A Study to Evaluate the Safety,Tolerability, Pharmacokinetics and Clinical Activity of Mocertatug Rezetecan for Injection in Participants With Advanced Solid Tumors (BEHOLD-1)

Inclusion criteria

• Males or females aged 18 years or older (≥18 years).
• Participants with pathologically confirmed advanced solid tumor (who have failed or are intolerant to standard of care.
• PROC cohort

• Histologically documented, advanced (metastatic and/or unresectable) high-grade serous/endometrioid ovarian, primary peritoneal, or fallopian tube cancer.
• Must have received or are intolerant to 1 but no more than 4 lines of prior systemic therapy.
• Platinum-resistant disease, defined as progression or relapse within 6 months after the completion of platinum-based therapy.
• Must have had prior bevacizumab , unless there is a documented contraindication or intolerance.
• Participants with known Folate receptor-α (FR-α) expressing tumors must have received mirvetuximab soravtansine if the regimen is locally available, unless there is a documented contraindication or intolerance.

Participants with known Breast cancer susceptibility gene (BRCA) mutated tumors should have received a Poly adenosine diphosphate-ribose polymerase (PARP) inhibitor if the regimen is locally available, unless there is a documented contraindication or intolerance.

• Endometrial cancer cohort

• Histologically documented, advanced (metastatic and/or unresectable) or recurrent endometrial cancer.
• Must have received or are intolerant to 1 but no more than 4 lines of prior systemic therapy.
• Must have had prior platinum and PD(L)-1 inhibitor (in same regimen or in separate regimens), if the regimen is locally available, unless there is a documented contradiction or intolerance
• All epithelial histologies are permitted including carcinosarcoma.
• Participants have at least one target lesion as assessed per the RECIST 1.1
• Tumor tissue from a newly obtained biopsy or archival tumor tissue is required for retrospective detection of B7 homolog 4 (B7-H4) expression by IHC in central laboratory and other biomarker analysis. Tissue from a newly obtained biopsy is preferred. If a newly obtained biopsy is not feasible, archival tumor tissue within 2 years prior to the first dose of study drug is acceptable.
• Eastern Cooperative Oncology Group Performance Status (ECOG PS) score of 0 to 2 and no deterioration within 2 weeks before the first dose.
• Have a life expectancy of at least 12 weeks.

Exclusion criteria

• Have received any B7-H4-targeted therapy
• Have received any of cytotoxic chemotherapy drugs, anti-tumor traditional Chinese medicines or other anti-tumor drugs within 28 days prior to the first dose of study drug; or need to continue these drugs during the study.
• Have received locoregional radiation therapy within 2 weeks prior to the first dose of study drug; more than 30% of bone marrow irradiation or wide-field radiation therapy within 4 weeks prior to the first dose of study treatment.
• Presence of pleural/abdominal effusion/ascites requiring clinical intervention; presence of pericardial effusion
• Major surgery within 28 days prior to the first dose of study treatment.
• Evidence of brain metastasis unless asymptomatic;
• Has inadequate bone marrow reserve or hepatic/renal functions .
• Mean Fridericia-corrected QT interval (QTcF) QTcF >450 msec or QTcF >480 msec for participants with bundle branch blocK;
• Evidence of current clinically significant arrhythmias or ECG abnormalities
• Left ventricular ejection fraction (LVEF) < 50%.
• Have severe, uncontrolled or active cardiovascular disorders, serious or poorly controlled hypertension, clinically significant bleeding symptoms or serious arteriovenous thromboembolic events
• Has current active pneumonitis/ILD or any history of ILD, any history of pneumonitis requiring steroids or immunomodulatory treatment within 90 days of planned randomization/enrollment or any history of drug-induced pneumonitis/ILD.Have received prior therapy with topoisomerase inhibitors or topoisomerase inhibitor Antibody-drug conjugate (ADCs)
• PROC

• Primary platinum refractory disease defined as those who have progressed on or within 12 weeks of last dose of first line platinum therapy not permitted.
• Non-epithelial carcinoma, clear-cell, mucinous, germ-cell, low-grade serous, or low-grade endometrioid carcinoma not permitted.
• Endometrial cancer a. Mesenchymal tumors of the uterus (uterine sarcomas) not permitted.