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Efficacy and Safety Study of Pembrolizumab (MK-3475) Versus Paclitaxel in Asian Participants With Advanced Gastric or Gastroesophageal Junction Adenocarcinoma Who Progressed After First-line Therapy With Platinum and Fluoropyrimidine (MK-3475-063/KEYNOTE-063)

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ClinicalTrials.gov Identifier: NCT03019588
Recruitment Status : Terminated (Business Reasons)
First Posted : January 12, 2017
Results First Posted : March 30, 2023
Last Update Posted : March 30, 2023
Sponsor:
Information provided by (Responsible Party):
Merck Sharp & Dohme LLC

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: None (Open Label);   Primary Purpose: Treatment
Conditions Gastric Neoplasms
Gastroesophageal Junction Adenocarcinoma
Interventions Biological: Pembrolizumab
Drug: Paclitaxel
Enrollment 94
Recruitment Details  
Pre-assignment Details  
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years). Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
Period Title: Overall Study
Started 47 47
Treated 47 44
Completed 0 0
Not Completed 47 47
Reason Not Completed
Death             44             46
Study terminated by Sponsor             3             1
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2 Total
Hide Arm/Group Description Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years). Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years. Total of all reporting groups
Overall Number of Baseline Participants 47 47 94
Hide Baseline Analysis Population Description
[Not Specified]
Age, Continuous  
Mean (Standard Deviation)
Unit of measure:  Years
Number Analyzed 47 participants 47 participants 94 participants
58.0  (10.4) 59.0  (11.2) 58.5  (10.8)
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 47 participants 47 participants 94 participants
Female
15
  31.9%
10
  21.3%
25
  26.6%
Male
32
  68.1%
37
  78.7%
69
  73.4%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 47 participants 47 participants 94 participants
Hispanic or Latino
0
   0.0%
0
   0.0%
0
   0.0%
Not Hispanic or Latino
47
 100.0%
47
 100.0%
94
 100.0%
Unknown or Not Reported
0
   0.0%
0
   0.0%
0
   0.0%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 47 participants 47 participants 94 participants
American Indian or Alaska Native
0
   0.0%
0
   0.0%
0
   0.0%
Asian
47
 100.0%
47
 100.0%
94
 100.0%
Native Hawaiian or Other Pacific Islander
0
   0.0%
0
   0.0%
0
   0.0%
Black or African American
0
   0.0%
0
   0.0%
0
   0.0%
White
0
   0.0%
0
   0.0%
0
   0.0%
More than one race
0
   0.0%
0
   0.0%
0
   0.0%
Unknown or Not Reported
0
   0.0%
0
   0.0%
0
   0.0%
Time to progression on first-line therapy  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 47 participants 47 participants 94 participants
< 6 months
30
  63.8%
30
  63.8%
60
  63.8%
>= 6 months
17
  36.2%
17
  36.2%
34
  36.2%
Eastern Cooperative Oncology Group Performance Status (ECOG PS)   [1] 
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 47 participants 47 participants 94 participants
ECOG = 0
14
  29.8%
12
  25.5%
26
  27.7%
ECOG = 1
33
  70.2%
35
  74.5%
68
  72.3%
[1]
Measure Description: ECOG PS is graded on a scale from 0 (best) to 5 (worst). 0= fully active, able to carry on all pre-disease performance without restriction; 1= restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature; 2= ambulatory and capable of all selfcare but unable to carry out any work activities (up and about more than 50% of waking hours); 3= capable of only limited selfcare; confined to bed or chair more than 50% of waking hours; 4= completely disabled, cannot carry on any selfcare, totally confined to bed or chair; 5= dead.
1.Primary Outcome
Title Overall Survival (OS)
Hide Description 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 were censored at the date of the last follow-up.
Time Frame Up to approximately 50 months
Hide Outcome Measure Data
Hide Analysis Population Description
Analysis population includes all randomized participants.
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description:
Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years).
Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
Overall Number of Participants Analyzed 47 47
Median (95% Confidence Interval)
Unit of Measure: Months
8.4
(4.0 to 9.5)
7.7
(5.4 to 11.3)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Pembrolizumab 200 mg, Paclitaxel 80 mg/m^2
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.2900
Comments [Not Specified]
Method Log Rank
Comments One-sided p-value based on log-rank test stratified by time to progression on first line therapy (< 6 months vs. ≥ 6 months) and ECOG PS (0 vs. 1).
