Pan-tumor Study of I-DXd in Subjects with Recurrent or Metastatic Solid Tumors

Prior treatment

• Prior treatment with orlotamab, enoblituzumab, or other B7-H3-targeted agents, including I-DXd.
• Prior discontinuation of an ADC that consists of an exatecan derivative (eg, T-DXd) due to treatment-related toxicities.
• Clinically active brain metastases, spinal cord compression, or leptomeningeal carcinomatosis, defined as untreated or symptomatic, or requiring therapy with steroids or anticonvulsants to control associated symptoms. Subjects with clinically inactive or treated brain metastases who are asymptomatic (ie, without neurologic signs or symptoms and not requiring treatment with corticosteroids or anticonvulsants) may be included in the study. Subjects must have a stable neurologic status for at least 2 weeks prior to C1D1. Note: For melanoma and BC subjects, a contrast-enhanced MRI (preferred) or CT of the brain should be included at baseline. For all other subjects, brain MRI or CT is required only in cases of pre-existing or suspected central nervous system tumor lesions.
• Inadequate treatment washout period before enrollment, defined as follows: - Major surgery (placement of vascular access will not be regarded as a major surgery) (washout period <4 weeks) - Surgery for low-invasive cases (eg, colostomy) (washout period <2 weeks) - Radiation therapy (washout period <4 weeks) - Palliative stereotactic radiation therapy without abdominal radiation (washout period ≤2 weeks) - Cranial irradiation, including whole brain radiation therapy and stereotactic radiosurgery (washout period ≤2 weeks) - Radiation therapy to the lung >30 Gy (washout period <6 months) - Palliative radiotherapy affecting lung areas at lower dose (washout period <3 weeks) - Any systemic anticancer therapy (including immunotherapy [other than antibodies] and investigational drugs) (washout period <3 weeks or 5 half-lives, whichever is longer) - Hormonal therapy (except for luteinizing hormone-releasing hormone [LHRH] agonists/antagonists) (washout period <2 weeks) - Locoregional therapy (chemoembolization, radioembolization) (washout period <4 weeks) - Nitrosoureas or mitomycin C (washout period <6 weeks) - Antibody-based anticancer therapy (washout period <3 weeks) - Chloroquine/hydroxychloroquine (washout period ≤14 days)
• Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses, including, but not limited to, any underlying pulmonary disorder (eg, pulmonary emboli within 3 months of the study enrollment, severe asthma, severe chronic obstructive pulmonary disease [COPD], restrictive lung disease, pleural effusion, etc) and any autoimmune, connective tissue, or inflammatory disorders with potential pulmonary involvement (eg, rheumatoid arthritis, Sjögren’s syndrome, sarcoidosis, etc), prior pneumonectomy, or requirement for supplemental oxygen.
• Unresolved toxicities from previous anticancer therapy, defined as toxicities (other than alopecia) not yet resolved to NCI-CTCAE v5.0 Grade ≤1 or baseline. Note: Subjects may be enrolled with chronic, stable Grade 2 toxicities (defined as no worsening to Grade >2 for at least 3 months prior to enrollment and managed with standard-of-care treatment) that the investigator deems related to previous anticancer therapy, following discussion with the Sponsor, such as the following: a) Chemotherapy-induced neuropathy b) Fatigue c) Endocrinopathies, which may include hypothyroidism, hyperthyroidism, type I diabetes, hyperglycemia, adrenal insufficiency, and/or adrenalitis d) Skin hypopigmentation (vitiligo)

Other illness

• Clinically significant corneal disease.
• History of (noninfectious) ILD/pneumonitis that required corticosteroids, current ILD/pneumonitis, or suspected ILD/pneumonitis that cannot be ruled out by imaging at Screening.

