# DESTINY-Gastric01: trastuzumab deruxtecan in previously treated HER2-positive gastric cancer

Source: https://onco.cc/key-papers/paper-destiny-gastric01-nejm-2020/  
OnCo record `paper-destiny-gastric01-nejm-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Trastuzumab deruxtecan shrank tumours in half of patients with HER2-positive gastric cancer that had progressed after trastuzumab, compared with 14 percent on chemotherapy, and lengthened survival by over four months.

## Summary

Randomised phase 2 trial in Japan and South Korea of 187 patients with HER2-positive advanced gastric or junctional adenocarcinoma after at least two prior regimens including trastuzumab, randomised 2:1 to trastuzumab deruxtecan 6.4 mg/kg or physician's choice of irinotecan or paclitaxel.

Objective response was 51 versus 14 percent and median overall survival 12.5 versus 8.4 months (hazard ratio 0.59); interstitial lung disease occurred in 10 percent, with myelosuppression as the other main toxicity.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2020
- DOI: 10.1056/NEJMoa2004413
- Authors: Shitara K, Bang YJ, Iwasa S, et al.
- Findings: Objective response 51 percent vs 14 percent.; Median overall survival 12.5 vs 8.4 months; hazard ratio 0.59.
- What it means: Trastuzumab deruxtecan is the standard second- or third-line treatment for HER2-positive gastric cancer, later confirmed against ramucirumab-paclitaxel in DESTINY-Gastric04.
- Caveats: Asian population; the Western DESTINY-Gastric02 study showed a lower response rate.; Interstitial lung disease requires monitoring.

## Sources

- N Engl J Med 2020: https://doi.org/10.1056/NEJMoa2004413
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32469182/

## Connected records

- cancers: [HER2-positive gastric cancer](https://onco.cc/cancers/gastric-her2-positive/)
- drugs: [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/)
- trials: [DESTINY-Gastric01](https://onco.cc/trials/destiny-gastric01/), [DESTINY-Gastric02](https://onco.cc/trials/destiny-gastric02/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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