NSCLC

Patients must meet the following criteria for study entry:

1. Must be ≥ 18 years of age at the time of signing the Informed Consent Form (ICF).
2. Must provide signed ICF.
3. Must have the ability to comply with the study protocol, in the investigator's judgment.
4. Women of childbearing potential must agree to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures and agree to refrain from donating eggs.
5. Men must agree to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures and agree to refrain from donating sperm.
6. Diagnosed NSCLC with adenocarcinoma and its variants according to the 2015 WHO classification (Travis et al. 2015).
7. Measurable disease, as defined by RECIST v1.1.

8. Have histologically or cytologically confirmed advanced or metastatic NSCLC defined as:

   Stage IIIB that either progressed after curative therapy (chemoradiation and/or surgery) or is not candidate to curative therapy, or Stage IV metastatic disease (de novo or distant relapse) [According to UICC TNM edition 8].

9. Expressing PD-L1 on at least 50% of tumour cells, as determined through use of the Dako PD-L1 IHC 22C3 pharmDx assay or the Ventana PD-L1 IHC SP263 assay.
10. Agree to have a tumour biopsy that is eligible for Gal-3 expression evaluation before the first study drug dose.
11. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
12. Have not received prior systemic chemotherapy for the treatment of recurrent, advanced or metastatic disease, treatment with chemotherapy and/or radiation as part of neoadjuvant/adjuvant therapy is allowed as long as completed at least 4 weeks prior to diagnosis of recurrent advanced or metastatic disease.
13. Patients must not have received immune checkpoint inhibitors (ICI) previously.
14. Must be eligible for atezolizumab at 1200 mg every 3 weeks as defined in the atezolizumab product label.
15. Patients receiving therapeutic anticoagulation must be on stable regimen.

16. Adequate haematologic and end-organ function, defined by the following laboratory test results, obtained within 14 days prior to initiation of study treatment:

    • Absolute neutrophil count (ANC) ≥1.5 x 109/L (1500/µL) without granulocyte colony-stimulating factor support.
    • Lymphocyte count ≥0.5 x 109/L (500/µL).
    • Platelet count ≥ 100 x 109/L (100,000/µL) without transfusion.
    • Haemoglobin ≥ 90 g/L (9 g/dL). Patients may be transfused to meet this criterion.

    • Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) ≤ 2.5 x upper limit of normal (ULN), with the following exceptions:

      • Patients with documented liver metastases: AST and ALT ≤ 5 x ULN.
      • Patients with documented liver or bone metastases: ALP ≤ 5 x ULN.
    • Total bilirubin ≤ 1.5 x ULN with the following exception:

Patients with known Gilbert disease: total bilirubin ≤ 3 x ULN.

• Creatinine clearance ≥50 mL/min (calculated using the Cockcroft-Gault formula).
• Albumin ≥25 g/L (2.5 g/dL).
• For patients not receiving therapeutic anticoagulation: INR and a PTT ≤1.5 x ULN.