DESTINY-Gastric04
The first randomised proof that a HER2 drug beats standard chemotherapy in second-line stomach cancer: Enhertu added about three months of life.
OS 14.7 vs 11.4 months (HR 0.70); PFS 6.7 vs 5.6 months (ASCO 2025 plenary, NEJM). Confirms the accelerated approval from DESTINY-Gastric01 (Asia) and DESTINY-Gastric02 (West). Grade ≥3 treatment-related events 68% vs 74%; ILD requires monitoring.
- Median 14.7 vs 11.4 months with T-DXd 6.4 mg/kg compared with Ramucirumab + paclitaxel; about 3.3 months longer for half the group.
- A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
- Put another way, the treated group had about 30 percent lower chance of the event at any given time (hazard ratio 0.7).
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Second-line HER2-positive gastric/GEJ cancer after trastuzumab: T-DXd vs ramucirumab + paclitaxel. People in a different situation may not see the same effect.
- The trial selected people by a biomarker (HER2); the result should not be assumed for people whose cancer does not have it.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
494 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survivalprimary | T-DXd 6.4 mg/kg | 246 | 14.7 months | 0.7 | — | link |
| Ramucirumab + paclitaxel | 248 | 11.4 months |
Pages like this
not linked directly; found by shared links- TrialToGA
Shares HER2 sequence in gastric cancer: zanidatamab/trastuzumab + chemo ± PD-1 → T-DXd, Kohei Shitara, HER2, Oesophageal cancer.
- TrialHERIZON-GEA-01
Shares HER2 sequence in gastric cancer: zanidatamab/trastuzumab + chemo ± PD-1 → T-DXd, HER2, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer.
- TrialCLARITY-Gastric 01
Shares Ramucirumab, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer.
- TrialRAINBOW
Shares Ramucirumab, Gastric & gastro-oesophageal junction cancer.
- IdeaTest flat versus weight-based dosing of antibodies, and use dose banding to cut waste
Shares Interstitial lung disease (ILD) / pneumonitis, Trastuzumab deruxtecan.
- InstitutionNational Cancer Center Hospital East
Shares Kohei Shitara, Trastuzumab deruxtecan, HER2, Oesophageal cancer.
- TrialDESTINY-CRC02
Shares Trastuzumab deruxtecan, HER2.
- PairingCaution: DXd ADC + agents with pneumonitis risk
Shares Interstitial lung disease (ILD) / pneumonitis, Trastuzumab deruxtecan.