Non-small Cell Lung CancerPhase 3NCT03515837
Study of Pemetrexed + Platinum Chemotherapy With or Without Pembrolizumab (MK-3475) in Adults With Tyrosine Kinase Inhibitor- (TKI)-Resistant Epidermal Growth Factor Receptor- (EGFR)-Mutated Metastatic Non-squamous Non-small Cell Lung Cancer (NSCLC) (MK-3475-789/KEYNOTE-789)
A Phase 3 study testing pembrolizumab, pemetrexed and carboplatin in people with Non-small Cell Lung Cancer, run by Merck Sharp & Dohme LLC at 158 sites in 17 countries.
Trial summary
The purpose of this study is to evaluate the efficacy and safety of pemetrexed plus platinum chemotherapy (carboplatin or cisplatin) with or without pembrolizumab (MK-3475; KEYTRUDA®) in the treatment of adults with the following types of tyrosine kinase inhibitor (TKI)-resistant, epidermal growth factor receptor… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Non-small Cell Lung Cancer
- What is being tested?
- pembrolizumab, pemetrexed and carboplatin
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 492 participants
- Where
- 158 sitesin 17 countries
- Study dates
- 29 Jun 2018to 2 Oct 2023
- Phase
- Phase 3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Histologically or cytologically confirmed diagnosis of Stage IV non-squamous NSCLC.
- Documentation of tumor activating EGFR mutation, specifically either DEL19 or L858R.
- Investigator-determined radiographic disease progression per RECIST 1.1 after treatment with an EGFR TKI therapy: a) Participants previously treated with 1st or 2nd generation EGFR TKI (e.g. erlotinib/afatinib/gefitinib) are required to have confirmed documented absence of EGFR T790M mutation; b) Participants with confirmed acquired T790M mutation after 1st or 2nd generation EGFR TKI (e.g. erlotinib/afatinib/gefitinib) are required to have osimertinib TKI treatment failure prior to enrollment; c) Participants previously failed osimertinib TKI treatment as 1st line therapy are eligible regardless of their EGFR T790M mutation status. Note: TKI washout period for all participants is 1 week or 2 half-lives after last treatment dose, whichever is longer. TKI washout should be completed prior to first dose of study treatment.
- Measurable disease per RECIST 1.1 as assessed by the local site investigator/radiology.
- Provided archival tumor tissue sample or newly obtained (no anti-neoplastic therapy since biopsy) core or excisional biopsy of a tumor lesion not previously irradiated.
- Life expectancy of at least 3 months.
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- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 7 days prior to the first dose of study treatment but before randomization.
- Male participants must agree to use contraception during the treatment period and for at least 120 days after the last dose of pembrolizumab and up to 180 days after last dose of chemotherapeutic agents.
- Female participants must not be pregnant, not breastfeeding, and must agree to use contraception during the treatment period and for at least 120 days after the last dose of pembrolizumab and up to 180 days after the last dose of chemotherapeutic agents.
- Adequate organ function.
Who cannot join
- Predominantly squamous cell histology NSCLC. Mixed tumors will be categorized by the predominant cell type; if small cell elements are present, the participant is ineligible.
- Symptomatic ascites or pleural effusion. A participant who is clinically stable following treatment for these conditions (including therapeutic thoraco- or paracentesis) is eligible.
- Received prior therapy with an anti-programmed cell death protein-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 co-inhibitory T-cell receptor (e.g. cytotoxic T-lymphocyte-associated protein-4 [CTLA-4], OX-40, CD137).
- Received prior systemic cytotoxic chemotherapy or investigational agent(s), excluding EGFR TKIs, for metastatic NSCLC. [Notes: 1) Prior treatment with chemotherapy and/or radiation as part of neoadjuvant/adjuvant therapy is allowed as long as therapy was completed at least 6 months prior to the diagnosis of metastatic NSCLC. 2) If participant received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting study treatment. 3) Prior exposure to traditional medicine(s) is allowed as long as therapy was discontinued at least 4 weeks prior to the first dose of study treatment.]
- Received prior radiotherapy within 2 weeks of start of study treatment or has received lung radiation therapy of >30 Gray (Gy) within 6 months before the first dose of study treatment. Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤2 weeks of radiotherapy) to non-central nervous system (CNS) disease.
- Received a live vaccine within 30 days prior to the first dose of study treatment.
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- 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.
- 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.
- Known additional malignancy that is progressing or has required active treatment within the past 5 years. (Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, superficial bladder cancer, or carcinoma in situ (e.g. breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy are not excluded.)
- Known active untreated CNS metastases and/or carcinomatous meningitis.
- Severe hypersensitivity (≥ Grade 3) to pembrolizumab and/or any of its excipients.
- Known sensitivity to any component of cisplatin, carboplatin, or pemetrexed.
- Active autoimmune disease that has required systemic treatment in past 2 years.
- History of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
- Active infection requiring systemic therapy.
- Known history of human immunodeficiency virus (HIV) infection.
