# Trastuzumab deruxtecan

Source: https://onco.cc/drugs/trastuzumab-deruxtecan/  
OnCo record `trastuzumab-deruxtecan` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.

## Summary

Approved in HER2+ metastatic breast cancer (DESTINY-Breast03: beat T-DM1), HER2-low (DESTINY-Breast04, 2022) and HER2-ultralow (DESTINY-Breast06, 2025) HR+ breast cancer, HER2+ gastric, HER2-mutant NSCLC, and tumour-agnostically for HER2 IHC 3+ solid tumours (2024). DESTINY-Breast09 (with pertuzumab) established it in first-line HER2+ metastatic disease. In Q2 2026 the FDA approved two early-stage HER2+ indications (neoadjuvant DESTINY-Breast11; post-neoadjuvant DESTINY-Breast05). Interstitial lung disease (~10-15%, ~1% fatal) requires monitoring. Membrane-permeable payload gives a strong bystander effect.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-04
- Brand: Enhertu
- Code: DS-8201, T-DXd
- Modality: ADC
- Mechanism: Trastuzumab backbone; DXd released by lysosomal cathepsins; TOP1 inhibition and bystander diffusion.
- Payload: DXd (exatecan derivative, TOP1 inhibitor), DAR ~8
- Linker: Tetrapeptide GGFG, protease-cleavable
- Approvals: US 2019: HER2+ metastatic breast cancer, ≥2 prior anti-HER2 regimens; US 2022: HER2-low metastatic breast cancer; HER2-mutant NSCLC; US 2024: HER2 IHC3+ solid tumours (tumour-agnostic); US 2025: HER2-low/ultralow HR+ breast cancer after endocrine therapy (DESTINY-Breast06); US 2026: Early-stage HER2+ breast cancer (neoadjuvant and post-neoadjuvant); EU 2023: Unresectable or metastatic HER2-low breast cancer after chemotherapy in the metastatic setting or recurrence within 6 months of adjuvant chemotherapy (DESTINY-Breast04), hormone-receptor-negative disease included; UK 2024: HER2-low metastatic or unresectable breast cancer after chemotherapy: NICE TA992 (29 July 2024) does not recommend trastuzumab deruxtecan, the cost per quality-adjusted life year being above the range NICE accepts; a rapid review (GID-TA12551) is in development; US 2024: Unresectable or metastatic HER2-positive (IHC 3+) solid tumours after previous systemic treatment, including colorectal cancer
- Dosing: IV infusion; 5.4 mg/kg every 3 weeks (breast, NSCLC, HER2 IHC3+ tumours); 6.4 mg/kg every 3 weeks (gastric)
- Toxicity (grade 3+): Nausea 7%; Fatigue 6%; Neutropenia 18%; Anaemia 7%

## Notes

- Triple-negative breast cancer: the HER2-low label (IHC 1+ or 2+/ISH-negative) rests on DESTINY-Breast04, where 63 of 557 patients were hormone receptor-negative (Modi 2022); about a third of TNBC is HER2-low (Schettini 2021, Denkert 2021). Ultralow TNBC (37.6% of untreated tumours; Boissiere-Michot 2026) is outside the label because DESTINY-Breast06 was hormone receptor-positive only.
- Triple-negative breast cancer: DESTINY-Breast04 enrolled 63 hormone-receptor-negative patients (11.3 percent) alongside 494 hormone-receptor-positive; in that exploratory cohort median progression-free survival was 8.5 versus 2.9 months (hazard ratio 0.46) and the long-term analysis reported that overall survival also favoured trastuzumab deruxtecan in hormone-receptor-negative disease. The FDA HER2-low indication after chemotherapy is not restricted by hormone receptor status; the HER2-ultralow indication (DESTINY-Breast06) is hormone-receptor-positive only, so an ultralow triple-negative tumour has no licensed route to the drug. In England the HER2-low indication is not commissioned (NICE TA992, not recommended), which is the largest access gap between the UK and the United States in this disease.
- Colorectal cancer biomarkers: the conjugate's colorectal trials selected on HER2 immunohistochemistry 3+ or 2+ with in situ hybridisation amplification under the colorectal-specific criteria; unlike in breast cancer there is no HER2-low colorectal indication, and the DESTINY-CRC02 dose comparison was run in the amplified population (Valtorta 2015).
