Study on Safety and Effectiveness of New Treatments Alone or with Pembrolizumab for Extensive-Stage Small Cell Lung Cancer Needing Second-Line Therapy

Inclusion Criteria

• Diagnosed with extensive-stage small cell lung cancer (ES-SCLC) needing second-line treatment.
• Cancer has progressed after initial treatment with a PD-1/PD-L1 inhibitor as part of first-line therapy.
• Cancer is classified as Stage IV according to specific medical guidelines.
• Received one prior line of systemic therapy for small cell lung cancer.
• Women of childbearing potential must have a negative pregnancy test before starting treatment.
• Cancer must be measurable by standard criteria.
• Must provide a tumor tissue sample for analysis.
• Good overall health with an ECOG performance status of 0 to 1.
• Hepatitis B positive participants must have undetectable viral load after antiviral therapy.
• Hepatitis C positive participants must have undetectable viral load.
• Expected to live more than 3 months.
• Male participants must use contraception or abstain from intercourse during treatment and for a specified time after.
• Female participants must not be pregnant or breastfeeding and must use contraception or abstain from intercourse during and after treatment.
• Blood pressure must be controlled to specified levels.
• Participants capable of producing sperm must agree to use contraception and not donate sperm during and after treatment.

Exclusion Criteria

• Received any cancer treatment or investigational drugs within 4 weeks before starting the study.
• Received radiation therapy within 2 weeks before starting the study.
• Received high-dose lung radiation within 6 months before starting the study.
• Received a live vaccine within 30 days before starting the study.
• Have another progressing cancer or one that required treatment in the past 3 years.
• Have active brain metastases or cancer in the brain lining unless stable and treated.
• Have severe allergic reactions to study treatments.
• Have an active autoimmune disease needing treatment in the past 2 years.
• Have lung disease requiring steroids or current lung disease.
• Have an active infection needing treatment.
• Had major surgery within 3 weeks before starting the study.
• Have significant heart disease or recent major heart events.
• Have active bleeding or recent major bleeding events.
• Have digestive issues affecting medication absorption.
• Have a history of inflammatory bowel disease or gastrointestinal perforation.
• Have a history of neurologic paraneoplastic syndrome.
• Have received certain prior cancer treatments or investigational drugs recently.
• Have significant fluid buildup in the body.
• Have a diagnosis of immunodeficiency or are on immunosuppressive therapy.
• Have HIV or active hepatitis B or C.
• Have progressive disease after initial chemotherapy with PD-1/L1 inhibitor.
• Have had a tissue or organ transplant.
• Have received certain prior treatments specific to Arm E of the study.