Method of Estimation Estimation Parameter Hazard Ratio (HR)
Estimated Value 0.89
Confidence Interval (2-Sided) 95%
0.58 to 1.36
Estimation Comments Based on Cox regression model with Efron's method of tie handling with treatment as a covariate stratified by time to progression on first line therapy (< 6 months vs. ≥ 6 months) and ECOG PS (0 vs. 1).
2.Primary Outcome
Title Progression-free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1)
Hide Description PFS is defined as the time from randomization to the first documented disease progression or death due to any cause, whichever occurs first. Per RECIST 1.1, progressive disease was defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. 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 was also considered progression. PFS as assessed by blinded independent central review will be presented.
Time Frame Up to approximately 50 months
Hide Outcome Measure Data
Hide Analysis Population Description
Analysis population includes all randomized participants.
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description:
Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years).
Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
Overall Number of Participants Analyzed 47 47
Median (95% Confidence Interval)
Unit of Measure: Months
1.9
(1.4 to 2.8)
4.0
(2.7 to 6.2)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Pembrolizumab 200 mg, Paclitaxel 80 mg/m^2
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.9954
Comments [Not Specified]
Method Log Rank
Comments One-sided p-value based on log-rank test stratified by time to progression on first line therapy (< 6 months vs. ≥ 6 months) and ECOG PS (0 vs. 1).
Method of Estimation Estimation Parameter Hazard Ratio (HR)
Estimated Value 1.77
Confidence Interval (2-Sided) 95%
1.14 to 2.74
Estimation Comments Based on Cox regression model with Efron's method of tie handling with treatment as a covariate stratified by time to progression on first line therapy (< 6 months vs. ≥ 6 months) and ECOG PS (0 vs. 1).
3.Secondary Outcome
Title Objective Response Rate (ORR) Per RECIST 1.1
Hide Description ORR was defined as the percentage of participants in the analysis population who had 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.
Time Frame Up to approximately 50 months
Hide Outcome Measure Data
Hide Analysis Population Description
Analysis population includes all randomized participants.
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description:
Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years).
Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
Overall Number of Participants Analyzed 47 47
Measure Type: Number
Number (95% Confidence Interval)
Unit of Measure: Percentage of participants
12.8
(4.8 to 25.7)
19.1
(9.1 to 33.3)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Pembrolizumab 200 mg, Paclitaxel 80 mg/m^2
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.7884
Comments [Not Specified]
Method Z-test
Comments One-sided p-value for testing. H0: difference in % = 0 versus H1: difference in % > 0.
Method of Estimation Estimation Parameter Difference in percentage
Estimated Value -6.0
Confidence Interval (2-Sided) 95%
-21.6 to 9.3
Estimation Comments Based on Miettinen & Nurminen method stratified by time to progression on first line therapy (< 6 months vs. ≥ 6 months) and ECOG PS (0 vs. 1).
4.Secondary Outcome
Title Number of Participants Who Experience an Adverse Event (AE)
Hide Description An adverse event is defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment.
Time Frame Up to approximately 50 months
Hide Outcome Measure Data
Hide Analysis Population Description
Analysis population includes all randomized participants who received at least one dose of study treatment.
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description:
Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years).
Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
Overall Number of Participants Analyzed 47 44
Measure Type: Count of Participants
Unit of Measure: Participants
46
  97.9%
43
  97.7%
5.Secondary Outcome
Title Number of Participants Who Discontinue Study Treatment Due to an AE
Hide Description An adverse event is defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment.
Time Frame Up to approximately 25 months
Hide Outcome Measure Data
Hide Analysis Population Description
Analysis population includes all randomized participants who received at least one dose of study treatment.
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description:
Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years).
Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
Overall Number of Participants Analyzed 47 44
Measure Type: Count of Participants
Unit of Measure: Participants
2
   4.3%
7
  15.9%
Time Frame Up to approximately 50 months
Adverse Event Reporting Description All-cause mortality includes all randomized participants; Adverse events tables include all participants who received at least one dose of study drug. Per protocol, MedDRA preferred terms "Neoplasm Progression", "Malignant Neoplasm Progression" and "Disease Progression" not related to the drug are excluded.
