A Randomized Phase 3 Multicenter Open-label Study to Compare the Efficacy of TAK-788 as First-line Treatment Versus Platinum-Based Chemotherapy in Patients With Non-Small Cell Lung Cancer With EGFR Exon 20 Insertion Mutations

The purpose of this study is to compare the effectiveness of TAK-788 as first-line treatment
with that of platinum-based chemotherapy in participants with locally advanced or metastatic
non-small cell lung cancer (NSCLC) whose tumors has epidermal growth factor receptor (EGFR)
exon 20 insertion mutations.

Participants will be randomly assigned to one of the two treatment groups- TAK-788 group or
Platinum-based chemotherapy group.

Participants will receive TAK-788 orally and pemetrexed/cisplatin or pemetrexed/carboplatin
via vein until the participants experience worsening disease (PD) as assessed by blinded
independent review committee (IRC), intolerable harmful effects or another discontinuation
criteria.

Inclusion Criteria:

- Male or female adult patients (aged 18 years or older)

- Histologically or cytologically confirmed nonsquamous cell locally advanced not
suitable for definitive therapy, recurrent, or metastatic (Stage IV) NSCLC

- Documented epidermal growth factor receptor (EGFR) in-frame exon 20 insertion mutation
assessed by a clinical laboratory improvements amendment (CLIA)-certified (US sites)
or an accredited (outside of the US) local laboratory The EGFR exon 20 insertion
mutation can be either alone or in combination with other EGFR or human epidermal
growth factor receptor 2 (HER2) mutations except EGFR mutations for which there are
approved anti-EGFR tyrosine kinase inhibitors [TKIs] (ie, exon 19 del, L858R, T790M,
L861Q, G719X, or S768I, where X is any other amino acid)

- Adequate tumor tissue available, either from primary or metastatic sites, for central
laboratory confirmation of EGFR exon 20 insertion mutation

- At least 1 measurable lesion per RECIST Version 1.1

- Life expectancy ≥3 months

- Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1

- Adequate organ and hematologic function as defined by blood transfusions with a
recommended >/ 14 day washout period.

Exclusion Criteria:

- Received prior systemic treatment for locally advanced or metastatic disease,
including local administration, such as intra-pleural injection of anticancer
medication with the exception noted below:

- Neoadjuvant or adjuvant chemotherapy/immune therapy for Stage I to III or
combined modality chemotherapy/radiation for locally advanced disease is allowed
if completed >6 months before the development of metastatic disease.

- Received radiotherapy ≤14 days before randomization or has not recovered from
radiotherapy-related toxicities

- Received a moderate or strong cytochrome P450 (CYP)3A inhibitor or moderate or strong
CYP3A inducer within 10 days before first dose of TAK-788

- Have been diagnosed with another primary malignancy other than NSCLC

- Have current spinal cord compression or leptomeningeal disease

- Have uncontrolled hypertension. Participants with hypertension should be under
treatment on study entry to control blood pressure

- Received a live vaccine within 4 weeks before randomization per Summary of product
characteristics (SmPCs) for pemetrexed, cisplatin, and carboplatin

- Taking medication(s) known to be associated with the development of torsades de
pointes.