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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03820986
Other study ID # 7902-003
Secondary ID MK-7902-003E7080
Status Active, not recruiting
Phase Phase 3
First received
Last updated
Start date March 12, 2019
Est. completion date November 8, 2024

Study information

Verified date February 2024
Source Merck Sharp & Dohme LLC
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of this study is to assess the safety and efficacy of pembrolizumab (MK-3475) combined with lenvatinib (MK-7902/E7080) compared to pembrolizumab alone (with placebo for lenvatinib) as first-line treatment in adults with no prior systemic therapy for their advanced melanoma. The primary study hypotheses are that: 1) The combination of pembrolizumab and lenvatinib is superior to pembrolizumab and placebo as assessed by Progression-free Survival (PFS) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), and 2) The combination of pembrolizumab and lenvatinib is superior to pembrolizumab and placebo as assessed by Overall Survival (OS). For this study, RECIST 1.1 has been modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ.


Description:

As of 03-April-2023 active participants, investigator, and sponsor personnel or delegate(s) involved in the treatment administration or clinical evaluation of the participants will be unblinded.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 674
Est. completion date November 8, 2024
Est. primary completion date January 18, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Has histologically or cytologically confirmed melanoma. - Has unresectable Stage III or Stage IV melanoma, as per American Joint Committee on Cancer guidelines, not amenable to local therapy. - Has been untreated for advanced or metastatic disease except as follows: 1. Proto-oncogene B-Raf (BRAF) V600 mutation-positive melanoma may have received standard of care targeted therapy as first-line therapy for advanced or metastatic disease. Participants that do not have a BRAF V600 mutation but did receive BRAF or BRAF/MEKi therapy are eligible to participate in this study after discussion with the medical monitor. 2. Prior adjuvant or neoadjuvant therapy, with targeted therapy or immunotherapy (such as anti-cytotoxic T-lymphocyte-associated protein 4 [CTLA-4], anti-programmed cell death 1 [anti-PD-1] therapy or interferon) will only be permitted if relapse did not occur during active treatment or within 6 months of treatment discontinuation. - Have documentation of BRAF V600-activating mutation status or consent to BRAF V600 mutation testing during the Screening period (participants with BRAF mutation-positive melanoma as well as BRAF wild-type or unknown are eligible). - Has an Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1. - Has the presence of =1 measurable lesion by computed tomography (CT) or magnetic resonance imaging (MRI) per RECIST 1.1. - Provides a tumor biopsy. Participants must submit tumor sample during Screening for confirmation of adequacy of tumor tissue at a central pathology laboratory. Participants who do not submit a tumor tissue sample will not be randomized. The tumor biopsy may not be obtained from a lone target lesion. Confirmation of presence of tumor tissue is not required prior to randomization. - Has resolution of toxic effect(s) of the most recent prior therapy to Grade 1 or less (except alopecia). If participant received major surgery or radiation therapy of >30 Gray (Gy), they must have recovered from the toxicity and/or complications from the intervention. - Male participants must agree to use contraception during the treatment period and for at least 7 days after the last dose of study treatment and refrain from donating sperm during this period. Please note that 7 days after lenvatinib/placebo is stopped, if the participant is on pembrolizumab only, no male contraception measures are needed. Contraception use by men should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. If the contraception requirements in the local label for any of the study interventions is more stringent than the requirements above, the local label requirements are to be followed. - Female participants must not be pregnant, not breastfeeding, and =1 of the following conditions applies: 1. Not a woman of childbearing potential (WOCBP). OR 2. A WOCBP who agrees to use study-approved contraception during the treatment period and for at least 120 days after the last dose of study treatment. - The participant (or legally acceptable representative) has provided documented informed consent for the study. - Has 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 before Cycle 1 Day 1. - Has adequate organ function. Exclusion Criteria: - 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 before the first dose of study treatment. - Has a known additional malignancy that is progressing or requires active treatment. Exceptions include early stage cancers (carcinoma in situ or Stage 1, non-ulcerated primary melanoma <1 mm in depth with no nodal involvement) treated with curative intent, basal cell carcinoma of the skin, squamous cell carcinoma of the skin, in situ cervical cancer, or in situ breast cancer that has undergone potentially curative therapy. - Has known active central nervous system metastases and/or carcinomatous meningitis. - Has ocular melanoma. - Has known hypersensitivity to active substances or any of their excipients including previous clinically significant hypersensitivity reaction to treatment with another monoclonal antibody. - Has an active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease-modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. - Has an active infection requiring systemic therapy. - Has known history of human immunodeficiency virus (HIV) infection - Has known history of or is positive for hepatitis B virus or hepatitis C virus infection. - Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease. - Has a history of active tuberculosis (Bacillus tuberculosis). - Gastrointestinal malabsorption or any other condition that might affect the absorption of lenvatinib. - Has had a major surgery within 3 weeks prior to first dose of study intervention. Note: Adequate wound healing after major surgery must be assessed clinically independent of time elapsed for eligibility. - Has a preexisting Grade =3 gastrointestinal or non-gastrointestinal fistula. - Has radiographic evidence of encasement or invasion of major blood vessel, or of intratumoral cavitation. - Has active hemoptysis (bright red blood of at least 0.5 teaspoon) within 3 weeks prior to the first dose of study treatment. - Has clinically significant cardiovascular disease from 12 months of the first dose of study treatment 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 urine protein =1 g/24-hour. Note: Participants with =2+ (=100 mg/dL) proteinuria on urine dipstick testing (or urinalysis) will undergo 24-hour urine collection for quantitative assessment of proteinuria. - Prolongation of QTcF interval to >480 ms. Note: If the QTcF is prolonged to >480 ms in the presence of a pacemaker, contact the Sponsor to determine eligibility. - Has left ventricular ejection fraction (LVEF) below the institutional (or local laboratory) normal range, as determined by multigated acquisition scan (MUGA) or echocardiogram. - Has received prior therapy in the adjuvant setting. Note: Targeted therapy, anti-CTLA-4, or anti-PD-1 may be allowed. - Has received prior systemic treatment for unresectable or metastatic melanoma other than targeted therapy as noted in Inclusion Criteria above - Has received prior therapy with a monoclonal antibody, chemotherapy, or an investigational agent or device within 4 weeks or 5 half-lives (whichever is longer) before administration of study treatment or not recovered (=Grade 1 or at Baseline) from adverse events due to previously administered agents. Exception to this rule would be use of denosumab, which is not excluded. Note: Participants with alopecia and =Grade 2 neuropathy are an exception and may enroll. - Has received prior radiotherapy within 2 weeks of first dose of study treatment (Cycle 1 Day 1). Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. - Has received live vaccine within 30 days before the first dose of study treatment. - Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment. - Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator. - Has had an allogeneic tissue/solid organ transplant. - Has a known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the study.

