This global study is being conducted to evaluate the safety and determine the recommended phase 3 dose of trastuzumab rezetecan in combination with mFOLFOX6 chemotherapy (dose level -1) and bevacizumab as first-line treatment in participants with advanced colorectal cancer that expresses HER2, including but not limited to HER2 immunohistochemistry (IHC) 2+ "equivocal" or 3+ "positive" based on gastric cancer criteria, focused on the Western population. Encouraging data in efficacy and safety with trastuzumab rezetecan in a similar setting in China (NCT06015048) were presented at 2026 American Society of Clinical Oncology annual meeting.
ECOG performance status score of 0 or 1.
Histologically or cytologically confirmed unresectable, recurrent, or metastatic colorectal adenocarcinoma that is HER2-positive. "HER2-positive" indicates IHC 2+ or 3+, or HER2 (ERBB2) amplification by NGS at a CLIA-certified or ISO-accredited laboratory. HER2 IHC 2+/3+ should be based on gastric cancer criteria.
Either have not received any prior systemic anti-tumor therapy (including, but not limited to, systemic chemotherapy, molecular targeted drug therapy, immunotherapy, biotherapy, or other investigational agents), or, if previously treated with neoadjuvant or adjuvant therapy, have first documented recurrence or metastasis >6 months after the last dose of neoadjuvant or adjuvant therapy. Participants known to have dMMR or high-level MSI-H are excluded unless the investigator determines they are unsuitable for anti-PD-1/PD-L1 therapy. Participants known to have BRAF V600 mutation are excluded unless the investigator determines they are unsuitable for BRAF-targeting therapy. Note that participants may have received a maximum of 2 doses of mFOLFOX6 with or without bevacizumab in the locally advanced/unresectable or metastatic setting prior to randomization.
Have at least one measurable lesion according to the RECIST version 1.1. Measurable lesions should not have received prior local therapy such as radiotherapy (lesions located within a previous radiotherapy field can be considered as target lesions if progression is confirmed).
Prior treatment with anti-HER2 ADCs featuring exatecan or its derivatives as the payload (a topoisomerase I inhibitor), such as trastuzumab deruxtecan (Enhertu®, DS-8201a).
Treatment with any investigational drug or therapy not yet approved for marketing within 4 weeks prior to the first dose of the IMP.
Systemic anti-tumor therapy within 4 weeks prior to the first dose of the IMP, including chemotherapy, biotherapy, targeted therapy, or immunotherapy. For small molecule targeted therapies, a washout period of at least 5 half-lives or 7 days (whichever is longer) from the last dose is required before the first dose of the IMP. Note that participants may have received a maximum of 2 doses of mFOLFOX6 with or without bevacizumab in the locally advanced/unresectable or metastatic setting prior to randomization.
Palliative radiotherapy completed within 2 weeks prior to the first dose of the IMP.
Parallel
Trastuzumab Rezetecan (SHR-A1811) injection; high dose
DrugTrastuzumab Rezetecan (SHR-A1811) injection; high dose
Trastuzumab Rezetecan (SHR-A1811) injection; low dose
DrugTrastuzumab Rezetecan (SHR-A1811) injection; low dose
Incidence of treatment-emergent adverse events
Determination of the recommended phase 3 dose
Objective response rate, as assessed by the investigator
Disease control rate, as assessed by the investigator
Duration of response, as assessed by the investigator
Progression free survival, as assessed by the investigator
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