Fam-trastuzumab deruxtecan-NXKI

After teasing in April that Enhertu (trastuzumab deruxtecan) met the primary progression-free survival (PFS) endpoint in a late-stage study of patients with HER2-positive breast cancer, AstraZeneca and Daiichi Sankyo have now shared detailed data supporting front-line use of the HER2-directed antibody-drug conjugate (ADC).Enhertu is currently approved as a second-line treatment for unresectable or metastatic HR-positive, HER2-low or HER2-ultralow breast cancer.The Phase III DESTINY-Breast09 study results, presented at the American Society of Clinical Oncology (ASCO) annual meeting on Monday, found that first-line Enhertu given in combination with Roche’s Perjeta (pertuzumab) reduced the risk of disease progression or death by 44% compared with the standard-of-care regimen of a taxane, Herceptin (trastuzumab) and Perjeta, also known as THP. The trial randomised 1157 treatment-naïve patients with HER2-positive locally advanced or metastatic breast cancer to receive either Enhertu plus Perjeta, the THP regimen, or Enhertu alone with placebo. The monotherapy arm will remain blinded until the final PFS analysis, but AstraZeneca and Daiichi reported that the Enhertu-Perjeta combo cohort achieved statistically significant PFS versus the comparator.After a median follow-up of 29 months, patients receiving the doublet therapy saw a median PFS of 40.7 months, compared with 26.9 months for those on THP. The median duration of response was 39 months for the Enhertu-plus-Perjeta arm, with 15.1% of patients achieving a complete response (CR) — nearly double the 8.5% CR rate seen in the standard-of-care group. While data on overall survival are still immature, lead study author Sara Tolaney said there is a positive trend favouring the Enhertu and Perjeta combo, with a hazard ratio of 0.84.The results have "the potential to establish a new first-line standard of care for metastatic HER2-positive breast cancer, a setting which hasn’t seen significant innovation in more than a decade," Tolaney said. Both the Enhertu-Perjeta combo arm and THP group had similar rates of serious adverse events, though nausea, vomiting and constipation were more common in patients who received the ADC. Additionally, interstitial lung disease occurred in about 12% of patients taking Enhertu, though most cases were not severe.  Rebecca Dent, the deputy clinical CEO at National Cancer Center Singapore and an ASCO expert in breast cancer, called the first-line results "impressive" during a media briefing."The best way to provide a greater chance of cure is to incorporate [Enhertu] into the curative setting," she said. "We're really excited to look at future data, looking at this in the earlier treatment of HER2-positive breast cancer."Enhertu also made a splash in gastric cancer at ASCO, posting practice-confirming results from the Phase III DESTINY-Gastric04 study that could cement the ADC's position as a second-line treatment of choice (see – Vital Signs: Top targets at ASCO 2025).

Positive results from the DESTINY-Breast09 Phase III trial showed Enhertu (trastuzumab deruxtecan) plus pertuzumab demonstrated a highly statistically significant and clinically meaningful improvement in progression-free survival (PFS) compared to a taxane, trastuzumab and pertuzumab (THP) as a 1st-line treatment for patients with HER2-positive metastatic breast cancer. Results will be presented today during a special late-breaking oral session at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, IL (abstract #LBA1008). In a prespecified interim analysis, Enhertu plus pertuzumab reduced the risk of disease progression or death by 44% versus THP (based on a hazard ratio [HR] of 0.56; 95% confidence interval [CI] 0.44-0.71; p<0.00001). Median PFS was 40.7 months with Enhertu plus pertuzumab compared to 26.9 months for THP, as assessed by blinded independent central review (BICR). The PFS benefit for Enhertu plus pertuzumab versus THP was consistent across subgroups, including for the prespecified stratification factors of de novo or recurrent disease, hormone receptor status and PIK3CA mutation status. Investigator-assessed PFS demonstrated a median PFS of 40.7 months for Enhertu plus pertuzumab compared to 20.7 months for THP (HR 0.49; 95% CI 0.39-0.61; nominal p-value <0.00001). Confirmed objective response rate (ORR) with Enhertu plus pertuzumab was 85.1% versus 78.6% with THP. There were 58 complete responses (CRs) with Enhertu plus pertuzumab compared to 33 with THP. Median duration of response (DOR) for Enhertu plus pertuzumab exceeded three years (39.2 months) versus 26.4 months with THP. Overall survival (OS) was not mature at the time of the interim analysis (16% maturity at data cut-off); however, interim OS data showed an early trend favouring the Enhertu combination compared to THP (HR 0.84; 95% CI 0.59-1.19). Sara Tolaney, MD, MPH, Chief of the Division of Breast Oncology, Dana-Farber Cancer Institute and principal investigator in the trial, said: “Patients with