Practice-entering research
DESTINY-Gastric04 — T-DXd vs ramucirumab+paclitaxel in HER2+ gastric/GEJ
Trastuzumab Deruxtecan Versus Ramucirumab Plus Paclitaxel in Previously Treated HER2-Positive Gastric or GEJ Adenocarcinoma (DESTINY-Gastric04)
- Phase
- Phase III
- Recruitment
- Completed
- Results maturity
- Primary analysis
- Publication
- Peer-reviewed
- Regulatory approval
- T-DXd FDA-approved in 2L HER2+ gastric/GEJ; DG04 is confirmatory OS (NEJM)
- NCT
- NCT04704934
- Registry checked
- 2026-10-29
- Editorial update
- 2026-10-31
Not a treatment recommendation. Experimental or ongoing research does not by itself replace standard care.
For patients
What is being studied? An antibody–drug conjugate prolonged survival versus standard second-line therapy in HER2-positive stomach cancer. Lung side effects need close monitoring.
Why promising? In second-line HER2+ gastric/GEJ, T-DXd prolonged overall survival versus ramucirumab+paclitaxel.
What is not proven? HER2− disease; universal first-line role (separate trials); use without ILD risk.
Is this standard care today? This listing alone does not replace standard care; approval and guideline context require clinician judgment.
For clinicians
NEJM 2025 (n=494): OS 14.7 vs 11.4 mo (HR 0.70; p=0.004); PFS HR 0.74; ORR 44.3% vs 29.1%. Drug-related ILD/pneumonitis ~13.9% (mostly low grade). Do not confuse with DG-01/02.
Cancer / population: Gastric / esophageal — Önceden trastuzumab temelli tedavi almış HER2+ mide / GEJ
Intervention: Trastuzumab deruxtecan (T-DXd)
Primary endpoint: OS
Source-verified summary: OS 14,7 vs 11,4 ay (HR 0,70). T-DXd 2L endikasyonu ABD’de mevcut; DG04 karşılaştırmalı OS kanıtını güçlendirir.
Limitations: DG-01/02 ile karıştırılmamalı; hat ve coğrafya farkı; ILD yönetimi kritik.