Study of Dato-DXd Plus Pembrolizumab vs Pembrolizumab Alone in the First-line Treatment of Subjects With Advanced or Metastatic NSCLC Without Actionable Genomic Alterations (TROPION-Lung08)

• Drug: Datopotamab Deruxtecan
• Drug: Pembrolizumab

Inclusion Criteria

Participants eligible for inclusion in the study must meet all inclusion criteria within 28 days of randomization into the study.

• Sign and date the Tissuea group of cells that work together to perform a function Screeningtesting for cancer or conditions that can lead to cancer before symptoms appear, also known as cancer screening and Main Informed Consenta process in which a patient receives detailed information about a procedure or treatment, including its potential risks, benefits, and alternatives. The patient then has the opportunity to understand the information and voluntarily agree to the procedure or treatment. Forms, prior to the start of any study-specific qualification procedures.
• Adults ≥18 years or the minimum legal adult age (whichever is greater) at the time of informed consent.
• Histologically documented non-squamous NSCLC that meets all of the following criteria (Note: Subjects with squamous histology were eligible prior to Protocol Version 5.0. After Protocol Version 5.0, subjects with squamous histology are not eligible. Subjects with mixed histology, including those with a squamous component, remain eligible the study even after Protocol Version 5.0):
  1. Stage IIIB or IIIC disease and not candidates for surgical resectionsurgical removal of tissue or part/all of an organ or definitive chemoradiation, or Stage IV NSCLC disease at the time of randomization (based on the American Joint Committee on Cancer, Eighth Edition). Participants with early-stage NSCLC who have relapsed should be restaged during screening to ensure their eligibility for the study.
  2. Documented negative test results for epidermal growth factor receptor (EGFR), lymphomacancers of the lymphatic system kinase (ALK), and proto-oncogene1 (ROS1) actionable genomic alterations (AGAs) based on analysis of tumor tissue. If test results for EGFR, ALK, and ROS1 are not available, subjects are required to undergo testing performed locally for these genomic alterations.
  3. No known AGAs in neurotrophic tyrosine receptor kinase (NTRK), proto-oncogenea type of gene that normally regulates cell growth and division, but when mutated can cause uncontrollable cell growth and may lead to cancer B-raf (BRAF), rearranged during transfection (RET), mesenchymal-epithelial transition factor (MET), or other actionable driver kinases with locally approved therapies. (Testing for genomic alterations besides EGFR, ALK, and ROS1 is not required prior to randomization). Subjects whose tumors harbor KRAS mutations are eligible for the study.
• Has provided a formalin-fixed tumor tissue sample for the measurement of trophoblast cell surface protein 2 (TROP2) protein expression and for the assessment of other exploratory biomarkers.
• Tumor has high programmed death receptor-1 (PD-L1) expression (TPS ≥50%) as determined by PD-L1 immunohistochemistry (IHC) 22C3 pharmDx assay by central testing (minimum of 6 slides).
• Has an adequate treatment washout period before Cycle 1 Day 1.
• Measurable disease based on local imagingtests that create detailed images of areas inside the body assessment using RECIST Version 1.1.
• Has left ventricular ejection fraction (LVEF) ≥50% by either an echocardiograma type of ultrasound that uses sound waves to create detailed images of the heart to assess heart structure, function and blood flow (ECHO) or multigated acquisition scan (MUGA) within 28 days before randomization.
• Eastern Cooperative Oncologythe study, diagnosis and treatment of cancer Group (ECOG) performance status (PS) of 0 or 1 at screening.
• Has a life expectancy of at least 3 months.
• Adequate bone marrowsoft, spongy tissue found in bones that makes blood cells function within 7 days before randomization.