HER2-positive metastatic breast cancer often experience disease progression around two years after initiating standard-of-care first-line treatment. With a median progression-free survival of more than three years, the DESTINY-Breast09 results show trastuzumab deruxtecan combined with pertuzumab has the potential to become a new first-line standard of care for these patients.” Susan Galbraith, Executive Vice President, Oncology Haematology R&D, AstraZeneca, said: “Bringing Enhertu earlier in the treatment of HER2-positive metastatic breast cancer may represent an important advancement for patients. The DESTINY-Breast09 trial showed the combination of Enhertu and pertuzumab in the first-line setting substantially increased the amount of time before a patient’s cancer progressed compared to standard of care and nearly doubled the number of patients showing no signs of disease on imaging. Establishing a strong therapeutic response as soon as metastatic disease is diagnosed is critical given that about one in three patients do not receive further treatment after progressing in the first-line setting.” Ken Takeshita, Global Head, R&D, Daiichi Sankyo, said: “Enhertu continues to transform the treatment of metastatic breast cancer with the first new data in more than a decade to demonstrate improved outcomes for a broad population of patients with HER2-positive disease compared to THP in the first-line setting. DESTINY-Breast09 shows that initiating treatment with Enhertu in combination with pertuzumab at the time of metastatic diagnosis can delay disease progression.” Summary of DESTINY-Breast09 interim analysis results Efficacy Measure Enhertu (5.4 mg/kg) + pertuzumab (n=383) THP (n=387) PFS by BICRi Median PFS (months) (95% CI) 40.7 (36.5-NC) 26.9 (21.8-NC) Hazard ratio (95% CI) HR 0.56 (0.44-0.71) p-value p<0.00001ii 24-month PFS rate (%) (95% CI) 70.1 (64.8-74.8) 52.1 (46.4-57.5) PFS by investigator Median PFS (months) (95% CI) 40.7 (36.5-NC) 20.7 (17.3-23.5) Hazard ratio (95% CI) HR 0.49 (0.39-0.61) Nominal p-value p<0.00001ii PFS2 by investigatoriii Median PFS2 (months) (95% CI) NC (NC-NC) 36.5 (36.1-NC) Hazard ratio (95% CI) HR 0.60 (0.45-0.79) Nominal p-value 0.00038ii ORR by BICR iv Confirmed ORR(%) (95% CI)v 85.1 (81.2-88.5) 78.6 (74.1-82.5) CR % (n) 15.1 (58) 8.5 (33) PR % (n) 70 (268) 70 (271) SD % (n) 9.9 (38) 14.5 (56) Median DOR in months (95% CI) 39.2 (35.1-NC) 26.4 (22.3-NC) Remaining in response at 24 months (%)​ 73.3​ 54.9​ THP, taxane, trastuzumab and pertuzumab; PFS, progression-free survival; BICR, blinded independent central review, CI, confidence interval; NC, not calculable; HR, hazard ratio; ORR, objective response rate; CR, complete response; PR, partial response, SD, stable disease; DOR, duration of response i. Interim analysis was based on a data cut-off of 26 Feb 2025; interim analysis criterion for superiority for primary endpoint (P-value <0.00043); ~38% maturity at data cut-off ii. Stratified log-rank test iii. PFS2 was defined by investigators according to local standard clinical practice as the time from randomisation to second progression (earliest progression event following first subsequent therapy) or death iv. ORR is (CR + PR) based on RECIST v1.1 v. Response required confirmation after 4 weeks Median duration of follow-up was nearly 2.5 years (29.2 months). As of the data cut-off, 302 (39.6%) patients remained on treatment, 174 in the Enhertu plus pertuzumab arm and 128 in the THP arm. The safety profile of Enhertu in combination with pertuzumab in DESTINY-Breast09 was consistent with the known profiles of each individual therapy with no new safety concerns identified. Interstitial lung disease (ILD)/pneumonitis occurred in 12.1% of patients treated with Enhertu in combination with pertuzumab, as determined by an independent adjudication committee. The majority of ILD events were low Grade (Grade 1 [n=17; 4.5%] or Grade 2 [n=27; 7.1%]). There were no Grade 3 or Grade 4 ILD events. There were two Grade 5 (0.5%) ILD events in the Enhertu plus pertuzumab arm. An additional investigational arm of the trial assessing Enhertu monotherapy versus THP remains blinded to patients and investigators and will continue to the final PFS analysis. Enhertu is a specifically engineered HER2-directed DXd antibody drug conjugate (ADC) discovered by Daiichi Sankyo and being jointly developed and commercialised by Daiichi Sankyo and AstraZeneca. Enhertu is already approved in more than 80 countries as 2nd-line treatment for patients with HER2-positive breast cancer based on the results from the DESTINY-Breast03 trial. Notes HER2-positive metastatic breast cancer Breast cancer is the second most common cancer and one of the leading causes of cancer-related deaths worldwide.1 More than two million breast cancer cases were diagnosed in 2022, with more than 665,000 deaths globally.1 While survival rates are high for those diagnosed with early breast cancer, only about 30% of patients diagnosed with or who progress to metastatic disease