Sym004 in Patients With Advanced Solid Tumors

Part A investigates the safety and pharmacokinetics (PK) of escalating weekly dosing of
Sym004 in patients with recurrent advanced solid tumors.

Part B and C validates the safety, PK and efficacy of weekly dosing of Sym004 at the maximum
tolerated dose (MTD) in a homogenous patient population with advanced metastatic colorectal
cancer (mCRC) and wild-type Kirsten rat sarcoma (KRAS). Part B will be initiated when a safe
dose has been established in Part A.

If MTD equals 12 mg/kg, then part C will explore the 9 mg/kg level.

Part D and E is to validate the safety, PK and efficacy when administered every 2 weeks at
doses of 12 mg/kg and 18 mg/kg, respectively.

Part F is to validate safety, PK and efficacy when administered with a single loading dose of
9 mg/kg followed by weekly doses of 6 mg/kg.

Inclusion Criteria:

Part A:

1. Patients with refractory or recurrent advanced late stage solid tumors without available
therapeutic options .

Part B, C, D, E and F:

1. Patients with refractory or recurrent advanced mCRC and wild-type KRAS who have
progressed on epidermal growth factor receptor (EGFR) Ab treatment.

2. Patients wit confirmed response while on treatment anti-EGFR Ab treatment.

3. Documented disease progression during or within 6 months after cessation of anti-EGFR
Ab treatment.

4. Patients must be willing to have a biopsy performed from a tumor lesion at screening
and at Visit 6.

Part A, B, C, D, E and F:

1. Histologically or cytologically confirmed diagnosis of cancer

2. Failure and/or intolerance to standard chemotherapy

3. Life expectancy of at least 3 months

4. Eastern Cooperative Oncology Group (ECOG) performance status ≤2

Exclusion Criteria:

1. Patients with clinically symptomatic brain metastases.

2. Received the following treatments prior to Visit 2:

- Cytotoxic or cytostatic anti-cancer chemotherapy within 4 weeks

- Total resection or irradiation of the target lesion

- Antibody therapy within 4 weeks and vaccines within 12 weeks

- Tyrosin kinase inhibitors within 4 weeks

- Any investigational agent within 4 weeks

3. Diarrhea CTCAE >1

4. Skin rash CTCAE >1

5. Abnormal organ or bone marrow function.

6. Use of immunosuppressive agents for the past 4 weeks prior to trial start, including
systemic corticosteroids used at doses above 20mg/day of prednisolone or equivalent.

7. History of other malignancy within 5 years prior to trial start, with the exception of
basal cell carcinoma of the skin and carcinoma in situ of the cervix (not in Part A).

8. Active severe infection, any other concurrent disease or medical conditions that are
deemed to interfere with the conduct of the trial as judged by the investigator.

9. Known HIV positive

10. Known active hepatitis B or C

11. Patients with known uncontrolled allergic conditions or allergy to the study drug
and/or their components.

12. Clinically significant cardiac disease including unstable angina, acute myocardial
infarction within six months from Visit 1, congestive heart failure, and arrhythmia
requiring therapy, with the exception of extra systoles or minor conduction
abnormalities and controlled and well treated chronic atrial fibrillation.

13. Significant concurrent, uncontrolled medical condition evaluated by the investigator
to interfere with effect of the trial drug.