Pembrolizumab (MK-3475) Plus Chemotherapy Versus Placebo Plus Chemotherapy in Participants Gastric or Gastroesophageal Junction (GEJ) Adenocarcinoma (MK-3475-859/KEYNOTE-859)
Stomach Neoplasms
About this trial
This is an interventional treatment trial for Stomach Neoplasms focused on measuring programmed cell death 1 (PD-1, PD1), programmed cell death ligand 1 (PD-L1, PDL1), programmed cell death ligand 2 (PD-L2, PDL2)
Eligibility Criteria
Inclusion Criteria
- Has histologically or cytologically confirmed diagnosis of locally advanced unresectable or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma with known programmed cell death ligand 1 (PD-L1) expression status
- Has human epidermal growth factor receptor 2 (HER2) negative cancer
- Male Participants must agree to use contraception during the treatment period and through 95 days after the last dose of chemotherapy refrain from donating sperm and be abstinent from heterosexual intercourse as their preferred and usual lifestyle and agree to remain abstinent or must agree to use contraception per study protocol unless confirmed to be azoospermic during this period
- Female Participants who are not pregnant, not breastfeeding, and at least one of the following conditions applies: not a woman of childbearing potential (WOCBP) OR is a WOCBP who agrees to use contraception or be abstinent from heterosexual intercourse as their preferred and usual lifestyle during the treatment period and through 180 days after the last dose of chemotherapy or through 120 days after the last dose of pembrolizumab, whichever is last, and agrees not to donate eggs to others or freeze/store for her own use for the purpose of reproduction during this period
- Has measurable disease per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by investigator assessment
- Has provided archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated
- Has provided tumor tissue sample deemed adequate for PD-L1 biomarker analysis
- Has provided tumor tissue sample for microsatellite instability (MSI) biomarker analysis
- Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 3 days prior to the start of study intervention
- Has adequate organ function as demonstrated by laboratory testing within 10 days prior to the start of study treatment
Exclusion Criteria
- Has squamous cell or undifferentiated gastric cancer
- Has had major surgery, open biopsy, or significant traumatic injury within 28 days prior to randomization, anticipation of the need for major surgery during the course of study intervention, or has not recovered adequately from the toxicity and/or complications from previous surgery
- Has preexisting peripheral neuropathy >Grade 1
- Is a WOCBP who has a positive urine pregnancy test within 24 hours for urine or within 72 hours for serum prior to randomization or treatment allocation
- Has had previous therapy for locally advanced, unresectable or metastatic gastric/GEJ cancer. Participants may have received prior neoadjuvant and/or adjuvant therapy as long as it was completed ≥6 months prior to randomization
- 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 (e.g., cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), OX- 40, CD137)
- Has received prior systemic anticancer therapy including investigational agents within 4 weeks prior to randomization or has not recovered from all AEs due to any previous therapies to ≤Grade 1 or baseline