• Subjects ages ≥18 years (follow local regulatory requirements if the legal age of consent for study participation is >18 years).
• For HNSCC Subjects: Subjects without radiographic evidence of major blood vessel invasion/infiltration or tumor demonstrating a >90-degree abutment or encasement of a major blood vessel.
• For HNSCC Subjects: Subjects with no prior history of Grade ≥3 bleeding as per the National Cancer Institute – Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0 within 28 days prior to the start of study drug related to the current head and neck cancer may be included in the study.
• For PDAC Subjects: Pathologically or cytologically documented unresectable or metastatic pancreatic adenocarcinoma that has relapsed or progressed after 1 prior line of gemcitabine-based systemic therapy in the locally advanced/metastatic setting or after 2 lines of therapy if the subject has actionable target tumor mutation and has been previously treated with targeted therapy. a. No prior treatment with topoisomerase I inhibitors, such as irinotecan or topotecan.
• For CRC Subjects: Pathologically or cytologically documented unresectable or metastatic CRC with MSS status.
• For CRC Subjects: Relapse or progression after 1 prior line of systemic therapy including a fluoropyrimidine plus oxaliplatin with or without anti-vascular endothelial growth factor (VEGF) mAb or anti-EGFR mAb therapy, as clinically indicated, or relapse or progression after 2 lines of therapy if the subject has received targeted therapy. Note: Prior adjuvant/neoadjuvant systemic cytotoxic chemotherapy will count as 1 line of prior systemic therapy if there is documented disease progression during therapy or within 6 months of chemotherapy completion.
• For CRC Subjects: No prior treatment with topoisomerase I inhibitors, such as irinotecan or topotecan.
• For HCC Subjects: Pathologically or cytologically documented unresectable or metastatic HCC (fibrolamellar and mixed hepatocellular/cholangiocarcinoma subtypes are not eligible) or noninvasive diagnosis of HCC as per the American Association for the Study of Liver Diseases (AASLD) criteria in subjects with a confirmed diagnosis of cirrhosis.
• For HCC Subjects: Relapse or progression after 1 prior line of an ICI-containing regimen (combination or monotherapy) in the locally advanced/metastatic setting , with a maximum of 2 prior lines. Subjects with actionable target tumor mutation should have been previously treated with targeted therapy.
• For HCC Subjects: Barcelona Clinic Liver Cancer (BCLC) Stage B or C.
• For HCC Subjects: Liver function status should be Child-Pugh (CP) Class A. CP status should be calculated based on clinical findings and laboratory results during the Screening Period.
• At least 1 measurable lesion on computed tomography (CT) or magnetic resonance imaging (MRI) according to RECIST v1.1, as assessed by the investigator.
• For Ad-eso/GEJ/Gastric Subjects: Pathologically or cytologically documented unresectable or metastatic Ad eso/GEJ/Gastric that has relapsed or progressed after 1 prior line of systemic therapy in the locally advanced/metastatic setting. a. Subjects with PD-(L)1+ or MSI-H/dMMR should receive ICI treatment if ICIs are standard of care in the country, unless the subject is ineligible for ICI treatment.
• If the subject has known history of HER2 positivity (defined by IHC 3+ or IHC 2+ and ISH+, as classified by ASCO-CAP) or other actionable target, the subject must have been previously treated with a targeted therapy.
• For UC Subjects: Pathologically or cytologically documented unresectable or metastatic UC of the bladder, renal pelvis, ureter, or urethra. Subjects with histological variants are allowed if urothelial histology is predominant. Small cell/neuroendocrine tumors are not allowed even if mixed histology.
• For UC Subjects: Relapse or progression after at least 1 prior line of ICI-containing systemic therapy, and 1 prior line of systemic chemotherapy, given in combination with other anticancer therapy or separately , with a maximum of 3 prior therapy lines. a. At least 1 line of therapy should include enfortumab vedotin in countries where enfortumab vedotin is approved and available. b. Perioperative systemic therapies will be counted as 1 line of therapy. c. To meet inclusion criteria requirement of prior ICI-containing therapy, use in the perioperative or metastatic setting will suffice. d. Subjects with actionable target tumor mutation should have been previously treated with targeted therapy. e. The same regimen administered twice in different disease settings will be counted as 1 line of prior therapy.
• Histologically confirmed unresectable or metastatic CC that was previously treated with ≥1 prior line of systemic therapy in the locally advanced or metastatic setting. Subjects with actionable target tumor mutation should have been previously treated with targeted therapy.
• For OVC Subjects: Histologically confirmed high-grade serous OVC, high-grade endometrioid OVC, primary peritoneal cancer, or fallopian tube cancer that was previously treated with at least 1 line of platinum-based therapy and bevacizumab unless the subject is ineligible for treatment with bevacizumab.
• For OVC Subjects: Subject is no longer considered eligible for platinum-based therapy per the investigator’s opinion or has progressed less than 180 days after the last dose of platinum therapy.
• For OVC Subjects: Subject is not considered primary platinum refractory and has not progressed during platinum treatment or within 4 weeks after the completion of platinum treatment.