- Biliary tract cancer: confirmed response rate 36.4% in 22 HER2-positive and 12.5% in 8 HER2-low patients in HERB, with interstitial lung disease in 25% including two deaths (Ohba 2024); 22.0% by investigator in the 41-patient DESTINY-PanTumor02 biliary cohort and 56.3% in centrally confirmed IHC 3+ tumours, with lung disease in 17.1% (Oh 2026). The tumour-agnostic IHC 3+ indication is the on-label route in gallbladder cancer.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Trastuzumab_deruxtecan
- FDA label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Trastuzumab%20deruxtecan
- NICE TA992: trastuzumab deruxtecan for HER2-low metastatic or unresectable breast cancer after chemotherapy, not recommended (29 July 2024): https://www.nice.org.uk/guidance/ta992
- DESTINY-Breast04 long-term survival analysis (Nature Medicine 2025): https://doi.org/10.1038/s41591-025-03981-4
- Enhertu label (openFDA): HER2-low and HER2-ultralow indications, DESTINY-Breast04 study section: https://api.fda.gov/drug/label.json?search=openfda.brand_name:%22ENHERTU%22
- FDA oncology approval notifications: https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancerhematologic-malignancies-approval-notifications

## Connected records

- biomarkers: [HER2 (ERBB2) activating mutation](https://onco.cc/biomarkers/her2-mutation/), [HER2 IHC 0 (HER2-negative, including ultralow)](https://onco.cc/biomarkers/her2-ihc-0/), [HER2 IHC 1+](https://onco.cc/biomarkers/her2-ihc-1-plus/), [HER2 IHC 2+ (equivocal, reflex to ISH)](https://onco.cc/biomarkers/her2-ihc-2-plus/), [HER2 IHC 3+ (HER2-positive by immunohistochemistry)](https://onco.cc/biomarkers/her2-ihc-3-plus/), [HER2 ISH amplified (ERBB2 gene amplification)](https://onco.cc/biomarkers/her2-ish-amplified/), [HER2-low (IHC 1+ or IHC 2+/ISH-negative)](https://onco.cc/biomarkers/her2-low-ihc/), [HER2-ultralow (IHC 0 with membrane staining)](https://onco.cc/biomarkers/her2-ultralow/)
- cancers: [Advanced and metastatic small bowel adenocarcinoma](https://onco.cc/cancers/advanced-small-bowel-adenocarcinoma/), [Advanced or recurrent endometrial cancer](https://onco.cc/cancers/advanced-recurrent-endometrial-cancer/), [Biliary tract cancer (all types)](https://onco.cc/cancers/biliary-tract-cancer/), [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Brain metastases (secondary brain tumours)](https://onco.cc/cancers/secondary-brain-tumours/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early HER2-positive breast cancer](https://onco.cc/cancers/her2-positive-early-breast-cancer/), [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Extrahepatic cholangiocarcinoma (perihilar and distal)](https://onco.cc/cancers/extrahepatic-cholangiocarcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [HER2-amplified colorectal cancer](https://onco.cc/cancers/her2-amplified-colorectal/), [HER2-low and HER2-ultralow metastatic breast cancer](https://onco.cc/cancers/her2-low-metastatic-breast-cancer/), [HER2-mutant non-small-cell lung cancer](https://onco.cc/cancers/her2-mutant-nsclc/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HER2-positive breast cancer with brain metastases](https://onco.cc/cancers/her2-positive-breast-brain-metastases/), [HER2-positive gastric cancer](https://onco.cc/cancers/gastric-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [HR-positive metastatic breast cancer after CDK4/6 inhibitors](https://onco.cc/cancers/hr-positive-metastatic-post-cdk46/), [Inflammatory breast cancer](https://onco.cc/cancers/inflammatory-breast-cancer/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Male breast cancer](https://onco.cc/cancers/male-breast-cancer/), [Metastatic