- Has received prior radiotherapy within 2 weeks prior to study start or has not recovered from all previous radiation-related toxicities, required corticosteroids, and have not had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤2 weeks of radiotherapy) to non central nervous system (CNS) disease
- Has received a live or live-attenuated vaccine within 30 days prior to 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 or any other form of immunosuppressive therapy within 7 days prior to the first dose of study treatment
- Has a known additional malignancy that is progressing or has required active treatment within the past 5 years with the exception of basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (eg, breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy
- Has known active CNS metastases and/or carcinomatous meningitis
- Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients
- Has an active autoimmune disease that has required systemic treatment in past 2 years
- Has a history of (non-infectious) 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 Hepatitis C virus [HCV] ribonucleic acid [RNA] detected qualitatively) infection
- Has a known history of active tuberculosis
- Has hypokalemia (serum potassium less than the lower limit of normal)
- Has hypomagnesemia (serum magnesium less than the lower limit of normal)
- Has hypocalcemia (serum calcium less than the lower limit of normal)
- Has a history or current evidence of any condition (eg, known deficiency of the enzyme dihydropyrimidine dehydrogenase), 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 a known psychiatric or substance abuse disorder that would interfere with the participant's ability to cooperate 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 180 days after the last dose of chemotherapy or through 120 days after the last dose of pembrolizumab, whichever is last
- Has had an allogenic tissue/solid organ transplant
- Has a known severe hypersensitivity (≥ Grade 3) to any of the study chemotherapy agents (including, but not limited to, infusional 5-fluorouracil or oral capecitabine) and/or to any of their excipients
- For participants taking cisplatin: has Grade ≥2 audiometric hearing loss
Sites / Locations
- UCLA Hematology/Oncology - Westwood (Building 200 Suite 120) ( Site 0124)
- UC Irvine Health/Division of Hematology Oncology, Dept of Medicine ( Site 0128)
- University of Miami, Sylvester Comprehensive Cancer Center ( Site 0113)
- Greater Baltimore Medical Center ( Site 0102)
- Minnesota Oncology Hematology, PA ( Site 8000)
- University of Rochester ( Site 0122)
- Cancer Treatment Centers of America - Philadelphia ( Site 0112)
- Allegheny General Hospital ( Site 0118)
- Oncology & Hematology Assoc. SW Virginia, Inc., DBA Blue Ridge Cancer Care ( Site 8001)
- Wenatchee Valley Clinic [Wenatchee, WA] ( Site 0116)
- Instituto Medico Alexander Fleming ( Site 0307)
- Instituto de Investigaciones Metabolicas ( Site 0312)
- Fundacion Favaloro - Hospital Universitario ( Site 0302)
- Centro Oncologico Riojano Integral ( Site 0313)
- Instituto San Marcos ( Site 0311)
- Liverpool Hospital ( Site 2301)
- Southern Medical Day Care Centre ( Site 2303)
- Box Hill Hospital ( Site 2300)
- Instituto do Cancer do Ceara ( Site 0407)
- CIONC - Centro Integrado de Oncologia de Curitiba ( Site 0405)
- Hospital de Caridade de Ijui ( Site 0402)
- Hospital Nossa Senhora da Conceicao ( Site 0403)
- CEPON - Centro de Pesquisas Oncologicas ( Site 0400)
- Instituto Nacional do Cancer Jose Alencar Gomes da Silva INCA ( Site 0401)
- IBCC - Instituto Brasileiro de Controle do Cancer ( Site 0404)
- BC Cancer - Abbotsford ( Site 0206)
- Sunnybrook Research Institute ( Site 0202)
