A Study of APG-1252 Plus Osimertinib(AZD9291) in EGFR TKI Resistant NSCLC Patients

Inclusion Criteria:

Only applicable to the dose-finding stage:

Patients with NSCLC with disease progression after first-line EGFR TKI and platinum-based chemotherapy.

Only applicable to dose-expansion stage:

Cohort 1: Patients with NSCLC with disease progression after third-generation EGFR TKI and platinum-based chemotherapy.

Cohort 2: Patients with NSCLC with disease progression after first- or second-generation EGFR TKI and platinum-based chemotherapy.

Cohort 3: Patients with advanced EGFR-mutated NSCLC not previously treated with TKI.

Applicable to any phase:

1. Histologically or cytologically confirmed incurable advanced or metastatic non-smallcell lung cancer.

2. At least 1 measurable lesion (RECIST 1.1).

3. Confirmed EGFR mutation positive before start use prior EGFR TKI(s) .

4. Willing to biopsy or to supply achieved tumor sample which biopsy after the mostrecent treatment.

5. Male or female patients age ≥18 years.

6. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1.

7. Estimated OS ≥3 months.

8. Adequate hematologic and bone marrow functions.

9. Adequate renal and liver function.

10. Brain metastases with clinically controlled neurologic symptoms.

11. Had recovered from all toxicities related to prior anticancer therapies to grade ≤ 2, except for patients with grade 2 nausea/vomiting and/or grade 2 diarrhea despiteoptimal supportive therapy who will not be allowed to participate in the study.

12. Willingness to use contraception by a method that is deemed effective by theinvestigator by both males and female patients of child bearing potential (postmenopausal women must have been amenorrhea for at least 12 months to beconsidered of non-childbearing potential) and their partners throughout thetreatment period and for at least three months following the last dose of studydrug.

13. Ability to understand and willingness to sign a written informed consent form (theconsent form must be signed by the patient prior to any study-specific procedures).

14. Willingness and ability to comply with study procedures and follow-up examination.

Exclusion Criteria:

1. Received chemotherapy, radiation therapy, surgery, immunotherapy, hormonal therapy,targeted therapy, biologic therapy (hormones for hypothyroidism or estrogenreplacement therapy (ERT), anti-estrogen analogs, agonists required to suppressserum testosterone levels are permitted); or any investigational therapy; , or hashad tumor embolization or tumor lysis syndrome (TLS) within 28 days prior to thefirst dose of study drug.

2. Received TKIs targeted therapy (except third generation EGFR TKIs) within 14 daysprior to the first dose of study drug.

3. A history of interstitial lung disease, drug-induced interstitial lung disease,radiation pneumonitis requiring steroid therapy, or any evidence of clinicallyactive interstitial lung disease.

4. Any of the following cardiac criteria: screening period resting period QTC > 470milliseconds (clinical electrocardiograph report value; if a single time> 470milliseconds, take the average of 3 inspections); rhythm of restingelectrocardiogram (ECG), any clinically important abnormality of conduction ormorphology (e.g., complete left bundle branch block, Grade 3 heart block, Grade 2heart block); family history of congenital long QT prolongation syndrome or long QTsyndrome.

5. Evidence of any serious or uncontrolled systemic disease; various chronic activeinfections such as hepatitis B (HBV-DNA ≥ 104 copy number/ml or 2000 IU/ml),hepatitis C and HIV; uncontrollable Hypertensive patients (requires 2 or more drugsto control blood pressure); unstable angina; angina pectoris within 3 months priorto study; congestive heart failure (NYHA class II or higher); myocardial infarction (NSTEMI or STEMI) history in 6 months before study enrollment; severe arrhythmiarequiring medical attention; severe liver, kidney, gastrointestinal or metabolicdiseases.

6. Patients who are unable to stop taking drugs or herbal medicine that are stronginhibitors or inducers of CYP3A within 1 week before the first study drugadministration and during the treatment. However, patients who discontinue use ofthese compounds at least 1 week prior to receiving this regimen are eligible.

7. Hemorrhagic constitution/disease, such as a history of non-chemotherapy-inducedthrombocytopenic hemorrhage or a history of ineffective platelet transfusion within 1 year prior to the first dose of study drug; Severe gastrointestinal bleedingoccurred within 3 months prior to the first dose of study drug; Active immunethrombocytopenic purpura (ITP), active autoimmune hemolytic anemia (AIHA), etc.

8. Use a therapeutic dose of anticoagulant or antiplatelet agent before the first useof APG-1252 or within 7 days of central catheter placement (if platelet count isstable (≧50×109/L), Subjects who previously received aspirin to prevent thrombosistherapy can reuse low-dose aspirin (i.e., up to 100 mg QD) after 3 weeks of studydrug treatment; Decisions regarding anticoagulants and antiplatelet therapy will bedetermined by the investigator and the sponsor; Allow low-dose anticoagulant drugsto maintain central venous catheters open.

9. Received a biologic (G-CSF, GM-CSF or erythropoietin) within 28 days prior to thefirst dose of study drug.

10. According to the investigator's judgment, patients who did not fully recover aftersurgery. Patients who underwent major surgery within 28 days prior to the firststudy drug and who underwent minor surgery within 7 days prior to the start of thestudy.

11. Other malignancies have been diagnosed within 5 years prior to the first use of thestudy drug; except effectively treated skin basal cell carcinoma, cutaneous squamouscell carcinoma, and/or effectively resected orthotopic cervical cancer and/or breastcancer.

12. Female patients during pregnancy or lactation.

13. Previous allergies or intolerance to treatment with osimertinib.

14. A diagnosis of febrile neutropenia within one week prior to the first use of thestudy drug.

15. Prior treatment with Bcl-2/Bcl-xL inhibitors.

16. Any other condition or circumstance of that would, in the opinion of theinvestigator, make the patient unsuitable for participation in the study.