are expected to live five years following diagnosis.2 HER2 is a tyrosine kinase receptor growth-promoting protein expressed on the surface of many types of tumours including breast cancer.3 HER2 protein overexpression may occur as a result of HER2 gene amplification.4 HER2-positive metastatic breast cancer is an aggressive disease driven by overexpression or amplification of HER2 that affects 15% to 20% of patients with metastatic breast cancer.5,6 Approximately 23,000 patientsare treated each year in the 1st-line HER2-positive setting across G7 countries alone.7 While HER2-targeted therapies have improved outcomes, prognosis remains poor with most patients experiencing disease progression within two years of 1st-line treatment with THP, which has been the standard of care for more than a decade.4,8-10 Further, approximately one in three patients do not go on to receive treatment following 1st-line therapy due to disease progression or death.11,12 DESTINY-Breast09 DESTINY-Breast09 is a global, multicentre, randomised, open-label, Phase III trial evaluating the efficacy and safety of Enhertu (5.4 mg/kg) either alone or in combination with pertuzumab versus standard of care THP (a taxane [docetaxel or paclitaxel], trastuzumab and pertuzumab) as a 1st-line treatment in patients with HER2-positive metastatic breast cancer. Patients were randomised 1:1:1 to receive either Enhertu monotherapy with a pertuzumab matching placebo; Enhertu in combination with pertuzumab; or THP. Randomisation was stratified by prior treatment (de novo metastatic disease versus progression from early-stage disease), hormone receptor status and PIK3CA mutation status. The primary endpoint of DESTINY-Breast09 is PFS as assessed by BICR in both the Enhertu monotherapy and Enhertu combination arms. Secondary endpoints include OS, ORR, DOR, investigator-assessed PFS and PFS2 and safety. DESTINY-Breast09 enrolled 1,157 patients across multiple sites in Africa, Asia, Europe, North America and South America. For more information about the trial, visit ClinicalTrials.gov. Enhertu Enhertu is a HER2-directed ADC. Designed using Daiichi Sankyo’s proprietary DXd ADC Technology, Enhertu is the lead ADC in the oncology portfolio of Daiichi Sankyo and the most advanced programme in AstraZeneca’s ADC scientific platform. Enhertu consists of a HER2 monoclonal antibody attached to a number of topoisomerase I inhibitor payloads (an exatecan derivative, DXd) via tetrapeptide-based cleavable linkers. Enhertu (5.4mg/kg) is approved in more than 80 countries worldwide for the treatment of adult patients with unresectable or metastatic HER2-positive (immunohistochemistry [IHC 3+ or in-situ hybridisation [ISH]+) breast cancer who have received a (or one or more) prior anti-HER2-based regimen, either in the metastatic setting or in the neoadjuvant or adjuvant setting, and have developed disease recurrence during or within six months of completing therapy based on the results from the DESTINY-Breast03 trial. Enhertu (5.4mg/kg) is approved in more than 80 countries worldwide for the treatment of adult patients with unresectable or metastatic HER2-low (IHC 1+ or IHC 2+/ ISH-) breast cancer who have received a prior systemic therapy in the metastatic setting or developed disease recurrence during or within six months of completing adjuvant chemotherapy based on the results from the DESTINY-Breast04 trial. Enhertu (5.4mg/kg) is approved in more than 30 countries for the treatment of adult patients with unresectable or metastatic hormone receptor (HR)-positive, HER2-low (IHC 1+ or IHC 2+/ISH-) or HER2-ultralow (IHC 0 with membrane staining) breast cancer, as determined by a locally or regionally approved test, that have progressed on one or more endocrine therapies in the metastatic setting based on the results from the DESTINY-Breast06 trial. Enhertu (5.4mg/kg) is approved in more than 60 countries worldwide for the treatment of adult patients with unresectable or metastatic non-small cell lung cancer (NSCLC) whose tumours have activating HER2 (ERBB2) mutations, as detected by a locally or regionally approved test, and who have received a prior systemic therapy based on the results from the DESTINY-Lung02 and/or DESTINY-Lung05 trials. Continued approval in China and the US for this indication is contingent upon verification and description of clinical benefit in a confirmatory trial. Enhertu (6.4mg/kg) is approved in more than 70 countries worldwide for the treatment of adult patients with locally advanced or metastatic HER2-positive (IHC 3+ or 2+/ISH+) gastric or gastroesophageal junction (GEJ) adenocarcinoma who have received a prior trastuzumab-based regimen based on the results from the DESTINY-Gastric01, DESTINY-Gastric02 and/or DESTINY-Gastric06 trials. Continued approval in China for this indication will depend on whether a randomised controlled confirmatory clinical trial can demonstrate clinical benefit in this population. Enhertu (5.4mg/kg) is approved in the US and other countries for the