cancer (cancer that has spread)](https://onco.cc/cancers/metastatic-cancer/), [Metastatic triple-negative breast cancer](https://onco.cc/cancers/tnbc-metastatic/), [Mucinous ovarian cancer](https://onco.cc/cancers/mucinous-ovarian-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Oesophageal and junctional adenocarcinoma](https://onco.cc/cancers/oesophageal-adenocarcinoma/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [p53-abnormal endometrial cancer, including uterine serous carcinoma](https://onco.cc/cancers/endometrial-p53-abnormal/), [Recurrent or metastatic cervical cancer](https://onco.cc/cancers/recurrent-metastatic-cervical-cancer/), [Salivary duct carcinoma](https://onco.cc/cancers/salivary-duct-carcinoma/), [Salivary gland cancers](https://onco.cc/cancers/salivary-gland/), [Small intestine cancer (small bowel adenocarcinoma)](https://onco.cc/cancers/small-bowel/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Uterine carcinosarcoma](https://onco.cc/cancers/uterine-carcinosarcoma/)
- technologies: [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [FES PET (oestrogen receptor imaging)](https://onco.cc/technologies/fes-pet/), [The ADC supply chain (antibody, payload-linker, conjugation, fill)](https://onco.cc/technologies/adc-supply-chain/), [Topoisomerase-I inhibitors (and ADC payloads)](https://onco.cc/technologies/topoisomerase-inhibitors/), [Troponin and natriuretic peptide monitoring during cancer treatment](https://onco.cc/technologies/cardiac-biomarker-monitoring/)
- targets: [HER2](https://onco.cc/targets/her2/), [Topoisomerase I (TOP1)](https://onco.cc/targets/top1/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/), [Daiichi Sankyo](https://onco.cc/companies/daiichi-sankyo/), [GI Innovation](https://onco.cc/companies/gi-innovation/)
- terms: [Amplification](https://onco.cc/terms/amplification/), [Bystander effect (ADC)](https://onco.cc/terms/bystander-effect/), [CNS penetration (brain-penetrant drugs)](https://onco.cc/terms/cns-penetration/), [DXd](https://onco.cc/terms/dxd/), [HER2 testing in biliary tract cancer (IHC, ISH and NGS)](https://onco.cc/terms/her2-testing-in-biliary-cancer/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/), [HER2-low eligibility for trastuzumab deruxtecan, and TROP2 ADCs without a test (triple-negative disease)](https://onco.cc/terms/her2-low-and-trop2-adc-eligibility-tnbc/), [HER2-positive (IHC 3+ or ISH-amplified)](https://onco.cc/terms/her2-positive/), [HER2-positive brain metastases](https://onco.cc/terms/her2-brain-metastases/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/), [Living with an antibody-drug conjugate: diarrhoea, blood counts, eyes and lungs](https://onco.cc/terms/adc-side-effects-breast/), [Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life](https://onco.cc/terms/tnbc-symptom-control-palliation/), [Tetrapeptide GGFG (maleimide-GGFG-aminomethyl)](https://onco.cc/terms/ggfg/), [Topoisomerase-I inhibitor payloads](https://onco.cc/terms/topoisomerase-i-payloads/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/)
- trials: [A Clinical Study of Patritumab Deruxtecan to Treat Breast Cancer (MK-1022-016)](https://onco.cc/trials/nct07060807/), [A Phase 1b/2 Study of T-DXd Combinations in HER2-positive Metastatic Breast Cancer](https://onco.cc/trials/nct04538742/), [A Phase II Study of HLX22 in Combination With Trastuzumab Deruxtecan in HER2-low, Hormone Receptor Positive Locally Advanced or Metastatic Breast Cancer Patients](https://onco.cc/trials/nct06832202/), [A Phase Ⅲ Study of Rilvegostomig in Combination With Fluoropyrimidine and Trastuzumab Deruxtecan as the First-line Treatment