arrhythmias
- Has hypersensitivity to pembrolizumab and/or enzalutamide and/or any of their excipients
- Has received prior ADT as neoadjuvant/adjuvant therapy for non-metastatic prostate cancer for >39 months in duration or within 9 months prior to randomization or with evidence of disease progression while receiving ADT
- Has had prior treatment with a next generation hormonal agent (eg, abiraterone, enzalutamide, apalutamide, darolutamide)
- Has received prior therapy with an anti-programmed cell death-1 (anti-PD-1), anti-programmed cell death-ligand 1 (anti-PD-L1), or anti PD-L2 agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor
- Has received a live vaccine within 30 days prior to randomization
- Has a "superscan" bone scan
- Has had an allogenic tissue/solid organ transplant
- Is 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 study treatment
Has received any prior pharmacotherapy, radiation therapy or surgery for metastatic prostate cancer with the following exceptions:
- Up to 3 months of ADT or orchiectomy with or without concurrent first-generation antiandrogens, if patient was not treated with docetaxel
- May have 1 course of palliative radiation or surgical therapy to treat symptoms resulting from metastatic disease if it was administered at least 4 weeks prior to randomization
- For participants with low volume metastatic disease, may have 1 course of definitive radiotherapy if it was administered at least 4 weeks prior to randomization
- Up to 6 cycles of docetaxel therapy with final treatment administration completed within 2 months of randomization and no evidence of disease progression. In these participants up to 6 months of ADT permitted
Sites / Locations
- Alaska Clinical Research Center ( Site 0274)
- Providence Alaska Medical Center ( Site 0276)
- City of Hope Medical Center ( Site 0217)
- UCLA Hematology/Oncology - Santa Monica ( Site 0241)
- University of Colorado, Anschutz Cancer Pavilion ( Site 0236)
- Hartford HealthCare Medical Group ( Site 0212)
- Smilow Cancer Center at Yale-New Haven ( Site 0250)
- Sibley Memorial Hospital ( Site 0275)
- Winship Cancer Institute of Emory University ( Site 0209)
- The University of Chicago ( Site 0264)
- Springfield Clinic [Springfield, IL] ( Site 0240)
- Cotton-O'Neil Cancer Center ( Site 0228)
- The Sidney Kimmel Comprehensive Cancer Center ( Site 0204)
- St. Vincent Frontier Cancer Center-Research ( Site 0213)
- Comprehensive Cancer Centers of Nevada ( Site 0269)
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health ( Site 0270)
- Weill Cornell Medical College ( Site 0263)
- Associated Medical Professionals of NY ( Site 0251)
- Duke University ( Site 0206)
- Tri-State Urologic Services PSC, Inc. ( Site 0253)
- MidLantic Urology ( Site 0273)
- Ralph H. Johnson VA Center ( Site 0256)
- Carolina Urologic Research Center ( Site 0259)
- Urology Associates [Nashville, TN] ( Site 0233)
- Inova Health System ( Site 0205)
- Urology of Virginia ( Site 0224)
- Seattle Cancer Care Alliance ( Site 0258)
- Chris OBrien Lifehouse ( Site 0300)
- Port Macquarie Base Hospital ( Site 0301)
- Riverina Cancer Care Center ( Site 0302)
- Gallipoli Medical Research Foundation ( Site 0309)
- John Flynn Hospital & Medical Centre ( Site 0308)
- Box Hill Hospital ( Site 0304)
- Monash Health ( Site 0305)