- Known history of Hepatitis B or known active Hepatitis C virus.
- Known history of active tuberculosis (TB; Bacillus tuberculosis)
- Pregnant, breastfeeding or 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 pembrolizumab and up to 180 days after the last dose of chemotherapeutic agents.
Trial locations and contacts
158 sites in 17 countries.
158 sites in 17 countries
China21 sites
Cancer Hospital Chinese Academy of Medical Sciences ( Site 0717)
Beijing, Beijing Municipality, 100021
Peking Union Medical College Hospital ( Site 0703)
Beijing, Beijing Municipality, 100032
Beijing Cancer Hospital ( Site 0718)
Beijing, Beijing Municipality, 100036
The First Hospital of Jilin University ( Site 0702)
Changchun, Jilin, 130021
Jilin Cancer Hospital ( Site 0705)
Changchun, Jilin, 130103
Xiangya Hospital of Central South University ( Site 0710)
Changsha, Hunan, 410008
Hunan Cancer Hospital ( Site 0722)
Changsha, Hunan, 410013
Southwest Hospital, The Third Military Medical University ( Site 0725)
Chongqing, Chongqing Municipality, 400038
Fujian Cancer Hospital ( Site 0723)
Fuzhou, Fujian, 350014
The First Affiliated Hospital.Zhejiang University ( Site 0713)
Hangzhou, Zhejiang, 310003
Sir Run Run Shaw Hospital School of Medicine, Zhejiang University ( Site 0715)
Hangzhou, Zhejiang, 310016
Zhejiang Cancer Hospital ( Site 0716)
Hangzhou, Zhejiang, 310022
The Affiliated Tumour Hospital of Harbin Medical University ( Site 0706)
Harbin, Heilongjiang, 150081
The First Affiliated Hospital of Anhui Medical University ( Site 0721)
Hefei, Anhui, 230088
Jiangsu Cancer Hospital ( Site 0719)
Nanjing, Jiangsu, 210000
Shanghai Chest Hospital ( Site 0700)
Shanghai, Shanghai Municipality, 200030
Zhongshan Hospital Fudan University ( Site 0712)
Shanghai, Shanghai Municipality, 200433
Affiliated Tumor Hospital of Xinjiang Medical University ( Site 0701)
Ürümqi, Xinjiang, 830000
Tangdu Hospital ( Site 0708)
Xi’an, Shanxi, 710038
The First Affiliated Hospital of Xi an Jiaotong University ( Site 0709)
Xi’an, Shanxi, 710061
Henan Cancer Hospital ( Site 0711)
Zhengzhou, Henan, 450008
United States19 sites
New York Oncology Hematology P.C ( Site 8000)
Albany, New York, 12208
Emily Couric Clinical Cancer Center ( Site 0020)
Charlottesville, Virginia, 22903
Parkland Health & Hospital System ( Site 2102)
Dallas, Texas, 75235
University of Texas Southwestern Medical Center at Dallas ( Site 0035)
Dallas, Texas, 75390
Southdale Cancer Care, University of Minnesota Medical Center- Edina ( Site 0048)
Edina, Minnesota, 55435
North Shore University Health System ( Site 0030)
Evanston, Illinois, 60201
Saint Lukes Hospital of Kansas City ( Site 0060)
Kansas City, Missouri, 64111
Monter Cancer Center ( Site 0054)
Lake Success, New York, 11042
Cedars-Sinai Medical Center ( Site 0070)
Los Angeles, California, 90048
Froedtert Hospital & the Medical College of Wisconsin ( Site 0041)
Milwaukee, Wisconsin, 53226
Pacific Cancer Care ( Site 0058)
Monterey, California, 93940
Memorial Sloan Kettering Cancer Center-Rockerfeller Patient Pavilion ( Site 0049)
New York, New York, 10022
UC Irvine Medical Center/Chao Family Comprehensive Cancer Center ( Site 0092)
Orange, California, 92868
Providence Portland Medical Center ( Site 0097)
Portland, Oregon, 97213
Kaiser Permanente Northwest ( Site 0037)
Portland, Oregon, 97227
Utah Cancer Specialists ( Site 0001)
Salt Lake City, Utah, 84106
St. Joseph Heritage Healthcare ( Site 0003)
Santa Rosa, California, 95403
Siouxland Regioinal Cancer Center dba June E. Nylen Cancer Center ( Site 0065)
Sioux City, Iowa, 51101
White Plains Hospital Center for Cancer Care ( Site 0014)
White Plains, New York, 10601
Japan19 sites
Hyogo Cancer Center ( Site 0604)
Akashi, Hyōgo, 673-8558
National Hospital Organization Kyushu Medical Center ( Site 0621)
Fukuoka, 810-8563
Kyushu University Hospital ( Site 0605)
Fukuoka, 812-8582
Kansai Medical University Hospital ( Site 0606)
Hirakata, Osaka, 573-1191
