ReviewJournal of gastrointestinal cancer2026
Trastuzumab Deruxtecan (T-DXd) in HER2-Positive Advanced Gastric and Gastroesophageal Junction Cancer: Evidence, Sequencing, Patient Selection, and Clinical Decision-Making.
Review in Journal of gastrointestinal cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo provide a clinically oriented review of trastuzumab deruxtecan (T-DXd) in HER2-positive advanced gastric or gastroesophageal junction adenocarcinoma, focusing on evidence, post-progression HER2 reassessment, second-line sequencing, patient selection, regional implementation, and toxicity management.
methodsThis narrative review integrates pivotal DESTINY-Gastric trials, HER2 reassessment studies, realworld cohorts, safety analyses, pathology guidance, and regulatory documents available through August 2026.
resultsDESTINY-Gastric04 established T-DXd as a preferred second-line treatment after progression on trastuzumab-containing therapy, improving median overall survival versus ramucirumab plus paclitaxel (14.7 vs 11.4 months; hazard ratio 0.70). HER2 expression is heterogeneous and dynamic; postprogression reassessment is therefore recommended whenever feasible using biopsy-specific scoring criteria. The 494 of 1,088 patients randomized in DESTINY-Gastric04 should not be interpreted as a 55% HER2-loss rate because screening attrition was multifactorial. T-DXd is preferred when HER2 positivity is retained, whereas ramucirumab plus paclitaxel remains appropriate when HER2 loss is documented. When HER2 status is unconfirmed, treatment should be individualized, recognizing regional regulatory differences. Older patients require careful toxicity assessment, particularly for interstitial lung disease (ILD)/pneumonitis. Grade 2 or higher ILD requires permanent discontinuation; grade 1 reinitiation must follow the applicable regional label.
conclusionT-DXd is a preferred second-line option for post-progression HER2-positive advanced gastric or gastroesophageal junction cancer, but optimal use requires careful HER2 reassessment and regionappropriate safety management. Evidence after T-DXd failure, ctDNA-guided selection, and sequential CLDN18.2-directed therapy remains limited and requires prospective validation.
Indexed as
Identifiers
42720868What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.