A trial of lenvatinib and pembrolizumab for liver cancer (LEAP 002)

Please note - this trial is no longer recruiting patients. We hope to add results when they are available.

Cancer type:

Liver cancer




Phase 3

This trial is looking at comparing lenvatinib on its own with lenvatinib and pembrolizumab for advanced liver cancer.

Advanced liver cancer is liver cancer that has spread into the near by tissues or to another part of the body.

More about this trial

Lenvatinib is a targeted drug called a cancer growth blocker. Doctors can use lenvatinib to treat advanced liver cancer. 

Pembrolizumab is an immunotherapy called a monoclonal antibody (MAB). Pembrolizumab works by stimulating the immune system Open a glossary item to fight cancer cells. 

Researchers are always looking to improve treatment. They think that adding pembrolizumab to lenvatinib might be better for people with advanced liver cancer. 

To find out if it is better half the people in this trial will have lenvatinib and pembrolizumab. The other half will have lenvatinib and a dummy drug (placebo Open a glossary item).

The aims of this trial are to find how:

  • well the combination of lenvatinib and pembrolizumab works 
  • safe this combination is 
  • it affects quality of life Open a glossary item
  • well the body handles this combination

Who can enter

The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you. 

Who can take part

You may be able to join this trial if all of the following apply. You:

  • have hepatocellular liver cancer 
  • have cancer that has spread to the blood vessels, lymph nodes or to another part of the body (BCLC stage Cor you have many areas of cancer in the liver (BLC stage B) that can’t be treated with treatment to 1 area of the body (local treatment) or has continued to get worse after local treatment or can’t have treatment with the aim to cure
  • are willing to have tests that show your liver is working normally (Child-Pugh class A) within 7 days of starting treatment
  • have at least 1 area of cancer that can be seen and measured on a scan Open a glossary item
  • have satisfactory blood tests results
  • are as active as you were before your diagnosis (performance status 0 or 1) within 7 days of starting treatment
  • are willing to use reliable contraception for a month after stopping lenvatinib or for 3 months after stopping pembrolizumab if you or your partner could become pregnant
  • are at least 18 years old 

Who can’t take part

You cannot join this trial if any of these apply. 

Cancer related

  • have cancer that has spread to the brain or spinal cord  
  • have had local treatment Open a glossary item such as chemoembolisation or radio ablation within 4 weeks of starting treatment
  • have had chemotherapy that reached the whole body including anti VEGF Open a glossary item treatment for your advanced liver cancer
  • have had drugs that work by stimulating or stopping T cells Open a glossary item of the immune system Open a glossary item
  • have had bleeding from your cancer in the 2 weeks before starting treatment
  • have changes to your brain such as how you think, your personality or your memory caused by your cancer within the past 6 months and treatment for it hadn’t worked within 3 days
  • have cancer that has grown into the large blood vessel of the liver called the portal vein
  • have cancer that has spread to a major blood vessel called the inferior vena cava
  • have cancer that is affecting your heart
  • have fluid in your abdomen (ascites) that the doctor can see or feel and isn’t controlled by medication

Medical conditions
You cannot join this trial if any of these apply. You:

  • have had bleeding from the food pipe (oesophagus) or stomach within the last 6 months
  • have problems with bleeding
  • have had a blood clot and are being monitored for it or are taking medication such as warfarin
  • can’t have a scan such as a CT scan or MRI scan
  • have a problem that affects how well medications are absorbed in your gut (digestive system)
  • have an abnormal opening between 2 parts of the body or between the inside and outside of the body that is large 
  • have a major bleed from any part of your body in the 2 weeks before starting treatment
  • have had a major heart problem such as a heart attack, congestive heart failure or unstable angina within a year of starting treatment
  • have had a stroke within a year of starting treatment
  • have had major surgery to the liver in the 4 weeks before starting treatment
  • still have any ongoing side effects or major complications from any major surgery
  • have had minor surgery in the 7 days before starting treatment
  • have a wound, ulcer, bone fracture or similar thing that hasn’t healed
  • have had radiotherapy, apart from to the liver, in the 2 weeks before starting treatment
  • still have ongoing side effects from radiotherapy or are still taking steroids
  • have an immune system that isn’t working properly
  • are taking steroids or any other medication that affects the immune system in the 7 days before starting treatment
  • have another cancer that is getting worse or has needed treatment in the past 3 years apart from successfully treated non melanoma skin cancer Open a glossary item and carcinoma in situ Open a glossary item
  • are very sensitive to the drugs, or any of their ingredients, used in this trial
  • have an autoimmune disease Open a glossary item that has needed active treatment in the past 2 years apart from medication that replaces a substance in the body for example hormone tablets for a thyroid that doesn’t make enough hormones
  • have inflammation of the lungs (pneumonitis)
  • have had steroids in the past for inflammation of the lungs
  • have a test that shows there is a large amount of protein in the urine
  • have a heart test or scan that shows the heart isn’t working well enough
  • have an infection that needs treatment that reaches the whole body apart from hepatitis B and hepatitis C
  • have both hepatitis B and hepatitis C
  • have HIV
  • have active tuberculosis (TB)
  • have had a donor (allogenic) stem cell or bone marrow transplant
  • have had an organ transplant
  • have or had an experimental drug or used an experimental device as part of another clinical trial in the past 4 weeks
  • have any other medical condition or mental health problem that the doctor or trial team think could affect you taking part

You cannot join this trial if any of these apply. You:

  • have had a live vaccine Open a glossary item in the past month
  • are pregnant or breastfeeding

Trial design

This is an international phase 3 trial. The team need 750 people worldwide to join with 30 people form the UK.