Kanazawa University Hospital ( Site 0617)
Kanazawa, Ishikawa-ken, 920-8641
National Cancer Center Hospital East ( Site 0601)
Kashiwa, Chiba, 277-8577
National Hospital Organization Shikoku Cancer Center ( Site 0616)
Matsuyama, Ehime, 791-0280
National Hospital Organization Nagoya Medical Center ( Site 0608)
Nagoya, Aichi-ken, 460-0001
Aichi Cancer Center Hospital ( Site 0612)
Nagoya, Aichi-ken, 464-8681
Niigata Cancer Center Hospital ( Site 0610)
Niigata, 951-8566
Okayama University Hospital ( Site 0614)
Okayama, 700-8558
Osaka International Cancer Institute ( Site 0611)
Osaka, 541-8567
Shizuoka Cancer Center Hospital and Research Institute ( Site 0602)
Sunto-gun, Shizuoka, 411-8777
National Cancer Center Hospital ( Site 0603)
Tokyo, 104-0045
Toranomon Hospital ( Site 0615)
Tokyo, 105-8470
Tokyo Metropolitan Komagome Hospital ( Site 0618)
Tokyo, 113-8677
Fujita Health University Hospital ( Site 0619)
Toyoake, Aichi-ken, 470-1192
Wakayama Medical University Hospital ( Site 0613)
Wakayama, 641-8510
Kanagawa Cancer Center ( Site 0609)
Yokohama, Kanagawa, 241-8515
Taiwan13 sites
Changhua Christian Hospital ( Site 0509)
Changhua, 50006
National Taiwan University Hospital Hsin-Chu Branch ( Site 0511)
Hsinchu, 300
Hualien Tzu Chi Medical Center-Hospital ( Site 0510)
Hualien City, Hualien, 970
Kaohsiung Chang Gung Memorial Hospital ( Site 0507)
Kaohsiung City, 833
Taipei Tzu Chi Hospital ( Site 0512)
New Taipei City, New Taipei, 231
Taipei Medical University Shuang Ho Hospital ( Site 0508)
New Taipei City, 235
China Medical University Hospital ( Site 0505)
Taichung, 40447
Taichung Veterans General Hospital ( Site 0504)
Taichung, 40705
National Cheng Kung University Hospital ( Site 0506)
Tainan, 704
National Taiwan University Hospital ( Site 0500)
Taipei, 100
Mackay Memorial Hospital ( Site 0503)
Taipei, 104
Taipei Veterans General Hospital ( Site 0501)
Taipei, 11217
Chang Gung Medical Foundation. Linkou ( Site 0502)
Taoyuan, 333
France9 sites
Hopital Prive d'Antony ( Site 0811)
Antony, Hauts-de-Seine, 92160
Hopital Jean Minjoz Besancon ( Site 0805)
Besançon, Doubs, 25030
CHU Caen Service de Pneumologie ( Site 0804)
Caen, Calvados, 14033
Centre Georges Francois Leclerc ( Site 0809)
Dijon, Cote-d'Or, 21000
Clinique Victor Hugo ( Site 0802)
Le Mans, Sarthe, 72000
Centre Leon Berard ( Site 0801)
Lyon, Auvergne, 69008
Centre D Oncologie de Gentilly ( Site 0810)
Nancy, Meurthe-et-Moselle, 54100
CHU Poitiers ( Site 0803)
Poitiers, Vienne, 86021
C.H.U. de Tours - Hopital Bretonneau ( Site 0806)
Tours, Indre-et-Loire, 37044
Germany9 sites
Medizinische Fakultaet Carl Gustav Carus der TU Dresden ( Site 0907)
Dresden, Saxony, 01307
Florence Nightingale Krankenhaus ( Site 0912)
Düsseldorf, North Rhine-Westphalia, 40489
Kliniken Essen-Mitte ( Site 0900)
Essen, North Rhine-Westphalia, 45136
Robert Bosch Krankenhaus Klinik Schillerhoehe ( Site 0904)
Gerlingen, Baden-Wurttemberg, 70839
Asklepios Klinikum Hamburg ( Site 0908)
Hamburg, 21075
Universitaetsklinikum Mannheim ( Site 0911)
Mannheim, Baden-Wurttemberg, 68167
Universitaetsklinikum Muenster ( Site 0906)
Münster, North Rhine-Westphalia, 48149
Pius Hospital Oldenburg ( Site 0905)
Oldenburg, Lower Saxony, 26121
Klinikum Wuerzburg Mitte gGmbH ( Site 0901)
Würzburg, Bavaria, 97074
South Korea9 sites
Chungbuk National University Hospital ( Site 0404)
Cheongju-si, Chungcheongbuk-do [Chungbuk], 28644
National Cancer Center ( Site 0400)
Gyeonggi-do, Kyonggi-do, 10408
Gachon University Gil Medical Center ( Site 0408)
Incheon, Incheon-gwangyeoksi [Incheon], 21565
Seoul National University Bundang Hospital ( Site 0405)
Seongnam-si, Kyonggi-do, 13620
Seoul National University Hospital ( Site 0402)
Seoul, Seoul-teukbyeolsi [Seoul], 03080
Asan Medical Center ( Site 0407)
Seoul, Seoul-teukbyeolsi [Seoul], 05505
Samsung Medical Center ( Site 0403)
Seoul, Seoul-teukbyeolsi [Seoul], 06351
The Catholic University of Korea. Seoul St. Mary s Hospital ( Site 0406)