- Princess Margaret Cancer Centre ( Site 0203)
- McGill University Health Centre ( Site 0208)
- Instituto Clinico Oncologico del Sur ( Site 0500)
- Fundacion Arturo Lopez Perez FALP ( Site 0501)
- Sociedad Oncovida S.A. ( Site 0508)
- Pontificia Universidad Catolica de Chile ( Site 0502)
- Cancer Hospital Chinese Academy of Medical Sciences ( Site 2421)
- Peking Union Medical College Hospital ( Site 2425)
- Fujian Medical University Union Hospital ( Site 2410)
- Fujian Provincial Cancer Hospital ( Site 2414)
- 900 Hospital of the Joint ( Site 2418)
- The First Affiliated Hospital of Xiamen University ( Site 2430)
- Zhongshan Hospital Xiamen University ( Site 2447)
- Guangdong General Hospital ( Site 2431)
- Peking University Shenzhen Hospital ( Site 2442)
- Fourth Hospital Of Hebei Medical University ( Site 2436)
- Harbin Medical University Cancer Hospital ( Site 2401)
- Henan Cancer Hospital ( Site 2415)
- Hubei Cancer Hospital ( Site 2434)
- Xiangya Hospital Central-South University ( Site 2419)
- Hunan Cancer Hospital ( Site 2439)
- Changzhou Cancer Hospital-Changzhou Fourth Peoples Hospital ( Site 2441)
- The 81st Hospital of PLA ( Site 2413)
- Jiangsu Cancer Hospital ( Site 2432)
- Yancheng First People s Hospital ( Site 2426)
- The First Affiliated Hospital of Nanchang University ( Site 2440)
- The First Hospital of Jilin University ( Site 2416)
- The Affiliated Hospital of Qingdao University ( Site 2405)
- Shanghai East Hospital ( Site 2403)
- Zhongshan Hospital affiliated to Fudan University ( Site 2407)
- 1st Affil hosp of Med College of Xi'an Jiaotong University ( Site 2428)
- Cancer Hospital Affiliated to Xinjiang Medical University ( Site 2420)
- Zhejiang Provincial People's Hospital ( Site 2446)
- Sir Run Run Show Hospital ( Site 2427)
- Zhejiang Cancer Hospital ( Site 2417)
- Sociedad de Oncología Y Hematología del Cesar S.A.S. ( Site 0608)
- Oncomedica S.A. ( Site 0606)
- Instituto Nacional de Cancerologia E.S.E ( Site 0605)
- Centro Medico Imbanaco de Cali S.A ( Site 0604)
- CIMCA Centro de Investigacion y Manejo del Cancer ( Site 3001)
- Policlinico San Bosco ( Site 3002)
- ICIMED - Instituto de Investigacion en Ciencias Medicas ( Site 3000)
- Masarykuv onkologicky ustav ( Site 3103)
- FN Ostrava ( Site 3105)
- Fakultni nemocnice Plzen ( Site 3102)
- Nemocnice AGEL Novy Jicin a.s. ( Site 3104)
- Fakultni nemocnice Olomouc ( Site 3100)
- Fakultni Thomayerova nemocnice ( Site 3101)
- Rigshospitalet ( Site 3202)
- Aalborg University Hospital ( Site 3204)
- Odense Universitets Hospital ( Site 3201)
- CHU de Rouen ( Site 1006)
- CHU-Jean Minjoz ( Site 1002)
- C.H.R.U. de Brest - Hopital Morvan ( Site 1007)
- Centre Oscar Lambret ( Site 1003)
- Institut de Cancerologie de l Ouest Centre Rene Gauducheau ( Site 1004)
- Institut Gustave Roussy ( Site 1000)
- CHU Hopital Saint Antoine ( Site 1001)
- SLK-Kliniken Heilbronn ( Site 1104)
- Universitaetsklinikum Leipzig ( Site 1114)
- Charite Universitaetsmedizin Berlin ( Site 1101)
- Facharztzentrum Eppendorf ( Site 1121)
- Asklepios Klinik Altona ( Site 1100)
- Celan SA ( Site 0705)
- Oncomedica ( Site 0702)
- Grupo Angeles SA ( Site 0701)
- MEDI-K CAYALA ( Site 0704)
- Centro Regional de Sub Especialidades Medicas SA ( Site 0703)
- Prince of Wales Hospital ( Site 2503)
- Princess Margaret Hospital. ( Site 2502)
- Queen Mary Hospital ( Site 2501)
- Bacs-Kiskun Megyei Korhaz ( Site 3306)
- Jasz-Nagykun-Szolnok Megyei Hetenyi Gyula Korhaz-Rendelointezet ( Site 3302)
- Semmelweis Egyetem.. ( Site 3305)
- Orszagos Onkologiai Intezet ( Site 3303)
