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Inclusion Criteria:

* Signed informed consent
* Adult men and women ≥18 years of age
* Participants must have histologically confirmed, locally advanced or metastatic NeuroEndocrine Carcionomas (NEC)
* Participants must be willing to undergo a tumor biopsy or must provide archived tumor tissue sample
* Participants must have at least one measurable target lesion as defined by RECIST v1.1
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
* Life expectancy ≥ 3 months

Exclusion Criteria:

* Participants with another known malignancy that is progressing or requires active treatment within the last 2 years
* Clinically active central nervous system (CNS) metastases
* Participants with leptomeningeal metastasis
* Participants who have received any ADC with a payload of topoisomerase I inhibitor (e.g., exatecan derivative)or had received topoisomerase I inhibitor (e.g., irinotecan) as the immediate prior therapy that the participant had progressed from.
* Treatment with any systemic anti-cancer treatment or other investigational products/device within 3 weeks before the first dose of study treatment
* Non-palliative radiotherapy within 2 weeks to non-thoracic area or within 4 weeks to the thoracic area prior to first dose of study treatment or a history of radiation pneumonitis
* Major surgery within 4 weeks of the first dose of study treatment
* Hypersensitivity to any ingredient of the study treatment
* Out of range value (as defined in protocol) within 10 days prior to the first dose of study treatment
* Impaired cardiac function or clinically significant cardiac disease within the last 3 months before administration of the first dose of the study treatment
* Lung-specific intercurrent clinically significant illnesses and any autoimmune, connective tissue, or inflammatory disorders including but not limited to pneumonitis
* Has a history of (noninfectious) ILD/pneumonitis that required steroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at Screening
* Pregnant or nursing (lactating) women
* Participants who have been on concomitant strong CYP3A or CYP2D6 inhibitors within 14 days or 5 half-lives before the first dose of study treatment, whichever is longer

• San Francisco, California, United States
• Peoria, Illinois, United States
• Detroit, Michigan, United States
• New York, New York, United States
• Cleveland, Ohio, United States
• Philadelphia, Pennsylvania, United States
• Nashville, Tennessee, United States
• Dallas, Texas, United States
• Houston, Texas, United States
• McAllen, Texas, United States
• Fairfax, Virginia, United States
• Norfolk, Virginia, United States
• Beijing, Beijing Municipality, China
• Beijing, Beijing Municipality, China
• Xiamen, Fujian, China
• Guangzhou, Guangdong, China
• Guangzhou, Guangdong, China
• Harbin, Heilongjiang, China
• Changsha, Hunan, China
• Changchun, Jilin, China
• Shanghai, Shanghai Municipality, China
• Shanghai, Shanghai Municipality, China
• Shanghai, Shanghai Municipality, China