A Study of Efficacy and Safety of Sacituzumab Tirumotecan (MK-2870) Plus Enfortumab Vedotin (EV) With and Without Pembrolizumab in Advanced Urothelial Carcinoma (MK-3475-04C/KEYMAKER-U04)

Merck Sharp & Dohme (MSD)

Status and phase: Enrolling; Phase 2; Phase 1

Conditions: Locally Advanced Urothelial Carcinoma; Metastatic Urothelial Carcinoma

Treatments: Biological: Pembrolizumab; Biological: Enfortumab Vedotin; Biological: Sacituzumab tirumotecan

Study type: Interventional

Funder types: Industry

Identifiers

NCT06483334

U1111-1293-7631 (Other Identifier)

2023-506387-14-00 (Registry Identifier)

3475-04C

MK-3475-04C (Other Identifier)

Details and patient eligibility

About

This study is a substudy being conducted under one pembrolizumab umbrella master study KEYMAKER-U04. The substudy will consist of 2 parts. Part 1 will evaluate the safety and preliminary efficacy of sacituzumab tirumotecan plus enfortumab vedotin (EV). Part 2 will be based on Part 1 results and will evaluate the efficacy, pharmacokinetics, and safety of sacituzumab tirumotecan plus EV in combination with pembrolizumab in participants with advanced urothelial carcinoma.

Enrollment: 98 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

The main inclusion criteria include but are not limited to the following:

• Must have histologically documented, locally advanced/metastatic urothelial carcinoma (la/mUC).
• Must provide an archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion demonstrating UC, not previously irradiated, and adequate for biomarker evaluation. A newly obtained biopsy is strongly preferred, but not required if archival tissue is evaluable.
• Any AEs due to previous anticancer therapies must have recovered to ≤Grade 1 or baseline. Endocrine-related AEs adequately treated with hormone replacement are eligible.
• PART 1 ONLY: Participants must have received platinum-based chemotherapy for treatment of la/mUC.
• PART 1 ONLY: Participants must not have received >2 lines of therapy for la/mUC. Platinum-based chemotherapy followed by avelumab maintenance is considered 2 lines of therapy.
• PART 2 ONLY: Participants must not have received prior systemic therapy for la/mUC.

Exclusion criteria

The main exclusion criteria include but are not limited to the following:

• Known additional malignancy that is progressing or has required active treatment within the past 3 years.
• Known active central nervous system metastases and/or carcinomatous meningitis.
• Has Grade ≥2 peripheral neuropathy.
• Has history of documented severe dry eye syndrome, severe Meibomian gland disease and/or blepharitis, or corneal disease that prevents/delays corneal healing.
• Has active inflammatory bowel disease requiring immunosuppressive medication or previous history of inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis, or chronic diarrhea).
• Has uncontrolled, significant cardiovascular disease or cerebrovascular disease and/or serious cardiovascular and cerebrovascular diseases within the 6 months preceding study intervention.
• Has active keratitis or corneal ulcerations. Superficial punctate keratitis is allowed if the disorder is being adequately treated in the opinion of the investigator.
• Has a history of uncontrolled diabetes.
• Has received an investigational agent or has used an investigational device within 4 weeks prior to study intervention administration.
• Has received a live or live-attenuated vaccine within 30 days prior to the first dose of study intervention.
• PART 2 ONLY: Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days before the first dose of study intervention. Inhaled or topical steroids are permitted in the absence of active autoimmune disease. Physiologic replacement doses of corticosteroids are permitted for participants with adrenal insufficiency.
• PART 2 ONLY: Has an active autoimmune disease that has required systemic treatment in past 2 years except replacement therapy. - Is human immunodeficiency virus (HIV)-infected and has a history of Kaposi's sarcoma and/or Multicentric Castleman's Disease.
• Has active Hepatitis B or Hepatitis C virus infection.
• Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
• Has an active infection requiring systemic therapy.
• PART 2 ONLY: History of allogeneic tissue/solid organ transplant.
• Has not adequately recovered from major surgery or has ongoing surgical complications.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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98 participants in 2 patient groups

Sacituzumab tirumotecan plus EV

Experimental group

Description:

Participants will receive sacituzumab tirumotecan as an intravenous (IV) infusion and EV as an IV infusion on Days 1 and 8 of every 3-week cycle until disease progression, intolerable toxicity, or investigator decision.

Treatment:

Biological: Enfortumab Vedotin

Biological: Sacituzumab tirumotecan

Sacituzumab tirumotecan plus EV and pembrolizumab

Experimental group

Description:

Participants will receive sacituzumab tirumotecan as an IV infusion and EV as an IV infusion on Days 1 and 8 of every 3-week cycle until disease progression, intolerable toxicity, or investigator decision. Participants will also receive pembrolizumab 200 mg as an IV infusion on Day 1 of every 3-week cycle for up to \~2 years (35 cycles).

Treatment:

Biological: Pembrolizumab

Biological: Enfortumab Vedotin

Biological: Sacituzumab tirumotecan