treatment of adult patients with unresectable or metastatic HER2-positive (IHC 3+) solid tumours who have received prior systemic treatment and have no satisfactory alternative treatment options based on the results from the DESTINY-PanTumor02, DESTINY-Lung01 and DESTINY-CRC02 trials. Continued approval for this indication in the US is contingent upon verification and description of clinical benefit in a confirmatory trial. Enhertu clinical development programme A comprehensive global clinical development programme is underway evaluating the efficacy and safety of Enhertu as monotherapy, in combination or sequentially with other anti-cancer therapies across multiple HER2-targetable cancers. Daiichi Sankyo collaboration AstraZeneca and Daiichi Sankyo entered into a global collaboration to jointly develop and commercialise Enhertu in March 2019 and Datroway (datopotamab deruxtecan) in July 2020, except in Japan where Daiichi Sankyo maintains exclusive rights for each ADC. Daiichi Sankyo is responsible for the manufacturing and supply of Enhertu and Datroway. AstraZeneca in breast cancer Driven by a growing understanding of breast cancer biology, AstraZeneca is challenging, and redefining, the current clinical paradigm for how breast cancer is classified and treated to deliver even more effective treatments to patients in need – with the bold ambition to one day eliminate breast cancer as a cause of death. AstraZeneca has a comprehensive portfolio of approved and promising compounds in development that leverage different mechanisms of action to address the biologically diverse breast cancer tumour environment. With Enhertu, AstraZeneca and Daiichi Sankyo are aiming to improve outcomes in previously treated HER2-positive, HER2-low and HER2-ultralow metastatic breast cancer, and are exploring its potential in earlier lines of treatment and in new breast cancer settings. In HR-positive breast cancer, AstraZeneca continues to improve outcomes with foundational medicines Faslodex (fulvestrant) and Zoladex (goserelin) and aims to reshape the HR-positive space with first-in-class AKT inhibitor, Truqap (capivasertib), the TROP-2-directed ADC, Datroway (datopotamab deruxtecan) and next-generation oral SERD and potential new medicine camizestrant. PARP inhibitor Lynparza (olaparib) is a targeted treatment option that has been studied in early and metastatic breast cancer patients with an inherited BRCA mutation. AstraZeneca with MSD (Merck & Co., Inc. in the US and Canada) continue to research Lynparza in these settings and to explore its potential in earlier disease. AstraZeneca is also exploring the potential of saruparib, a potent and selective inhibitor of PARP1, in combination with camizestrant in BRCA-mutated, HR-positive, HER2-negative advanced breast cancer. To bring much-needed treatment options to patients with triple-negative breast cancer, an aggressive form of breast cancer, AstraZeneca is collaborating with Daiichi Sankyo to evaluate the potential of Datroway alone and in combination with immunotherapy Imfinzi (durvalumab). AstraZeneca in oncology AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients. The Company's focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyse changes in the practice of medicine and transform the patient experience. AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death. AstraZeneca AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialisation of prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca’s innovative medicines are sold in more than 125 countries and used by millions of patients worldwide. Please visit astrazeneca.com and follow the Company on social media @AstraZeneca. Contacts For details on how to contact the Investor Relations Team, please click here. For Media contacts, click here. 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AstraZeneca. Investor Relations: Epidemiology. Available at: https://www.astrazeneca.com/content/dam/az/Investor_Relations/Epidemiology-data-2024.xlsx. Accessed May 2025. 8. Swain SM, et al. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA): end-of-study results from a double-blind, randomised, placebo-controlled, Phase III study. Lancet Oncol. 2020;21(4):519-530. 9. Blumenthal G, et al. First FDA Approval of Dual Anti-HER2 Regimen: Pertuzumab in Combination with Trastuzumab and Docetaxel for HER2-Positive Metastatic Breast Cancer. Clin Can Res. 2013;19(18). 10. Tripathy D, et al. De Novo Versus Recurrent HER2-Positive Metastatic Breast Cancer: Patient Characteristics, Treatment, and Survival from the SystHERs Registry. Oncologist. 2020;25(2):e214-e222. 11. Hall P, et al. Attrition rates from first- to third-line therapy in HER2+ metastatic breast cancer in Europe. Presented at SABCS Annual Meeting 2023. Poster #PO3-16-11. 12. Hartkopt AD, et al. Attrition in the First Three Therapy Lines in Patients with Advanced Breast Cancer in the German Real-World PRAEGNANT Registry. Geburtshilfe Frauenheilkd. 2024;84(5):459–469. Oncology Corporate and financial