- Peter MacCallum Cancer Centre ( Site 0306)
- Fiona Stanley Hospital ( Site 0311)
- Ordensklinikum Linz GmbH Elisabethinen ( Site 0901)
- Landeskrankenhaus Salzburg - Universitatklinikum der PMU ( Site 0900)
- Krankenhaus der Barmherzigen Brüder Wien ( Site 0904)
- Medizinische Universitaet Wien ( Site 0903)
- Oncocentro Ceara ( Site 2309)
- Instituto de Cancer e Transplante de Curitiba ICTR ( Site 2306)
- Hospital Sao Vicente de Paulo ( Site 2303)
- Hospital de Clinicas de Porto Alegre ( Site 2304)
- Clinica de Oncologia Reichow ( Site 2308)
- Fundacao Dr Amaral Carvalho ( Site 2302)
- Instituto do Cancer do Estado de Sao Paulo - ICESP ( Site 2305)
- The Ottawa Hospital ( Site 0100)
- Niagara Health System - St. Catharines ( Site 0107)
- CISSS de la Monteregie-Centre ( Site 0105)
- Centre Hospitalier de l Universite de Montreal - CHUM ( Site 0109)
- CIUSSS Ouest de l Ile - St-Mary s Hospital ( Site 0106)
- CHUQ-Univ Laval-Hotel Dieu de Quebec ( Site 0101)
- Centro Investigación del Cáncer James Lind ( Site 2401)
- IC La Serena Research ( Site 2406)
- Clinica Universidad Catolica del Maule ( Site 2407)
- Clinica Alemana ( Site 2408)
- Pontificia Universidad Catolica de Chile ( Site 2402)
- Sociedad Medica Aren y Bachero Limitada ( Site 2403)
- Oncocentro ( Site 2400)
- Peking University First Hospital ( Site 0800)
- Zhejiang Provincial People's Hospital ( Site 0809)
- The First Affiliated Hospital of Wenzhou Medical University ( Site 0834)
- Institucion Prestadora de Servicios de Salud Clinica de la Costa LTDA ( Site 2504)
- Sociedad de Oncología Y Hematología del Cesar S.A.S. ( Site 2509)
- Administradora Country SA - Clinica del Country ( Site 2507)
- Instituto Nacional de Cancerologia E.S.E ( Site 2506)
- Hemato Oncologos ( Site 2503)
- Rigshospitalet ( Site 1005)
- Herlev og Gentofte Hospital. ( Site 1004)
- Aalborg Universitetshospital ( Site 1000)
- Odense Universitetshospital ( Site 1003)
- Vejle Sygehus ( Site 1002)
- Keski-Suomen keskussairaala ( Site 1017)
- Tampereen yliopistollinen sairaala ( Site 1022)
- HYKS ( Site 1020)
- TYKS T-sairaala Syopatautien pkl ( Site 1019)
- Centre Leon-Berard ( Site 1110)
- Institut de cancérologie Strasbourg Europe (ICANS) ( Site 1114)
- CHU de Brest -Site Hopital Morvan ( Site 1103)
- Centre Georges Francois Leclerc ( Site 1112)
- CHU-Jean Minjoz ( Site 1101)
- Institut Bergonie ( Site 1104)
- Hopital Foch ( Site 1105)
- C.H.R.U. de Rennes. Hopital de Pontchaillou ( Site 1117)
- Institut Jean Godinot-Clinical Research Unit ( Site 1118)
- Centre D Oncologie de Gentilly ( Site 1107)
- Centre Bourgogne ( Site 1119)
- Hospices Civils de Lyon Centre Hospitalier Lyon Sud ( Site 1102)
- Hopital Henri Mondor ( Site 1116)
- Universitaetsklinikum Freiburg ( Site 1200)
- Klinikum der Universitaet Muenchen - Grosshadern ( Site 1210)
- Klinikum Rechts der Isar ( Site 1206)
- Klinikum Nuernberg Nord ( Site 1213)
- Staedtisches Klinikum Braunschweig gGmbH ( Site 1217)
- Universitaetsklinikum Magdeburg A.o.R. ( Site 1211)
- Universitaetsklinikum der Technischen Universitaet Dresden ( Site 1204)
- Charite Universitaetsmedizin Berlin ( Site 1201)
- Universitaetsklinikum Hamburg-Eppendorf ( Site 1212)
- Cork University Hospital ( Site 1304)
- Beaumont Hospital ( Site 1302)
- Tallaght University Hospital ( Site 1301)
- St Vincents University Hospital ( Site 1300)
