On October 30, 2025 Daiichi Sankyo reported that the first patient has been dosed in the DESTINY-Lung06 phase 3 trial evaluating ENHERTU (trastuzumab deruxtecan) plus pembrolizumab versus pembrolizumab, platinum-based chemotherapy and pemetrexed as a first-line treatment in patients with unresectable, locally advanced or metastatic HER2 overexpressing and PD-L1 TPS <50% non-squamous non-small cell lung cancer (NSCLC).
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ENHERTU is a specifically engineered HER2 directed DXd antibody drug conjugate (ADC) discovered by Daiichi Sankyo (TSE: 4568) and being jointly developed and commercialized by Daiichi Sankyo and AstraZeneca (LSE/STO/Nasdaq: AZN).
One of the current recommended first-line treatments for patients with HER2 overexpressing metastatic non-squamous NSCLC is pembrolizumab plus platinum-based chemotherapy and pemetrexed.1,2,3 Improved outcomes for immunotherapy-based treatments correlate with higher PD-L1 levels, underscoring the need for more targeted treatment options for patients with PD-L1 TPS <50%.4 There currently are no HER2 directed medicines approved in the first-line setting of metastatic NSCLC.1,2,3,5
"DESTINY-Lung06 is evaluating a targeted treatment strategy for patients with HER2 overexpressing metastatic non-squamous non-small cell lung cancer with low PD-L1 expression," said Abderrahmane Laadem, MD, Head, Late-Stage Oncology Clinical Development, Daiichi Sankyo. "In the trial, we are evaluating whether replacing traditional chemotherapy with ENHERTU and combining it with standard of care immunotherapy could potentially improve outcomes for patients in the first-line metastatic setting."
About DESTINY-Lung06
DESTINY-Lung06 is a multicenter, randomized, open-label, phase 3 trial evaluating the efficacy and safety of ENHERTU (5.4 mg/kg) in combination with pembrolizumab versus pembrolizumab, platinum-based chemotherapy (cisplatin or carboplatin) and pemetrexed as a first-line treatment in patients with unresectable, locally advanced or metastatic HER2 overexpressing and PD-L1 TPS <50% non-squamous NSCLC without known actionable genomic alterations. Patients will be randomized 1:1 to receive either ENHERTU plus pembrolizumab or pembrolizumab, platinum-based chemotherapy and pemetrexed.
The primary endpoint is progression-free survival (PFS) as assessed by blinded independent central review (BICR). The key secondary endpoint is overall survival. Additional secondary endpoints include PFS as assessed by investigator, objective response rate and duration of response as assessed by BICR and investigator and safety.
DESTINY-Lung06 will enroll approximately 686 patients across multiple sites in Asia, Europe, North America and South America. For more information about the trial, visit ClinicalTrials.gov.
About Non-Small Cell Lung Cancer
Lung cancer is the most common cancer globally and is the leading cause of cancer-related death in both men and women.6More than 2.48 million lung cancer cases were diagnosed in 2022, with 1.8 million deaths globally.6 NSCLC is the most common type of lung cancer, accounting for approximately 85% of cases.7 Prognosis is particularly poor for patients with metastatic NSCLC as only approximately 10% will live beyond five years after diagnosis.8,9
HER2 is a tyrosine kinase receptor growth-promoting protein expressed on the surface of multiple tumor types.[10] HER2 overexpressing NSCLC occurs in up to approximately 20% of patients with NSCLC and is associated with poor treatment response and worse clinical outcomes.11,12,13,14,15 For patients with HER2 overexpressing metastatic non-squamous NSCLC, one of the current recommended first-line treatments is pembrolizumab plus platinum-based chemotherapy and pemetrexed.1,2,3 Improved outcomes for immunotherapy-based treatments correlate with higher PD-L1 levels, underscoring the need for more targeted treatment options for patients with PD-L1 TPS <50%.4 There currently are no HER2 directed medicines approved in the first-line setting for HER2 overexpressing NSCLC.1,2,3,5
About ENHERTU
ENHERTU (trastuzumab deruxtecan; fam-trastuzumab deruxtecan-nxki in the U.S. only) is a HER2 directed ADC. Designed using Daiichi Sankyo’s proprietary DXd ADC Technology, ENHERTU is the lead ADC in the oncology portfolio of Daiichi Sankyo and the most advanced program in AstraZeneca’s ADC scientific platform. ENHERTU consists of a HER2 monoclonal antibody attached to a number of topoisomerase I inhibitor payloads (an exatecan derivative, DXd) via tetrapeptide-based cleavable linkers.
ENHERTU (5.4 mg/kg) is approved in more than 85 countries/regions worldwide for the treatment of adult patients with unresectable or metastatic HER2 positive (immunohistochemistry [IHC] 3+ or in-situ hybridization [ISH]+) breast cancer who have received a prior anti-HER2-based regimen, either in the metastatic setting or in the neoadjuvant or adjuvant setting, and have developed disease recurrence during or within six months of completing therapy based on the results from the DESTINY-Breast03 trial.
ENHERTU (5.4 mg/kg) is approved in more than 85 countries/regions worldwide for the treatment of adult patients with unresectable or metastatic HER2 low (IHC 1+ or IHC 2+/ISH-) breast cancer who have received a prior systemic therapy in the metastatic setting or developed disease recurrence during or within six months of completing adjuvant chemotherapy based on the results from the DESTINY-Breast04 trial.
ENHERTU (5.4 mg/kg) is approved in more than 45 countries/regions worldwide for the treatment of adult patients with unresectable or metastatic hormone receptor (HR) positive, HER2 low (IHC 1+ or IHC 2+/ ISH-) or HER2 ultralow (IHC 0 with membrane staining) breast cancer, as determined by a locally or regionally approved test, that have progressed on one or more endocrine therapies in the metastatic setting based on the results from the DESTINY-Breast06 trial.
ENHERTU (5.4 mg/kg) is approved in more than 60 countries/regions worldwide for the treatment of adult patients with unresectable or metastatic NSCLC whose tumors have activating HER2 (ERBB2) mutations, as detected by a locally or regionally approved test, and who have received a prior systemic therapy based on the results from the DESTINY-Lung02 and/or DESTINY-Lung05 trials. Continued approval in China and the U.S. for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.
ENHERTU (6.4 mg/kg) is approved in more than 70 countries/regions worldwide for the treatment of adult patients with locally advanced or metastatic HER2 positive (IHC 3+ or IHC 2+/ISH+) gastric or gastroesophageal junction (GEJ) adenocarcinoma who have received a prior trastuzumab-based regimen based on the results from the DESTINY-Gastric01, DESTINY-Gastric02 and/or DESTINY-Gastric06 trials. Continued approval in China for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.
ENHERTU (5.4 mg/kg) is approved in more than 10 countries/regions worldwide for the treatment of adult patients with unresectable or metastatic HER2 positive (IHC 3+) solid tumors who have received prior systemic treatment and have no satisfactory alternative treatment options based on efficacy results from the DESTINY-PanTumor02, DESTINY-Lung01 and DESTINY-CRC02 trials. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.
About the ENHERTU Clinical Development Program
A comprehensive global clinical development program is underway evaluating the efficacy and safety of ENHERTU as a monotherapy or in combination or sequentially with other cancer medicines across multiple HER2 targetable cancers.
(Press release, Daiichi Sankyo, OCT 30, 2025, View Source [SID1234665026])