LBPO.CL03 · 临床研究 · Late-Breaking
First-line (1L) trastuzumab deruxtecan (T-DXd) + rilvegostomig (rilve) + fluoropyrimidine (FP) in HER2-positive (HER2+) gastric cancer (GC), gastroesophageal junction adenocarcinoma (GEJA), or esophageal adenocarcinoma (EA): DESTINY-Gastric03 (DG-03) Part 4 arm A results
作者与单位
摘要 Abstract
Background:
T-DXd monotherapy is approved in several countries for advanced HER2+ GC/GEJA after an indicated HER2-directed regimen. 1L rilve (a monovalent, Fc-reduced, bispecific IgG1 antibody against PD-1 and TIGIT receptors) + chemotherapy showed encouraging efficacy and a manageable safety profile in advanced GCs. We report early data from DG-03 Part 4 arm A evaluating 1L T-DXd + rilve + FP in HER2+ GCs.
Methods:
DG-03 (NCT04379596) is a Phase 1b/2, open-label, multipart trial. Part 4 arm A enrolled patients (pts) with previously untreated advanced/metastatic HER2+ (IHC 3+ or IHC 2+/ISH+; local test) GC/GEJA/EA. Pts received T-DXd + rilve + FP (5-fluorouracil or capecitabine). PD-L1 status was assessed by central test retrospectively. Primary endpoint was confirmed objective response rate (ORR) by investigator assessment (INV) per RECIST 1.1; safety was also assessed.
Results:
At data cutoff (Oct 16, 2025), 30 pts were enrolled and received treatment (Tx). Median duration of follow up was 7.6 (range, 1.9-12.6) months; median duration of Tx exposure for T-DXd and rilve was 7.0 (range, 1.8-11.3) months. Confirmed ORR by INV (n/n) was 70% (21/30) overall, 78% (18/23) and 50% (3/6) in pts with HER2 IHC 3+ and IHC 2+/ISH+ tumors, and 82% (9/11) and 50% (3/6) in pts with PD-L1 CPS ≥1 and CPS <1 tumors, respectively. Safety data are shown in the Table. Adjudicated drug-related interstitial lung disease/pneumonitis occurred in 2 pts (7%; both Grade 2); there were no reports of drug-related left ventricular dysfunction.
Conclusions:
Early results showed promising antitumor activity with 1L T-DXd + rilve + FP in HER2+ GCs; safety findings were generally consistent with the known profiles of each agent as monotherapy, with no new safety signals observed. Data support further study of this 1L triplet regimen in HER2+ GCs. n (%) HER2+
(arm A; N=30) AEs 29 (97) Drug-related AEs* 26 (87) Grade ≥3 AEs 11 (37) Drug-related Grade ≥3 AEs* 8 (27) Serious AEs 8 (27) Drug-related serious AEs* 4 (13) AEs leading to dose interruption of T-DXd / rilvegostomig 10 (33) / 11 (37) AEs leading to dose reduction of T-DXd / rilvegostomig 3 (10) / 0 AEs leading to discontinuation of any treatment 4 (13) Drug-related AEs leading to death* 0 *Assessed by the investigator as possibly related to any treatment
AE, adverse event; HER2+, HER2-positive; T-DXd, trastuzumab deruxtecan
利益披露 Disclosure
Y. Y. Janjigian,
Abbvie; AmerisourceBergen; Arcus Biosciences; AskGene Pharma; Astellas Pharma; AstraZeneca; Basilea Pharmaceutical; Bayer; Boehringer Ingelheim; Bristol-Myers Squibb; Clinical Care Options Other, Consulting or advisory role.
Daiichi Sankyo; Debbies Dream Foundation; Eisai; Genzyme; Geneos; GlaxoSmithKline; Guardant Health; H.C. Wainwright & Co.; HMP Education; Imedex; Imugene; Inspirna; Jazz Pharmaceuticals Other, Consulting or advisory role.