- University Hospital Limerick ( Site 1305)
- University Hospital Waterford ( Site 1303)
- Rambam Medical Center ( Site 1400)
- Hadassah Ein Kerem Medical Center ( Site 1404)
- Meir Medical Center ( Site 1401)
- Rabin Medical Center ( Site 1402)
- Sourasky Medical Center ( Site 1403)
- Assaf Harofeh Medical Center ( Site 1405)
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori ( Site 1503)
- Istituto Clinico Humanitas Research Hospital ( Site 1500)
- Centro Di Riferimento Oncologico ( Site 1511)
- IRCCS Giovanni Paolo II. Ospedale Oncologico ( Site 1509)
- Azienda Ospedaliera Cannizzaro ( Site 1501)
- Istituto Nazionale dei Tumori ( Site 1510)
- Istituto Nazionale Tumori IRCCS Fondazione Pascale ( Site 1508)
- Fondazione Policlinico Universitario A. Gemelli ( Site 1512)
- Azienda Ospedaliera Santa Maria ( Site 1502)
- A.O. Verona-Ospedale Civile Maggiore Borgo-Trento ( Site 1504)
- Toho University Sakura Medical Center ( Site 0732)
- Ehime University Hospital ( Site 0745)
- Sapporo Medical University Hospital ( Site 0730)
- Kitasato University Hospital ( Site 0734)
- Yokohama City University Medical Center ( Site 0735)
- Nara Medical University Hospital ( Site 0744)
- Kindai University Hospital ( Site 0743)
- Osaka University Hospital ( Site 0742)
- Saitama Medical University International Medical Center ( Site 0737)
- Dokkyo Medical University Saitama Medical Center ( Site 0736)
- Hamamatsu University Hospital ( Site 0748)
- Yamaguchi University Hospital ( Site 0746)
- Chiba Cancer Center ( Site 0733)
- Harasanshin Hospital ( Site 0747)
- Nagano Municipal Hospital ( Site 0731)
- Osaka City University Hospital ( Site 0741)
- Toranomon Hospital ( Site 0740)
- Nippon Medical School Hospital ( Site 0738)
- Tokyo Women's Medical University Hospital ( Site 0739)
- Chonnam National University Hwasun Hospital ( Site 0406)
- National Cancer Center ( Site 0400)
- Seoul National University Bundang Hospital ( Site 0401)
- Kyungpook National University Chilgok Hospital ( Site 0404)
- Seoul National University Hospital ( Site 0405)
- Severance Hospital Yonsei University Health System ( Site 0402)
- Asan Medical Center ( Site 0403)
- Hospital San Lucas Cardiologica del Sureste ( Site 2606)
- Hospital Civil de Guadalajara Fray Antonio Alcalde ( Site 2607)
- Centro Estatal de Cancerologia de Chihuahua ( Site 2608)
- Grupo Medico Camino SC ( Site 2613)
- Centro Oncologico Internacional. SEDNA ( Site 2609)
- Boca Raton Clinical Research QTO ( Site 2611)
- Radboud University Medical Center ( Site 1606)
- Antoni van Leeuwenhoek Ziekenhuis ( Site 1603)
- Vrije Universiteit Medisch Centrum ( Site 1601)
- Isala Klinieken, Locatie Sophia ( Site 1604)
- Meander Medisch Centrum ( Site 1602)
- Franciscus Gasthuis en Vlietland ( Site 1605)
- St. Antonius Ziekenhuis ( Site 1600)
- Auckland City Hospital ( Site 0321)
- Hospital Nacional Carlos Alberto Seguin Escobedo ESSALUD ( Site 2700)
- Clinica Peruano Americana S.A. ( Site 2702)
- Hospital Nacional Guillermo Almenara Irigoyen ( Site 2708)
- Instituto de Oncologia y Radioterapia Clinica Ricardo Palma ( Site 2706)
- Hospital Militar Central [Lima, Peru] ( Site 2704)
- Szpital Uniwersytecki nr 1 im. Dr. Antoniego Jurasza w Bydgoszczy ( Site 1720)
- Centrum Onkologii im. Prof. Franciszka Lukaszczyka ( Site 1716)
