Summary

This study is designed to assess the safety and efficacy of lenvatinib in combination
with pembrolizumab versus standard of care (SOC) chemotherapy, and to also assess the
safety and efficacy of lenvatinib monotherapy in participants with recurrent/metastatic
head and neck squamous cell carcinoma (R/M HNSCC) that have progressed after platinum
therapy and a programmed cell death protein 1 (PD-1) or anti-programmed death ligand 1
(PD-L1) inhibitor. The primary hypothesis is that lenvatinib + pembrolizumab is superior
to SOC chemotherapy with respect to ORR per modified Response Evaluation Criteria in
Solid Tumors (RECIST) 1.1 as assessed by blinded independent central review.

Eligibility

1. Pathologically confirmed recurrent (not amenable to curative treatment with local and/or systemic therapies) or metastatic (disseminated) HNSCC of the oral cavity, oropharynx, hypopharynx, and/or larynx that is considered incurable by local therapies
2. Disease progression at any time during or after treatment with a platinum-containing (e.g., carboplatin or cisplatin) regimen
3. Disease progression on or after treatment with an anti-PD-1/PD-L1 mAb (programmed cell death protein 1/programmed death-ligand 1 monoclonal antibody)
4. Pre-study imaging that demonstrates evidence of disease progression based on investigator review of at least 2 pre-study images per RECIST 1.1, following initiation of treatment with a PD-1/PD-L1 inhibitor
5. Measurable disease by CT or MRI based on Response Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as verified by blinded independent central review (BICR). Tumor lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions
6. ECOG performance status of 0 or 1 assessed within 7 days of the first dose of study intervention
7. Male participants are eligible to participate if they agree to the following during the intervention period and for at least 1 week after the last dose of lenvatinib, 3 months after the last dose of capecitabine and paclitaxel, and and 6 months after the last dose of docetaxel:
8. Refrain from donating sperm
9. Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent; or must agree to use contraception unless confirmed to be azoospermic
10. Contraceptive use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
11. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
12. Is not a woman of childbearing potential (WOCBP)
13. Is a WOCBP and using a contraceptive method 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 (abstinent on a long term and persistent basis), during the intervention period and for at least 120 days post pembrolizumab or 1 month post lenvatinib, whichever occurs last (Arms 1 and 3), or during the intervention period and for at least 6 months after the last dose of capecitabine, docetaxel, paclitaxel; and 2 months after the last dose of cetuximab (Arm 2)
14. Female participants who randomize to Arm 2 must also agree not to donate or freeze/store eggs during the intervention period and for at least 6 months after the last dose of capecitabine, docetaxel, paclitaxel; and 2 months after the last dose of cetuximab
15. Adequately controlled blood pressure (BP) with or without antihypertensive medications
16. 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 prior to randomization
17. Participants with history of hepatitis C virus (HCV) infection are eligible if HCV viral load is undetectable at screening
18. Adequate organ function