A Study of SAR444245 Combined With Other Anticancer Therapies for the Treatment of Participants With Lung Cancer or Mesothelioma (Pegathor Lung 202)

Study Overview
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Brief Summary
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Primary Objective: -To determine the antitumor activity of SAR444245 in combination with other anticancer therapies. Secondary Objectives: To confirm the dose and to assess the safety profile of SAR444245 when combined with other anticancer therapies. To assess other indicators of antitumor activity. To assess the pharmacokinetic (PK) profile of SAR444245 when given in combination with pembrolizumab. To assess the immunogenicity of SAR444245.

Detailed Description
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The duration of the study for an individual patient will start from the signature of the main informed consent and include a screening period of up to 28 days, a treatment period [max 35 cycles {cohorts A1, A2, and B1} = 735 days or until PD {cohort C1}], an end-of-treatment visit at least 30 days following the last administration of study drug (or until the patient receives another anticancer therapy, whichever is earlier), and a follow-up visit 3 months after treatment discontinuation and every 3 months following, until disease progression, or initiation of another antitumor treatment, or death, whichever is earlier

Official Title
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A Phase 2 Non-randomized, Open-label, Multi-cohort, Multi-center Study Assessing the Clinical Benefit of SAR444245 (THOR-707) Combined With Other Anticancer Therapies for the Treatment of Participants With Lung Cancer or Pleural Mesothelioma

Conditions
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Pleural Mesothelioma, Non-small Cell Lung Cancer