Seoul, Seoul-teukbyeolsi [Seoul], 06591
Ulsan University Hospital ( Site 0401)
Ulsan, Ulsan-Kwangyokshi, 44033
Brazil8 sites
Fundacao Pio XII - Hospital de Cancer de Barretos ( Site 1911)
Barretos, São Paulo, 14784-400
Hospital de Caridade de Ijui ( Site 1907)
Ijuí, Rio Grande do Sul, 98700-000
Hospital Bruno Born ( Site 1913)
Lajeado, Rio Grande do Sul, 95900-010
Liga Norte Riograndense Contra o Cancer ( Site 1909)
Natal, Rio Grande do Norte, 59075-740
Hospital de Clinicas de Porto Alegre ( Site 1905)
Porto Alegre, Rio Grande do Sul, 90035-903
Uniao Brasileira de Educacao e Assistencia Hospital Sao Lucas da Pucrs ( Site 1904)
Porto Alegre, Rio Grande do Sul, 90610-000
Hosp. Clinicas da Fac. de Medicina de Ribeirao Preto - USP ( Site 1912)
Ribeirão Preto, São Paulo, 14048-900
Instituto do Cancer do Estado de Sao Paulo - ICESP ( Site 1903)
São Paulo, 01246-000
Israel8 sites
Ha Emek Medical Center ( Site 1707)
Afula, Northern District, 1834111
Barzilai Medical Center ( Site 1706)
Ashkelon, Southern District, 7830604
Soroka Medical Center ( Site 1702)
Beersheba, Southern District, 8457108
Rambam Medical Center ( Site 1703)
Haifa, Heifa, 3109601
Meir Medical Center ( Site 1701)
Kfar Saba, Central District, 4428164
Rabin Medical Center ( Site 1704)
Petah Tikva, Central District, 4941492
Chaim Sheba Medical Center. ( Site 1700)
Ramat Gan, Tell Abib, 5265601
Sourasky Medical Center ( Site 1705)
Tel Aviv, Tell Abib, 6423906
United Kingdom8 sites
Birmingham Heartlands Hospital ( Site 1002)
Birmingham, B9 5SS
Sussex University Hospitals ( Site 1003)
Brighton, Brighton And Hove, BN2 5BE
Western General Hospital ( Site 1009)
Edinburgh, Edinburgh, City of, EH4 2XU
St James s University Hospital ( Site 1008)
Leeds, LS9 7TF
Leicester Royal Infirmary ( Site 1000)
Leicester, Leicestershire, LE1 5WW
University College London Hospitals NHS Foundation Trust ( Site 1006)
London, London, City of, NW1 2PG
Chelsea & Westminster Hospital ( Site 1001)
London, London, City of, SW10 9NH
Barking Havering and Redbridge University Hospitals NHS Trust Queen s Hospital ( Site 1004)
Romford, RM7 0AG
Italy7 sites
IRCCS Giovanni Paolo II. Ospedale Oncologico ( Site 1305)
Bari, 70124
Azienda Ospedaliero Universitaria Careggi ( Site 1301)
Florence, 50134
Istituto Europeo di Oncologia ( Site 1303)
Milan, Lombardy, 20141
Azienda Ospedaliera dei Colli V. Monaldi ( Site 1306)
Naples, 80131
AOU San Luigi Gonzaga di Orbassano ( Site 1300)
Orbassano, Torino, 10043
Universita Campus Bio-Medico di Roma ( Site 1304)
Roma, 00128
Ospedale San Vincenzo di Taormina ( Site 1302)
Taormina, Messina, 98039
Spain7 sites
Hospitalo Univ. Germans Trias i Pujol ( Site 1100)
Badalona, Barcelona [Barcelona], 08916
Hospital de la Santa Creu i Sant Pau ( Site 1102)
Barcelona, Barcelona [Barcelona], 08025
Hospital Universitari Vall d Hebron ( Site 1106)
Barcelona, Barcelona [Barcelona], 08035
Hospital Ramon y Cajal ( Site 1101)
Madrid, 28034
Hospital Universitario 12 de Octubre ( Site 1103)
Madrid, 28041
Complejo Hospitalario Carlos Haya de Malaga ( Site 1107)
Málaga, 29010
Hospital Universitario Virgen Macarena ( Site 1104)
Seville, 41009
Hong Kong5 sites
Hong Kong Integrated Oncology Centre ( Site 0304)
Hong Kong
Queen Mary Hospital ( Site 0301)
Hong Kong
Queen Mary Hospital ( Site 0303)
Hong Kong
Hong Kong United Oncology Centre ( Site 0306)
Kowloon
Tuen Mun Hospital ( Site 0305)
Tuenmen
Australia4 sites
Eastern Health ( Site 0202)
Box Hill, Victoria, 3128
Chris OBrien Lifehouse ( Site 0200)
Camperdown, New South Wales, 2050
Austin Health ( Site 0203)
Heidelberg, Victoria, 3084
Westmead Hospital ( Site 0201)
Westmead, New South Wales, 2145
Canada4 sites
William Osler Health System ( Site 0100)
Brampton, Ontario, L6R 3J7
Jewish General Hospital ( Site 0105)
Montreal, Quebec, H3T 1E2
Sunnybrook Health Sciences, Odette Cancer Centre ( Site 0102)
Toronto, Ontario, M4N 3M5
Princess Margaret Cancer Centre ( Site 0104)
