Inclusion Criteria:
1. Have a signed informed consent form prior to any study specific procedures or
treatment. 2. Be ≥18 years of age (male or female) at the time of consent. 3. Have 1 of the following histologically or cytologically confirmed tumor types with
qualifying characteristics, and have received a minimum of 2 (and no more than 5)
lines of prior therapy for metastatic (Stage IV) disease:
1. RCC (renal cell carcinoma
- - clear cell or papillary)
2.
SCLC (small cell lung cancer) OR have received a minimum of 3 (and no more than
5) lines of prior therapy for metastatic (Stage IV) disease:
3. GC (gastric adenocarcinoma)
4. Human epidermal growth factor receptor positive (HER2+) MBC (metastatic breast
cancer)
5. Other solid tumors (e.g., non-small cell lung cancer, colorectal cancer,
carcinoma of unknown primary) with the exception of rapidly progressing
neoplasms (e.g., pancreatic cancer, glioblastoma, hepatocellular carcinoma)
Note: Subjects with RCC and GC are a priority and should constitute approximately
50% (12 subjects) of the enrolled popululation. Enrollment of all others will be
capped when reaching a combined 50%, in order to maintain 12 slots for subjects with
RCC and GC.
4. Have at least 1 radiologically measurable lesion as per RECIST v 1.1, defined as a
lesion that is at least 10 mm in longest diameter or lymph node and that is at least
15 mm in short axis imaged by CT scan or magnetic resonance imaging (MRI) and
obtained by imaging within 28 days prior to screening. Tumor lesions situated in a
previously irradiated area are considered measurable if progression has been
demonstrated in such lesions. 5. Have resolution of all previous treatment related toxicities to Grade 1 severity or
lower, except for stable sensory neuropathy (≤ Grade 2) and alopecia. If the subject
received major surgery or radiation therapy of >30 Gy, they must have recovered from
the toxicity and/or complications from the intervention. 6. Provided there are suitable and accessible lesions, no biopsy contraindications,
minimal risk of complications and a positive informed decision, subject as are
willing to provide fresh tissue for biomarker analysis, and, based on the adequacy
of the tissue sample quality, for assessment of biomarker status. Two biopsies will
be necessary: at baseline (within 30 days prior to first dose) and within 7 days
after Cycle 3/Day 1.
Newly obtained biopsy specimens are preferred to archived samples and formalin-
fixed, paraffin-embedded block specimens are preferred to slides. In the event a
fresh pre-treatment biopsy is not able to be provided, the most recent archival
biopsy must be provided in its place. 7. Have Eastern Cooperative Oncology Group performance status of 0 or 1 and sustained
between screening and initiation of dosing on Day 1. 8. QT interval corrected for heart rate using Fridericia's (QTcF) method ≤450 msec. 9. Have an albumin level of ≥3 g/dL at screening. 10. Have life expectancy of 3 months or greater as determined by the treating physician. 11. Have adequate organ function within 15 days prior to first administration of study
drug on Day 1, as defined by meeting all of the following criteria:
1. Total bilirubin ≤1.5 × upper limit of normal (ULN) OR direct bilirubin ≤ ULN
for subjects with total bilirubin levels >1.5 x ULN. 2. Aspartate aminotransferase and alanine aminotransferase ≤2.5 × ULN or ≤5 × ULN
for subjects with known hepatic metastases. 3. Fasting serum glucose within normal range and hemoglobin A1c ≤8%
4. Thyroid function tests (thyroid stimulating hormone [TSH] within normal limits
for subjects with normal thyroid function and free thyroxine [FT4]) within
normal limits for subjects on thyroid treatment. 12. Have adequate renal function within 15 days prior to first administration of study
drug on Day 1, as defined by creatinine ≤1.5 × ULN and creatinine clearance ≥30
mL/min, as per the below Cockcroft Gault formula. 13. Have adequate hematologic function within 15 days prior to first administration of
study drug on Day 1, as defined by meeting all of the following criteria:
1. Hemoglobin ≥9 g/dL (uncorrected by red blood cell transfusion or erythropoietin
support)
2. Absolute neutrophil count ≥1.5 × 109/L. 3. Platelet count ≥100 × 109/L. 14. Have adequate coagulation function within 15 days prior to first administration of
study drug on Day 1, as defined by either of the following criteria:
1. International normalized ratio (INR) <1.5 × ULN OR for subjects receiving
warfarin or low molecular weight heparin, the subject must, in the
investigator's opinion, be clinically stable with no evidence of active
bleeding while receiving anticoagulant therapy. The INR for these subjects may
exceed 1.5 × ULN if that is the goal of anticoagulant therapy. 2. Activated partial thromboplastin time (aPTT) <1.5 × ULN unless subject is
receiving anticoagulant therapy, provided prothrombin time or aPTT is within
therapeutic range of intended use of anticoagulants. 15. Female subject of childbearing potential must have a negative urine or serum
pregnancy within 72 hours prior to receiving the first dose of study medication. If
the urine test is positive or cannot be confirmed as negative, a serum pregnancy
test will be required. 16. Female subject of childbearing potential must be willing to use an adequate form of
contraception from the first dose of study medication through 90 days after the last
dose of study drug. 17. Female subject must agree not to breastfeed and not to donate ova starting at
screening and throughout the study treatment, and for 90 days after the last dose of
study drug. 18. Male subject with a pregnant or breastfeeding partner(s) must agree to remain
abstinent or use a condom for the duration of the pregnancy or for the time partner
is breastfeeding throughout the study period and for 90 days after the last dose of
study drug. 19. Male subject with female partner(s) of childbearing potential must not donate sperm
during the treatment period and for at least 90 days after the last dose of study
drug. 20. Male subject with female partner(s) of childbearing potential should agree to use a
highly effective method of contraception during the treatment period and for at
least 90 days after the last dose of the study drug. 21. Be willing and have the ability to comply with scheduled visits (including
geographical proximity), treatment plans, laboratory tests, and other study
procedures.
