A Study Comparing Abelacimab to Apixaban in the Treatment of Cancer-associated VTE

Inclusion Criteria:

• Male or female subjects ≥18 years old or other legal maturity age according to thecountry of residence

• Confirmed diagnosis of cancer (by histology, adequate imaging modality), other thanbasal-cell or squamous-cell carcinoma of the skin alone with one of the following:

• Active cancer, defined as either locally active, regionally invasive, ormetastatic cancer at the time of randomization and/or

• Currently receiving or having received anticancer therapy (radiotherapy,chemotherapy, hormonal therapy, any kind of targeted therapy or any otheranticancer therapy) in the last 6 months.

• Confirmed symptomatic or incidental proximal lower limb deep vein thrombosis (DVT) (i.e., popliteal, femoral, iliac, and/or inferior vena cava [IVC] thrombosis) and/ora confirmed symptomatic pulmonary embolism (PE), or an incidental PE in a segmental,or larger pulmonary artery.

Patients are eligible within 120 hours from diagnosis of the qualifying VTE

• Anticoagulation therapy with a therapeutic dose of DOAC for at least 6 months isindicated

• Able to provide written informed consent

Exclusion Criteria:

• Thrombectomy, insertion of a caval filter or use of a fibrinolytic agent to treatthe current (index) DVT and/or PE

• More than 120 hours of pre-treatment with therapeutic doses of UFH, LMWH,fondaparinux, DOAC, or other anticoagulants

• An indication to continue treatment with therapeutic doses of an anticoagulant otherthan that VTE treatment prior to randomization (e.g., atrial fibrillation [AF],mechanical heart valve, prior VTE)

• Platelet count <50,000/mm3 at the screening visit

• PE leading to hemodynamic instability (blood pressure [BP] <90 mmHg or shock)

• Acute ischemic or hemorrhagic stroke or intracranial hemorrhage within the 4 weekspreceding screening

• Brain trauma or a cerebral or spinal cord surgery or spinal procedures such aslumbar puncture or epidural/spinal anesthesia within 4 weeks of screening

• Need for aspirin in a dosage of >100 mg/day or any other antiplatelet agent alone orin combination with aspirin

• Primary brain cancer or untreated intracranial metastases at baseline

• Acute myeloid or lymphoid leukemia

• Bleeding requiring medical attention at the time of randomization or in thepreceding 4 weeks

• Planned brain, spinal cord, cardiac, vascular, major thoracic and/or major abdominalsurgery in the 4 weeks following randomization

• Eastern Cooperative Oncology Group (ECOG) performance status of 3 or 4 at screening

• Life expectancy <3 months at randomization

• Calculated creatinine clearance (CrCl) <30 mL/min (Cockcroft-Gault equation) at thescreening visit

• Hemoglobin <8 g/dL at the screening visit

• Acute hepatitis, chronic active hepatitis, liver cirrhosis; or an alanineaminotransferase (ALT) ≥3 x and/or bilirubin ≥2 x upper limit of normal (ULN) at thescreening visit in absence of clinical explanation

• Uncontrolled hypertension (systolic BP>180 mm Hg or diastolic BP >100 mm Hg despiteantihypertensive treatment)

• Women of child-bearing potential (WOCBP) who are unwilling or unable to use highlyeffective contraceptive measures during the study from screening up to 3 days afterlast treatment of apixaban or 100 days after administration of abelacimab (SeeSection 5.3.6. for highly effective contraceptive measures)

• Sexually active males with sexual partners of childbearing potential must agree touse a condom or other reliable contraceptive measure up to 3 days after lasttreatment of apixaban or 100 days after administration of abelacimab

• Pregnant or breast-feeding women

• Patients known to be receiving strong dual inducers or inhibitors of both CYP3A4 andP gp

• History of hypersensitivity to any of the study drugs (including apixaban) orexcipients, to drugs of similar chemical classes, or any contraindication listed inthe label for apixaban

• Subjects with any condition that in the Investigator's judgement would place thesubject at increased risk of harm if he/she participated in the study

• Use of other investigational (not registered) drugs within 5 half-lives prior toenrollment or until the expected pharmacodynamic(s) (PD) effect has returned tobaseline, whichever is longer. Participation in academic non-interventional studiesor interventional studies, comprising testing different strategies or differentcombinations of registered drugs is permitted