 
Arm/Group Title Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Hide Arm/Group Description Participants receive pembrolizumab 200 mg intravenous (IV) infusion on Day 1 of each 3-week cycle for up to 35 cycles (up to approximately 2 years). Participants receive paclitaxel 80 mg/m^2 IV infusion on Days 1, 8 and 15 of each 4-week cycle for up to approximately 2 years.
All-Cause Mortality
Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Affected / at Risk (%) Affected / at Risk (%)
Total   44/47 (93.62%)      46/47 (97.87%)    
Hide Serious Adverse Events
Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total   13/47 (27.66%)      14/44 (31.82%)    
Blood and lymphatic system disorders     
Anaemia  1  2/47 (4.26%)  2 1/44 (2.27%)  1
Febrile neutropenia  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Endocrine disorders     
Adrenal insufficiency  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Thyroiditis  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Gastrointestinal disorders     
Ileus  1  2/47 (4.26%)  2 0/44 (0.00%)  0
Abdominal pain  1  1/47 (2.13%)  1 1/44 (2.27%)  1
Vomiting  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Intestinal obstruction  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Pancreatitis acute  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Small intestinal obstruction  1  0/47 (0.00%)  0 1/44 (2.27%)  1
General disorders     
Pyrexia  1  2/47 (4.26%)  2 0/44 (0.00%)  0
Asthenia  1  1/47 (2.13%)  1 3/44 (6.82%)  3
Fatigue  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Hepatobiliary disorders     
Biliary obstruction  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Hepatic function abnormal  1  1/47 (2.13%)  2 0/44 (0.00%)  0
Infections and infestations     
Pneumonia  1  1/47 (2.13%)  1 3/44 (6.82%)  3
Post procedural infection  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Rhinitis  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Sepsis  1  1/47 (2.13%)  1 1/44 (2.27%)  1
Herpes zoster  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Peritonitis  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Urinary tract infection  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Injury, poisoning and procedural complications     
Upper limb fracture  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Investigations     
Neutrophil count decreased  1  0/47 (0.00%)  0 2/44 (4.55%)  2
White blood cell count decreased  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Metabolism and nutrition disorders     
Decreased appetite  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Musculoskeletal and connective tissue disorders     
Bone pain  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Nervous system disorders     
Ischaemic stroke  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Renal and urinary disorders     
Acute kidney injury  1  2/47 (4.26%)  2 0/44 (0.00%)  0
Respiratory, thoracic and mediastinal disorders     
Asthma  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Haemoptysis  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Pulmonary oedema  1  1/47 (2.13%)  1 0/44 (0.00%)  0
Dyspnoea  1  0/47 (0.00%)  0 1/44 (2.27%)  1
Vascular disorders     
Hypovolaemic shock  1  1/47 (2.13%)  1 0/44 (0.00%)  0
1
Term from vocabulary, MedDRA 24.0
Indicates events were collected by systematic assessment
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 5%
Pembrolizumab 200 mg Paclitaxel 80 mg/m^2
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total   46/47 (97.87%)      43/44 (97.73%)    
Blood and lymphatic system disorders     
Anaemia  1  17/47 (36.17%)  21 20/44 (45.45%)  26
Granulocytopenia  1  0/47 (0.00%)  0 3/44 (6.82%)  17
Leukopenia  1  1/47 (2.13%)  1 4/44 (9.09%)  22