Lilly; Lynx Health; Merck; Merck Serono; Mersana; Michael J. Hennessy Associates; OncLive; OncoDaily; Paradigm; Peerview; Pfizer; Physicans' Education Resource; Research to Practice; Seagen Other, Consulting or advisory role.
Signatera; Silverback Therapeutics; WebMD; Zymeworks Other, Consulting or advisory role.
Bristol-Myers Squibb Japan; Merck Travel.
Axis Medical Education; Clinical Care Options; Giants of Cancer Care; Research to Practice Other, Other relationships.
Inspirna; OncoDaily; Veeda Oncology Stock, Stock Option.
Abbvie; AmerisourceBergen; Arcus Biosciences; AskGene Pharma; Astellas Pharma; AstraZeneca; Basilea Pharmaceutical; Bayer; BeOne Medicines; Boehringer Ingelheim; Bristol-Myers Squibb Other, Honoraria.
Clinical Care Options; Daiichi Sankyo; eChinaHealth; Eisai; Geneos; Genzyme; Gilead Sciences; GlaxoSmithKline; Guardant Health; H.C. Wainwright & Co.; HMP Education; IDEOlogy Health; Imedex; Imugene Other, Honoraria.
i3 Health; Inspirna; Lilly; Lynx Health; Master Clinician Alliance; Merck; Merck Serono; Mersana; Michael J. Hennessy Associates; Oncology Information Group; Paradigm; Peerview; Pfizer Other, Honoraria.
Physicans' Education Resource; Regeneron; Research to Practice; Seagen; Silverback Therapeutics; Suzhou Liangyihui Network Technology; Talem Health; TotalCME; WebMD; Zymeworks Other, Honoraria.
Arcus Biosciences; Astellas Pharma; AstraZeneca; Bayer; Bristol-Myers Squibb; Cycle for Survival; Department of Defense; Fred's Team; Genentech/Roche; Inspirna; Lilly; Merck; NCI; Stand up to Cancer ).
Transcenta ).
H. van Laarhoven,
Amgen; Amphera; Astellas Pharma; AstraZeneca; BeiGene; Boehringer Ingelheim; Bristol-Myers Squibb; Daiichi Sankyo; MSD Oncology; MyeoloidTx Other, Consulting or advisory role.
AstraZeneca; Bristol-Myers Squibb; CongressCare; Daiichi Sankyo; MedTalks; Travel Congress Management; Uitgeverij Jaap Other, Speakers' Bureau.
AstraZeneca Travel.
Amgen; Auristone; Bristol-Myers Squibb; Incyte; Merck KGaA; ORCA Therapeutics; Servier ).
H. Shoji,
Astellas Pharma Other, Consulting or advisory role.
AbbVie; Amgen; Astellas Pharma; AstraZeneca; Daiichi Sankyo; Elevation Oncology; MSD; Ono Pharmaceutical; Takeda ).
L. Wyrwicz, None.
S. Lonardi,
Amgen; Astellas Pharma; AstraZeneca; Bayer; Beigene; Bristol-Myers Squibb; Daiichi Sankyo; GSK; Helion; Incyte; Lilly; Merck Serono; MSD; Nimbus Therapeutics; Rottapharm; Servier; Takeda Other, Advisory board.
Amgen; AstraZeneca; Bristol-Myers Squibb; GlaxoSmithKline; Incyte; Lilly; Merck Serono; MSD; Pierre-Fabre; Roche; Servier Other, Invited speaker.
Amgen; AstraZeneca; Bayer; Bristol-Myers Squibb; Lilly; Merck Serono; Roche Other, Coordinating PI.
GONO Foundation g., Board of Directors, non-salaried role).
B. Karaszewska, None..
X. Liang, None.
A. Calvo Ferrándiz,
AstraZeneca; Daiichi Sankyo; MSD Other, Advisory board.
Amgen; Astellas Pharma; AstraZeneca; BMS; MSD Other, Invited speaker.
