Esophageal carcinoma (squamous + adeno) · line 2 · Trastuzumab deruxtecan (T-DXd) — 2L+ HER2+ gastric (DESTINY-Gastric01)
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.
| Line of therapy | 2 |
|---|---|
| Track | aggressive |
| Linked regimen | REG-TDXD-GASTRIC |
| ID | IND-ESOPH-METASTATIC-2L-HER2-POSITIVE-T-DXD |
|---|---|
| Type | Indication |
| Status | reviewed 2026-05-07 | pending_clinical_signoff |
| Diseases | DIS-ESOPHAGEAL |
| Sources | SRC-DESTINY-GASTRIC01-SHITARA-2020 SRC-DESTINY-GASTRIC04-SHITARA-2025 SRC-ESMO-ESOPHAGEAL-2024 SRC-NCCN-ESOPHAGEAL-2025 |
Notes
Extrapolation indication — confidence: moderate. DESTINY-Gastric01 + DESTINY-Gastric04 enrolled HER2+ gastric/GEJ adenocarcinoma (Siewert I-III); pure esoph-confined adeno was not formally enrolled. NCCN- Esophageal/EGJ 2025 + ESMO-Esophageal 2024 endorse HER2 testing in metastatic esoph adeno and recommend trastuzumab-based 1L (ToGA backbone); 2L T-DXd is the natural extension of this routing for HER2+ esoph adeno post 1L trastuzumab failure. Reuses REG-TDXD-GASTRIC (gastric T-DXd regimen) unchanged — same dose (6.4 mg/kg q3w), schedule, components for esoph adeno extrapolation. No new regimen authored; reuse audit confirmed identical backbone per DG-04 protocol. Companion to IND-ESOPH-METASTATIC-1L-HER2-TRASTUZUMAB-CHEMO (1L ToGA esoph extrapolation): together they form the HER2+ esoph adeno treatment pathway 1L → 2L matching the gastric pathway. STUB — pending Co-Lead sign-off (CHARTER §6.1 two-reviewer requirement). Algorithm extension required: ALGO-ESOPH-METASTATIC-2L should add a HER2-positive adeno post-trastuzumab branch routing to this indication. Out of scope for A1-extension (algorithm chunk D1 will handle). Authored 2026-05-07 by GI-2 A1-extension chunk (gi2-a1ext-her...
Used By
Algorithms
ALGO-ESOPH-2L- ALGO-ESOPH-2L