A Study With NKT3964 for Adults With Advanced/Metastatic Solid Tumors

Inclusion Criteria:

- Must have a pathologically confirmed, advanced and unresectable or metastatic solid

tumor listed below with documented disease progression on last standard treatment.

For Part 1 Monotherapy Dose Escalation (including Food Effect Sub-study): Patients must

be refractory to, or intolerant of existing therapy(ies) known to provide clinical

benefit for their condition.

Part 1 Monotherapy Dose Escalation and Food Effect Sub-study:

1. Ovarian cancer

2. Endometrial cancer (only 'endometrioid' subtype requires CCNE1 amplification)

3. Gastric, gastroesophageal junction (GEJ) or esophageal adenocarcinoma with CCNE1

amplification

4. Small cell lung cancer (SCLC)

5. Triple-negative breast cancer (TNBC; HER2, estrogen receptor and progesterone

receptor negative)

6. HR+ (includes estrogen-receptor or progesterone-receptor) and HER2- breast cancer

(must have progressed following treatment with a CDK4/6 inhibitor, and is not

suitable for endocrine therapy [ET])

7. Other solid tumors with CCNE1 amplification

Part 2 Monotherapy Dose Expansion:

Part 2A: HR+ and HER2- breast cancer that is locally advanced and unresectable

(Stage III) or metastatic (Stage IV); previously treated with ≥1 line of SOC

including CDK4/6 inhibitor plus ET and not suitable for further ET. Subjects must

have progressed after receiving therapy for ≥3 months in the metastatic setting or

for ≥6 months in the adjuvant setting. Subjects must have received ≤2 lines of

systemic cytotoxic therapy (chemotherapy or cytotoxic antibody drug conjugate) in

the metastatic setting.

Part 2B: Advanced platinum-based chemotherapy- resistant or refractory epithelial

ovarian/fallopian/primary peritoneal carcinoma or clear cell ovarian cancer (defined

as recurrence ≤6 months after completing platinum-based regimen) with progression on

at least one platinum containing therapy and previously treated with ≤4 prior lines

of systemic therapy administered for advanced/metastatic disease and with CCNE1

amplification.

Part 2C: Advanced unresectable or metastatic gastric, GEJ or esophageal

adenocarcinoma with progression on at least one systemic therapy and previously

treated with ≤3 prior lines of systemic therapy administered for advanced/metastatic

disease, with CCNE1 amplification.

Part 2D: Advanced endometrial adenocarcinoma or uterine papillary serous carcinoma

previously treated with ≤4 prior lines of systemic therapy administered for

advanced/metastatic disease with CCNE1 amplification. Subjects with clear cell

carcinoma or uterine serous carcinoma histology may be considered regardless of

CCNE1 status after discussion and approval from the Sponsor.

Part 2E: Advanced/recurrent uterine carcinosarcoma previously treated with 1 prior

platinum-based chemotherapy regimen and ≤3 prior lines of systemic therapy. Prior

bevacizumab or PARP inhibitors are allowed and must be at least 3 weeks prior to the

start of study drug.

Part 3 Combination Dose Escalation: Subjects must be refractory to or intolerant of

existing therapy(ies) known to provide clinical benefit for their condition

• Advanced endometrial adenocarcinoma or uterine papillary serous carcinoma

previously treated with ≤4 prior lines of systemic therapy administered for

advanced/metastatic disease with CCNE1 amplification.

- Subjects with clear cell carcinoma or uterine serous carcinoma histology may be

considered regardless of CCNE1 status after discussion and approval from the

Sponsor

Part 4 Combination Dose Expansion:

• Advanced endometrial adenocarcinoma or uterine papillary serous carcinoma

previously treated with ≤4 prior lines of systemic therapy administered for

advanced/metastatic disease with CCNE1 amplification.

- Subjects with clear cell carcinoma or uterine serous carcinoma histology may be

considered regardless of CCNE1 status after discussion and approval from the Sponsor

- Measurable disease per RECIST v1.1, except for subjects with HR+/HER2- breast

cancer or endometrial cancer (Part 1) who must have measurable or evaluable

(including skin or bone lesion only) disease.

- Age ≥19 years

- ECOG PS 0-1

- Have adequate organ function

- Subjects with female reproductive organs must be surgically sterile,

post-menopausal, or, if of child-bearing potential, must meet pre-specified criteria

- Subjects who are capable of insemination must meet pre-specified criteria

- Ability to swallow oral medications.

- Consent to provide archived tumor tissues and paired tumor biopsy at pretreatment

and on-treatment.

Exclusion Criteria:

-Locally advanced solid tumor that is a candidate for curative treatment through

radical surgery and/or radiotherapy, or chemotherapy.

-History of another malignancy with exceptions

-History of lymphohistiocytic or lymphoid hyperplasia; hemophagocytic

lymphohistiocytosis.

-Failed to recover from effects of prior anticancer treatment therapy to baseline or

Grade ≤ 1 severity (per CTCAE)

-Clinically significant cardiovascular event within 6 months prior to start of

NKT3964 treatment

-Known active CNS metastases and/or carcinomatous meningitis

-Clinically active interstitial lung disease currently requiring treatment

-History of uveitis, retinopathy or other clinically significant retinal disease

-Active or chronic corneal disorders, other active ocular conditions requiring

ongoing therapy, or any clinically significant corneal disease

-Active wound healing from major surgery within 1 month or minor surgery within 10

days before the first dose of NKT3964.

-Known human immunodeficiency virus (HIV), active hepatitis B or C infection

-Prior investigative treatment with a selective or nonselective CDK2 inhibitor or

degrader

- Childs-Pugh class B or C cirrhosis or any other clinically significant liver

disorder

- Palliative radiation therapy within 14 days or other radiation therapy within 4

weeks prior to C1D1

- Prior severe hypersensitivity reaction to paclitaxel or other drugs formulated

in Polyoxyl 35 Castor Oil (Cohort 3A and 4A only) or severe hypersensitivity

reaction to doxorubicin or any other component of the product, other

anthracyclines or anthracenediones (Cohort 3B and 4B only).

- For subjects in Cohort 3B or 4B only:

• Left ventricular ejection fraction (LVEF) <50% as measured by echocardiogram

(ECHO) or multigated acquisition (MUGA) scan within 4 weeks prior to first dose

• Active cardiac conditions including myocarditis, pericarditis, or clinically

significant valvular heart disease

• Known elevated cardiac biomarkers at baseline

- History of anthracycline-related cardiomyopathy regardless of recovery

- Cumulative lifetime exposure to doxorubicin, including planned doxorubicin

in Part 3b or Part 4b, exceeding 450 mg/m2