Toronto, Ontario, M5G 2M9
Mexico4 sites
Instituto Jaliscience de Cancerologia ( Site 2000)
Guadalajara, Jalisco, 44280
Medica Sur S.A.B de C.V. ( Site 2003)
Mexico City, 14050
Oaxaca Site Management Organization SC ( Site 2001)
Oaxaca City, 68000
Instituto Nacional de Cancerologia. ( Site 2007)
Tlalpan, 14080
Sweden4 sites
Sahlgrenska Universitetssjukhuset ( Site 1502)
Gothenburg, Vastra Gotalands Lan [se-14], 413 45
Linkopings Universitetssjukhus ( Site 1504)
Linköping, Ostergotlands Lan [se-05], 581 85
Skanes Universitetssjukhus Lund ( Site 1503)
Lund, Skane Lan [se-12], 221 85
Karolinska Universitetssjukhuset Solna ( Site 1500)
Solna, Stockholms Lan [se-01], 171 64
About this study
Official title: A Randomized, Double-Blind, Phase 3 Study of Pemetrexed + Platinum Chemotherapy With or Without Pembrolizumab (MK-3475) in TKI-resistant EGFR-mutated Tumors in Metastatic Non-squamous Non-small Cell Lung Cancer (NSCLC) Participants (KEYNOTE-789)
The purpose of this study is to evaluate the efficacy and safety of pemetrexed plus platinum chemotherapy (carboplatin or cisplatin) with or without pembrolizumab (MK-3475; KEYTRUDA®) in the treatment of adults with the following types of tyrosine kinase inhibitor (TKI)-resistant, epidermal growth factor receptor (EGFR)-mutated, metastatic non-squamous non-small cell lung cancer (NSCLC) tumors: 1) TKI-failures (including osimertinib [TAGRISSO®] failure) with T790M-negative mutation tumors, 2) T790M-positive mutation tumors with prior exposure to osimertinib, and 3) first-line osimertinib failure regardless of T790M mutation status.
The primary study hypotheses are that the combination of pembrolizumab plus chemotherapy has superior efficacy compared to saline placebo plus chemotherapy in terms of: 1) Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) based on blinded independent central review, and 2) Overall Survival (OS). This study will be considered to have met its success criteria if the combination of pembrolizumab plus chemotherapy is superior to saline placebo plus chemotherapy in terms of PFS or OS.
Upon study completion, participants are discontinued and may be enrolled in a pembrolizumab extension study, if available.
- Conditions
- Non-small Cell Lung Cancer
- Being tested
- pembrolizumab, pemetrexed, carboplatin, cisplatin, saline solution
- Keywords
- PD1, PD-1, PDL1, PD-L1
- Medical subject headings
- Carcinoma, Non-Small-Cell Lung
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
pembrolizumabBiological
Also called MK-3475
IV infusion
pemetrexedDrug
IV infusion
carboplatinDrug
IV infusion
cisplatinDrug
IV infusion
saline solutionDrug
Also called Normal saline solution
IV infusion
| Study group | Role | What they receive |
|---|---|---|
| Pembro+Pemetrexed+Chemo | Experimental | Participants receive pembrolizumab (pembro) 200 mg via intravenous (IV) infusion on Day 1 of each 3-week cycle (Q3W) for up to 35 cycles PLUS pemetrexed 500 mg/m^2 via IV infusion Q3W with no restrictions on the number of cycles PLUS platinum chemotherapy (chemo) (either carboplatin Area Under the Curve [AUC] 5 via IV infusion Q3W for 4 cycles [Cycles 1-4] or cisplatin 75 mg/m^2 via IV infusion Q3W for 4 cycles [Cycles 1-4]). Receives: Biological: pembrolizumab; Drug: pemetrexed; Drug: carboplatin; Drug: cisplatin |
| Placebo+Pemetrexed+Chemo | Active comparator | Participants receive normal saline solution via IV infusion on Day 1 of each 3-week cycle (Q3W) for up to 35 cycles PLUS pemetrexed 500 mg/m^2 via IV infusion Q3W with no restrictions on the number of cycles PLUS platinum chemotherapy (chemo)(either carboplatin AUC 5 via IV infusion Q3W for 4 cycles [Cycles 1-4] or cisplatin 75 mg/m^2 via IV infusion Q3W for 4 cycles [Cycles 1-4]). Receives: Drug: pemetrexed; Drug: carboplatin; Drug: cisplatin; Drug: saline solution |
What is being measured
The primary outcome is the main question the study is designed to answer.