- University of Debrecen Medical Center Clinic of Oncology ( Site 3300)
- St. James s Hospital ( Site 1200)
- Beaumont Hospital ( Site 2101)
- Tallaght University Hospital ( Site 1202)
- Chaim Sheba Medical Center ( Site 1304)
- Edith Wolfson Medical Center ( Site 1307)
- Sourasky Medical Center ( Site 1306)
- Hadassah Ein Karem Jerusalem ( Site 1301)
- Soroka University Medical Center ( Site 1305)
- Rambam Medical Center ( Site 1303)
- Meir Medical Center ( Site 1308)
- Rabin Medical Center ( Site 1302)
- Istituto Europeo di Oncologia ( Site 1411)
- Istituto Nazionale dei Tumori Fondazione IRCSS ( Site 1402)
- Istituto Oncologico Veneto ( Site 1412)
- Azienda Ospedaliera San Camillo Forlanini ( Site 1413)
- Aichi Cancer Center Hospital ( Site 2619)
- National Cancer Center Hospital East ( Site 2617)
- Hyogo Cancer Center ( Site 2604)
- Kobe City Medical Center General Hospital ( Site 2603)
- Ibaraki Prefectural Central Hospital ( Site 2610)
- Kagawa University Hospital ( Site 2615)
- Kitasato University Hospital ( Site 2618)
- Kanagawa Cancer Center ( Site 2614)
- Kansai Medical University Hospital ( Site 2608)
- Kindai University Hospital ( Site 2616)
- Osaka University Hospital ( Site 2600)
- Saitama Cancer Center ( Site 2601)
- National Hospital Organization Kyushu Cancer Center ( Site 2612)
- Hiroshima City Hiroshima Citizens Hospital ( Site 2611)
- Kumamoto University Hospital ( Site 2602)
- Niigata Cancer Center Hospital ( Site 2613)
- Osaka International Cancer Institute ( Site 2607)
- National Cancer Center Hospital ( Site 2606)
- Tokyo Metropolitan Komagome Hospital ( Site 2605)
- The Cancer Institute Hospital of JFCR ( Site 2609)
- Seoul National University Hospital ( Site 2803)
- Severance Hospital Yonsei University Health System ( Site 2800)
- Asan Medical Center ( Site 2802)
- Samsung Medical Center ( Site 2801)
- Hospital Civil de Guadalajara Fray Antonio Alcalde ( Site 0808)
- Christus Muguerza Clinica Vidriera ( Site 0802)
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran ( Site 0806)
- Medical Care and Research S.A. de C.V. ( Site 0809)
- Instituto Nacional de Cancerologia. ( Site 0804)
- Auckland City Hospital ( Site 2700)
- Clinica Ricardo Palma Instituto de Oncologia y Radioterapia ( Site 0908)
- Instituto Nacional de Enfermedades Neoplasicas ( Site 0901)
- Hospital Nacional Arzobispo Loayza ( Site 0902)
- Clinica San Gabriel ( Site 0907)
- Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego ( Site 1506)
- Dolnoslaskie Centrum Onkologii we Wroclawiu ( Site 1504)
- Szpital Uniwersytecki w Krakowie ( Site 1503)
- Magodent Szpital Elblaska ( Site 1509)
- Narodowy Instytut Onkologii im. Marii Sklodowskiej-Curie - Panstwowy Instytut Badawczy w Warszawie (
- Przychodnia Lekarska Komed ( Site 1514)
- Regionalny Szpital Specjalistyczny im Wl. Bieganskiego w Grudziadzu ( Site 1505)
- Chelyabinsk Regional Clinical Oncology Dispensary-Chemotherapy ( Site 1608)
- SBHI Leningrad Regional Clinical Hospital ( Site 1616)
- Blokhin National Medical Oncology ( Site 1604)
- Central Clinical Hospital with Polyclinic ( Site 1614)
- SBHI Samara Regional Clinical Oncology Dispensary ( Site 1609)
- City Clinical Oncology Center ( Site 1603)
- Cancer Care Langenhoven Drive Oncology Centre ( Site 1708)
- Universitas Annex National Hospital ( Site 1701)
- Sandton Oncology Medical Group PTY LTD ( Site 1700)
- Wits Clinical Research ( Site 1707)
- Tshwane District Hospital ( Site 1702)
- The Oncology Centre Overport and Umhlanga ( Site 1705)
- Cancercare Rondebosch Oncology ( Site 1709)
