This two-part study will include a dose escalation part to determine the recommended dose for
expansion of DS8201a and pembrolizumab and a dose expansion part to evaluate efficacy,
safety, and tolerability of the combination.
This phase 1b, open-label, 2-part, multicenter, non-randomized, multiple-dose study will
evaluate DS-8201a in combination with pembrolizumab in participants with advanced/metastatic
breast cancer or non-small cell lung cancer (NSCLC).
In the dose escalation part of the study, escalating doses of DS-8201a in combination with
pembrolizumab will be assessed. DS-8201a and pembrolizumab 200 mg will be administered on Day
1 of every 21-day cycle. The initial dose administered for DS8201a will be 3.2 mg/kg Q3W.
Escalation to the next dose (5.4 mg/kg Q3W) will be based on acceptable safety signals based
on the earlier dose cohort.
Upon completion of dose escalation with the recommended dose of escalation (RDE) established,
the dose expansion part of the study will begin. The dose expansion part will include 4
cohorts: Human epidermal growth factor receptor 2 (HER2+) breast cancer participants with
prior ado-trastuzumab emtansine (T-DM1), HER2 low breast cancer participants with prior
failed standard treatments, HER2-expressing NSCLC participants who have not received any
prior treatment with anti-PD-1, anti-PD-L1, or HER2 agents, and HER2-mutant NSCLC
participants who have not received any prior treatment with anti-PD-1, anti-PD-L1, or HER2
agents.
Inclusion Criteria:
- Written informed consent
- Adults ≥18 years
- Eastern Cooperative Oncology Group performance status (ECOG PS) 0 to 1
- Pathologically documented HER2-expressing locally advanced/metastatic breast cancer,
and HER2-expressing or HER2-mutant locally advanced/metastatic NSCLC
- Willing to provide a tumor biopsy during screening and during treatment
- Have at least 1 measurable lesion per Response Evaluation Criteria in Solid Tumors
(RECIST) version 1.1 as assessed by the Investigator
- Adequate cardiac function, as defined by left ventricular ejection fraction (LVEF)
≥50% within 28 days before enrollment.
- Adequate organ function
- Adequate treatment washout period before enrollment
Inclusion Criteria Specific to Part 1
- Participants in Part 1 should meet the additional inclusion criteria listed for 1 of
the 4 cohorts in Part 2.
Inclusion Criteria Specific to Part 2
Inclusion Criteria for Cohort 1
- Pathologically documented, locally advanced/metastatic breast cancer that has
centrally determined HER2-positive expression as per American Society of Clinical
Oncology-College of American Pathologists (ASCO-CAP) Guidelines
- Received prior trastuzumab emtansine (T-DM1) therapy with documented progression
Inclusion Criteria for Cohort 2
- Pathologically documented, locally advanced/metastatic breast cancer that has
centrally determined HER2-low expression (immunohistochemistry [IHC] 1+ or IHC 2+/in
situ hybridization [ISH-])
- Participants must have exhausted treatments that can confer any clinically meaningful
benefit (eg, other therapies such as hormonal therapy for participants who are hormone
receptor positive)
Inclusion Criteria for Cohort 3
- Pathologically documented, locally advanced/metastatic NSCLC that has centrally
determined HER2-expression (IHC 1+, 2+, or 3+)
- Participants who have known epidermal growth factor receptor (EGFR) mutation,
anaplastic lymphoma kinase (ALK), BRAF V600E mutation, or ROS1 fusion should have
disease progression after treatment with at least one genomically-targeted therapy for
metastatic disease that are known to confer clinical benefit, or are intolerant to
treatment, or refuse standard treatment
Inclusion Criteria for Cohort 4
- Pathologically documented, locally advanced/metastatic HER2-mutant NSCLC
- Participants who have known EGFR mutation, ALK, BRAF V600E mutation, or ROS1 fusion
should have disease progression after treatment with at least one genomically-targeted
therapy for metastatic disease that are known to confer clinical benefit, or are
intolerant to treatment, or refuse standard treatment
Exclusion Criteria:
- Prior treatment with pembrolizumab or DS-8201a
- Medical history of myocardial infarction (MI) within 6 months before enrollment,
symptomatic congestive heart failure (New York Heart Association Class II to IV).
Participants with troponin levels above the upper limit of normal at Screening (as
defined by the manufacturer), and without any MI-related symptoms, should have a
cardiologic consultation before enrollment to rule out MI
- Corrected QT interval (QTc) prolongation to >470 ms (females) or >450 ms (males)
- History of (non-infectious) interstitial lung disease (ILD)/pneumonitis that required
steroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be
ruled out by imaging at screening
- Spinal cord compression or clinically active central nervous system metastases
- Active, known or suspected autoimmune disease
- Condition requiring systemic treatment with either corticosteroids (>10 mg daily
prednisone equivalent) or other immunosuppressive medications within 14 days of start
of study treatment
- Prior therapy with an anti-PD-1 or anti-PD-L1 agent
- Prior therapy with an agent directed to another stimulatory or coinhibitory T-cell
receptor (eg, CTLA-4, OX 40, CD137) and was discontinued from that treatment due to a
Grade 3 or higher immune-related adverse event (irAE)
- Prior anti-HER2 therapy is not allowed for participants with HER2 low-expressing
breast cancer or participants with NSCLC (Cohorts 2, 3, or 4). Prior treatment with
pan-HER tyrosine kinase inhibitor is allowed.
- Prior systemic anticancer therapy, including investigational agents within 2 to 6
weeks prior to treatment
- Unresolved toxicities from previous anticancer therapy
- Live vaccine within 30 days prior to the first dose of study drug
- 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
- Multiple primary malignancies within 3 years, except adequately resected non-melanoma
skin cancer, curatively treated in situ disease, other solid tumors curatively
treated, or contralateral breast cancer
- History of severe hypersensitivity reactions to other monoclonal antibodies and/or any
of the study drug components
- Active infection requiring systemic therapy
- Known history of human immunodeficiency virus (HIV) infection
- Active hepatitis B or C virus infection
- 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, or any other reason the participant is found not
appropriate to participate in the opinion of the treating Investigator
- Known psychiatric or substance abuse disorders
- Prior organ transplantation, including allogeneic stem cell transplantation
- Pregnant, breastfeeding, or planning to become pregnant
- Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses
- Uncontrolled infection requiring IV antibiotics, anti-virals, or anti-fungals