Progression-free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. PFS was assessed by blinded independent central review (BICR) using RECIST 1.1. Per RECIST 1.1, PD is defined as at least a 20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. Note: The appearance of one or more new lesions is also considered PD. The PFS presented was analyzed using the product-limit (Kaplan-Meier) method for censored data.
Measured: Up to ~40 months
Overall Survival (OS)
OS is defined as the time from randomization to death due to any cause. Participants without documented death at the time of the final analysis will be censored at the date of the last follow-up. The OS presented was analyzed using the product-limit (Kaplan-Meier) method for censored data.
Measured: Up to ~51 months
Secondary outcomes (6)
Objective Response Rate (ORR) Per RECIST 1.1
ORR was assessed by BICR using RECIST 1.1. ORR is defined as the percentage of participants in the analysis population who experience a Complete Response (CR: Disappearance of all target lesions) or a Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters) per RECIST 1.1. The ORR for participants is presented.
Measured: Up to ~51 months
Duration of Response (DOR) Per RECIST 1.1
DOR was assessed by BICR using RECIST 1.1. For participants who experience a response of CR or PR, DOR is defined as the time from the earliest date of qualifying response until earliest date of PD or death from any cause, whichever comes first. The DOR presented was analyzed using the product-limit (Kaplan-Meier) method for censored data.
Measured: Up to ~51 months
Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status (Item 29) and Quality of Life (Item 30) Combined Score
The EORTC QLQ-C30 is a questionnaire to assess the overall quality of life of cancer patients. Participant responses to the questions regarding Global Health Status (GHS; "How would you rate your overall health during the past week?") and Quality of Life (QoL; "How would you rate your overall quality of life during the past week?") are each scored on a 7-point scale (1=Very poor to 7=Excellent). The two raw scores were averaged into a combined score, then normalized using linear transformation so each participant's score ranged from 0 to 100 (0=Worst overall health/quality of life and 100=Best overall health/quality of life). The change from baseline in GHS (EORTC QLQ-C30 Item 29) and QoL (EORTC QLQ-C30 Item 30) combined score is presented.
Measured: Baseline and Week 18
Time to True Deterioration (TTD) in the EORTC Questionnaire Composite Endpoint of Cough, Chest Pain or Dyspnea
TTD is the time from baseline to first onset of 10 points or more deterioration from baseline with confirmation by the subsequent visit of 10 points or more deterioration from baseline in the composite endpoint of cough [EORTC QLQ-Lung Cancer Module 13 (LC13) Item 1; How much did you cough?], chest pain [EORTC QLQ-LC13 Item 10; Have you had pain in your chest?], or dyspnea [EORTC QLQ-C30 Item 8; Were you short of breath?]. Individual responses are given on a 4-point scale (1=Not at all; 4=Very much), with a lower score indicating a better outcome. The TTD was analyzed using the product-limit (Kaplan-Meier) method for censored data. The time to true deterioration in the composite endpoint of cough, chest pain or dyspnea is presented.
Measured: Baseline and up to ~51 months
Percentage of Participants Who Experienced an Adverse Event (AE)
An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study treatment, whether or not considered related to the use of study treatment. The percentage of participants who experienced an AE is presented.
Measured: Up to ~44 months
Percentage of Participants Who Discontinued Study Treatment Due to AEs
An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study treatment, whether or not considered related to the use of study treatment. The percentage of participants who discontinued study treatment due to an adverse event is presented.
Measured: Up to ~41 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 May 2018
- Study start29 Jun 2018
- Primary completion17 Jan 2023
- Study completion2 Oct 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Non-small Cell Lung CancerStudies of the same condition, open and under way.
- More trials run by Merck Sharp & Dohme LLCThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 492 participants (actual)
Sponsor and investigators
- Lead sponsor
- Merck Sharp & Dohme LLC
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Medical Director, Study director, Merck Sharp & Dohme LLC
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03515837
- Sponsor's protocol ID
- 3475-789
- Other IDs
- MK-3475-789, 184019, 2017-004188-11, 2017
- Status last verified
- Nov 2024
- First submitted
- 23 Apr 2018
- Last updated
- 22 Nov 2024
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
Publications
Yang JC, Lee DH, Lee JS, Fan Y, de Marinis F, Iwama E, Inoue T, Rodriguez-Cid J, Zhang L, Yang CT, de la Mora Jimenez E, Zhou J, Perol M, Lee KH, Vicente D, Ichihara E, Riely GJ, Luo Y, Chirovsky D, Pietanza MC, Bhagwati N, Lu S. Phase III KEYNOTE-789 Study of Pemetrexed and Platinum With or Without Pembrolizumab for Tyrosine Kinase Inhibitor-Resistant, EGFR-Mutant, Metastatic Nonsquamous Non-Small Cell Lung Cancer. J Clin Oncol. 2024 Dec;42(34):4029-4039. doi: 10.1200/JCO.23.02747. Epub 2024 Aug 22.