for HER2-positive Gastric Cancer](https://onco.cc/trials/nct06764875/), [A Single Arm Phase 2 Study to Evaluate Efficacy and Safety of Trastuzumab Deruxtecan for Patients With HER2 Mutant NSCLC](https://onco.cc/trials/nct05246514/), [A Study of Novel Agents or Combinations as Perioperative Treatment in Participants With Locally Advanced Resectable Gastroesophageal Adenocarcinoma](https://onco.cc/trials/nct07069712/), [A Study of Novel Anti-cancer Agents in Patients With Metastatic Triple Negative Breast Cancer](https://onco.cc/trials/nct03742102/), [A Study of T-DXd as Monotherapy or in Combination With Anti-cancer Agents in Patients With Selected HER2-expressing Tumors](https://onco.cc/trials/nct06271837/), [A Study of T-DXd for the Treatment of Solid Tumors Harboring HER2 Activating Mutations](https://onco.cc/trials/nct04639219/), [A Study of Trastuzumab Deruxtecan in People With Non-Small Cell Lung Cancer](https://onco.cc/trials/nct07428044/), [A Study to Evaluate the Safety and Therapeutic Activity of GI-102 As a Single Agent and in Combination with Conventional Anti-cancer Drugs, Pembrolizu](https://onco.cc/trials/nct05824975/), [A Study to Investigate the Efficacy and Safety of Trastuzumab Deruxtecan as the First Treatment Option for Unresectable, Locally Advanced/Metastatic N](https://onco.cc/trials/nct05048797/), [A Study to Provide Continued Access to and Assess Long-Term Safety of the Study Drug(s)](https://onco.cc/trials/nct06174987/), [A Trial of Trastuzumab Rezetecan in Unresectable Locally Recurrent/Metastatic Breast Cancer](https://onco.cc/trials/nct07497386/), [Beamion BCGC-1: A Study to Find a Suitable Dose of Zongertinib Used Alone and in Combination With Other Treatments to Test Whether it Helps People Wit](https://onco.cc/trials/nct06324357/), [Beamion LUNG-1](https://onco.cc/trials/beamion-lung-1/), [DESTINY-Breast03](https://onco.cc/trials/destiny-breast03/), [DESTINY-Breast04](https://onco.cc/trials/destiny-breast04/), [DESTINY-Breast05](https://onco.cc/trials/destiny-breast05/), [DESTINY-Breast06](https://onco.cc/trials/destiny-breast06/), [DESTINY-Breast09](https://onco.cc/trials/destiny-breast09/), [DESTINY-Breast11](https://onco.cc/trials/destiny-breast11/), [DESTINY-Breast12](https://onco.cc/trials/destiny-breast12/), [DESTINY-CRC01](https://onco.cc/trials/destiny-crc01/), [DESTINY-CRC02](https://onco.cc/trials/destiny-crc02/), [DESTINY-Endometrial01: A Phase III Study of Trastuzumab Deruxtecan Plus Rilvegostomig or Pembrolizumab as First-Line Treatment of HER2-Expressing (IHC](https://onco.cc/trials/nct06989112/), [DESTINY-Gastric01](https://onco.cc/trials/destiny-gastric01/), [DESTINY-Gastric02](https://onco.cc/trials/destiny-gastric02/), [DESTINY-Gastric04](https://onco.cc/trials/destiny-gastric04/), [DESTINY-Lung01](https://onco.cc/trials/destiny-lung01/), [DESTINY-Lung02](https://onco.cc/trials/destiny-lung02/), [DESTINY-PanTumor02](https://onco.cc/trials/destiny-pantumor02/), [EIS-12656 as Single Agent and in Combination in Patients With Specified Solid Tumors](https://onco.cc/trials/nct06525298/), [Ph1b/2 Study of the Safety and Efficacy of T-DXd Combinations in Advanced HER2-expressing Gastric Cancer (DESTINY-Gastric03)](https://onco.cc/trials/nct04379596/), [Phase 3 Study of T-DXd and Rilvegostomig Versus SoC in Advanced HER2-expressing Biliary Tract Cancer](https://onco.cc/trials/nct06467357/), [Phase II Umbrella Study of Novel Anti-cancer Agents in Participants With NSCLC Who Progressed on an Anti-PD-1/PD-L1 Containing Therapy](https://onco.cc/trials/nct03334617/), [Pre-operative Targeted Treatments in Molecularly Selected Resectable Colorectal Cancer (UNICORN)](https://onco.cc/trials/nct05845450/), [Protein-Matched ADC or PDC Umbrella Trial in Advanced Pancreatic and Breast Cancer](https://onco.cc/trials/nct07825753/), [Scalp Cooling in MBC](https://onco.cc/trials/nct04986579/), [Study of AZD5305 as Monotherapy and in Combination With Anti-cancer Agents in Patients With Advanced Solid Malignancies](https://onco.cc/trials/nct04644068/), [Study of AZD9574 as Monotherapy and in Combination With Anti-cancer Agents in Participants With Advanced Solid Malignancies](https://onco.cc/trials/nct05417594/), [Study of TDXd, Chemotherapy, Pembrolizumab, and Trastuzumab in First-Line Metastatic HER2-Positive Gastric or Gastroesophageal Junction Cancer](https://onco.cc/trials/nct06731478/), [Study of Trastuzumab Deruxtecan Versus Standard of Care Chemotherapy for HER2-Expressing (IHC 3+/2+) Endometrial Cancer](https://onco.cc/trials/nct07022483/), [Study of Trastuzumab Deruxtecan With Bevacizumab Versus Bevacizumab Monotherapy for First-line Maintenance in HER2-Expressing Ovarian Cancer (DESTINY-](https://onco.cc/trials/nct06819007/), [Study of Trastuzumab Deruxtecan, Pembrolizumab, and Platinum-based Chemotherapy in First-line HER2 Overexpressing Non-small Cell Lung Cancer](https://onco.cc/trials/nct06899126/), [Testing the Combination of Anti-Cancer Drugs, Selumetinib and DS-8201a (Trastuzumab Deruxtecan), for Advanced Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct07619521/), [Testing Two Different Drugs (Sacituzumab-govitecan and Trastuzumab-deruxtecan) Combinations Prescribed in an Alterning Pattern to Patients With Metastatic or Lo](https://onco.cc/trials/nct07151586/), [Trastuzumab Deruxtecan (T-DXd) in Patients Who Have Hormone Receptor-negative and Hormone Receptor-positive HER2-low or HER2 IHC 0 Metastatic Breast Cancer](https://onco.cc/trials/nct05950945/), [TUXEDO-1](https://onco.cc/trials/tuxedo-1/), [Upfront Trastuzumab-Deruxtecan Plus Capecitabine and Bevacizumab for Patients With HER-2 Positive Metastatic Colorectal Cancer.](https://onco.cc/trials/nct07407465/)
- key papers: [Assessment of a HER2 scoring system for colorectal cancer: results from a validation study](https://onco.cc/key-papers/paper-valtorta-her2-scoring-colorectal-heracles-mod-pathol-2015/), [Clinical and genomic characterization of ERBB2-altered gallbladder cancer: exploring differences between an American and a Chilean cohort](https://onco.cc/key-papers/paper-mondaca-erbb2-gallbladder-us-chile-jco-go-2024/), [Clinical, pathological, and PAM50 gene expression features of HER2-low breast cancer](https://onco.cc/key-papers/paper-schettini-her2-low-features-npj-breast-cancer-2021/), [DESTINY-Breast03: trastuzumab deruxtecan beats T-DM1 as second-line treatment of HER2-positive metastatic breast cancer](https://onco.cc/key-papers/paper-destiny-breast03-nejm-2022/), [DESTINY-Breast04: trastuzumab deruxtecan works in HER2-low breast cancer, creating a new treatable group](https://onco.cc/key-papers/paper-destiny-breast04-nejm-2022/), [DESTINY-Breast06: trastuzumab deruxtecan before any chemotherapy in hormone-receptor-positive, HER2-low or ultralow breast cancer](https://onco.cc/key-papers/paper-destiny-breast06-nejm-2024/), [DESTINY-Gastric01: trastuzumab deruxtecan in previously treated HER2-positive gastric cancer](https://onco.cc/key-papers/paper-destiny-gastric01-nejm-2020/), [DESTINY-Lung01: trastuzumab deruxtecan in HER2-mutant non-small-cell lung cancer](https://onco.cc/key-papers/paper-destiny-lung01-nejm-2022/), [DESTINY-Lung02: two doses of trastuzumab deruxtecan in HER2-mutant metastatic non-small-cell lung cancer](https://onco.cc/key-papers/paper-destiny-lung02-goto-jco-2023/), [DESTINY-PanTumor02: