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OP RSH PRO00039835 EFSTATHIOU MK-2400-001 ARM 1	

Types:      Research Oncology Treatment
Synonyms:  PRO00039835, MK-2400-001, EFSTATHIOU

Cycle 1	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Participant ID card

Provide to participant at the time of informed consent. 
Update with randomization number at time of randomization (C1D1).
		  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	ILD/pneumonitis patient guide and wallet card (Arm 1)

To be provided to participants assigned to I-DXd at the randomization visit and before first dose.
		  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Randomization
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Cardiology
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Single ECGs thereafter every 4 cycles predose (eg, C1D1, C5D1, C9D1, etc), at EOT, and as clinically indicated during the Treatment Period. If ECG is abnormal, follow institutional guidelines. Single ECGs will be performed unless clinically significant
abnormality is noted by the investigator, in which case they should be done in triplicate
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Imaging
☑	ONC NURSING COMMUNICATION 75	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
			Imaging
◯	NM BONE SCAN LIMITED	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		◉	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
			Imaging
  	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	ONLY for participants with a history of brain metastases or who are clinically symptomatic.
On Study: Brain imaging to be performed as clinically indicated or to confirm CR when metastases were present at Screening.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 15 minutes of end of infusion) of Cycle 1, Cycle 2, and Cycle 3.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 of Cycle 1 and Cycle 3 within 3 to 6 hours after start of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Archival tissue for biomarkers.

Randomized participants with soft tissue disease to submit an archival soft tissue sample from prior to most recent therapy, if available. If archival soft tissue was already submitted for stratification an additional archival sample is not required at randomization
for soft tissue participants.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose.
See Section 8.8.1.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose for C1D1 and C3D1.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose for C1D1 and C3D1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	TESTOSTERONE, TOTAL, IMMUNOASSAY (FOR ADULT MALES)	Interval: --	Occurrences: --	Comments:	Total testosterone is determined every 4 cycles (eg, C1D1, C5D1, C9D1, etc).
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1			Research tolerance: -0/+0 days	Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	At C1D8 collect ±24 hours from D8
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
				Day 15	Perform every 1 day x1			Research tolerance: -0/+0 days	Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	At C1D15, collect ±24 hours from D15.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	At C1D15, collect ±24 hours from D15.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
					
