A Study to Assess RXC004 Efficacy in Advanced Solid Tumours After Progression on Standard of Care (SoC) Therapy (PORCUPINE2)

Core Inclusion Criteria:

1. At least one lesion that is measurable by RECIST 1.1 at baseline (within 6 weeks prior to start of study treatment).
2. Mandatory paired biopsies; Patients must have at least one lesion suitable for biopsy at screening
3. Adequate organ and marrow function
4. Female patients of childbearing potential must have a negative pregnancy test prior to start of dosing
5. Female patients of childbearing potential and male patients with female partners of childbearing potential must agree to use a highly effective method of contraception during the study from the time of treatment initiation, and for at least 5 months after the last dose of study drug.

Module 1 (PDAC) Specific Inclusion Criteria

1. Histological documentation of advanced (unresectable)/metastatic (Stage III/IV) PDAC, with documented loss of function tumour mutation in RNF43
2. Patients must have received one prior systemic treatment for advanced (unresectable)/metastatic PDAC (Stage III/IV), with clear evidence of radiological disease progression
3. Patients must be enrolled and receive first dose of study treatment within 6 weeks of radiologically confirmed progression
4. Karnofsky performance status ≥70.

Module 2 and Module 3 (BTC) Specific Inclusion Criteria

1. Histological documentation of advanced (unresectable)/metastatic (Stage III/IV) BTC (intrahepatic or extrahepatic cholangiocarcinoma, ampulla of Vater, or gallbladder cancer)
2. Patients must have received one prior systemic treatment for advanced (unresectable)/metastatic BTC, with clear evidence of radiological disease progression
3. Patients must be enrolled and receive first dose of study treatment within 6 weeks of radiologically confirmed progression
4. ECOG status 0 or 1.

Core Exclusion Criteria:

1. Prior therapy with a compound of the same mechanism of action as RXC004
2. Patients at higher risk of bone fractures
3. Any known uncontrolled inter-current illness or persistent clinically significant toxicity related to prior anti-cancer treatment
4. Patients who have any history of an active (requiring treatment) other malignancy within 2 years of study entry
5. Patients with known or suspected brain metastases
6. Use of anti-neoplastic agents
7. Patients with a known hypersensitivity to any RXC004 excipients
8. Patients with a contra-indication for denosumab treatment
9. Patients who are pregnant or breast-feeding
10. Known active human immunodeficiency viruses (HIV), hepatitis B (HBV), or hepatitis C (HCV) infections
11. Use of any live or live-attenuated vaccines against infectious diseases (e.g., influenza nasal spray, varicella) within 4 weeks (28 days) of initiation of study treatment
12. Mean resting corrected QTcF >470 ms, obtained from triplicate ECGs performed at screening.

There are no exclusion criteria specific to Modules 1 and 2.

Module 3 Specific Exclusion Criteria:

1. Patients with any contraindication to the use of pembrolizumab as per approved label
2. Has received prior therapy with an anti-programmed cell death-1 (anti-PD-1), anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor, and was discontinued from that treatment due to a Grade 3 or higher AE
3. Has received prior radiotherapy within 2 weeks of start of study treatment or have had a history of radiation pneumonitis
4. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of pembrolizumab in this study
5. Has severe hypersensitivity (≥ Grade 3) to pembrolizumab and/or any of its excipients
6. Has an active autoimmune disease that has required systemic treatment in past 2 years
7. Has a history of (non-infectious) pneumonitis / interstitial lung disease that required steroids or has current pneumonitis / interstitial lung disease
8. Has an active infection requiring systemic therapy
9. Patients with a history of allogeneic tissue/solid organ transplant
10. Patients with active infections, including tuberculosis, HIV, HBV, or HCV