trastuzumab deruxtecan in HER2-expressing solid tumours](https://onco.cc/key-papers/paper-destiny-pantumor02-jco-2024/), [Efficacy and safety of trastuzumab deruxtecan in patients with HER2-expressing biliary tract or pancreatic tumors: a subgroup analysis of DESTINY-PanTumor02](https://onco.cc/key-papers/paper-oh-destiny-pantumor02-biliary-pancreatic-esmo-open-2026/), [Exploring the spectrum of HER2 in non-metastatic triple negative breast cancer: from HER2-null to HER2-low, including HER2-ultralow status](https://onco.cc/key-papers/paper-boissiere-michot-her2-ultralow-tnbc-virchows-arch-2026/), [Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01)](https://onco.cc/key-papers/paper-siena-destiny-crc01-trastuzumab-deruxtecan-lancet-oncol-2021/), [Trastuzumab deruxtecan in human epidermal growth factor receptor 2-expressing biliary tract cancer (HERB; NCCH1805): a multicenter, single-arm, phase II trial](https://onco.cc/key-papers/paper-ohba-herb-trastuzumab-deruxtecan-biliary-jco-2024/), [TUXEDO-1: trastuzumab deruxtecan in HER2-positive breast cancer with active brain metastases](https://onco.cc/key-papers/paper-tuxedo-1-trastuzumab-deruxtecan-brain-metastases-nat-med-2022/)
- drugs: [HER2 IHC and ISH companion assays (HercepTest, PATHWAY 4B5, HER2 Dual ISH)](https://onco.cc/drugs/her2-testing-assays/), [Poziotinib](https://onco.cc/drugs/poziotinib/), [Sevabertinib](https://onco.cc/drugs/sevabertinib/), [Trastuzumab duocarmazine](https://onco.cc/drugs/trastuzumab-duocarmazine/), [Zanidatamab zovodotin](https://onco.cc/drugs/zanidatamab-zovodotin/)
- ideas: [A randomised trial of antibody-drug conjugate sequence in metastatic triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-adc-sequencing-trial/), [AI quantification of HER2-low and HER2-ultralow](https://onco.cc/ideas/idea-ai-her2-low-scoring/), [Antibody-drug conjugates for mesothelioma: why they have failed so far and how they could work](https://onco.cc/ideas/idea-adc-for-mesothelioma/), [Brain metastases included by default in every solid-tumour trial](https://onco.cc/ideas/idea-tr1-brain-mets-default-included/), [Calibrated reference slides so every lab scores HER2-low the same way](https://onco.cc/ideas/idea-tr2-her2-low-reference-materials/), [Can T-DXd alone cure early HER2-positive disease?](https://onco.cc/ideas/idea-tdxd-first-then-nothing/), [Continuous-flow synthesis of ultra-potent ADC payloads to ease the capacity squeeze](https://onco.cc/ideas/idea-reg-hpapi-continuous-flow/), [Dose and schedule optimisation trials specific to antibody-drug conjugates](https://onco.cc/ideas/idea-tr1-adc-dose-and-schedule-optimisation/), [HER2 ADCs as standard for HER2-positive serous endometrial cancer](https://onco.cc/ideas/idea-her2-adc-serous-endometrial/), [Randomised trials to test whether biomarker-negative patients really do not benefit](https://onco.cc/ideas/idea-tr2-biomarker-negative-arms/), [Reduce the dose once the cancer responds: response-adapted de-escalation trials](https://onco.cc/ideas/idea-tr1-response-adapted-dose-reduction/), [Reflex HER2 testing of every advanced gallbladder and extrahepatic biliary cancer](https://onco.cc/ideas/idea-gbc-reflex-her2-testing-advanced-biliary/), [Reflex re-scoring of HER2 0 versus 1+ with digital assistance so every eligible triple-negative patient reaches trastuzumab deruxtecan](https://onco.cc/ideas/idea-tnbc-her2-ultralow-testing-uptake/), [Sequencing HER2 ADCs by payload after T-DXd](https://onco.cc/ideas/idea-her2-adc-sequencing-payload/), [Sequential multiple-assignment randomised trials to find the best order of