Dato-DXd and rilvegostomig after surgery for high-risk muscle invasive bladder cancer

Who can take part

• Participant must be > 18 years of age at the time of signing the ICF
• Histologically confirmed MIUC of the bladder or upper tract
• Completed R0 radical resection 28 to 120 days before randomisation, with negative margins and no residual or metastatic disease
• Pathologic evidence of urothelial carcinoma at high-risk of recurrence and; not received neoadjuvant therapy and has pT3-pT4aN0, or any pT with pN+ stage; completed neoadjuvant treatment and has ypT2-ypT4a, or any ypT with ypN+ stage
• No evidence of disease at screening,
• ECOG performance status of 0 or 1 with no deterioration over the previous 2 weeks prior to randomisation
• Minimum life expectancy of > 12 weeks at time of screening
• An archival surgical tumour sample must be available pre-randomisation for central testing
• Adequate organ and bone marrow function within 28 days before randomisation

Who cannot take part

• Any adjuvant systemic or radiation therapy post-surgery for urothelial carcinoma
• History of another primary malignancy except for malignancy treated with curative intent with no known active disease within 2 years before the first dose of study intervention and of low potential risk for recurrence
• Active or prior documented autoimmune or inflammatory disorders requiring systemic treatment in the past 5 years
• Prior exposure to TROP2-directed therapies, other ADCs with deruxtecan, therapeutic anti-cancer vaccines, anti-TIGIT therapy or any other anti-cancer therapy targeting immune-regulatory receptors or mechanisms
• Current or prior use of immunosuppressive medication within 14 days prior to treatment assignment/randomisation
• Partial cystectomy in the setting of bladder cancer primary tumour or partial nephrectomy
• Severe or uncontrolled systemic diseases, history of organ transplant or allogeneic stem cell transplant, or psychological disorders/social situations, and/or substance abuse
• History of clinically significant corneal disease
• Ongoing toxicities except alopecia from prior cancer treatment must be Grade ≤ 1 or at baseline. Stable Grade 2 toxicities are allowed if unchanged for ≥3 months and managed by standard care
• Active or uncontrolled hepatitis B or C virus infection
• Known HIV infection that is not well controlled
• Any other active or uncontrolled infection including tuberculosis requiring systemic treatment that has not resolved by the time of randomisation
• History of non-infectious ILD/pneumonitis including radiation, pneumonitis that required steroids, has current ILD/pneumonitis, or has suspected ILD/pneumonitis that cannot be ruled out by imaging at screening
• Uncontrolled or significant cardiac conditions
• Known history of severe hypersensitivity reactions to any study drug
• Any tumour with predominant or pure high grade neuroendocrine carcinoma component
• Has clinically severe pulmonary function compromise
• Mean resting corrected QTcF > 470 ms regardless of gender, obtained from triplicate 12-lead ECGs performed at screening
• Not eligible to receive at least one of SoC according to local regulations/approvals
• Currently pregnant (confirmed with positive pregnancy test), breastfeeding or planning to become pregnant