This study is looking at a new drug called sacituzumab tirumotecan to see if it helps people with advanced or metastatic gastroesophageal adenocarcinoma, which is a type of cancer in the stomach and esophagus. The study aims to find out if this drug is better than the usual treatment chosen by doctors, focusing on how long patients live (Overall Survival, or OS).

To join the study, participants must have certain types of cancer confirmed by tests, have tried at least two other treatments without success, and be in good enough health to participate. People can't join if they have severe eye problems, certain heart diseases, or active infections, among other conditions.

• Study Length: The study involves multiple visits over an extended period.
• Compensation: Participants may receive compensation for their involvement.
• Risks: There may be risks associated with the new treatment, like side effects.

Participants will be monitored closely to ensure their safety and to see how well the drug works compared to standard treatments.