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Investigational agents for treating advanced small cell lung cancer

A Phase 1b/2 Study to Evaluate the Efficacy and Safety of Investigational Agents as Monotherapy or in Combination With Pembrolizumab for the Treatment of Participants With PD-1/L1-refractory Extensive-Stage Small Cell Lung Cancer in Need of Second-Line Therapy (KEYNOTE-B98)

Phase1; Phase2 Interventional Merck Sharp & Dohme LLC · NCT04938817

This study is testing new treatment options for people with advanced small cell lung cancer who need a second round of therapy to see if they work better when combined with an existing medication.

Quick facts

PhasePhase1; Phase2
Study typeInterventional
Enrollment110 (estimated)
Ages18 Years and up
SexAll
SponsorMerck Sharp & Dohme LLC Industry-sponsored
Drugs / interventionspembrolizumab, quavonlimab, favezelimab, trastuzumab, datopotamab, lenvatinib, chemotherapy, radiation, prednisone
Locations48 sites (Gilbert, Arizona and 47 other locations)
Trial IDNCT04938817 on ClinicalTrials.gov

What this trial studies

This study evaluates the safety and efficacy of investigational agents, either alone or in combination with pembrolizumab, for patients with extensive-stage small cell lung cancer (ES-SCLC) who require second-line therapy. The trial consists of two parts: an initial safety lead-in to assess the tolerability of the investigational combinations, followed by an efficacy evaluation. Participants must have previously progressed on anti-PD-1/PD-L1 therapy as part of their first-line treatment. The study aims to establish a recommended phase 2 dose (RP2D) for the combinations being tested.

Who should consider this trial

Good fit: Ideal candidates are individuals with histologically confirmed extensive-stage small cell lung cancer who have progressed after first-line anti-PD-1/PD-L1 therapy.

Not a fit: Patients who have not received prior treatment for small cell lung cancer or those with non-extensive stage disease may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could provide new treatment options for patients with advanced small cell lung cancer who have limited alternatives.

How similar studies have performed: Other studies have shown promise with similar approaches using PD-1/PD-L1 inhibitors in small cell lung cancer, indicating potential for success.

Eligibility criteria

Show full inclusion / exclusion criteria 
Inclusion Criteria:

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

* Arms A-E:

  * Has histologically or cytologically confirmed diagnosis of ES-SCLC in need of second-line therapy
  * Has progressed on or after treatment with an anti-programmed cell death 1 (PD-1)/ programmed cell death ligand 1 (PD-L1) monoclonal antibody (mAb) administered as part of first-line platinum-based systemic therapy for ES-SCLC
  * Has ES-SCLC defined as Stage IV (T any, N any, M1a/b/c) by the American Joint Committee on Cancer, Eighth Edition
  * Has received 1 prior line of systemic therapy for small cell lung cancer (SCLC)
  * If a woman of childbearing potential (WOCBP), participant must have a negative highly sensitive pregnancy test within 24 hours (for a urine test) or 72 hours (for a serum test) before the first dose of study treatment
  * Has measurable disease per RECIST 1.1 as assessed by local site investigator/radiology and verified by BICR
  * Has submitted an archival tumor tissue sample or newly obtained core, incisional, or excisional biopsy of a tumor lesion not previously irradiated
  * Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1 assessed within 7 days before allocation/randomization
  * Participants who are Hepatitis B surface antigen (HBsAg) positive are eligible if they have received Hepatitis B virus (HBV) antiviral therapy for at least 4 weeks and have undetectable HBV viral load before randomization
  * Participants with history of Hepatitis C virus (HCV) infection are eligible if HCV viral load is undetectable at screening
  * Has a predicted life expectancy of \>3 months
* Arms A-D:

  * Male participants must be abstinent from heterosexual intercourse or agree to use contraception during treatment for at least 7 days after the last dose of lenvatinib. No contraception is required if the participant is receiving pembrolizumab, pembrolizumab/quavonlimab, MK-4830, or favezelimab/pembrolizumab
  * Female participants are not pregnant or breastfeeding and are not a WOCBP or if are a WOCBP, are abstinent from heterosexual intercourse or are using contraception during the intervention period and for at least 120 days after the last dose of pembrolizumab, pembrolizumab/quavonlimab, MK-4830, or favezelimab/pembrolizumab or 30 days after the last dose of lenvatinib, whichever occurs last
  * Female participants must abstain from breastfeeding during the intervention period and for at least 120 days after the last dose of pembrolizumab, pembrolizumab/quavonlimab, MK-4830, or favezelimab/pembrolizumab or 7 days after the last dose of lenvatinib, whichever occurs last
* Has adequately controlled blood pressure (BP) with or without antihypertensive medications, defined as BP ≤150/90 millimeters of mercury (mm Hg) with no change in antihypertensive medications within 1 week before allocation/randomization
* Arm E:

  * If capable of producing sperm, the participant agrees to refrain from donating sperm and abstain from penile-vaginal intercourse or use a penile/external condom when having penile-vaginal intercourse with a nonparticipant of childbearing potential who is not currently pregnant. The length of time required to continue contraception for the study intervention R-Dx-d is 150 days
  * If a person of childbearing potential (POCBP) must use a contraceptive method that is highly effective (with a failure rate of \<1% per year), with low user dependency, or if they adhere to penile-vaginal intercourse abstinence as their preferred and usual lifestyle (abstinent on a long-term and persistent basis), during the intervention period and for at least the time needed to eliminate the study intervention after the last dose of study intervention. In addition, the participant agrees not to donate eggs (ova, oocytes) to others or freeze/store eggs during this period for the purpose of reproduction. The length of time required to continue contraception for the study intervention R-Dx-d is 210 days after the last dose

