FOCUS: PCC + Bevacizumab + CA4P Versus PCC + Bevacizumab + Placebo for Subjects With Platinum Resistant Ovarian Cancer

This is a multicenter, multinational, randomized, double-blind, 2-arm, parallel-group, Phase
2/3 study to evaluate the efficacy and safety of PCC plus bevacizumab and CA4P versus PCC
plus bevacizumab and placebo in subjects with platinum-resistant ovarian cancers (prOC).
Subjects with platinum-resistant, recurrent, epithelial ovarian, primary peritoneal or
fallopian tube cancer will be randomized 1:1 to receive PCC plus bevacizumab and CA4P or PCC
plus bevacizumab and placebo. Subjects will be stratified by selected chemotherapy (PLD vs.
paclitaxel), platinum free interval (< 3 vs. 3 to 6 months from last platinum therapy to
subsequent progression), and line of therapy (2nd vs. 3rd). This is a 2-part study,
consisting of a Phase 2, exploratory study (Part 1) followed by a Phase 3, pivotal study
(Part 2). Both parts of the study will have similar overall design. Approximately 80 subjects
will be randomized into Part 1 and approximately 356 subjects will be randomized into Part 2.

All subjects randomized will receive bevacizumab 10 mg/kg intravenously (IV) on Days 1 and
15, repeated every 4 weeks (q4wk) and PCC with paclitaxel 80 mg/m2 IV on Days 1, 8, 15 and
22, repeated q4wk, or paclitaxel 80 mg/m2 IV on Days 1, 8, 15, repeated q4wk or PLD 40 mg/m2
IV on Day 1, repeated q4wk. Subjects in the Treatment Arm will also receive CA4P 60 mg/m2 on
the same day as bevacizumab (Days 1 and 15, repeated q4wk), while subjects in the Control Arm
will receive placebo on those days.

Order of dosing will follow the guidance listed below during this study when bevacizumab and
CA4P / Placebo are dosed the same day as PCC,

- Bevacizumab followed by CA4P / Placebo followed after 1-3 hours by paclitaxel,

- PLD followed by bevacizumab followed by CA4P / Placebo Subjects will continue randomized
treatment until disease progression, unacceptable toxicity, investigator decision,
withdrawal of consent, or sponsor discontinues study for any reason. Subjects will
undergo tumor assessments (RECIST) at baseline and every 8 weeks and CA-125 levels at
baseline and every 4 weeks.

The primary endpoint is PFS. Secondary endpoints include ORR, OS, proportion of subjects who
remain progression free at 6, 9, and 12 months, and safety. Endpoints will be compared
between the Treatment Arm and the Control arm. The study duration is estimated to last
approximately 3 years.

This study will have 2 parts with the same overall design. Part 1 will enroll up to
approximately 80 subjects and will include multiple interim analyses to test the safety and
efficacy assumptions in this specific subject population. Upon meeting certain efficacy
criteria in Part 1, the protocol will be amended and additional sites added in order to
enroll an additional 356 subjects into Part 2 of the study. Subjects enrolled in Part 2 will
be analyzed separately and used as a stand-alone confirmatory efficacy study.

Inclusion:

1. Signed informed consent form (ICF)

2. Age ≥ 18 years (Age ≥ 19 years if required by local regulatory authorities)

3. ECOG PS of 0-1

4. Histologically or cytologically-confirmed epithelial ovarian, fallopian tube or
primary peritoneal cancer in recurrent stage

5. prOC (platinum-resistant ovarian cancers) defined as progression within > 1 to < 6
months (+ 2 weeks) of completing previous cycle of primary platinum-based therapy, or
during or within < 6 months (+ 2 weeks) of starting additional platinum based
therapies

6. Received ≥ 1 but ≤ 3 prior platinum-based regimens

7. Measurable disease according to RECIST 1.1

8. Left ventricular ejection fraction (LVEF) greater than or equal to at least 45% at
baseline assessment if subject is receiving PLD, and/or anthracycline is a concomitant
medication

9. No evidence of active (progressing) brain metastasis. (Treated brain metastasis
allowed with a posttreatment magnetic resonance imaging (MRI) or Computed Tomography
(CT) of brain showing no active (progressing) brain metastasis). Treatment of brain
metastasis may include surgery, radiosurgery (linear accelerator (LINAC), gamma
knife), or whole brain irradiation. Surgery for brain metastasis must be > 8 weeks
from study entry

