Resumen

El propósito de este estudio es evaluar la eficacia y la seguridad del tratamiento con quimiorradioterapia definitiva (dCRT) + pembrolizumab (MK-3475) en comparación con el tratamiento con dCRT + placebo con respecto a la Supervivencia libre de eventos (EFS) y la Supervivencia global (OS) en: * participantes cuyos tumores expresan la Puntuación positiva combinada (CPS) de Muerte programada-ligando 1 (PD-L1) ≥10 * participantes cuyos tumores expresan CPS de PD-L1 ≥1 * todos los participantes Las hipótesis primarias del estudio son que la dCRT + pembrolizumab es superior a la dCRT + placebo con respecto a: * EFS en participantes cuyos tumores expresan CPS de PD-L1 ≥10 * EFS en participantes cuyos tumores expresan CPS de PD-L1 ≥1 * EFS en todos los participantes * OS en participantes cuyos tumores expresan CPS de PD-L1 ≥10 * OS en participantes cuyos tumores expresan CPS de PD-L1 ≥1 * OS en todos los participantes

Descripción detallada

Los participantes reciben pembrolizumab o placebo MÁS uno de dos regímenes de quimioterapia MÁS radioterapia durante aproximadamente un año. Los regímenes de quimioterapia son: * FP (5-fluorouracilo \[5-FU\] + cisplatino) o * FOLFOX (5-FU + oxaliplatino + leucovorina o levoleucovorina).

Elegibilidad

Edad mínima: 18 YearsSexo: ALL

Criterios de inclusión

Has histologically or cytologically confirmed diagnosis of CTX N+ M0 or cT2-T4a NX M0 ESCC, GEJC, EAC, or histologically or cytologically confirmed diagnosis of cTX N+ M1 cervical or upper thoracic esophageal carcinoma with supraclavicular lymph node metastases only
Is deemed suitable for dCRT
Is ineligible for curative surgery based on the documented opinion of a qualified medical/surgical/radiation oncologist.
Is not expected to require tumor resection during the course of the study
Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1 within 3 days of the first dose of study treatment
Has adequate organ function
Male participants must use adequate contraception (a male condom plus partner use of an additional contraceptive method) unless confirmed to be azoospermic (vasectomized or secondary to medical cause) and refrain from donating sperm during the study treatment period and through 90 days after the last dose of chemotherapy
Female participants who are a Woman of Childbearing Potential (WOCBP) must use contraception that is highly effective (with a failure rate of \<1% per year), with low user dependency, or be abstinent from heterosexual intercourse as their preferred and usual lifestyle, during the study treatment period through 180 days after the last dose of chemotherapy or 120 days after the last dose of pembrolizumab, whichever is greater, and agree not to donate eggs to others or freeze/store for her own use for the purpose of reproduction during this period
Female participants must not be pregnant or breastfeeding

Criterios de exclusión

Has direct invasion of tumor into adjacent organs such as the aorta or trachea or has radiographic evidence of \>90 degree encasement or invasion of a major blood vessel, or of intratumoral cavitation
Has had major surgery other than for insertion of a feeding tube, open biopsy, or significant traumatic injury within 28 days prior to randomization, or anticipates the need for major surgery during study treatment; participants with gastric or esophageal fistulae are excluded
Has had weight loss of \>20% in the previous 3 months
Has had prior chemotherapy or radiotherapy for esophageal cancer
Has had a myocardial infarction within the past 6 months
Has symptomatic congestive heart failure
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-programmed cell death-ligand 2 (anti-PD-L2) agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor (e.g. cytotoxic T-lymphocyte-associated protein 4 \[CTLA-4\], OX-40, CD137)
Has received a live or live-attenuated vaccine within 30 days prior to the first dose of study intervention; administration of killed vaccines is allowed
Has received any prior systemic anticancer therapy for esophageal cancer including investigational agents
Has not recovered from all adverse events (AEs) due to previous non-anticancer therapies to ≤Grade 1 or Baseline
Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of study treatment
Has a known additional malignancy that is progressing or has required active treatment within the past 3 years. Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (e.g. breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy are not excluded from the study. Participants with localized prostate cancer that has undergone potentially curative treatment can be enrolled in the study.
Has severe hypersensitivity (≥Grade 3) to pembrolizumab, any of the study chemotherapy agents, or their 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 or known active Hepatitis C virus infection
Has a known history of active tuberculosis (TB; Bacillus tuberculosis)
Is pregnant or 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 study treatment (180 days for participants receiving cisplatin who are breastfeeding)
Has had an allogeneic tissue/solid organ transplant

Ubicaciones

Instituto Medico Alexander Fleming ( Site 0063)

Buenos Aires, Buenos Aires F.D., Argentina

Fundacion Favaloro ( Site 0061)

Ciudad de Buenos Aires, Buenos Aires F.D., Argentina

Hospital Municipal de Gastroenterologia Dr. Bonorino Udaondo ( Site 0066)

Buenos Aires, Argentina

CEMIC ( Site 0064)

Buenos Aires, Argentina

Ensayo aleatorizado, doble ciego, controlado con placebo de fase 3 de pembrolizumab (MK-3475) versus placebo en participantes con carcinoma esofágico que reciben quimiorradioterapia definitiva concurrente (KEYNOTE 975)

Resumen

Descripción detallada

Elegibilidad

Criterios de inclusión

Criterios de exclusión

Intervenciones

pembrolizumab

placebo

cisplatin

5-FU

radiotherapy

leucovorin

levoleucovorin

oxaliplatin

Ubicaciones

Instituto Medico Alexander Fleming ( Site 0063)

Fundacion Favaloro ( Site 0061)

Hospital Municipal de Gastroenterologia Dr. Bonorino Udaondo ( Site 0066)

CEMIC ( Site 0064)

Patrocinadores