- Nasz Lekarz Przychodnie Medyczne ( Site 1718)
- Szpital Uniwersytecki w Krakowie ( Site 1707)
- Radomskie Centrum Onkologii ( Site 1701)
- Wojewodzki Szpital im. Sw. Ojca Pio w Przemyslu ( Site 1700)
- Wojewodzki Szpital Specjalistyczny nr 4 w Bytomiu ( Site 1717)
- Szpital Kliniczny im. Przemienienia Panskiego Uniwersytetu Medycznego im. K. Marcinkowskiego w Pozna
- Szpital Wojewodzki im. Mikolaja Kopernika ( Site 1709)
- Twoja Przychodnia - Szczeciskie Centrum Medyczne ( Site 1721)
- Krasnoyarsk Regional Clinical Oncological Dispensary ( Site 1810)
- SBIH City clinical hospital named after D.D. Pletniov ( Site 1813)
- Russian Scientific Center of Roentgenoradiology ( Site 1800)
- Volga District Medical Center Federal Medical and Biological Agency ( Site 1805)
- Omsk Clinical Oncology Dispensary ( Site 1809)
- Instituto Catalan de Oncologia - ICO ( Site 1901)
- Hospital Josep Trueta ( Site 1900)
- Hospital Universitario Lucus Augusti ( Site 1905)
- Hospital Universitario Ramon y Cajal ( Site 1902)
- Hospital Clinico San Carlos ( Site 1906)
- Hospital 12 de Octubre de Madrid ( Site 1903)
- Hospital Virgen de la Macarena ( Site 1904)
- Kantonsspital Graubuenden ( Site 2003)
- Kantonsspital St. Gallen ( Site 2000)
- CHUV (centre hospitalier universitaire vaudois) ( Site 2002)
- Universitaetsspital Zuerich ( Site 2001)
- Kaohsiung Chang Gung Memorial Hospital ( Site 0504)
- National Cheng Kung University Hospital ( Site 0503)
- National Taiwan University Hospital ( Site 0500)
- Taipei Veterans General Hospital ( Site 0501)
- Chang Gung Medical Foundation. Linkou ( Site 0502)
- Chulalongkorn Hospital, Medical Oncology Unit ( Site 0600)
- Ramathibodi Hospital. ( Site 0601)
- Faculty of Medicine Siriraj Hospital ( Site 0602)
- Srinagarind Hospital ( Site 0604)
- Acibadem Adana Hastanesi ( Site 2106)
- Ankara Universitesi Tip Fakultesi. ( Site 2101)
- Hacettepe Universitesi Tıp Fakultesi ( Site 2105)
- Ankara Sehir Hastanesi ( Site 2103)
- Istanbul Uni. Cerrahpasa Tip Fakultesi ( Site 2100)
- Ege University Medical Faculty Tulay Aktas Oncology Hospital ( Site 2102)
- Konya Necmettin Erbakan University Medical Faculty ( Site 2104)
- Aberdeen Royal Infirmary ( Site 1315)
- Royal Cornwall Hospitals NHS Trust ( Site 1317)
- University College London Hospitals NHS Foundation Trust ( Site 1320)
- Royal Marsden NHS Foundation Trust ( Site 1318)
- Velindre Cancer Centre Hospital ( Site 1322)
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Pembrolizumab + Enzalutamide + ADT
Placebo + Enzalutamide + ADT
Starting on Day 1 of each 21-day cycle, participants receive 200 mg pembrolizumab IV every 3 weeks (Q3W) for up to 35 cycles (approximately 2 years), plus 160 mg enzalutamide taken orally once daily, while maintaining continuous ADT with a luteinizing-hormone releasing hormone (LHRH) agonist or antagonist during study treatment. Participants will continue to receive enzalutamide and ADT until criteria for discontinuation are met.
Starting on Day 1 of each 21-day cycle, participants receive placebo IV Q3W for up to 35 cycles (approximately 2 years), plus 160 mg enzalutamide taken orally once daily, while maintaining continuous ADT with a LHRH agonist or antagonist during study treatment. Participants will continue to receive enzalutamide and ADT until criteria for discontinuation are met.