Testing the Addition of an Anti-cancer Drug, BAY 1895344, to Usual Chemotherapy for Advanced Stage Solid Tumors, With a Specific Focus on Patients With Small Cell Lung Cancer, Poorly Differentiated Neuroendocrine Cancer, and Pancreatic Cancer
Testing the Addition of an Anti-cancer Drug, BAY 1895344, to Usual Chemotherapy for Advanced Stage Solid Tumors, With a Specific Focus on Patients With Small Cell Lung Cancer, Poorly Differentiated Neuroendocrine Cancer, and Pancreatic Cancer
This phase I trial investigates the side effects and best dose of BAY 1895344 when given
 together with usual chemotherapy (irinotecan liposome or topotecan) in treating patients with
 solid tumors that have spread to other places in the body (advanced), with a specific focus
 on small cell lung cancer, poorly differentiated neuroendocrine cancer, and pancreatic
 cancer. BAY 1895344 may stop the growth of tumor cells by blocking some of the enzymes needed
 for cell growth. Chemotherapy drugs, such as irinotecan liposome and topotecan, work in
 different ways to stop the growth of tumor cells, either by killing the cells, by stopping
 them from dividing, or by stopping them from spreading. Adding BAY 1895344 to irinotecan
 liposome or topotecan may help to slow the growth of tumors for longer than seen with those
 drugs alone.
PRIMARY OBJECTIVES:

 I. To assess safety and tolerability of each of the ATR kinase inhibitor BAY1895344 (BAY
 1895344) plus topoisomerase 1 (top1) inhibitor (liposomal irinotecan [irinotecan liposome]
 [nal-IRI] or topotecan hydrochloride [topotecan]) combinations.

 II. To estimate maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of each of
 the combinations.

 SECONDARY OBJECTIVES:

 I. To observe and record anti-tumor activity. II. To estimate objective response rate (ORR),
 progression free survival (PFS), overall survival (OS) and duration of response (DOR) in
 patients treated with each combination.

 III. To estimate plasma pharmacokinetic (PK) characteristics of BAY 1895344 plus each top1
 inhibitor (nal-IRI or topotecan) when used in combination.

 IV. To estimate changes in pharmacodynamic (PD) markers of deoxyribonucleic acid (DNA) damage
 (gamma-H2AX, pS343-NBS1) elicited by each combination from on-treatment tumor biopsies (in
 dose expansion cohorts only).

 EXPLORATORY OBJECTIVES:

 I. To estimate response outcomes (ORR, PFS, OS, DOR) in study patients by tumor ataxia
 telangiectasia mutated (ATM) expression loss (assessed by immunohistochemistry [IHC]).

 II. To estimate response outcomes (ORR, PFS, OS, DOR) in study patients with tumor DNA damage
 response (DDR) mutations (assessed by whole exome sequencing [WES] and ribonucleic acid [RNA]
 sequencing [RNA Seq]).

 OUTLINE: This is a dose-escalation study of BAY 1895344. Patients are assigned to 1 of 2
 cohorts.

 COHORT I: Patients receive BAY 1895344 orally (PO) twice daily (BID) on days 1 and 2 and
 irinotecan liposome intravenously (IV) over 90 minutes on day 1. Cycles repeat every 14 days
 in the absence of disease progression or unacceptable toxicity.

 COHORT II: Patients receive topotecan IV over 30 minutes on days 1-5 and BAY 1895344 PO BID
 on days 2 and 5. Cycles repeat every 21 days in the absence of disease progression or
 unacceptable toxicity.

 After completion of study treatment, patients are followed up for 6 months.
Inclusion Criteria:

 -  DOSE ESCALATION COHORTS: Patients must have a biopsy-proven solid tumor that is
 metastatic or unresectable and has progressed on at least one line of standard therapy

 -  DOSE EXPANSION COHORTS: Patients must have biopsy proven metastatic or unresectable
 small cell lung cancer (SCLC), poorly differentiated neuroendocrine carcinoma (PD-NEC)
 (any extrapulmonary neuroendocrine carcinoma with small cell or large cell histology)
 or pancreatic adenocarcinoma (PDA) and have progressed on at least one line of
 standard therapy

 -  DOSE EXPANSION COHORTS: Patients must have at least one measurable lesion outside of
 the lesion to be biopsied

