Lenvatinib/Everolimus or Lenvatinib/Pembrolizumab Versus Sunitinib Alone as Treatment of Advanced Renal Cell Carcinoma

Inclusion Criteria:

- Histological or cytological confirmation of renal cell carcinoma (RCC) with a
clear-cell component

- At least 1 measurable target lesion according to Response Evaluation in Solid Tumors
(RECIST) 1.1

- Karnofsky Performance Status (KPS) of ≥70

- Adequately controlled blood pressure (BP) with or without antihypertensive
medications, defined as BP ≤150/90 mmHg at Screening and no change in antihypertensive
medications within 1 week prior to Cycle 1/Day 1 (C1/D1)

- Adequate organ function per blood work

Exclusion Criteria:

- Participants who have received any systemic anticancer therapy for RCC, including
anti-vascular endothelial growth factor (VEGF) therapy, or any systemic
investigational anticancer agent

- Participants with central nervous system (CNS) metastases are not eligible, unless
they have completed local therapy (eg, whole brain radiation therapy (WBRT), surgery
or radiosurgery) and have discontinued the use of corticosteroids for this indication
for at least 4 weeks before starting treatment in this study. Any signs (eg,
radiologic) or symptoms of CNS metastases must be stable for at least 4 weeks before
starting study treatment

- Active malignancy (except for RCC, definitively treated basal or squamous cell
carcinoma of the skin, and carcinoma in-situ of the cervix or bladder) within the past
24 months. Participants with history of localized & low risk prostate cancer are
allowed in the study if they were treated with curative intent and there is no
prostate specific antigen (PSA) recurrence within the past 5 years

- Prior radiation therapy within 21 days prior to start of study treatment with the
exception of palliative radiotherapy to bone lesions, which is allowed if completed 2
weeks prior to study treatment start

- Received a live vaccine within 30 days of planned start of study treatment

- Participants with urine protein ≥1 gram/24 hour

- Fasting total cholesterol >300 milligram per deciliter (mg/dL) (or ˃7.75 millimole per
liter (mmol/L)) and/or fasting triglycerides level ˃2.5 x upper limit of normal (ULN).
Note: these participants can be included after initiation or adjustment of
lipid-lowering medication

- Uncontrolled diabetes as defined by fasting glucose >1.5 times the ULN. Note: these
participants can be included after initiation or adjustment of glucose-lowering
medication

- Prolongation of corrected QT (QTc) interval to >480 milliseconds (ms)

- Bleeding or thrombotic disorders or participants at risk for severe hemorrhage. The
degree of tumor invasion/infiltration of major blood vessels should be considered
because of the potential risk of severe hemorrhage associated with tumor
shrinkage/necrosis following lenvatinib therapy

- Clinically significant hemoptysis or tumor bleeding within 2 weeks prior to the first
dose of study drug

- Significant cardiovascular impairment within 12 months of the first dose of study
drug: history of congestive heart failure greater than New York Heart Association
Class II, unstable angina, myocardial infarction, cerebrovascular accident, or cardiac
arrhythmia associated with hemodynamic instability. The following is also excluded:
left ventricular ejection fraction below the institutional normal range as determined
by multiple-gated acquisition scan or echocardiogram

- Active infection (any infection requiring systemic treatment)

- Participants known to be positive for Human Immunodeficiency Virus (HIV).

- Known active Hepatitis B (eg, Hepatitis B surface antigen (HBsAg) reactive) or
Hepatitis C (eg, hepatitis C virus ribonucleic acid (HCV RNA) [qualitative] is
detected)

- Known history of, or any evidence of, interstitial lung disease

- Has a history of (non-infectious) pneumonitis that required steroids, or current
pneumonitis

- Participants with a diagnosis of immunodeficiency or who are receiving chronic
systemic steroid therapy (doses exceeding 10 mg/day of prednisone equivalent) or any
other form of immunosuppressive therapy within 7 days prior to the first dose of study
treatment. Physiologic doses of corticosteroids (up to 10 mg/day of prednisone or
equivalent) may be used during the study

- Active autoimmune disease (with the exception of psoriasis) that has required systemic
treatment in the past 2 years (ie, with use of disease modifying agents,
corticosteroids or immunosuppressive drugs). Replacement therapy (eg, thyroxine,
insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary
insufficiency) is not considered a form of systemic treatment.

- Known intolerance to any of the study drugs (or any of the excipients)

- Participant has had an allogenic tissue/solid organ transplant.