Study Design


Related Conditions & MeSH terms


Intervention

Biological:
Pembrolizumab
IV infusion
Drug:
Lenvatinib
Oral capsule
Placebo for lenvatinib
Oral capsule

Locations

Country Name City State
Australia Eastern Health ( Site 0457) Box Hill Victoria
Australia Lismore Base Hospital ( Site 0453) Lismore Australian Capital Territory
Australia Fiona Stanley Hospital ( Site 0456) Murdoch Western Australia
Australia Melanoma Institute Australia ( Site 0452) North Sydney New South Wales
Australia Westmead Hospital ( Site 0451) Westmead New South Wales
Australia Princess Alexandra Hospital ( Site 0454) Wooloongabba Queensland
Austria LKH Universitatsklinikum Graz ( Site 0776) Graz Steiermark
Austria Medizinische Universitat Wien ( Site 0778) Wien
Brazil PERSONAL - Oncologia de Precisao e Personalizada ( Site 0399) Belo Horizonte Minas Gerais
Brazil Hospital de Caridade de Ijui ( Site 0391) Ijui Rio Grande Do Sul
Brazil Hospital Sao Vicente de Paulo ( Site 0396) Passo Fundo Rio Grande Do Sul
Brazil Uniao Brasileira de Educacao e Assistencia Hospital Sao Lucas da Pucrs ( Site 0397) Porto Alegre Rio Grande Do Sul
Brazil Instituto Nacional de Cancer Hospital do Cancer II ( Site 0394) Rio de Janeiro
Canada BC Cancer-Kelowna - Sindi Ahluwalia Hawkins Centre ( Site 0661) Kelowna British Columbia
Canada Centre Hospitalier de l Universite de Montreal - CHUM ( Site 0652) Montreal Quebec
Canada McGill University Health Centre ( Site 0651) Montreal Quebec
Canada Lions Gate Hospital ( Site 0662) North Vancouver British Columbia
Canada Sunnybrook Research Institute ( Site 0654) Toronto Ontario
Chile Fundacion Arturo Lopez Perez FALP ( Site 0421) Santiago Region M. De Santiago
Chile Pontificia Universidad Catolica de Chile ( Site 0422) Santiago Region M. De Santiago
Chile Sociedad Medica Aren y Bachero Limitada ( Site 0426) Santiago Region M. De Santiago
Chile Centro Investigación del Cáncer James Lind ( Site 0425) Temuco Araucania
Chile Oncocentro ( Site 0424) Vina del Mar Valparaiso
China Beijing Cancer Hospital ( Site 0601) Beijing Beijing
China The First Hospital Of Jilin University ( Site 0603) Chang Chun Jilin
China Fujian Provincial Cancer Hospital ( Site 0612) Fuzhou Fujian
China Sun Yat-Sen University Cancer Center ( Site 0602) Guangzhou Guangdong
China Sir Run Run Shaw Hospital ( Site 0605) Hangzhou Zhejiang
China Zhejiang Cancer Hospital ( Site 0608) Hangzhou Zhejiang
China Yunnan Cancer Hospital ( Site 0604) Kunming Yunnan
China Nanjing Drum Tower Hospital ( Site 0609) Nanjing Jiangsu
China Fudan University Shanghai Cancer Center ( Site 0607) Shanghai Shanghai
China Tianjin Medical University Cancer Institute & Hospital ( Site 0606) Tianjin Tianjin
China Henan Cancer Hospital ( Site 0610) Zhengzhou Henan
France Centre Hospitalier Victor Dupouy ( Site 0012) Argenteuil Val-d Oise
France Hopital Ambroise Pare Boulogne ( Site 0007) Boulogne-Billancourt Hauts-de-Seine
France CHU Dijon Bourgogne ( Site 0010) Dijon Cote-d Or
France CHRU Lille - Hopital Claude Huriez ( Site 0004) Lille Nord