This is a randomised trial. Everyone is put into 1 of 2 groups. Neither you nor your doctor can choose which group you are in. The groups are:

  • lenvatinib and pembrolizumab
  • lenvatinib and a dummy drug (placebo)

Lenvatinib is a capsule. You take it once a day. Your doctor will tell you how many to take. You take the capsules at home apart from the days you have pembrolizumab or the dummy drug. On these days you take the lenvatinib capsule at the hospital about an hour after pembrolizumab or the dummy drug. 

You have pembrolizumab or the dummy drug as a drip into a vein. You have it every 3 weeks. It takes about 30 minutes to have. 

You continue to have lenvatinib as long as it is helping and the side effects aren’t too bad. You continue to have pembrolizumab or the dummy drug for up to 2 years as long as it is helping and the side effects aren’t too bad.

You have a card that says you are taking part in this trial. It has information about the trial and contact numbers of the trial team. You should always carry this card. 

You give several blood samples throughout the trial. Researchers will use these to find out what happens to lenvatinib and pembrolizumab in the body when they are taken together. They will also look for substances (biomarkers Open a glossary item) in the blood that might show how well treatment is working.

You give a poo (stool) sample before starting treatment then:

  • at 2 different times during treatment
  • at the end of treatment

Researchers will use this sample to look for substances (biomarkers) that might show:

  • how well the treatment might work
  • how well the treatment is working 

You don’t have to give this poo sample if you don’t want to. You can still take part in the trial. 

Quality of life
You fill in a few questionnaires before starting treatment then

  • every 3 weeks for 27 weeks then
  • every 6 weeks for up to a year

The questions ask about:

  • how you are
  • what you can do 
  • any side effects you might have

Hospital visits

You see the doctor to have some tests before you start. These tests include:

During treatment you see the doctor every 3 weeks for:

  • a physical examination
  • blood tests
  • heart trace
  • CT scan and or an MRI scan

When you finish treatment you see the doctor for a physical examination and blood tests. You then see the doctor a month and 2 months later:

  • to see how you are
  • for a CT scan and or an MRI scan
  • heart trace
  • heart scan

Your doctor will then tell you how often they want to see you.

Side effects

The trial team monitor you during treatment and afterwards. Contact your advice line or tell your doctor or nurse if any side effects are bad or not getting better. 

Pembrolizumab can affect the immune system. It may cause inflammation in different parts of the body which can cause serious side effects. They could happen during treatment, or some months after treatment has finished. Rarely, these side effects could be life threatening.

If you have any of these side effects, you should tell the doctor or nurse as soon as possible that you are on or have been on an immunotherapy. 

The most common side effects of pembrolizumab are:

  • itching 
  • diarrhoea
  • cough
  • joint, back or tummy (stomach) pain
  • rash
  • high temperature (fever)
  • loss of skin colour
  • the thyroid not making enough hormones (hypothyroidism) causing tiredness, weight gain, feeling cold and constipation
  • low levels of salt in the blood causing tiredness, confusion, headache and muscle cramps 

Lenvatinib can cause some serious side effects that can be life threatening and might need urgent medical attention. You need to tell your doctor straight away if you have any of the following side effects. 

The most common serious side effects of lenvatinib are:

  • stroke, mini stroke or bleeding in the brain causing numbness and weakness on one side of the body
  • blood clot in the legs causing swelling of the lower leg muscle (calf muscle) that is warm and tender or a blood clot in the lungs (pulmonary embolism) that can cause sudden onset of shortness of breath, rapid breathing, tight feeling in the chest or chest pain, cough or coughing up blood, fast heart rate and a blue colour in the lips
  • heart problems, feeling your own heart beat (palpitations), heart attack or not being able to pump as well (heart failure) causing severe shortness of breath
  • an abnormal opening between 2 parts of the body or from inside to the outside of the body (fistula) or a hole forming in the bowel (bowel perforation)
  • bleeding inside the body particularly from the gut that might cause blood in the poo or black, tarry poo
  • not enough fluid in your body (dehydration) and your kidneys not working
  • liver damage causing yellowing of the skin or eyes, loss of appetite, tummy pain or high temperature
  • changes to the way your brain works causing confusion, drowsiness, poor concentration and loss of consciousness 

Other common side effects include:

Your doctor or a member of the trial team will talk to you about the side effects of lenvatinib and pembrolizumab before you agree to take part in this trial. 

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Daniel Palmer

Supported by

Merck Sharp & Dohme Ltd

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Last reviewed:

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