This study tests a new drug called **sacituzumab tirumotecan** for **advanced gastroesophageal adenocarcinoma**. This is a type of cancer affecting the stomach and esophagus. The study checks if this drug helps patients live longer compared to the usual treatment chosen by doctors. To join, participants need to have had at least two rounds of treatment before. They must also have cancer that cannot be removed by surgery. **HER2+** patients (those with a certain protein in their cancer cells) should have tried a drug called trastuzumab first.

Key Points:

• Participants must have a specific type of advanced cancer and have tried other treatments.
• The study will compare a new drug to regular treatment options to see which one is better.
• Participants will need to provide a tissue sample and have their health monitored closely during the study.

There are certain health conditions that may prevent someone from joining, like severe eye problems or heart issues. It's important to speak with your doctor to see if this study is a good fit for you.