• For BTC Subjects: Pathologically or cytologically documented unresectable or metastatic BTC (intra- or extrahepatic cholangiocarcinoma or gallbladder carcinoma).
• For BTC Subjects: Relapse or progression after at least 1 prior line of systemic therapy, or 2 prior lines of systemic therapy if the subject has an actionable target and has received targeted therapy.
• Documentation of radiological disease progression on or after the previous standard of care regimen in the advanced/metastatic setting. a. Subjects who experience disease progression during treatment or within a time frame of up to 6 months (180 days) after the completion of neoadjuvant/adjuvant treatment are considered eligible if they meet all other criteria and the prior treatment is defined as a line of therapy.
• For BTC Subjects: Histological subtypes other than ampullary cancer, small cell cancer, lymphoma, sarcoma, neuroendocrine tumors, mixed tumor histology, and/or mucinous cystic neoplasms (Please note that the histological subtypes listed here are not allowed.)
• For HER2-Low BC Subjects: Pathologically or cytologically documented unresectable or metastatic BC.
• For HER2-Low BC Subjects: Low HER2 expression, defined as IHC 2+/ISH- or IHC 1+ (ISH- or untested) according to ASCO-CAP 2018 HER2 testing guidelines, based on most recent testing, regardless of hormonal status.
• For HER2-Low BC Subjects: Progression on or after treatment with T-DXd.
• For HER2-Low BC Subjects: Relapse or progression after at least 2 and a maximum of 3 prior lines of systemic therapy. Subjects with metastatic HR+ BC who have received endocrine-based therapy and have received at least 2 and a maximum of 3 prior lines of additional systemic therapy in the metastatic setting. Subjects with actionable target tumor mutation should have been previously treated with targeted therapy.
• For HER2 IHC 0 BC Subjects: Pathologically or cytologically documented unresectable or metastatic BC.
• For HER2 IHC 0 BC Subjects: Negative for HER2 expression, defined as IHC 0 (ISH- or untested) according to ASCO CAP 2018 HER2 testing guidelines, based on the most recent testing, regardless of hormonal status.
• For HER2 IHC 0 BC Subjects: Relapse or progression after at least 2 and a maximum of 3 prior lines of systemic therapy. Subjects with metastatic HR+ BC who have received endocrine-based therapy and have received at least 2 and a maximum of 3 prior lines of additional systemic therapy in the metastatic setting. Subjects with actionable target tumor mutation should have been previously treated with targeted therapy.
• For Cutaneous (Acral and Non-acral) Melanoma Subjects: Histologically or cytologically confirmed cutaneous (acral and non-acral) melanoma.
• For Cutaneous (Acral and Non-acral) Melanoma Subjects: Disease progression while on or after having received treatment with ≥1 prior line of ICI based therapy. Prior anti-PD-(L)1 therapy in the adjuvant setting may be counted as 1 line if there is recurrence within 12 weeks of the last dose. If the subject had BRAF mutated melanoma or other actionable target tumor mutation, they must have had disease progression on targeted therapy as well.
• Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
• Has adequate organ function within 7 days before the start of study drug. Transfusion (red blood cell or platelet) or granulocyte-colony stimulating factor (G-CSF) administration is not allowed within 2 weeks prior to screening laboratory assessments. Adequate organ function is defined as follows: - Platelet count ≥100 × 109/L - Hemoglobin ≥8.5 g/dL - Absolute neutrophil count ≥1.5 × 109/L - Creatinine clearance ≥30 mL/min, as calculated using the Cockcroft-Gault equation - Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST): ≤3 × upper limit of normal (ULN) in subjects with no liver metastasis or ≤5.0 × ULN in subjects with liver metastasis or primary liver tumor - Total bilirubin (TBL): ≤1.5 × ULN if no liver metastases or ≤3 × ULN in the presence of documented Gilbert’s syndrome (unconjugated hyperbilirubinemia) or liver metastases at Baseline. For HCC, please refer to the additional inclusion criteria for HCC subjects. - International normalized ratio (INR)/prothrombin time and either partial thromboplastin time (PTT) or activated PTT (aPTT): ≤1.5 × ULN. Note: Except for subjects receiving anti-vitamin K derivative anticoagulant therapy who must have prothrombin time-INR within therapeutic range as deemed appropriate by the investigator.
• For EC Subjects: Pathologically or cytologically documented EC of any histological carcinoma subtype or endometrial carcinosarcoma, irrespective of MSI or MMR status.
• For EC Subjects: Relapse or progression after a platinum-containing systemic treatment and an ICI containing regimen (combined or sequential). Subjects with actionable target tumor mutation should have been previously treated with targeted therapy, ), with a maximum of 3 prior lines of therapy for endometrial carcinoma or carcinosarcoma. Neoadjuvant/adjuvant therapy may count as 1 line of therapy if the subject progressed within 6 months after completion of therapy.
• For HNSCC Subjects: Pathologically or cytologically documented unresectable or metastatic squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx, excluding nasopharynx, nasal cavity and paranasal sinuses, and unknown primary.
• For HNSCC Subjects: Has disease progression after platinum-based and ICI treatment, whether administered in combination or separately. Subjects with actionable target tumor mutation should have been previously treated with targeted therapy, with a maximum of 2 prior therapy lines for unresectable or metastatic HNSCC.