10. Hemoglobin > 9 g/dl. Erythroid growth factors should not have been used in the 2 weeks
prior to study entry. Red blood cell transfusions are permitted to maintain the
hemoglobin level > 9 g/dl

11. Adequate bone marrow function in the investigator's opinion

12. Adequate hepatic function defined by the following:

- Total bilirubin < 2 x Upper Limit of Normal (ULN)

- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) < 2.5 X ULN
for the referenced lab (< 5 X ULN for subjects with liver metastases)

13. Adequate renal function defined by the following:

- Serum creatinine < 2 X ULN for the referenced lab

14. Subjects of childbearing potential must have a negative serum pregnancy test prior to
study entry and must be practicing a highly effective form of contraception

15. At least 2 weeks since prior radiotherapy and has recovered from any Grade 3
toxicities

16. Life expectancy ≥ 12 weeks

Exclusion:

1. Subjects who have received prior CA4P therapy

2. Previously having failed treatment with bevacizumab combined with the intended PCC.

- For clarity: Investigators should not select a bevacizumab + PCC combination for the
FOCUS trial if the patient has previously failed that same regimen, however they may
select a new PCC regimen to combine with bevacizumab. For example, a patient who
failed bevacizumab + weekly paclitaxel would be allowed to enroll in FOCUS only if
they are assigned to bevacizumab + PLD for the study.

3. Previous treatment with greater than three traditional chemotherapy treatment regimens

4. Untreated brain metastasis or leptomeningeal brain metastasis

5. Solid organ or bone marrow transplant

6. Primary platinum-refractory disease (defined as progression during dosing or within
one (1) month of completing the last cycle of patients first platinum-containing
regimen)

7. > Grade 2 peripheral neuropathy

8. Current thrombotic or hemorrhagic disorder/event or history of prior event within 6
months of start of Screening

9. History of prior cerebrovascular event, (including transient ischemic attack) within 6
months of start of Screening

10. Recent history (within 6 months of start of Screening) of angina pectoris, myocardial
infarction (including non-Q wave MI), or NYHA Class III and IV congestive heart
failure

11. History of torsade de pointes, ventricular tachycardia or fibrillation, pathologic
sinus bradycardia (<60 bpm), heart block (excluding 1st degree block, benign PR
interval prolongation only), congenital long QT syndrome or new ST segment elevation
or depression or new Q wave on ECG

12. Known uncontrolled HIV infection

13. Uncontrolled, clinically significant active infection

14. Serious non-healing wound, ulcer or bone fracture

15. Subjects with known hypersensitivity to any of the components of CA4P, paclitaxel,
PLD, or bevacizumab (paclitaxel and PLD dependent on whether PI plans they will be
dosed with that PCC)

16. Subjects who are currently or planning on receiving concurrent investigational therapy
or who have received investigational therapy for any indication within 30 days of the
first scheduled day of dosing

17. Subjects with any other intercurrent medical condition, including mental illness or
substance abuse, deemed by the Investigator to be likely to interfere with a subject's
ability to provide informed consent, cooperate and participate in the study, or to
interfere with the interpretation of the study results

18. Subjects with other invasive malignancies, with the exception of non-melanoma skin
cancer, or with previous cancer treatment that contraindicates this protocol therapy
within last 3 years

19. Prior radiation therapy to the pelvis or abdomen within 4 weeks of entry into the
study

20. History of fistula, gastrointestinal (GI) perforation or intra-abdominal abscess, or
invasive disease/metastases of the bowel which in the investigators opinion may
increase the risk of GI perforation with bevacizumab treatment.

21. Uncontrolled hypertension (HTN)

- Sustained BP greater than 150 mmHG SBP / 100 mmHG DBP

22. Uncontrolled elevated proteinuria levels in the investigator's opinion

23. Corrected QT interval ([QTc] Fridericia) > 480 ms

24. Significant vascular disease or recent peripheral arterial thrombosis

25. Subjects with active bleeding or pathologic conditions that carry high risk of
bleeding

26. Subjects who are pregnant or lactating