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.

Source YAML: complete record

Components	`DRUG-TRASTUZUMAB-DERUXTECAN`

ID	`REG-TDXD-GASTRIC`
Type	Regimen
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-GASTRIC-2024` `SRC-NCCN-GASTRIC-2025`

Notes

DESTINY-Gastric01 (Shitara 2020): 2L+ HER2+ gastric/GEJ adenocarcinoma post-trastuzumab failure — T-DXd vs investigator's-choice chemo ORR 51% vs 14%, mOS 12.5 vs 8.4 mo (HR 0.59). Asian-population trial; DESTINY-Gastric02 single-arm Western confirmed activity. Gastric dose 6.4 mg/kg q3w (higher than breast 5.4 mg/kg due to faster clearance). ILD remains key dose-limiting toxicity — baseline + serial CT chest + pulmonology referral on any new respiratory symptom mandatory.

Used By

Algorithms

ALGO-ESOPH-2L - ALGO-ESOPH-2L

Indication

IND-ESOPH-METASTATIC-2L-HER2-POSITIVE-T-DXD - IND-ESOPH-METASTATIC-2L-HER2-POSITIVE-T-DXD
IND-GASTRIC-METASTATIC-2L-HER2-TDXD - IND-GASTRIC-METASTATIC-2L-HER2-TDXD