Neutropenia  1  1/47 (2.13%)  1 6/44 (13.64%)  19
Endocrine disorders     
Hyperthyroidism  1  3/47 (6.38%)  3 0/44 (0.00%)  0
Hypothyroidism  1  5/47 (10.64%)  5 1/44 (2.27%)  1
Gastrointestinal disorders     
Abdominal distension  1  4/47 (8.51%)  5 3/44 (6.82%)  3
Abdominal pain  1  11/47 (23.40%)  12 6/44 (13.64%)  9
Abdominal pain upper  1  6/47 (12.77%)  7 7/44 (15.91%)  8
Ascites  1  3/47 (6.38%)  3 4/44 (9.09%)  4
Constipation  1  7/47 (14.89%)  8 7/44 (15.91%)  8
Diarrhoea  1  8/47 (17.02%)  21 8/44 (18.18%)  8
Dyspepsia  1  5/47 (10.64%)  5 1/44 (2.27%)  1
Nausea  1  10/47 (21.28%)  11 9/44 (20.45%)  10
Vomiting  1  8/47 (17.02%)  11 4/44 (9.09%)  7
General disorders     
Asthenia  1  6/47 (12.77%)  7 6/44 (13.64%)  6
Fatigue  1  9/47 (19.15%)  9 7/44 (15.91%)  9
Influenza like illness  1  1/47 (2.13%)  1 3/44 (6.82%)  3
Oedema peripheral  1  4/47 (8.51%)  4 3/44 (6.82%)  4
Pyrexia  1  8/47 (17.02%)  9 7/44 (15.91%)  11
Infections and infestations     
Pneumonia  1  0/47 (0.00%)  0 5/44 (11.36%)  5
Upper respiratory tract infection  1  2/47 (4.26%)  2 5/44 (11.36%)  6
Investigations     
Alanine aminotransferase increased  1  5/47 (10.64%)  5 7/44 (15.91%)  8
Aspartate aminotransferase increased  1  6/47 (12.77%)  7 7/44 (15.91%)  7
Blood albumin decreased  1  3/47 (6.38%)  3 1/44 (2.27%)  1
Blood alkaline phosphatase increased  1  9/47 (19.15%)  10 1/44 (2.27%)  1
Blood bilirubin increased  1  4/47 (8.51%)  5 1/44 (2.27%)  1
Gamma-glutamyltransferase increased  1  7/47 (14.89%)  7 1/44 (2.27%)  1
Neutrophil count decreased  1  1/47 (2.13%)  1 17/44 (38.64%)  55
Weight decreased  1  5/47 (10.64%)  5 4/44 (9.09%)  4
White blood cell count decreased  1  1/47 (2.13%)  1 13/44 (29.55%)  49
Metabolism and nutrition disorders     
Decreased appetite  1  5/47 (10.64%)  5 16/44 (36.36%)  19
Hyperglycaemia  1  2/47 (4.26%)  2 3/44 (6.82%)  3
Hypoalbuminaemia  1  14/47 (29.79%)  16 6/44 (13.64%)  7
Hypokalaemia  1  2/47 (4.26%)  2 3/44 (6.82%)  6
Hyponatraemia  1  2/47 (4.26%)  2 3/44 (6.82%)  3
Hypoproteinaemia  1  3/47 (6.38%)  3 1/44 (2.27%)  1
Musculoskeletal and connective tissue disorders     
Arthralgia  1  4/47 (8.51%)  5 2/44 (4.55%)  4
Back pain  1  7/47 (14.89%)  7 2/44 (4.55%)  2
Nervous system disorders     
Dizziness  1  2/47 (4.26%)  2 3/44 (6.82%)  3
Hypoaesthesia  1  0/47 (0.00%)  0 4/44 (9.09%)  5
Neuropathy peripheral  1  1/47 (2.13%)  1 6/44 (13.64%)  6
Respiratory, thoracic and mediastinal disorders     
Cough  1  1/47 (2.13%)  1 5/44 (11.36%)  6
Dyspnoea  1  2/47 (4.26%)  2 3/44 (6.82%)  3
Skin and subcutaneous tissue disorders     
Alopecia  1  3/47 (6.38%)  3 21/44 (47.73%)  21
Pruritus  1  5/47 (10.64%)  6 2/44 (4.55%)  3
Rash  1  1/47 (2.13%)  4 4/44 (9.09%)  4
1
Term from vocabulary, MedDRA 24.0
Indicates events were collected by systematic assessment
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
The Sponsor must have the opportunity to review all proposed abstracts, manuscripts or presentations regarding this trial 45 days prior to submission for publication/presentation. Any information identified by the Sponsor as confidential must be deleted prior to submission; this confidentiality does not include efficacy and safety results.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Senior Vice President, Global Clinical Development
Organization: Merck Sharp & Dohme LLC
Phone: 1-800-672-6372
EMail: ClinicalTrialsDisclosure@merck.com
Layout table for additonal information
Responsible Party: Merck Sharp & Dohme LLC
ClinicalTrials.gov Identifier: NCT03019588    
Other Study ID Numbers: 3475-063
MK-3475-063 ( Other Identifier: Merck Protocol Number )
First Submitted: January 11, 2017
First Posted: January 12, 2017
Results First Submitted: June 21, 2022
Results First Posted: March 30, 2023
Last Update Posted: March 30, 2023