France Hopital La Timone ( Site 0002) Marseille Bouches-du-Rhone
France Hopital ARCHET 2 ( Site 0009) Nice Alpes-Maritimes
France CHU de la Miletrie Poitiers ( Site 0011) Poitiers Vienne
France CHU de Rouen ( Site 0013) Rouen Seine-Maritime
France Institut Claudius Regaud IUCT Oncopole ( Site 0003) Toulouse Haute-Garonne
France Institut Gustave Roussy ( Site 0001) Villejuif Val-de-Marne
Germany Hautkrebszentrum Buxtehude ( Site 0037) Buxtehude Niedersachsen
Germany Universitaetsklinikum Carl Gustav Carus ( Site 0041) Dresden Sachsen
Germany Universitaetsklinikum Erlangen ( Site 0044) Erlangen Bayern
Germany SRH Wald-Klinikum Gera GmbH ( Site 0042) Gera Thuringen
Germany Klinik fur Dermatologie Allergologie und Venerologie ( Site 0035) Hannover Baden-Wurttemberg
Germany Universitaetsklinikum Schleswig-Holstein Campus Kiel ( Site 0033) Kiel Schleswig-Holstein
Germany Universitaetsklinikum Leipzig ( Site 0040) Leipzig Sachsen
Germany Universitaetsklinikum Wuerzburg-Department of Dermatology ( Site 0036) Wuerzburg Bayern
Israel HaEmek Medical Center ( Site 0306) Afula
Israel Soroka Medical Center ( Site 0303) Beer Sheva
Israel Rambam Medical Center ( Site 0301) Haifa
Israel Hadassah Ein Karem Hebrew University Medical Center ( Site 0305) Jerusalem
Israel Rabin Medical Center ( Site 0302) Petah Tikva
Israel Chaim Sheba Medical Center ( Site 0304) Ramat Gan
Israel Sourasky Medical Center ( Site 0307) Tel Aviv
Israel Shamir Medical Center-Assaf Harofeh ( Site 0308) Zerifin
Italy ASST Papa Giovanni XXIII ( Site 0062) Bergamo Abruzzo
Italy Fondazione IRCCS Istituto Nazionale dei Tumori di Milano ( Site 0064) Milano
Italy Istituto Europeo di Oncologia ( Site 0067) Milano
Italy Istituto Nazionale Tumori Fondazione Pascale ( Site 0061) Napoli
Italy Istituto Oncologico Veneto ( Site 0063) Padova
Italy Azienda Ospedaliera Universitaria Senese ( Site 0065) Siena Toscana
Korea, Republic of Kyungpook National University Chilgok Hospital ( Site 0553) Daegu Taegu-Kwangyokshi
Korea, Republic of Samsung Medical Center ( Site 0551) Seoul
Korea, Republic of Seoul National University Hospital ( Site 0554) Seoul
Korea, Republic of Severance Hospital Yonsei University Health System ( Site 0552) Seoul
Poland Centrum Onkologii im.prof. F. Lukaszczyka w Bydgoszczy ( Site 0273) Bydgoszcz Kujawsko-pomorskie
Poland Uniwersyteckie Centrum Kliniczne ( Site 0281) Gdansk Pomorskie
Poland Narodowy Instytut Onkologii - Oddzial w Gliwicach ( Site 0278) Gliwice Slaskie
Poland Pratia MCM Krakow ( Site 0280) Krakow Malopolskie
Poland Szpital Kliniczny im. Heliodora Swiecickiego Uniwers Medyczn ( Site 0272) Poznan Wielkopolskie
South Africa Sandton Oncology Medical Group PTY LTD ( Site 0802) Johannesburg Gauteng
South Africa Cape Town Oncology Trials Pty Ltd ( Site 0803) Kraaifontein Western Cape
South Africa Cancer Care Langenhoven Drive Oncology Centre ( Site 0805) Port Elizabeth Eastern Cape
Spain Complejo Hospitalario Universitario A Coruna. CHUAC ( Site 0182) A Coruna La Coruna
