A Phase I/II Open-Label, Non-Randomized Dose Escalation Study of Immunoconjugate L-DOS47

The primary purpose of this research study is to evaluate how safe, how well tolerated and how effective a range of doses of L-DOS47 in patients with non-squamous non-small cell lung cancer when given as a monotherapy.

Patients will be recruited into cohorts, with a minimum of three and a maximum of six patients per cohort. All patients at a given dose level must complete Cycle 1 (3 week period) before escalation in subsequent patients can proceed. The decision for dose escalation to the next dose level will be made after the safety and available pharmacokinetic (PK) data have been reviewed by the Trial Steering Committee (TSC).

Escalation of L-DOS47 will continue until a maximum tolerated dose (MTD) is reached.

After the MTD of L-DOS47 has been determined in Phase I, up to 20 patients will be enrolled (taken forward from Phase I) to evaluate the preliminary efficacy of L-DOS47 (i.e., response rate using the Response Evaluation Criteria in Solid Tumours \[RECIST\] version 1.1 criteria, disease progression and survival); monitoring will include radiologic evaluations every second cycle. The safety and tolerability of L-DOS47 will also be further evaluated. Pharmacokinetic information will be collected as well as relevant observations on the activity of L-DOS47.

For all patients, treatment with L-DOS47 will continue either until the patient experiences disease progression, unacceptable toxicity, the patient withdraws consent or has completed four treatment cycles and does not wish to continue with additional cycles, whichever occurs first. After four cycles, patients may continue to receive L-DOS47 for as long as there is sustained clinical benefit and it is well tolerated, in the opinion of the Investigator.

Eligibility Criteria:
Main Inclusion Criteria:

Patients will be entered in the study only if they meet all of the following criteria:

1. Male or female aged ≥ 18 years old
2. Have histologically confirmed non-squamous NSCLC that are:

   1. Chemo naïve Stage IIIb or IV non-squamous NSCLC who are not candidates for chemotherapy or radiotherapy, or who refused standard therapy
   2. Refractory Stage IIIb or IV non-squamous NSCLC. (Staging of non-squamous NSCLC must be assessed according to TNM, 7th edition and based on computed tomography (CT) scan.)
3. Have at least a single measurable lesion in accordance with the RECIST v1.1 criteria.
4. Eastern Cooperative Oncology Group (ECOG) performance status: 0-2
5. Have a life expectancy of ≥ 3 months
6. Have adequate bone marrow, renal and liver function

Main Exclusion Criteria:

1. Are pregnant or nursing mother
2. Have a prior history of other malignancies with the exception of non melanoma skin cancer
3. Have known history of central nervous system (CNS) metastatic disease (previously treated or untreated)
4. Show evidence of active infection
5. Have received treatment in another clinical study within the 30 days before commencing study drug or have not recovered from side effects of a study drug, except for alopecia
6. Have a serious uncontrolled medical condition
7. Known positive human immunodeficiency virus (HIV), known hepatitis B surface antigen, or hepatitis C positive
8. Sustained QTc (QT interval corrected for heart rate) with Fridericia's correction \> 450 ms at screening, or a history of additional risk factors for Torsades de pointes (e.g., heart failure, hypokalemia, family history of long QT syndrome)
9. Pre-existing peripheral neuropathy ≥ CTC Grade 2
10. Have dementia or significantly altered mental status that would prohibit the understanding or rendering of informed consent or compliance with the requirements of the protocol
11. Are receiving chemotherapy during the 30 days before study treatment start; are receiving radiotherapy, targeted therapy, hormonal therapy, immunotherapy, major surgery or other study drugs during the 4 weeks before study treatment start, or have not recovered from all treatment related toxicities to Grade ≤ 1, except for alopecia. (Radiotherapy is allowed for the symptomatic treatment of bone metastases.)
12. Are taking systemic steroids (other than inhalers or topical steroids) or other medication to suppress the immune system
13. Are participating (or planning to participate) in any other clinical trial during this study.