PubMed 39173098
Study at a glance
From the registry record, last updated by the sponsor on 22 Nov 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-Blind, Phase 3 Study of Pemetrexed + Platinum Chemotherapy With or Without Pembrolizumab (MK-3475) in TKI-resistant EGFR-mutated Tumors in Metastatic Non-squamous Non-small Cell Lung Cancer (NSCLC) Participants (KEYNOTE-789)
- ClinicalTrials.gov ID
- NCT03515837
- Acronym / sponsor ID
- 3475-789
- Conditions
- Non-small Cell Lung Cancer
- Keywords
- PD1, PD-1, PDL1, PD-L1
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 492 participants (actual)
- Lead sponsor
- Merck Sharp & Dohme LLCIndustry (pharma, biotech, devices)
- Study start
- 29 Jun 2018 (actual)
- Primary completion
- 17 Jan 2023 (actual)
- Study completion
- 2 Oct 2023 (actual)
- First posted
- 4 May 2018 (actual)
- Results
- Posted 17 Jan 2024
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to evaluate the efficacy and safety of pemetrexed plus platinum chemotherapy (carboplatin or cisplatin) with or without pembrolizumab (MK-3475; KEYTRUDA®) in the treatment of adults with the following types of tyrosine kinase inhibitor (TKI)-resistant, epidermal growth factor receptor (EGFR)-mutated, metastatic non-squamous non-small cell lung cancer (NSCLC) tumors: 1) TKI-failures (including osimertinib [TAGRISSO®] failure) with T790M-negative mutation tumors, 2) T790M-positive mutation tumors with prior exposure to osimertinib, and 3) first-line osimertinib failure regardless of T790M mutation status.
The primary study hypotheses are that the combination of pembrolizumab plus chemotherapy has superior efficacy compared to saline placebo plus chemotherapy in terms of: 1) Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) based on blinded independent central review, and 2) Overall Survival (OS). This study will be considered to have met its success criteria if the combination of pembrolizumab plus chemotherapy is superior to saline placebo plus chemotherapy in terms of PFS or OS.
Upon study completion, participants are discontinued and may be enrolled in a pembrolizumab extension study, if available.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Pembro+Pemetrexed+Chemo | Experimental | Biological: pembrolizumab, Drug: pemetrexed, Drug: carboplatin, Drug: cisplatinParticipants receive pembrolizumab (pembro) 200 mg via intravenous (IV) infusion on Day 1 of each 3-week cycle (Q3W) for up to 35 cycles PLUS pemetrexed 500 mg/m^2 via IV infusion Q3W with no restrictions on the number of cycles PLUS platinum chemotherapy (chemo) (either carboplatin Area Under the Curve [AUC] 5 via IV infusion Q3W for 4 cycles [Cycles 1-4] or cisplatin 75 mg/m^2 via IV infusion Q3W for 4 cycles [Cycles 1-4]). |
| Placebo+Pemetrexed+Chemo | Active comparator | Drug: pemetrexed, Drug: carboplatin, Drug: cisplatin, Drug: saline solutionParticipants receive normal saline solution via IV infusion on Day 1 of each 3-week cycle (Q3W) for up to 35 cycles PLUS pemetrexed 500 mg/m^2 via IV infusion Q3W with no restrictions on the number of cycles PLUS platinum chemotherapy (chemo)(either carboplatin AUC 5 via IV infusion Q3W for 4 cycles [Cycles 1-4] or cisplatin 75 mg/m^2 via IV infusion Q3W for 4 cycles [Cycles 1-4]). |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- Histologically or cytologically confirmed diagnosis of Stage IV non-squamous NSCLC.
- Documentation of tumor activating EGFR mutation, specifically either DEL19 or L858R.
- Investigator-determined radiographic disease progression per RECIST 1.1 after treatment with an EGFR TKI therapy: a) Participants previously treated with 1st or 2nd generation EGFR TKI (e.g. erlotinib/afatinib/gefitinib) are required to have confirmed documented absence of EGFR T790M mutation; b) Participants with confirmed acquired T790M mutation after 1st or 2nd generation EGFR TKI (e.g. erlotinib/afatinib/gefitinib) are required to have osimertinib TKI treatment failure prior to enrollment; c) Participants previously failed osimertinib TKI treatment as 1st line therapy are eligible regardless of their EGFR T790M mutation status. Note: TKI washout period for all participants is 1 week or 2 half-lives after last treatment dose, whichever is longer. TKI washout should be completed prior to first dose of study treatment.