Spain Hospital Clinic i Provincial Barcelona ( Site 0190) Barcelona
Spain Hospital Duran i Reinals ICO de Hospitalet ( Site 0187) Hospitalet del Llobregat Barcelona
Spain Hospital Universitario Insular de Gran Canaria ( Site 0189) Las Palmas de Gran Canaria Las Palmas
Spain Hospital General Universitario Gregorio Maranon ( Site 0191) Madrid
Spain Hospital Universitario La Paz ( Site 0184) Madrid
Spain Hospital Universitario Ramon y Cajal ( Site 0183) Madrid
Spain Hospital Universitario Carlos Haya ( Site 0186) Malaga
Spain Hospital Universitario Marques de Valdecilla ( Site 0181) Santander Cantabria
Sweden Sahlgrenska Universitetssjukhuset ( Site 0212) Goteborg Vastra Gotalands Lan
Sweden Laenssjukhuset Ryhov ( Site 0215) Jonkoping Jonkopings Lan
Sweden Skanes Universitetssjukhus ( Site 0213) Lund Skane Lan
Sweden Karolinska Universitetssjukhuset ( Site 0211) Solna Stockholms Lan
Sweden Norrlands Universitetssjukhus ( Site 0216) Umea Vasterbottens Lan
Sweden Akademiska Sjukhuset ( Site 0218) Uppsala Uppsala Lan
Sweden Centrallasarettet Vaxjo ( Site 0214) Vaxjo Kronobergs Lan
Switzerland Universitaetsspital Basel ( Site 0094) Basel Basel-Stadt
Switzerland Kantonsspital Graubuenden ( Site 0091) Chur Grisons
Switzerland Kantonsspital Winterthur ( Site 0095) Winterthur Zurich
Switzerland Universitaetsspital Zuerich ( Site 0092) Zuerich-Flughafen Zurich
United Kingdom Western General Hospital ( Site 0121) Edinburgh Edinburgh, City Of
United Kingdom Guys and St Thomas NHS Foundation Trust ( Site 0126) London London, City Of
United Kingdom Derriford Hospital ( Site 0129) Plymouth
United Kingdom Singleton Hospital ( Site 0131) Swansea
United States University of Colorado Cancer Center ( Site 0708) Aurora Colorado
United States St. Vincent Frontier Cancer Center ( Site 0724) Billings Montana
United States University of North Carolina - Cancer Hospital ( Site 0751) Chapel Hill North Carolina
United States Inova Schar Cancer Institute ( Site 0739) Fairfax Virginia
United States Minnesota Oncology Specialist, PA ( Site 0766) Fridley Minnesota
United States Baptist MD Anderson Cancer Center ( Site 0767) Jacksonville Florida
United States The Angeles Clinic and Research Institute ( Site 0707) Los Angeles California
United States Atlantic Health System ( Site 0768) Morristown New Jersey
United States Yale Cancer Center ( Site 0709) New Haven Connecticut
United States Mid-Florida Cancer Centers ( Site 0764) Orange City Florida
United States Valley Hospital ( Site 0749) Paramus New Jersey
United States AMG Oncology ( Site 0714) Park Ridge Illinois
United States Illinois Cancer Care, PC ( Site 0765) Peoria Illinois
United States OHSU Center for Health & Healing ( Site 0731) Portland Oregon
United States California Pacific Medical Center Research Institute ( Site 0705) San Francisco California
United States UCSF Helen Diller Family Comprehensive Cancer Center ( Site 0704) San Francisco California
United States John Wayne Cancer Institute ( Site 0706) Santa Monica California