- Groote Schuur Hospital ( Site 1706)
- Outeniqua Cancercare Oncology Unit ( Site 1704)
- Cape Town Oncology Trials Pty Ltd ( Site 1703)
- Hospital General Universitario de Elche ( Site 1803)
- Hospital Universitario General de Asturias ( Site 1802)
- Institut Catala d Oncologia Hospital Germans Trias i Pujol ( Site 1806)
- Hospital Universitario Marques de Valdecilla ( Site 1804)
- HOSPITAL UNIVERSITARIO QUIRONSALUD MADRID-ONCOLOGIA MEDICA ( Site 1805)
- Hospital General Universitari Vall d Hebron ( Site 1801)
- Universitaetsspital Basel ( Site 1900)
- Hopitaux Universitaires de Geneve HUG ( Site 1907)
- Kantonsspital Graubuenden ( Site 1903)
- Kantonsspital St. Gallen ( Site 1901)
- Istituto Oncologica della Svizzera Italiana (IOSI) ( Site 1905)
- Universitaetsspital Zuerich ( Site 1902)
- Luzern Kantonsspital ( Site 1904)
- Chang Gung Medical Foundation. Kaohsiung Branch ( Site 2902)
- National Cheng Kung University Hospital ( Site 2901)
- National Taiwan University Hospital ( Site 2900)
- Mackay Memorial Hospital ( Site 2903)
- Adana Sehir Hastanesi ( Site 2002)
- Hacettepe University Medical Faculty ( Site 2017)
- Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi ( Site 2006)
- Trakya Universitesi Tip Fakultesi ( Site 2015)
- Ataturk Universitesi Tip Fakultesi Hastanesi ( Site 2000)
- Istanbul Universitesi Cerrahpasa Tip Fakultesi ( Site 2001)
- Dokuz Eylul Universitesi Tip Fakultesi Hastanesi ( Site 2011)
- Malatya Inonu Universitesi Tip Fakultesi Hastanesi ( Site 2009)
- Sakarya Universitesi Egitim ve Arastirma Hastanesi ( Site 2012)
- City Clinical Hosp.4 of DCC ( Site 2201)
- MI Kryviy Rih Center of Dnipropetrovsk Regional Council ( Site 2200)
- MI Precarpathian Clinical Oncology Center ( Site 2204)
- Communal non profit enterprise Regional Clinical Oncology Center ( Site 2208)
- Clinic of National Cancer Institute ( Site 2203)
- Medical and Diagnostic Centre LLC Dobryi Prognoz ( Site 2205)
- Lviv State Oncology Regional Treatment and Diagnostic Center ( Site 2210)
- MI Odessa Regional Oncological Centre ( Site 2212)
- Medical Centre LLC Oncolife ( Site 2202)
- Kyiv City Clinical Oncology Centre ( Site 2213)
- South Devon Healthcare Foundation Trust. Torbay Hospital ( Site 1205)
- Castle Hill Hospital ( Site 1201)
- University College London Hospital ( Site 1211)
- St. Georges University Hospital NHS Foundation Trust ( Site 1204)
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Pembrolizumab + Chemotherapy (FP or CAPOX regimen)
Placebo + Chemotherapy (FP or CAPOX regimen)
Participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 of each 21-day cycle (Q3W) for up to 35 cycles (approximately 2 years) + physicians' choice of either cisplatin 80 mg/m^2 IV on Day 1 Q3W and 5-fluorouracil (5FU) 800 mg/m^2/day via continuous IV infusion on Days 1 to 5 Q3W (FP regimen) OR oxaliplatin 130 mg/m^2 IV on Day 1 Q3W + capecitabine 1000 mg/m^2 orally twice a day (BID) on Days 1 to 14 Q3W (CAPOX regimen). Participants who complete up to 35 administrations of pembrolizumab (approximately 2 years) or achieve a complete response (CR) but experience progression of disease (PD), can initiate a second course of pembrolizumab for up to 17 cycles (approximately 1 additional year).
Participants receive placebo on Day 1 Q3W for up to 35 cycles (approximately 2 years) + physicians' choice of either cisplatin 80 mg/m^2 IV on Day 1 Q3W and 5FU 800 mg/m^2/day via continuous IV infusion on Days 1 to 5 Q3W (FP regimen) OR oxaliplatin 130 mg/m^2 IV on Day 1 Q3W + capecitabine 1000 mg/m^2 orally BID on Days 1 to 14 Q3W (CAPOX regimen).