 -  Patients must be able to swallow pills

 -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

 -  Hemoglobin > 9 g/dL

 -  Leukocytes >= 3,000/mcL

 -  Absolute neutrophil count >= 1,500/mcL

 -  Platelets >= 100,000/mcL

 -  Total bilirubin =< 2 x institutional upper limit of normal (ULN)

 -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase
 [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
 =< 3 x institutional ULN

 -  Glomerular filtration rate (GFR) >= 60 mL/min/1.73 m^2

 -  Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral
 therapy with undetectable viral load within 6 months are eligible for this trial

 -  For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral
 load must be undetectable on suppressive therapy, if indicated

 -  Patients with a history of hepatitis C virus (HCV) infection must have been treated
 and cured. For patients with HCV infection who are currently on treatment, they are
 eligible if they have an undetectable HCV viral load

 -  Patients with treated brain metastases are eligible if follow-up brain imaging after
 central nervous system (CNS)-directed therapy shows no evidence of progression.
 Furthermore, these patients must be asymptomatic from previously treated brain
 metastases (e.g. not on steroids for neurologic symptoms within 30 days of study
 enrollment)

 -  Patients with a prior or concurrent malignancy whose natural history or treatment does
 not have the potential to interfere with the safety or efficacy assessment of the
 investigational regimen are eligible for this trial

 -  Patients with known history or current symptoms of cardiac disease, or history of
 treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac
 function using the New York Heart Association Functional Classification. To be
 eligible for this trial, patients should be class 2B or better

 -  The effects of BAY 1895344 on the developing human fetus are unknown. For this reason
 and because DNA-damage response inhibitors as well as other therapeutic agents used in
 this trial are known to be teratogenic, women of child-bearing potential and men must
 agree to use adequate contraception (hormonal or barrier method of birth control;
 abstinence) prior to study entry and for the duration of study participation and for 6
 months after completion of BAY 1895344 administration. Should a woman become pregnant
 or suspect she is pregnant while she or her partner is participating in this study,
 she should inform her treating physician immediately. Men treated or enrolled on this
 protocol must also agree to use adequate contraception prior to the study, for the
 duration of study participation, and 6 months after completion of BAY 1895344
 administration

 -  Patient must have the ability to understand and the willingness to sign a written
 informed consent document. Participants with impaired decision-making capacity (IDMC)
 who have a legally-authorized representative (LAR) and/or family member available will
 also be eligible

 Exclusion Criteria:

 -  Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
 nitrosoureas or mitomycin C) prior to entering the study

 -  Patients who have not recovered from adverse events due to prior anti-cancer therapy
 (i.e., have residual toxicities > grade 1) with the exception of alopecia

 -  Patients who are receiving any other investigational agents

 -  The investigator(s) must state a medical or scientific reason if patients who have
 brain metastases will be excluded from the study

 -  History of allergic reactions attributed to compounds of similar chemical or biologic
 composition to BAY 1895334 or other agents used in study

 -  Patients receiving any medications or substances that are substrates of CYP3A4 with a
 narrow therapeutic window, or strong inhibitors/inducers of CYP3A4 are ineligible, if
 they cannot be transferred to alternative medication. Because the lists of these
 agents are constantly changing, it is important to regularly consult a
 frequently-updated medical reference. As part of the enrollment/informed consent
 procedures, the patient will be counseled on the risk of interactions with other
 agents, and what to do if new medications need to be prescribed or if the patient is
 considering a new over-the-counter medicine or herbal product

 -  Patients with uncontrolled intercurrent illness

 -  Patients with psychiatric illness/social situations that would limit compliance with
 study requirements

 -  Pregnant women are excluded from this study because BAY 1895344 is agent with the
 potential for teratogenic or abortifacient effects. Because there is an unknown but
 potential risk for adverse events in nursing infants secondary to treatment of the
 mother with BAY 18953354, breastfeeding should be discontinued if the mother is
 treated with BAY 18953354. These potential risks may also apply to other agents used
 in this study

 -  Patients with an uncontrolled infection requiring IV antibiotics will not be eligible
 to participate in the study

 -  Patients who have previously been treated with any of the study compounds will not be
 eligible to participate in the study