Sponsors (2)

Lead Sponsor Collaborator
Merck Sharp & Dohme LLC Eisai Inc.

Countries where clinical trial is conducted

United States,  Australia,  Austria,  Brazil,  Canada,  Chile,  China,  France,  Germany,  Israel,  Italy,  Korea, Republic of,  Poland,  South Africa,  Spain,  Sweden,  Switzerland,  United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Primary Progression-free Survival (PFS) as Assessed by Blinded Independent Central Review (BICR) Per Modified Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) PFS is defined as the time from date of randomization to the date of the first documentation of progressive disease (PD) or death from any cause, whichever occurs first. Per RECIST 1.1, PD is defined as =20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of =5 mm. Note: The appearance of one or more new lesions is also considered PD. For this study, RECIST 1.1 has been modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. Up to approximately 46 months
Primary Overall Survival (OS) OS is defined as the time from date of randomization to date of death from any cause. Up to approximately 46 months
Secondary Objective Response Rate (ORR) as Assessed by BICR Per RECIST 1.1 ORR is defined as the percentage of participants in the analysis population who have 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) per RECIST 1.1. For this study, RECIST 1.1 has been modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. Up to approximately 46 months
Secondary Duration of Response (DOR) as Assessed by BICR Per RECIST 1.1 For participants who demonstrated CR (disappearance of all target lesions) or PR (at least a 30% decrease in the sum of diameters of target lesions), DOR is defined as the date of the first documented evidence of CR or PR until disease progression or death from any cause, whichever occurs first. Per RECIST 1.1, PD is defined as =20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of =5 mm. Note: The appearance of one or more new lesions is also considered PD. For this study, RECIST 1.1 has been modified to follow a maximum of 10 target lesions and a maximum of 5 target lesions per organ. Up to approximately 46 months
Secondary Number of Participants With Adverse Events (AEs) An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. Up to approximately 46 months
Secondary Number of Participants Who Discontinue Study Treatment Due to Adverse Events (AEs) An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants who discontinued any study treatment due to an AE is presented. Up to approximately 46 months
Secondary Change From Baseline in European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire-Core 30 [QLQ-C30] Global Health Status (GHS)/Quality of Life (QoL) Score The EORTC QLQ-C30 is a questionnaire to assess the overall quality of life of cancer patients. The GHS/QoL combined score consists of participant responses to the questions "How would you rate your overall health during the past week?" and "How would you rate your overall quality of life during the past week?" GHS/QoL responses range in score from 0 to 100, with a higher score indicating a better outcome. Baseline and Week 21
Secondary Change From Baseline in European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire-Core 30 [QLQ-C30] Physical Function (PF) Score The EORTC QLQ-C30 is a questionnaire to assess the overall quality of life of cancer patients. The PF Score consists of participant responses to questions regarding PF (5 questions about daily activities [strenuous activities, long walks, short walks, bed/chair rest and needing help with eating, dressing, washing themselves or using the toilet]). For PF, responses range in score from 0 to 100, with a higher score indicating a better outcome. Baseline and Week 21
Secondary Time to True Deterioration (TTD) Based on Change From Baseline in EORTC QLQ-C30 GHS/QoL Score TTD is defined as the time from Baseline to 1st onset of a =10-point negative change (decrease) in EORTC-QLQ-C30 GHS Score. The EORTC QLQ-C30 is a questionnaire to assess the overall quality of life of cancer patients. TThe GHS/QoL Score consists of participant responses to the questions "How would you rate your overall health during the past week?" and "How would you rate your overall quality of life during the past week?" GHS/QoL responses range in score from 0 to 100, with a higher score indicating a better outcome. A longer TTD indicates a better outcome Up to approximately 30 months
Secondary Time to True Deterioration (TTD) Based on Change From Baseline in EORTC QLQ-C30 in Physical Function (PF) Score TTD is defined as the time from Baseline to 1st onset of a =10-point negative change (decrease) in EORTC-QLQ-C30 PF Score. The EORTC QLQ-C30 is a questionnaire to assess the overall quality of life of cancer patients. The PF Score consists of participant responses to questions regarding PF (5 questions about daily activities [strenuous activities, long walks, short walks, bed/chair rest & needing help with eating, dressing, washing themselves or using the toilet]. For PF, responses range in score from 0 to 100, with a higher score indicating a better outcome. Up to approximately 30 months
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