Zelenectide Pevedotin in NECTIN4 Amplified Advanced or Metastatic Non-small Cell Lung Cancer

Prior treatment

• Prior Stevens-Johnson syndrome (SJS)/ toxic epidermal necrolysis (TEN)/drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), erythema multiforme, symmetric drug-related intertriginous and flexural exanthema (SDRIFE), or Baboon syndrome.
• Requirement, while on study, for treatment with strong inhibitors or strong inducers of human cytochrome P450 3A (CYP3A) or inhibitors of P-glycoprotein (P-gp) including herbal- or food-based inhibitors.
• Active interstitial lung disease (ILD) or pneumonitis requiring ongoing treatment with steroids (>10 mg per day of prednisone or equivalent) or other immunosuppressive medications; or any prior history of ILD or non-infectious pneumonitis requiring high-dose glucocorticoids.
• Suspicion of relevant and recent systemic viral syndrome or need for quarantine/isolation that is not resolved prior to first dose of study treatment in the opinion of the Investigator.
• Uncontrolled hypertension (systolic blood pressure (BP) ≥ 150 mm mercury (Hg) or diastolic BP ≥ 95 mm Hg) prior to first dose.
• Prior treatment with MMAE (vedotin) based therapy.
• Active systemic infection or fever not attributable to underlying malignancy requiring therapeutic oral or IV antibiotics within 14 days prior to first dose of study treatment. Participants receiving prophylactic antibiotics are eligible.
• Receipt of live or attenuated vaccine within 30 days of first dose.
• Prior treatment with any systemic anticancer therapy within 28 days or 5 half-lives, whichever is shorter, prior to first dose of study treatment; the following exceptions are permitted: a. Palliative radiotherapy for bone or soft tissue metastasis completed > 7 days prior to baseline imaging.
• Treatment with any other investigational agent or participation in another clinical study with therapeutic intent within 28 days or 5 half-lives, whichever is shorter, prior to first dose of study treatment.
• Has not adequately recovered from recent major surgery (excluding placement of vascular access).
• Ongoing clinically significant toxicity (Grade ≥ 2) associated with prior treatment for NSCLC (including radiotherapy or surgery), with the exception of well-controlled immuno-oncology related endocrine disorders on supportive or replacement therapy, and alopecia.
• Known active carcinomatous meningitis or untreated central nervous system (CNS) metastases. a. Participants with treated brain metastases may participate in the study if they are stable for at least 3 months prior to the first dose, either without the use of steroids or on stable or decreasing dose of ≤ 10 mg daily prednisone or equivalent and are without any symptoms that would confound the evaluation of neurologic or other adverse events (AEs).

Other illness

• Evidence of mixed small cell lung cancer (SCLC) and NSCLC histology.
• Known active hepatitis C infection with positive viral load if hepatitis C virus is antibody positive (if antibody is negative then viral load is not applicable). Participants who have been treated for hepatitis C infection can be included if they have documented sustained virologic response of ≥ 12 weeks.
• National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Grade ≥ 2 peripheral neuropathy.
• Known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study.
• History or another active malignancy that would interfere with the safety or efficacy evaluation of the clinical study.
• Known hypersensitivity or allergy to any of the ingredients of any of the study interventions, or to MMAE.
• Known active hepatitis B, defined as positive surface antigen and/or anti-hepatitis B core antibody and positive polymerase chain reaction (PCR) assay.

Lab values

• Uncontrolled diabetes, defined as hemoglobin A1C (HbA1c) ≥ 8%.
• History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant’s ability to take part in the full duration of the study, or is not in the best interest of the participant to take part, in the opinion of the Investigator.
• Known human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Well-controlled HIV will be allowed if the participant meets all the following criteria at inclusion: a. Cluster of differentiation (CD4+) counts ≥ 350 cells/μL b. HIV viral load < 400 copies/mL c. Without a history of opportunistic infection within the last 12 months d. On established antiretroviral therapy (ART) for at least 4 weeks.
• Participants with history of a cerebral vascular event (stroke or transient ischemic attack), unstable angina, myocardial infarction, congestive heart failure or symptoms of New York Heart Association (NYHA) Class III or IV (Appendix 13.3) documented within 6 months prior to first dose of study treatment or: a. Mean resting corrected QT interval (QTc) > 470 msec by Fridericia QT correction b. Any factors that increase the risk of QTc prolongation such as congenital long QT syndrome, or family history of long QT syndrome c. Any clinically important abnormalities (as assessed by the Investigator) in rhythm, conduction, or morphology of resting ECGs (eg, complete left bundle branch block, third degree heart block).