Exclusion Criteria:

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

* Arms A-E:

  * Has received prior systemic anticancer therapy including investigational agents within 4 weeks before start of study treatment
  * Has received prior radiotherapy within 2 weeks of start of study treatment
  * Has received lung radiation therapy \>30 Gray (Gy) within 6 months before the first dose of study treatment
  * Has received a live or live attenuated vaccine within 30 days before the first dose of study treatment
* Has a known additional malignancy that is progressing or has required active treatment within the past 3 years
* Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Participants with brain metastases may participate only if they satisfy all of the following: completed treatment (e.g., whole brain radiation treatment, stereotactic radiosurgery, or equivalent) ≥14 days before the first dose of study intervention; have no evidence of new or enlarging brain metastases confirmed by post-treatment repeat brain imaging (using the same modality) performed ≥4 weeks after pretreatment brain imaging; and are neurologically stable without the need for steroids for ≥7 days before the first dose of study intervention as per local site assessment. Participants with untreated brain metastases will be allowed if they are asymptomatic, the investigator determines there is no immediate CNS-specific treatment required, there is no significant surrounding edema, and the brain metastases are of 5 millimeter (mm) or less in size and 3 or less in number.
* Has a history of severe hypersensitivity reaction (≥Grade 3) to any study treatment and/or any of its excipients
* Has an active autoimmune disease that has required systemic treatment in past 2 years except replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid)
* Has an active infection requiring systemic therapy
* Arms A-D:

  * Has had major surgery within 3 weeks before first dose of study treatment
  * Has a preexisting ≥Grade 3 gastrointestinal or non-gastrointestinal fistula
  * Has clinically significant cardiovascular disease or major arterial thromboembolic event within 12 months before first dose of study intervention, including New York Heart Association Class III or IV congestive heart failure, unstable angina, myocardial infarction, cerebral vascular accident, or cardiac arrhythmia associated with hemodynamic instability
  * Has active hemoptysis (bright red blood of at least 0.5 teaspoon) within 3 weeks before the first dose of study treatment
  * Has gastrointestinal malabsorption or any other condition that might affect oral study intervention absorption
  * Has serious nonhealing wound, ulcer, or bone fracture within 28 days before the start of study treatment
  * Has any major hemorrhage or venous thromboembolic events within 3 months before the start of study treatment
  * Has a history of inflammatory bowel disease
  * Has a history of a gastrointestinal perforation within 6 months before the start of study treatment
  * Has a known history of, or active, neurologic paraneoplastic syndrome
  * Has received prior therapy with a receptor tyrosine kinase (RTK) inhibitor or anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), anti-immunoglobulin-like transcript (ILT)-4, or anti-lymphocyte-activation gene 3 (LAG-3) agents
  * Has received prior therapy with an anti-PD-1/L1 agent and was permanently discontinued from that treatment due to a treatment-related adverse event
  * Has received an investigational agent or has used an investigational device within 4 weeks prior to study intervention administration
  * Has radiographic evidence of encasement or invasion of a major blood vessel, or of intratumoral cavitation
  * Has symptomatic ascites, pleural effusion, or pericardial effusion
  * Has a 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
  * Has a known history of Human Immunodeficiency Virus (HIV) infection
  * Has concurrent active HBV or HCV
  * Has progressive disease as initial response to first-line systemic chemotherapy in combination with PD-1/L1 inhibitor for ES-SCLC
  * Has had an allogenic tissue/solid organ transplant
  * Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease
* Arm E:

  * Received prior treatment with a CDH6-targeted agent or an ADC that consists of an exatecan derivative that is a topoisomerase I inhibitor (eg, trastuzumab deruxtecan, datopotamab deruxtecan)
  * Has received an investigational agent or has used an investigational device within 4 weeks (or 5 half-lives, whichever is shorter) prior to study intervention administration
  * Has Chronic steroid treatment (\>10 mg/day prednisone \[or equivalent\] per day), except for inhaled steroids for asthma or COPD, mineralocorticoids (e.g., fludrocortisone) for participants with orthostatic hypotension, topical steroids for mild skin conditions, low-dose supplemental corticosteroids for adrenocortical insufficiency, Premedication for treatment groups and/or premedication in case of any hypersensitivity, or intra-articular steroid injections
  * Is an HIV-infected participants with a history of Kaposi's sarcoma and/or Multicentric Castleman's Disease
  * Any history of pneumonitis/interstitial lung disease (ILD) irrespective of prior steroid use, current ILD, or suspected ILD, or ILD that cannot be ruled out at screening

Where this trial is running

Gilbert, Arizona and 47 other locations

Study contacts

How to participate

  1. Review the eligibility criteria above with your treating physician.
  2. Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
  3. Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.
View on ClinicalTrials.gov → Find more trials like this →
Conditions Small Cell Lung CarcinomaProgrammed Cell Death Receptor 1Programmed Cell Death Receptor Ligand 1Programmed Cell Death Receptor Ligand 2PD-1PDL1PD-L1PD-L2
Last reviewed 2026-06-13 by the Find a Trial editorial team. Information on this page is for educational purposes and is not medical advice. Always consult qualified healthcare professionals about clinical trial participation.