Summary

This pan-tumor trial is designed as a signal-seeking trial to assess efficacy and safety
of raludotatug deruxtecan (R-DXd) monotherapy in locally advanced or metastatic solid
tumors with various cadherin-6 (CDH6) expression levels, including gynecological cancers
(endometrial cancer, cervical cancer, and non-high-grade serous ovarian cancer) and
genitourinary cancers (urothelial cancer and clear cell renal cell carcinoma [ccRCC]).

Objectives

This trial is designed to evaluate the efficacy and safety of R-DXd in locally advanced
or metastatic solid tumors with various CDH6 expression levels. Solid tumor types will
include gynecological cancers (endometrial cancer, cervical cancer, and non-high-grade
serous ovarian cancer) and genitourinary cancers (urothelial cancer and ccRCC).

For all cohorts except ccRCC, the primary endpoint will be objective response rate (ORR)
by investigator assessment per RECIST 1.1. For the ccRCC cohort, the primary endpoint
will be disease control rate (DCR) by investigator assessment per RECIST 1.1. All cohorts
will also have the assessment of safety and tolerability as another primary objective.

Eligibility

1. Participants must meet all of the following criteria to be eligible for enrollment into the trial: 1. Adults =18 years of age on the day of signing the ICF. 2. Participants must have at least 1 lesion, not previously irradiated, amenable to biopsy, and must consent to provide a pre-treatment biopsy from a primary and/or metastatic lesion. 3. Has at least 1 measurable lesion according to RECIST version 1.1 per investigator assessment. 4. Participants must have progressed radiologically on or after their most recent line of systemic therapy. 5. Eastern Cooperative Oncology Group performance status of 0 or 1. 6. Additional inclusion criteria for endometrial cancer cohort 1. Pathologically or cytologically documented endometrial cancer (carcinoma of any histological subtype or carcinosarcoma), irrespective of MSI or mismatch repair status. 2. Documented disease progression after having received =1 line of therapy (no more than 3), including PBC-containing systemic treatment and an anti-PD-1 therapy containing regimen (combined or sequential) in the advanced/metastatic setting. 7. Additional inclusion criteria for cervical cancer cohort 1. Pathologically or cytologically documented recurrent or persistent squamous, adenosquamous, or adenocarcinoma of the uterine cervix. 2. Disease progression after having received =1 prior line of therapy that includes systemic therapy in the advanced or metastatic setting. 8. Additional inclusion criterion for non-HGSOC cohort a. Pathologically or cytologically documented unresectable or metastatic CCOC, low grade endometrioid, low-grade serous, or mucinous OVC that was previously treated with at least 1 prior line of therapy. 9. Additional inclusion criteria for urothelial cancer cohort 1. Pathologically or cytologically documented unresectable or metastatic urothelial carcinoma of the bladder, renal pelvis, ureter, or urethra. Histological variants are allowed if urothelial histology is predominant. 2. Relapsed or progressed after treatment with =1 prior line of therapy (maximum of 3) that contains anti-PD-(L)1 therapy in the perioperative or metastatic setting. 10. Additional inclusion criterion for the ccRCC cohort a. Pathologically or cytologically documented unresectable or metastatic ccRCC that was previously treated with no more than 3 prior systemic regimens for locally advanced or metastatic RCC, including both a PD-(L)1 checkpoint inhibitor and a VEGF-TKI in sequence or in combination. Participants who meet any of the following criteria will be disqualified from entering the trial: 1. Clinically active brain metastases, spinal cord compression, or leptomeningeal carcinomatosis 2. Any of the following within the past 6 months prior to enrollment: cerebrovascular accident, transient ischemic attack, or other arterial thromboembolic event. 3. Uncontrolled or significant cardiovascular disease as specified in the protocol. 4. Has a history of (noninfectious) ILD/pneumonitis that required corticosteroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening. 5. Clinically severe pulmonary compromise 6. Chronic steroid treatment (>10 mg/day) with exceptions as noted in the protocol. 7. History of other active malignancy within 3 years prior to enrollment, with the exception of those with a negligible risk of metastasis or death (eg, 5-year OS rate >90%) and treated with expected curative outcome. 8. Unresolved toxicities from previous anticancer therapy, defined as toxicities (other than alopecia) not yet resolved to NCI-CTCAE Version 5.0, Grade =1 or baseline. 9. Prior exposure to other CDH6-targeted agents or an ADC that consists of an exatecan derivative that is a topoisomerase I inhibitor (eg, trastuzumab deruxtecan, datopotamab deruxtecan). 10. Evidence of ongoing uncontrolled systemic bacterial, fungal, or viral infection. 11. Has active or uncontrolled HIV, HBV, or HCV infection.

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