Naptumomab Estafenatox in Combination With Pembrolizumab Preceded by Obinutuzumab in Patients With Urothelial Cancers

Inclusion Criteria:

* All patients must provide signed informed consent prior to any study specific procedures that are not part of standard medical care
* At least 18 years of age
* Must have advanced or metastatic disease at the time of enrollment.
* Must have histologically and/or cytologically confirmed evidence of predominantly transitional cell urothelial cancer (carcinomas of the renal pelvis, ureter, urinary bladder or urethra)
* Must have received no more than 2 prior lines of therapy for advanced or metastatic disease; patients may have received adjuvant/neoadjuvant therapy which must have been completed prior to entry into the current trial
* Must be willing and able to comply with scheduled visits, procedures, drug administration plan, etc. as outlined in the protocol
* Have an estimated life expectancy of at least 12 weeks
* COVID-19 vaccine is not mandatory. However, patients who have been vaccinated against COVID-19 prior to study entry, should fulfill the following conditions:

  * The patient completed the primary series vaccination (initial 2 doses of the vaccine)
  * At least 14 days have passed since the last dose (primary or booster) before receiving Obi pretreatment

Exclusion Criteria:

* Active infection requiring treatment within 3 days of enrollment
* Other active neoplastic disease (cancer) requiring concurrent anti-neoplastic treatment
* Known, suspected or documented parenchymal brain metastases unless patient is stable after being treated with surgery and/or radiation
* Active or previously documented autoimmune or inflammatory disorders such as, but not limited to rheumatoid arthritis, systemic lupus erythematosus, uveitis, ulcerative colitis, Crohn's syndrome, Wegener's syndrome, multiple sclerosis, myasthenia gravis, scleroderma, and sarcoidosis

The following are exceptions to this criterion:

* Vitiligo or psoriasis not requiring systemic treatment (within the last 2 years)
* Endocrinopathies (e.g., following Hashimoto syndrome) stable on hormone replacement or do not require any therapy

  * History of primary immunodeficiency
  * History or prior allogeneic organ transplant 7. The use of immunosuppressive agents within 28 days of enrollment (D-13; obinutuzumab pretreatment) including, but not limited to, cyclosporine, mycophenolate, azathioprine, methotrexate, adalimumab, infliximab, vedolizumab, tofacitinib, dupilumab, rituximab, etc. and including pharmacologic doses of glucocorticoids defined as glucocorticoid equivalents of \>10 mg/day of prednisone (with the exception of systemic steroids given as a premedication before each of the study medications, or used prior to administration of radiographic contrast material in subjects with allergies) are not acceptable within 14 days prior to enrollment. Subjects are permitted to receive topical, intranasal, inhalational, and intra-ocular glucocorticoids
  * Have received a live attenuated vaccine within 28 days prior to the first dose of Obi
  * HIV infection that is not considered well-controlled
  * Pregnant or breastfeeding
  * Participants of reproductive potential who are not willing to employ effective birth control from screening to 90 days after the last dose of study treatment
  * Participation in an investigational drug study within the past 4 weeks
  * Major surgery or trauma within 4 weeks of study entry (D-13; obinutuzumab pre-treatment)
  * Previous treatment with one of the study drugs (NAP, pembro or Obi)
  * Certain cardiovascular conditions like current or recent CHF, myocardial infarction, acute coronary syndrome, ongoing angina pectoris, severe peripheral vascular disease, or CVA (stroke). Your doctor will discuss eligibility with you in more detail
  * Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients
  * History of progressive multifocal leukoencephalopathy (PML)