Intervention / Treatment
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* Drug: THOR-707
* Drug: Pembrolizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant must be ≥18 years of age (or country's legal age of majority if >18 years), at the time of signing the informed consent. Histologically or cytologically confirmed diagnosis of Stage IV NSCLC (cohorts A1, A2, and B1), or unresectable malignant pleural mesothelioma (cohort C1). Cohort A1: PD-L1 expression TPS ≥ 50% Cohort A2: PD-L1 expression TPS 1 - 49% Prior anticancer therapy Cohorts A1 and A2: No prior systemic therapy for advanced/metastatic NSCLC. Participants who received adjuvant or neoadjuvant therapy are eligible if the adjuvant/neoadjuvant therapy was completed at least 6 months prior to the development of metastatic disease. Cohort B1: One prior anti-PD1/PD-L1 regimen (may include chemotherapy) plus one additional chemotherapy regimen Cohort C1: One or two prior systemic treatments that include pemetrexed-based regimen in combination with platinum agent. All cohorts must have a measurable disease Mandatory baseline biopsy for the first 20 participants to enroll in cohorts A1, A2 Cohort B1: Based on the Investigator's judgment, either docetaxel or pemetrexed is not the best treatment option for the participant. Females are eligible to participate if they are not pregnant or breastfeeding, not a woman of childbearing potential (WOCBP) or are a WOCBP that agrees: to use approved contraception method and submit to regular pregnancy testing prior to treatment and for 150 days after discontinuing study treatment to refrain from donating or cryopreserving eggs for 150 days after discontinuing study treatment. Males are eligible to participate if they agree to refrain from donating or cryopreserving sperm, and either abstain from heterosexual intercourse OR use approved contraception during study treatment and for at least 210 days after discontinuing study treatment. Capable of giving signed informed consent. Exclusion Criteria: Participants are excluded from the study if any of the following criteria apply: Eastern Cooperative Oncology Group (ECOG) performance status of ≥ 2. Poor bone marrow reserve Poor organ function Participants with baseline SpO2 ≤ 92%. Active brain metastases or leptomeningeal disease. History of allogenic tissue/solid organ transplant Last administration of prior antitumor therapy or any investigational treatment within 28 days or less than 5 times the half-life, whichever is shorter; major surgery or local intervention within 28 days. Has received prior IL-2-based anticancer treatment. Comorbidity requiring corticosteroid therapy Antibiotic use (excluding topical antibiotics) ≤14 days prior to first dose of IMP Severe or unstable cardiac condition within 6 months prior to starting study treatment Active, known, or suspected autoimmune disease that has required systemic treatment in the past 2 years Known second malignancy either progressing or requiring active treatment within the last 3 years Cohorts A1, A2, and C1: Prior treatment with an agent (approved or investigational) that blocks the PD1/PD-L1 pathway (participants who joined a study with an anti-PD1/PD-L1 but have written confirmation they were on control arm are allowed). Receipt of a live-virus vaccination within 28 days of planned treatment start. Seasonal flu vaccines that do not contain live virus are permitted. The above information is not intended to contain all considerations relevant to the potential participation in a clinical trial.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cohort A1: Non-small cell lung cancer 1rst line therapy with Tumor proportion score > 50%<br>SAR444245 + pembrolizumab, on day 1 of a 21-day treatment cycle (up 35 cycles). | Drug: THOR-707<br>* Intravenous infusion: solution for infusion<br>Drug: Pembrolizumab<br>* Intravenous infusion: solution for infusion<br>* Other names: Keytruda® or generic;|
| Experimental: Cohort A2: Non-small cell lung cancer 1rst line therapy with Tumor proportion score 1-49%<br>SAR444245 + pembrolizumab, on day 1 of a 21-day treatment cycle (up 35 cycles). | Drug: THOR-707<br>* Intravenous infusion: solution for infusion<br>Drug: Pembrolizumab<br>* Intravenous infusion: solution for infusion<br>* Other names: Keytruda® or generic;|
| Experimental: Cohort B1: Non-small cell lung cancer 2/3rd line therapy<br>SAR444245 + pembrolizumab, on day 1 of a 21-day treatment cycle (up 35 cycles). | Drug: THOR-707<br>* Intravenous infusion: solution for infusion<br>Drug: Pembrolizumab<br>* Intravenous infusion: solution for infusion<br>* Other names: Keytruda® or generic;|
| Experimental: Cohort C1: :Mesotheloma 2/3rd line therapy<br>SAR444245 + pembrolizumab, on day 1 of a 21-day treatment cycle (up 35 cycles). | Drug: THOR-707<br>* Intravenous infusion: solution for infusion<br>Drug: Pembrolizumab<br>* Intravenous infusion: solution for infusion<br>* Other names: Keytruda® or generic;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective response rate (ORR) | Objective response rate (ORR), defined as the proportion of participants who have a confirmed complete response (CR) or partial response (PR), derived based on Investigator's assessment per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 for Cohort A1, Cohort A2, and Cohort B1; per modified RECIST (mRECIST) for Cohort C1. | Baseline to the date of first documented progression or initiation of subsequent anticancer therapy or approximatively 9 months after the last participant receive first dose | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To confirm the dose | Incidence of Dose-limiting toxicities (DLTs) during DLT observation period | Observation period is 1 cycle (21 days) | 
| Assessment of SAR444245 safety profile when combined with other anticancer therapies-Treatment Emergent Adverse Events | Incidence of Treatment Emergent Adverse Events (TEAEs) and laboratory abnormalities according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) V5.0 and American Society for Transplantation and Cellular Therapy (ASTCT) consensus gradings | From 1st IMP dose up to 30 days after the last dose of IMP | 
| Assessment of SAR444245 safety profile when combined with other anticancer therapies-Serious Adverse Events | Incidence of Serious Adverse Events (SAEs) and laboratory abnormalities according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) V5.0 and American Society for Transplantation and Cellular Therapy (ASTCT) consensus gradings | From 1st IMP dose up to 90 days after the last dose of IMP | 
| Time to response | Time to response (TTR) defined as the time from the first administration of investigational medicinal product (IMP) to the first tumor assessment at which the overall response was recorded as PR or CR that is subsequently confirmed and determined by investigator per RECIST 1.1 (for NSCLC) or mRECIST (for mesothelioma) | From the date of first dose until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months | 
| Duration of response | Duration of response (DoR), defined as the time from first tumor assessment at which the overall response was recorded as PR or CR that is subsequently confirmed until progressive disease (PD) determined by investigator per RECIST 1.1 (for NSCLC) or mRECIST (for mesothelioma) or death from any cause, whichever occurs first. | From the date of first dose until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months | 
| Clinical benefit rate | Clinical benefit rate (CBR) including CR or PR at any time plus stable disease (SD) of at least 6 months (per RECIST 1.1 [for NSCLC] or mRECIST [for mesothelioma]). | From the date of first dose until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months | 
| Progression free survival (PFS) | Progression free survival (PFS), defined as the time from the date of first IMP administration to the date of the first documented disease progression as per RECIST 1.1 for NSCLC) or mRECIST (for mesothelioma) or death due to any cause, whichever occurs first | From the date of first dose until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months | 
| To assess the plasma concentrations of SAR444245 |  | Day 1, Day 2, and Day 3 of Cycle1, at Day 1 of Cycle 2-4-7-10 + every 5th cycle (each cycle is 21 days), maximum is up to approximately 24 months | 
| To assess the incidence of anti-drug antibodies (ADAs) against SAR444245. |  | Day 1 and Day 8 of Cycle1, Day 1 of Cycle 2-4-7-10 + every 5th cycle (each cycle is 21 days) and 30 days after last IMP administration, maximum is up to approximately 24 months |