Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Participants who had PD per RECIST v1.1 were eligible for an optional lenvatinib treatment (14 mg/m^2, capsules, orally, once daily in continuous 21-day cycles until next PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first) plus any remaining cycles of chemotherapy if 5 cycles were not completed prior to PD.

One-sided P value

Hazard ratio was based on Cox Proportional Hazard Model including treatment group as a factor and stratified by Age (less than [<]18 years, more than or equal to [>=]18 years) in interactive response technology (IRT). Efron method was used for ties.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Participants who had PD per RECIST v1.1 were eligible for an optional lenvatinib treatment (14 mg/m^2, capsules, orally, once daily in continuous 21-day cycles until next PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first) plus any remaining cycles of chemotherapy if 5 cycles were not completed prior to PD.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Participants who had PD per RECIST v1.1 were eligible for an optional lenvatinib treatment (14 mg/m^2, capsules, orally, once daily in continuous 21-day cycles until next PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first) plus any remaining cycles of chemotherapy if 5 cycles were not completed prior to PD.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Participants who had PD per RECIST v1.1 were eligible for an optional lenvatinib treatment (14 mg/m^2, capsules, orally, once daily in continuous 21-day cycles until next PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first) plus any remaining cycles of chemotherapy if 5 cycles were not completed prior to PD.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Participants who had PD per RECIST v1.1 were eligible for an optional lenvatinib treatment (14 mg/m^2, capsules, orally, once daily in continuous 21-day cycles until next PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first) plus any remaining cycles of chemotherapy if 5 cycles were not completed prior to PD.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Participants who had PD per RECIST v1.1 were eligible for an optional lenvatinib treatment (14 mg/m^2, capsules, orally, once daily in continuous 21-day cycles until next PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first) plus any remaining cycles of chemotherapy if 5 cycles were not completed prior to PD.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received lenvatinib 14 mg/m^2, capsules, orally, once daily, plus ifosfamide 3000 mg/m^2/day, intravenously and etoposide 100 mg/m^2/day, intravenously. Ifosfamide and etoposide were administered on Days 1 to 3 of each 21-day cycle for up to 5 cycles. Lenvatinib was administered in continuous 21-day cycles. Treatment continued until PD, development of unacceptable toxicity, participant choice, withdrawal of consent or discontinuation of study by the sponsor, whichever occurred first.

Participants received lenvatinib 14 mg/m^2 suspension, orally, once daily in continuous 21-day cycles until PD, development of unacceptable toxicity, participant request, withdrawal of consent, or discontinuation of study by the sponsor. Participants who were unable to swallow capsules received lenvatinib as an extemporaneous suspension prepared from the capsule.