- Measurable disease per RECIST 1.1 as assessed by the local site investigator/radiology.
- Provided archival tumor tissue sample or newly obtained (no anti-neoplastic therapy since biopsy) core or excisional biopsy of a tumor lesion not previously irradiated.
Key exclusion criteria (19 listed)
- Predominantly squamous cell histology NSCLC. Mixed tumors will be categorized by the predominant cell type; if small cell elements are present, the participant is ineligible.
- Symptomatic ascites or pleural effusion. A participant who is clinically stable following treatment for these conditions (including therapeutic thoraco- or paracentesis) is eligible.
- Received prior therapy with an anti-programmed cell death protein-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 co-inhibitory T-cell receptor (e.g. cytotoxic T-lymphocyte-associated protein-4 [CTLA-4], OX-40, CD137).
- Received prior systemic cytotoxic chemotherapy or investigational agent(s), excluding EGFR TKIs, for metastatic NSCLC. [Notes: 1) Prior treatment with chemotherapy and/or radiation as part of neoadjuvant/adjuvant therapy is allowed as long as therapy was completed at least 6 months prior to the diagnosis of metastatic NSCLC. 2) If participant received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting study treatment. 3) Prior exposure to traditional medicine(s) is allowed as long as therapy was discontinued at least 4 weeks prior to the first dose of study treatment.]
- Received prior radiotherapy within 2 weeks of start of study treatment or has received lung radiation therapy of >30 Gray (Gy) within 6 months before the first dose of study treatment. Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤2 weeks of radiotherapy) to non-central nervous system (CNS) disease.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| pembrolizumabAlso: MK-3475IV infusion | Biological | Pembro+Pemetrexed+Chemo |
| pemetrexedIV infusion | Drug | Pembro+Pemetrexed+Chemo, Placebo+Pemetrexed+Chemo |
| carboplatinIV infusion | Drug | Pembro+Pemetrexed+Chemo, Placebo+Pemetrexed+Chemo |
| cisplatinIV infusion | Drug | Pembro+Pemetrexed+Chemo, Placebo+Pemetrexed+Chemo |
| saline solutionAlso: Normal saline solutionIV infusion | Drug | Placebo+Pemetrexed+Chemo |
Primary outcome
Progression-free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
Time frame: Up to ~40 months
PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. PFS was assessed by blinded independent central review (BICR) using RECIST 1.1. Per RECIST 1.1, PD is defined as at least a 20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. Note: The appearance of one or more new lesions is also considered PD. The PFS presented was analyzed using the product-limit (Kaplan-Meier) method for censored data.
Overall Survival (OS)
Time frame: Up to ~51 months
OS is defined as the time from randomization to death due to any cause. Participants without documented death at the time of the final analysis will be censored at the date of the last follow-up. The OS presented was analyzed using the product-limit (Kaplan-Meier) method for censored data.
6 secondary outcomes
Objective Response Rate (ORR) Per RECIST 1.1
Time frame: Up to ~51 months
Duration of Response (DOR) Per RECIST 1.1
Time frame: Up to ~51 months
Change From Baseline in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Global Health Status (Item 29) and Quality of Life (Item 30) Combined Score
Time frame: Baseline and Week 18
Time to True Deterioration (TTD) in the EORTC Questionnaire Composite Endpoint of Cough, Chest Pain or Dyspnea
Time frame: Baseline and up to ~51 months
Percentage of Participants Who Experienced an Adverse Event (AE)
Time frame: Up to ~44 months
Percentage of Participants Who Discontinued Study Treatment Due to AEs
Time frame: Up to ~41 months
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Nov 2024.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Results publication: PubMed 39173098Yang JC, Lee DH, Lee JS, Fan Y, de Marinis F, Iwama E, Inoue T, Rodriguez-Cid J, Zhang L, Yang CT, de la Mora Jimenez E, Zhou J, Perol M, Lee KH, Vicente D, Ichihara E, Riely GJ, Luo Y, Chirovsky D, Pietanza MC, Bhagwati N, Lu S. Phase III KEYNOTE-789 Study of Pemetrexed and Platinum With or Without Pembrolizumab for Tyrosine Kinase Inhibitor-Resistant, EGFR-Mutant, Metastatic Nonsquamous Non-Small Cell Lung Cancer. J Clin Oncol. 2024 Dec;42(34):4029-4039. doi: 10.1200/JCO.23.02747. Epub 2024 Aug 22.
- Merck Clinical Trials InformationLink provided by the sponsor.
- Individual participant dataSharing planned: Yes. http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Medical Director study director
Merck Sharp & Dohme LLC
158 sites in 17 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing pembrolizumab, pemetrexed and carboplatin in people with Non-small Cell Lung Cancer, run by Merck Sharp & Dohme LLC at 158 sites in 17 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 22 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 158 sites in China, United States, Japan, Taiwan, France and 12 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 17 Jan 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Progression-free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) (time frame: Up to ~40 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03515837, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Nov 2024.