Cycle 2	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 15 minutes of end of infusion) of Cycle 1, Cycle 2, and Cycle 3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 3	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Imaging
☑	ONC NURSING COMMUNICATION 75	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
			Imaging
◯	NM BONE SCAN LIMITED	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		◉	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
			Imaging
  	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	ONLY for participants with a history of brain metastases or who are clinically symptomatic.
On Study: Brain imaging to be performed as clinically indicated or to confirm CR when metastases were present at Screening.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 15 minutes of end of infusion) of Cycle 1, Cycle 2, and Cycle 3.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 of Cycle 1 and Cycle 3 within 3 to 6 hours after start of infusion
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose for C1D1 and C3D1.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose for C1D1 and C3D1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 4	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 5	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Cardiology
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Single ECGs thereafter every 4 cycles predose (eg, C1D1, C5D1, C9D1, etc), at EOT, and as clinically indicated during the Treatment Period. If ECG is abnormal, follow institutional guidelines. Single ECGs will be performed unless clinically significant
abnormality is noted by the investigator, in which case they should be done in triplicate
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	TESTOSTERONE, TOTAL, IMMUNOASSAY (FOR ADULT MALES)	Interval: --	Occurrences: --	Comments:	Total testosterone is determined every 4 cycles (eg, C1D1, C5D1, C9D1, etc).
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 6	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Imaging
☑	ONC NURSING COMMUNICATION 75	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
			Imaging
◯	NM BONE SCAN LIMITED	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		◉	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
			Imaging
  	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	ONLY for participants with a history of brain metastases or who are clinically symptomatic.
On Study: Brain imaging to be performed as clinically indicated or to confirm CR when metastases were present at Screening.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 7	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 8	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 9	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Cardiology
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Single ECGs thereafter every 4 cycles predose (eg, C1D1, C5D1, C9D1, etc), at EOT, and as clinically indicated during the Treatment Period. If ECG is abnormal, follow institutional guidelines. Single ECGs will be performed unless clinically significant
abnormality is noted by the investigator, in which case they should be done in triplicate
			Imaging
☑	ONC NURSING COMMUNICATION 75	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
			Imaging
◯	NM BONE SCAN LIMITED	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		◉	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
			Imaging
  	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	ONLY for participants with a history of brain metastases or who are clinically symptomatic.
On Study: Brain imaging to be performed as clinically indicated or to confirm CR when metastases were present at Screening.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	TESTOSTERONE, TOTAL, IMMUNOASSAY (FOR ADULT MALES)	Interval: --	Occurrences: --	Comments:	Total testosterone is determined every 4 cycles (eg, C1D1, C5D1, C9D1, etc).
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 10	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 11	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 12	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Imaging
☑	ONC NURSING COMMUNICATION 75	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		☑	CT CHEST W WO CONTRAST ABDOMEN W WO CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	CT CHEST WO CONTRAST ABDOMEN WO CONTRAST PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or MRI
		☐	MRI CHEST W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI CHEST WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI ABDOMEN WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
		☐	MRI PELVIS WO CONTRAST	Interval: --	Occurrences: --	Comments:	Or CT
			Imaging
◯	NM BONE SCAN LIMITED	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
		◉	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	Participants who discontinue treatment without documented radiographical disease progression, verified by BICR per PCWG Modified RECIST 1.1, should continue to be monitored for disease status by radiologic imaging (CT/MRI and bone scans) until
documented radiographical disease progression verified by BICR, withdrawal of consent, death, or the end of the study, whichever occurs first. For clinically stable participants, communication with the Sponsor is required before stopping imaging.
EOT: If a scan was obtained within 4 weeks prior to discontinuation, another scan at discontinuation is not mandatory. See Section 8.2.1.3
			Imaging
  	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	ONLY for participants with a history of brain metastases or who are clinically symptomatic.
On Study: Brain imaging to be performed as clinically indicated or to confirm CR when metastases were present at Screening.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
			Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Notify provider of the following:
-         ANC < 1000
-         Hemoglobin < 8 g/dL
-         Platelets < 50,000
-         QTC > 500 ms
-         SCr >3x baseline
-         AST/ALT >= 3x ULN
-         Alk Phos >= 5x ULN
Total Bilirubin >= 2x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Notify provider if there is a weight change of >= 10%
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	INSERT PERIPHERAL IV OR ACCESS PORTACATH	Interval: --	Occurrences: --		  	dextrose 5% flush syringe 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S				  	dextrose 5% infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 min prior to chemotherapy.			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to chemotherapy.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes before chemo
			Chemotherapy
  	INV-INFINATAMAB DERUXTECAN (I-DXD) (MK-2400-001/PRO00039835/EFSTATHIOU) 12 mg/kg in dextrose 5% 250 mL IVPB	Dose: 12 mg/kg	Route: intravenous	once over 90 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Infuse over 90 minutes (+/- 10 min) through 0.2-micron inline filter. Subsequent infusions may be administered over 30 min (+/-5 min) if no reaction. Protect from light. FLUSH WITH D5W ONLY. Not compatible with NS. Bag stable 4 hrs at room temp or 24 hrs refrigerated.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFINATAMAB DERUXTECAN (I-DXD) 100 MG SOLN (MK-2400-001/PRO00039835/EFSTATHIOU)	Medications	12 mg/kg	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	A post-infusion observation period is required for at least 1 hour post-infusion at each cycle to monitoring for potential IRR events
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
EOT: At time of discontinuation of treatment	Repeat 1 time	Cycle length: 1 day	EOT	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 109	Interval: --	Occurrences: --	Comments:	Full physical examination
			Nursing Orders
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	An eye examination performed by an ophthalmologist or optometrist includes a visual acuity test, slit lamp examination, tonometry, and fundoscopy. An eye examination will be done at Screening, EOT, and as clinically indicated.
			Cardiology
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	Single ECGs thereafter every 4 cycles predose (eg, C1D1, C5D1, C9D1, etc), at EOT, and as clinically indicated during the Treatment Period. If ECG is abnormal, follow institutional guidelines. Single ECGs will be performed unless clinically significant
abnormality is noted by the investigator, in which case they should be done in triplicate
			Imaging
  	TTE COMPLETE, WO CONTRAST, WO DOPPLER	Interval: --	Occurrences: --	Comments:	Echo or MUGA

The same test should be used for the participant throughout the study. If ECHO/MUGA scan is
performed as part of standard of care within 14 days before signed informed consent, results could be considered to assess participant's eligibility.
ECHO or MUGA scan assessments will be performed at Screening and at the EOT Visit.
		  	ZZ_HIST_NM CARDIAC BLOOD POOL MUGA (AT REST)	Interval: --	Occurrences: --	Comments:	Echo or MUGA

