# DESTINY-Gastric04

Source: https://onco.cc/trials/destiny-gastric04/  
OnCo record `destiny-gastric04` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first randomised proof that a HER2 drug beats standard chemotherapy in second-line stomach cancer: Enhertu added about three months of life.

## Summary

DESTINY-Gastric04, trial NCT04704934 sponsored by Daiichi Sankyo and AstraZeneca and reported at the ASCO 2025 plenary and in the New England Journal of Medicine, was the first randomised proof that a HER2 drug beats standard chemotherapy in second-line HER2-positive gastric cancer, with trastuzumab deruxtecan adding a few months of life. It randomised 494 patients after trastuzumab to trastuzumab deruxtecan or ramucirumab plus paclitaxel and met its primary overall survival endpoint, also improving progression-free survival, confirming the accelerated approvals from DESTINY-Gastric01 and DESTINY-Gastric02; interstitial lung disease requires monitoring. Where it sits after zanidatamab-based first-line therapy is the open question.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-07
- Registry id: NCT04704934
- Phase: 3
- Setting: Second-line HER2-positive gastric/GEJ cancer after trastuzumab: T-DXd vs ramucirumab + paclitaxel
- Sponsor: Daiichi Sankyo / AstraZeneca
- Enrolled: 494
- Result: OS 14.7 vs 11.4 months, HR 0.70.
- Outcomes: Overall survival: T-DXd 6.4 mg/kg 14.7 months vs Ramucirumab + paclitaxel 11.4 months, HR 0.7
- Replication: Consistent with DESTINY-Gastric01 (OS 12.5 vs 8.4 months vs chemotherapy, third line).

## Sources

- ClinicalTrials.gov NCT04704934: https://clinicaltrials.gov/study/NCT04704934

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [HER2-positive gastric cancer](https://onco.cc/cancers/gastric-her2-positive/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/)
- technologies: [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [Topoisomerase-I inhibitors (and ADC payloads)](https://onco.cc/technologies/topoisomerase-inhibitors/)
- targets: [HER2](https://onco.cc/targets/her2/)
- drugs: [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/), [Daiichi Sankyo](https://onco.cc/companies/daiichi-sankyo/)
- terms: [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/)
- people: [Kohei Shitara](https://onco.cc/people/shitara-kohei/)
- pairings: [HER2 sequence in gastric cancer: zanidatamab/trastuzumab + chemo ± PD-1 → T-DXd](https://onco.cc/pairings/her2-gastric-sequence/)

---
JSON: https://onco.cc/api/v1/entities/destiny-gastric04.json