A Study of Disitamab Vedotin With Other Anticancer Drugs in Solid Tumors

This clinical trial is to evaluate disitamab vedotin in combination with tucatinib in subjects with LA/metastatic breast cancer or gastric cancer/GEJC that express HER2. The study has a dose escalation phase evaluating disitamab vedotin plus tucatinib followed by a dose optimization phase. The 2 dose levels identified in the dose escalation phase will be assessed in the optimization phase for both safety and efficacy in HER2-expressing LA/mBC and LA/mGC/GEJC. Once the safety and efficacy profile of disitamab vedotin plus tucatinib has been established and a disitamab vedotin dose with the optimum benefit/risk ratio has been determined the disitamab vedotin plus tucatinib combination therapy will be evaluated in an expansion phase with 4 expansion cohorts in subjects with HER2-low LA/mGC/GEJC, HER2+ LA/mGC/GEJC, HER2-low LA/mBC, and HER2+ LA/mBC.

Inclusion criteria

General Inclusion Criteria

• Measurable disease according to RECIST v1.1
• Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0 or 1

Dose Escalation and Optimization Phase Inclusion Criteria

• Histologically or cytologically confirmed diagnosis of gastric or gastroesophageal junction adenocarcinoma or breast carcinoma
• Locally-advanced, unresectable, or metastatic stage
• Must have experienced disease progression on or after standard of care therapies or be intolerant of standard of care therapies.

Cohort A (HER2-Low Breast Cancer) Inclusion Criteria

• Histologically or cytologically confirmed diagnosis of breast carcinoma
• Locally-advanced, unresectable, or metastatic stage
• HER2-low status determined by most recent local assessment (IHC 1+ or IHC 2+/ISH-negative)
• Prior therapies requirements

• No more than 3 prior systemic cytotoxic chemotherapy regimens (including ADCs) for LA/mBC.
• Participants with known BRCA mutation must have received a PARP-inhibitor where available and not medically contraindicated
• Have progression on or after, or intolerant to, T-DXd, sacituzumab govitecan, or other topoisomerase I inhibitor therapies, if available as local standard of care therapy
• Participants with HR+ tumors must have intolerance to endocrine therapy or endocrine therapy refractory disease:

• Progressed on ≥2 lines of endocrine therapy for LA/mBC AND had received a CDK4/6 inhibitor in the adjuvant or metastatic setting OR
• Progressed on 1 line of endocrine therapy for LA/mBC AND had a relapse while on adjuvant endocrine therapy after definitive surgery for primary tumor AND had received a CDK4/6 inhibitor in the adjuvant or advanced setting
• Participants with HR negative, HER2-low and PD-L1-positive (CPS 10 or greater) tumors must have received pembrolizumab with chemotherapy if available as local standard of care therapy.
• Participants with HR negative, HER2-low and PD-L1-positive (CPS 10 or greater) tumors must have received pembrolizumab (or other PD-(L)1 inhibitor) with chemotherapy if available as local standard of care therapy and not medically contraindicated.

Cohort B (HER2+ Breast Cancer) Inclusion Criteria

• Histologically or cytologically confirmed diagnosis breast carcinoma
• Locally-advanced, unresectable, or metastatic stage
• HER2+ status determined by most recent local assessment (IHC 3+ or IHC 2+/ISH+)
• Participants must have:

• Received prior trastuzumab, pertuzumab and a taxane if available as local standard of care therapy for advanced disease.
• Have progression on or after, or intolerant to, T-DXd or other topoisomerase I inhibitor therapies
• No more than 3 prior systemic cytotoxic chemotherapy regimens (including ADCs) for LA/mBC

Cohort C (HER2-Low Gastric or Gastroesophageal Junction Adenocarcinoma) Inclusion Criteria

• Histologically or cytologically confirmed diagnosis of gastric or gastroesophageal junction adenocarcinoma
• Locally-advanced, unresectable, or metastatic stage
• HER2-low expression defined as IHC 1+ or IHC 2+/ISH-negative determined by most recent local assessment
• Willing and able to provide archival or newly obtained formalin-fixed paraffin-embedded (FFPE) tumor tissue blocks
• Participants must have received:

• Prior systemic therapy with platinum, fluorouracil, or taxane for locally advanced unresectable or metastatic disease
• Progression within 6 months of last dose of (neo)adjuvant cytotoxic chemotherapy is considered as 1 line of systemic therapy for LA/mGC/GEJC
• Prior anti-PD-(L)1 therapy is allowed
• No more than 2 prior systemic cytotoxic chemotherapy regimens (including ADC) for LA/mGC/GEJC
• Must not have received prior treatment with HER2 directed therapy

Cohort D (HER2+ LA/mGC/GEJC) Inclusion Criteria

• Histologically or cytologically confirmed diagnosis of gastric or gastroesophageal junction adenocarcinoma
• Locally-advanced, unresectable, or metastatic stage
• HER2+ status determined by most recent local assessment (IHC 3+ or IHC 2+/ISH+)
• Participants must have:

• Received prior trastuzumab plus fluoropyrimidine and platinum containing chemotherapy if no contraindication.
• Prior T-DXd treatment is allowed
• Prior PD1 inhibitor therapy is allowed
• No more than 2 prior systemic cytotoxic chemotherapy regimens (including ADCs) for LA/mGC/GEJC

Exclusion criteria

• Known hypersensitivity to any excipient contained in the drug formulation of disitamab vedotin or tucatinib
• Prior therapy with ADCs with MMAE payload
• Prior therapy with tucatinib
• Active CNS and/or leptomeningeal metastasis.
• Participants who have received prior systemic anticancer treatment including investigational agents within 4 weeks prior to first dose of study treatment
• History of other invasive malignancy within 3 years before the first dose of study intervention, or any evidence of residual disease from a previously diagnosed malignancy.
• Unable to swallow oral tablets or capsules or any significant GI disease which would preclude the adequate oral absorption of medications