The same test should be used for the participant throughout the study. If ECHO/MUGA scan is performed as part of standard of care within 14 days before signed informed consent, results could be considered to assess participant's eligibility.
ECHO or MUGA scan assessments will be performed at Screening and at the EOT Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG Performance Status

Obtain prior to dosing. After Cycle 8, obtain at every other cycle (Cycle 10, 12, 14, etc).
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose for C1D1 and C3D1.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect predose for C1D1 and C3D1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --	Comments:	For Arm 1 (I-DXd), urinalysis is only needed at screening and EOT.
For Arm 2, obtain at screening, C1D1, every other cycle (D1 of C3, C5, etc), and EOT.
			Labs
  	TESTOSTERONE, TOTAL, IMMUNOASSAY (FOR ADULT MALES)	Interval: --	Occurrences: --	Comments:	Total testosterone is determined every 4 cycles (eg, C1D1, C5D1, C9D1, etc).
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
					
Safety FU: (SFU) 40 days from last dose	Repeat 1 time	Cycle length: 1 day	SFU	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant medications

Report medications started 42 days prior to the first dose and up to 40 days after last dose of study intervention.
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Directed physical examination.

Perform as clinically indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Subsequent anticancer therapy status.

Safety follow-up visit must take place before the start of new therapy. For clinically stable participants, communication with the Sponsor is required before starting first subsequent new anticancer therapy
			Nursing Orders
  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Survival status

Updated survival status may be requested by the Sponsor at any time during the course of the study.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect Day 1 (within 8 hours before infusion) of Cycle 1, 2, 3, 4, 6, 8, 12, and 16, then every 8 cycles thereafter.
			Nursing Orders
  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	FACT-P
EQ-5D-5L

Complete at site on Day 1 of every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	BPI-SF Analgesic Log 

Completed at home by the participant.
During the study treatment phase, complete daily for 7 consecutive days before every cycle through Cycle 10, then every 2 cycles through Cycle 24, then every 4 cycles thereafter or until discontinuation (ie, at EOT visit) and at Safety Follow-up Visit.
A 3-day window will be permitted to complete the BPI-SF and Analgesic Log prior to the expected 7 days.
			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs to be collected prior to study treatment administration. Vital signs (temperature, blood pressure, pulse rate, respiratory rate, and SpO2) are measured after 5-minute rest.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --	Comments:	If >=10% change in body weight occurs, weight-based therapy should be readjusted.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	After screening, PT or INR and aPTT/PTT should be monitored as clinically indicated and more closely monitored in participants receiving anticoagulant therapy during treatment.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Screening performed within 10 days before the first study intervention. If performed within 3 days before the first study intervention, assessments do not have to be repeated at C1D1.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
					
FU:Q6W to W48, Then Q12W	Repeat 1 time	Cycle length: 42 days	FU	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	SSRE evaluation
(symptomatic skeletal-related event)
			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	Adverse Events

Collect AEs (including IRRs) and SAEs. Additional details are in Section 8.4.1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Subsequent anticancer therapy status.

Safety follow-up visit must take place before the start of new therapy. For clinically stable participants, communication with the Sponsor is required before starting first subsequent new anticancer therapy
			Nursing Orders
  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Survival status

Updated survival status may be requested by the Sponsor at any time during the course of the study.
			Labs
  	PROSTATE SPECIFIC ANTIGEN	Interval: --	Occurrences: --	Comments:	PSA by central laboratory.

Screening: Obtain within 10 days before randomization.
If PSA is collected within 10 days before randomization, an additional PSA is not required at randomization. If the central laboratory result is not available before randomization, the PSA test may also be performed locally to determine eligibility.
Randomization and during study: Any PSA to determine efficacy during the study cannot be performed locally in lieu of the central laboratory. Window for PSA collections is ±7 days. After discontinuation: PSA will be measured by a central laboratory at the same time points as imaging. See Section 8.2.1.3.
					
Survival FU(SurvFU)	Repeat 1 time	Cycle length: 1 day	Surv FU	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:   MK-2400-001-00_Efstathiou
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Dose Modifications and Management for Ifinatamab Deruxtecan Treatment: Refer to Section 6.6.1 Protocol  Access Hyperlink:  MK-2400-001-00_Efstathiou
			Nursing Orders
  	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Subsequent anticancer therapy status.

Safety follow-up visit must take place before the start of new therapy. For clinically stable participants, communication with the Sponsor is required before starting first subsequent new anticancer therapy
			Nursing Orders
  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Survival status

Updated survival status may be requested by the Sponsor at any time during the course of the study.