Exclusion Criteria:
1. Had prior chemotherapy, targeted small molecule therapy, or radiation therapy within
2 weeks prior to the first dose of study treatment or who has not recovered from
adverse reactions due to a previously administered agent or major surgery. 2. Is currently participating and receiving study therapy or has participated in a
study of an investigational agent and received study therapy or used an
investigational device within 4 weeks of the first dose of treatment. 3. Has a diagnosis of immunodeficiency or receiving systemic steroid therapy or any
other form of immunosuppressive therapy within 7 days prior to the first dose of
study treatment. The use of physiologic doses of corticosteroids (≤30 mg/day of
hydrocortisone, ≤10 mg/day of prednisone, ≤2 mg/day of dexamethasone, or equivalent)
may be approved after consultation with the sponsor. 4. Has taken a medication that is a strong CYP3A4 inhibitor or inducer within 4 weeks
of the first dose of treatment (see Appendix 12)
5. Has known history of active tuberculosis. 6. Has known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies)
7. Has known active Hepatitis B (anti hepatitis B surface antibody, anti hepatitis B
core antibody, hepatitis B surface antigen [HBsAg]) or Hepatitis C (hepatitis C
antibody) infection. 8. Has a current diagnosis of severe acute respiratory syndrome coronavirus (SARS CoV)
2 infection confirmed by reverse transcription polymerase chain reaction (PCR) test.
Subject needs to have a negative PCR test at screening and a negative PCR test
within 14 days prior to the first dose of study treatment. 9. Has a history of clinically severe autoimmune disease, or a history of organ
transplant. 10. Has insulin dependent (Type I) diabetes or poorly controlled Type II diabetes (per
clinical discretion) with hemoglobin A1c >8%
11. Has known additional malignancy that is progressing or required active treatment
within previous 5 years. Exceptions include basal cell carcinoma or squamous cell
carcinoma of the skin that has undergone potentially curative therapy, superficial
bladder cancer, or in situ cervical cancer. Subjects with other malignancies are
eligible if they were cured by surgery alone or surgery plus radiotherapy and have
been continuously disease free for at least 5 years. 12. Has known active central nervous system metastases and/or carcinomatous meningitis.
Subjects with previously treated brain metastases may participate provided they are
stable (without evidence of disease progression by imaging for at least 4 weeks
prior to the first dose of trial treatment and any neurologic symptoms have returned
to baseline), have no evidence of new or enlarging brain metastases, and are not
using systemic steroids for at least 7 days prior to trial treatment. This exception
does not include carcinomatous meningitis which is excluded regardless of clinical
stability. 13. Has a history of interstitial lung disease, pneumonitis within 12 months prior to
screening or current pneumonitis. 14. Has an active infection requiring systemic therapy. 15. Has a history or current evidence of any condition, therapy, or laboratory
abnormality that might confound the results of the trial, interfere with the
subject's participation for the full duration of the trial, or is not in the best
interest of the subject to participate, in the opinion of the treating investigator. 16. Has a history or ongoing clinically significant cardiovascular disease such as
unstable angina, myocardial infarction, or acute coronary syndrome, symptomatic or
uncontrolled arrhythmia, congestive heart failure, baseline ECG abnormalities,
including, but not limited to, QTc prolongation (prolonged QTcF defined as ≥450
msec) or any Class III or IV cardiac disease as defined by the New York Heart
Association Functional Classification. 17. Has overt or latent disorders of the exocrine pancreas (such as acute or chronic
pancreatitis of any etiology) or chronic (including autoimmune) gastrointestinal
disorders such as Crohn's disease, ulcerative colitis, rheumatoid arthritis, lupus,
scleroderma, Sjogren's syndrome, and polyarteritis nodosa. 18. Has a known psychiatric or substance abuse disorder(s) that would interfere with
informed consent or cooperation with the requirements of the trial. 19. Is pregnant or breastfeeding or expecting to conceive children within the projected
duration of the trial, starting with the prescreening or screening visit through 90
days after the last dose of study drug. 20. Is a first degree relative of the investigator, staff, or study sponsor.
