TIGER-3: Open Label, Multicenter Study of Rociletinib (CO-1686) Mono Therapy Versus Single-agent Cytotoxic Chemotherapy in Patients With Mutant EGFR NSCLC Who Have Failed at Least One Previous EGFR-Directed TKI and Platinum-doublet Chemotherapy

Inclusion Criteria:

All patients must meet all of the following inclusion criteria:

   1. Histologically or cytologically confirmed metastatic or unresectable locally advanced
   NSCLC with radiological progression on the most recent therapy received

   2. Documented evidence of a tumor with 1 or more EGFR activating mutations excluding exon
   20 insertion

   3. Disease progression confirmed by radiological assessment while receiving treatment
   with single agent EGFR-TKI (e.g., erlotinib, gefitinib, afatinib, or dacomitinib) or
   EGFR-TKI in combination with other targeted therapy (e.g. bevacizumab, immunotherapy)

   4. Multiple lines of prior treatment are permitted and there is no specified order of
   treatment, but in the course of their treatment history, patients must have received
   and have radiologically documented disease progression following:

   At least 1 line of prior treatment with a single-agent EGFR-TKI (e.g., erlotinib,
   gefitinib, afatinib, or dacomitinib)

   If EGFR-TKI is a component of the most recent treatment line, the washout period for
   the EGFR-TKI is a minimum of 3 days before the start of study drug treatment

   AND

   A platinum-containing doublet chemotherapy (either progressed during therapy or
   completed at least 4 cycles without progression with subsequent progression after a
   treatment-free interval or after a maintenance treatment).

   If cytotoxic chemotherapy is a component of the most recent treatment line, treatment
   with chemotherapy should have been completed at least 14 days prior to start of study
   treatment. When an EGFR-TKI is given in combination with platinum-containing doublet
   chemotherapy, treatment with the EGFR-TKI may continue until at least 3 days before
   start of treatment.

   5. Have undergone a biopsy of either primary or metastatic tumor tissue within 60 days
   prior to start of treatment and have tissue sent to the central laboratory prior to
   randomization

   6. Measureable disease according to RECIST Version 1.1

   7. Life expectancy of at least 3 months

   8. ECOG performance status of 0 to 1

   9. Age ≥ 18 years (in certain territories, the minimum age requirement may be higher
   e.g., age ≥ 20 years in Japan and Taiwan, age ≥ 21 years in Singapore)

10. Patients should have recovered to National Cancer Institute (NCI) Common Terminology
   Criteria for Adverse Events (CTCAE) Grade ≤ 1 from any significant
   chemotherapy-related toxicities

11. Adequate hematological and biological function

12. Written consent on an Institutional Review Board (IRB)/Independent Ethics Committee
   (IEC)-approved ICF before any study specific evaluation

Exclusion Criteria:

Any of the following criteria will exclude patients from study participation:

   1. Any other malignancy associated with a high mortality risk within the next 5 years and
   for which the patients may be (but not necessarily) currently receiving treatment

   Patients with a history of malignancy that has been completely treated, with no
   evidence of that cancer currently, are permitted to enroll in the trial provided all
   chemotherapy was completed > 6 months prior and/or bone marrow transplant > 2 years
   prior

   2. Known pre-existing interstitial lung disease

   3. Tumor small cell transformation by local assessment, irrespective of presence of
   T790M+ component

   4. Patients with leptomeningeal carcinomatosis are excluded. Other central nervous system
   (CNS) metastases are only permitted if treated, asymptomatic, and stable (not
   requiring steroids for at least 2 weeks prior to randomization and the patient is
   neurologically stable i.e. free from new symptoms of brain metastases)

   5. Patients who are currently receiving treatment with any medications that have the
   potential to prolong the QT interval and that treatment cannot be either discontinued
   or switched to a different medication (known to have no effect on QT) before starting
   protocol-specified treatment (see http://crediblemeds.org/ for a list of QT-prolonging
   medications)

   6. Prior treatment with rociletinib, or other drugs that target T790M+ mutant EGFR with
   sparing of WT-EGFR including but not limited to osimertinib, HM61713, and TAS-121

   7. Any contraindications for therapy with pemetrexed, paclitaxel, gemcitabine or
   docetaxel unless a contraindication with respect to one of these drugs will not affect
   the use of any of the others as a comparator to rociletinib

   8. Any of the following cardiac abnormalities or history:

      1. Clinically significant abnormal 12-lead ECG, QT interval corrected using
      Fridericia's method (QTCF) > 450 msec

      2. Inability to measure QT interval on ECG

      3. Personal or family history of long QT syndrome

      4. Implantable pacemaker or implantable cardioverter defibrillator

      5. Resting bradycardia < 55 beats/min

   9. Non-study related surgical procedures ≤ 7 days prior to randomization. In all cases,
   the patient must be sufficiently recovered and stable before treatment administration

10. Females who are pregnant or breastfeeding

11. Refusal to use adequate contraception for fertile patients (females and males) while
   on treatment and for 6 months after the last dose of study treatment (rociletinib and
   chemotherapy irrespective of single cytotoxic agent used)

12. Presence of any serious or unstable concomitant systemic disorder incompatible with
   the clinical study (e.g., substance abuse, uncontrolled intercurrent illness including
   uncontrolled diabetes, active infection, arterial thrombosis, and symptomatic
   pulmonary embolism)

13. Any other reason the investigator considers the patient should not participate in the
   study

14. Treatment with live vaccines initiated less than 4 weeks prior to randomization