ADCs](https://onco.cc/ideas/idea-tr2-smart-sequencing-adc/), [Systemic-first management of HER2-positive brain metastases](https://onco.cc/ideas/idea-cns-first-adc-strategy/), [Test flat versus weight-based dosing of antibodies, and use dose banding to cut waste](https://onco.cc/ideas/idea-tr1-weight-based-vs-flat-dosing-trials/), [Trials that include, and report, brain metastases in triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-brain-metastasis-trials/), [Tumour-on-a-chip with blood flow to test whether big drugs actually get in](https://onco.cc/ideas/idea-bio1-tumour-on-chip-penetration/), [Use the brain's own transport door to carry antibody drugs across](https://onco.cc/ideas/idea-bio2-transferrin-shuttle-adc/)
- pairings: [Caution: DXd ADC + agents with pneumonitis risk](https://onco.cc/pairings/ild-overlap-caution/), [Caution: TOP1 ADC immediately after TOP1 ADC](https://onco.cc/pairings/adc-after-adc-caution/), [HER2 sequence in gastric cancer: zanidatamab/trastuzumab + chemo ± PD-1 → T-DXd](https://onco.cc/pairings/her2-gastric-sequence/), [HER2-low scoring → T-DXd](https://onco.cc/pairings/her2-low-to-tdxd/)
- roadmaps: [ADC roadmap: from Mylotarg to bispecific and dual-payload ADCs](https://onco.cc/roadmaps/adc-generations/), [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/), [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- institutions: [Gustave Roussy](https://onco.cc/institutions/gustave-roussy/), [National Cancer Center Hospital](https://onco.cc/institutions/ncc-japan/), [National Cancer Center Hospital East](https://onco.cc/institutions/ncc-hospital-east/), [Pharmaceuticals and Medical Devices Agency](https://onco.cc/institutions/pmda/)
- people: [Bob T. Li](https://onco.cc/people/bob-li/), [Cristina Saura](https://onco.cc/people/cristina-saura/), [Domenica Lorusso](https://onco.cc/people/domenica-lorusso/), [Funda Meric-Bernstam](https://onco.cc/people/funda-meric-bernstam/), [Giuseppe Curigliano](https://onco.cc/people/giuseppe-curigliano/), [Ian E. Krop](https://onco.cc/people/ian-krop/), [Javier Cortés](https://onco.cc/people/javier-cortes/), [Joohyuk Sohn](https://onco.cc/people/sohn-joohyuk/), [Kan Yonemori](https://onco.cc/people/yonemori-kan/), [Kohei Shitara](https://onco.cc/people/shitara-kohei/), [Koichi Goto](https://onco.cc/people/goto-koichi/), [Noboru Yamamoto](https://onco.cc/people/yamamoto-noboru/), [Sara A. Hurvitz](https://onco.cc/people/sara-hurvitz/), [Sara M. Tolaney](https://onco.cc/people/sara-tolaney/), [Shanu Modi](https://onco.cc/people/shanu-modi/), [Sung-Bae Kim](https://onco.cc/people/kim-sung-bae/), [Toshihiko Doi](https://onco.cc/people/doi-toshihiko/), [Yeon Hee Park](https://onco.cc/people/park-yeon-hee/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- pathways: [Breast cancer (KEGG map)](https://onco.cc/pathways/breast-cancer-signalling/), [Colorectal cancer (KEGG map)](https://onco.cc/pathways/colorectal-cancer-signalling/), [DNA replication & origin licensing](https://onco.cc/pathways/dna-replication-licensing/), [Drug efflux pumps (ABC transporters)](https://onco.cc/pathways/drug-efflux-pumps/), [Endometrial cancer (KEGG map)](https://onco.cc/pathways/endometrial-cancer-signalling/), [Gastric cancer (KEGG map)](https://onco.cc/pathways/gastric-cancer-signalling/), [Non-small cell lung cancer (KEGG map)](https://onco.cc/pathways/nsclc-signalling/), [Receptor tyrosine kinase activation](https://onco.cc/pathways/rtk-activation/), [The blood-brain barrier & brain metastasis](https://onco.cc/pathways/blood-brain-barrier-metastasis/)

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JSON: https://onco.cc/api/v1/entities/trastuzumab-deruxtecan.json