Other

• Known diffusing capacity of the lung for carbon monoxide (DLCO) < 50% or FEV1 % <50% predicted.
• Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently).
• Active keratitis or corneal ulcerations.

• Able to understand the study procedures and agree to participate in the study by providing written informed consent.
• Histologically or cytologically confirmed advanced or metastatic NSCLC. a. Cohort A: Histologically or cytologically confirmed non-squamous NSCLC. b. Cohort B: Histologically or cytologically confirmed squamous NSCLC
• Confirmed NECTIN4 gene amplification by an analytically validated clinical trial assay (CTA).
• Participants must not have received more than 3 prior lines of systemic therapy in the advanced/metastatic setting. • Participants with no known actionable genomic alterations must have received both platinum based therapy and immunotherapy given either sequentially or in combination for advanced/metastatic NSCLC. • Those with known actionable genomic alterations (eg, EGFR, ALK, BRAF, MET, ROS1, NTRK1/2/3, RET) are eligible provided they have received or are not candidates for available standard targeted therapy in the advanced/metastatic setting.
• Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 a. Target lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions post irradiation.
• Adequate archival or fresh tumor tissue comprised of advanced or metastatic NSCLC should be available for submission to central laboratory, if not provided during pre-screening.
• WOCBP and male participants must be willing to follow highly effective contraception at least as conservative as Clinical Trial Facilitation Group (CTFG) recommendations of < 1% failure rate starting at Screening, throughout the study period, and for at least 6.5 months following the last dose of zelenectide pevedotin.
• Fertile male participants must agree to refrain from sperm donation from first dose until at least 6.5 months following the last dose of zelenectide pevedotin. Women must not breastfeed or donate eggs from first dose until 6.5 months following the last dose of zelenectide pevedotin.
• Life expectancy ≥ 12 weeks.
• ECOG PS of ≤ 1.
• International normalized ratio (INR)/prothrombin time (PT) ≤ 1.5 × ULN unless participant is receiving a stable dose of anticoagulant therapy and PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of the appropriate anticoagulants.
• Adequate bone marrow function including the following: a. Hemoglobin ≥ 9 g/dL b. Absolute neutrophil count (ANC) ≥ 1500 cells/mm3 c. Platelet count ≥ 100,000 cells/mm3 Note: Red blood cells (RBCs) should not be given 4 weeks prior to bone marrow function assessment and platelet transfusions or growth factors should not be given 2 weeks prior to bone marrow function assessment.
• Negative pregnancy test for women of childbearing potential (WOCBP) (negative serum test at Screening and negative urine or serum test within 72 hours prior to the first dose).
• Oxygen saturation of ≥ 93% on room air.
• Adequate organ function: a. Total bilirubin ≤ 1.5 × upper limit of normal (ULN) or ≤ 3 × ULN for participants with Gilbert disease b. Serum albumin ≥ 2.5 g/dL c. Aspartate aminotransferase (AST) ≤ 2.5 × ULN or ≤ 5 × ULN in the presence of liver metastases d. Alanine aminotransferase (ALT) ≤ 2.5 × ULN or ≤ 5 × ULN in the presence of liver metastases e. Alkaline phosphatase (ALP) ≤ 2.5 × ULN or ≤ 5 × ULN in the presence of liver or bone metastases f. Estimated glomerular filtration rate (eGFR) ≥ 30 mL/min (using the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] creatinine equation adjusted by participant’s body surface area, or as measured by 24-hour urine collection).
• ≥ 18 years of age on day of signing informed consent.