AstraZeneca and Daiichi Sankyo's ENHERTU fam-trastuzumab deruxtecan-nxki) has been approved in the US 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. This indication is approved under accelerated approval based on objective response rate (ORR) and duration of response (DoR). Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

ENHERTU is a specifically engineered HER2-directed antibody drug conjugate (ADC) discovered by Daiichi Sankyo and being jointly developed and commercialized by AstraZeneca and Daiichi Sankyo. The first tumor-agnostic approval of a HER2-directed therapy and ADC by the Food and Drug Administration (FDA) was based on results from the subgroup of patients with HER2-positive IHC 3+ tumors in each of the DESTINY-PanTumor02, DESTINY-Lung01 and DESTINY-CRC02 Phase II trials. In the DESTINY-PanTumor02 Phase II trial, patients with centrally or locally assessed HER2-positive (IHC 3+) solid tumors including either biliary tract, bladder, cervical, endometrial, ovarian, pancreatic or other tumors treated with ENHERTUshowed a confirmed ORR of 51.4% (95% confidence interval [CI]: 41.7-61.0) and a median DoR range of 19.4 months (range: 1.3-27.9+ [+ denotes ongoing responses at data cutoff]).

In DESTINY-Lung01, patients with centrally confirmed HER2-positive (IHC 3+) non-small cell lung cancer (NSCLC) treated with ENHERTUshowed aconfirmed ORR of 52.9% (95% CI: 27.8-77.0) and median DoR range of 6.9 months (range: 4.0-11.7+). A confirmed ORR of 46.9% (95% CI: 34.3-59.8) and median DoR range of 5.5 months (range: 1.3+-9.7+) was seen in patients with centrally confirmed HER2-positive (IHC 3+) colorectal cancer in the DESTINY-CRC02 trial. The safety of ENHERTU was evaluated in 347 patients with unresectable or metastatic HER2-positive (IHC 3+) solid tumors in the DESTINY-Breast01, DESTINY-PanTumor02, DESTINY-Lung01 and DESTINY-CRC02 trials.

The safety profile observed across the trials was consistent with previous clinical trials of ENHERTU with no new safety concerns identified. Based on these results, fam-trastuzumab deruxtecan-nxki (ENHERTU) has been included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) as a treatment option for multiple metastatic tumors. This approval was granted under the FDA?s Real-Time Oncology Review program after securing Priority Review and Breakthrough Therapy Designation for ENHERTU in the US in this setting.

The US regulatory submission was reviewed under Project Orbis, which provides a framework for concurrent submission and review of oncology medicines among participating international partners. As part of Project Orbis, ENHERTU is also under regulatory review for the same indication by regulatory authorities in Australia, Brazil and Singapore.