M. Kwiatkowski, None.
K. Lee,
Abbvie; Astellas Pharma; BeiGene; Daiichi Sankyo; Metafines; MSD; Ono Pharmaceutical; PIN therapeutics; Takeda Other, Consulting or advisory role.
Astellas Pharma; Bayer; Celltrion; Merck KGaA; MSD Oncology; Ono Pharmaceutical Other, Honoraria.
ALX Oncology; Amgen; Arcus Biosciences; Astellas Pharma; AstraZeneca; Avelos Therapeutics; Bayer; BeiGene; Boehringer Ingelheim; Bolt Biotherapeutics; Daiichi Sankyo; Erasca, Inc; Exelixis ).
Genome & Company; GlaxoSmithKline; Hanmi; IDRx; IgM Biosciences; Ildong Pharmaceutical; InventisBio; Jazz Pharmaceuticals; Jiangsu Hengrui Pharmaceuticals; Leap Therapeutics; MedPacto; Medicenna ).
Merk KGaA; Metafines; MSD; Ono Pharmaceutical; Panolos Bioscience; Pfizer; Roche; Taiho Pharmaceutical; Torl Biotherapeutics; Trishula Therapeutics; Wellmarker Bio; Yuhan ).
ALX Oncology Other, Uncompensated relationship.
T. Liu, None.
K. Shitara,
Astellas Pharma; AstraZeneca; Bristol-Myers Squibb; Janssen; Lilly; Ono Pharmaceutical Other, Honoraria.
Abbvie; ALX Oncology; Amgen; Arcus Biosciences Inc.; Astellas Pharma; AstraZeneca; Bayer; Boehringer Ingelheim; Bristol-Myers Squibb; CMIC Co., Ltd.; Daiichi Sankyo; Elevation Oncology Other, Consulting or advisory role.
eChainaHealth, Inc.; Gilead Sciences; GlaxoSmithKline K.K.; Guardant Health; Healios; Janssen; Leap Therapeutics; Levolution Medicines, Inc.; Moderna Inc; MSD; Novartis; Oncolys BioPharma Other, Consulting or advisory role.
Ono Pharmaceutical; Phanes Therapeutics; Sanofi; Scandion Oncology; Suzuhou Liangyihui Network Technology Co.; Takeda; Zymeworks Other, Consulting or advisory role.
Amgen; Astellas Pharma; AstraZeneca; Chugai Pharma; Daiichi Sankyo; Eisai; Insyte Biosciences G.K.; Medpace Japan K.K.; MSD; Ono Pharmaceutical; PRA Health Sciences; PPD-SNBL; Syneos Health ).
Taiho Pharmaceutical; Toray Industries ).
S. Y. Rha,
Amgen; Arcus Biosciences; Astellas Pharma; AstraZeneca; BeOne Medicines; Daiichi Sankyo; Eisai; indivumed; LG Chem; MSD Oncology; Ono Pharmaceutical; Toray Industries Other, Consulting or advisory role.
Amgen; Astellas Pharma; AstraZeneca; Bristol-Myers Squibb/Ono Pharmaceutical; Daiichi Sankyo/UCB Japan; Eisai; MSD Oncology Other, Speakers' Bureau.
S. Siena,
Agenus; AstraZeneca; BMS; Checkmab; Daiichi Sankyo; GSK; Merck; MSD; Novartis; Seagen; T-One-Therapeutics Other, Advisory board.
R. Rabbie,
AstraZeneca Employment, Stock, Stock Option.
C. Lloyd,
AstraZeneca Employment, Stock, Stock Option.
M. Scott,
AstraZeneca Employment, Stock, Stock Option.
A. W. Lambert,
AstraZeneca Employment, Stock, Stock Option.
J. Lee,
Amgen; AstraZeneca; Daiichi Sankyo; Guardant Health AMEA; Immunoncia; Mirati Therapeutics; Trutino Biosciences Other, Consulting or advisory role.
AstraZeneca; Merck Sharp & Dohme; Samsung Bioepis ).