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항목
AntibodyCurated CoreFDAstaleApproved
zanidatamab (Ziihera, ZW25, zanidatamab-hrii)
Jazz Pharmaceuticals / Zymeworks·HER2 (biparatopic)
35 trials
AntibodyCurated CoreFDAstaleApproved
trastuzumab (Herceptin, Ogivri, Herzuma)
Roche / Genentech·HER2
1100 trials
ADCCurated CoreFDAstaleApproved
trastuzumab deruxtecan (Enhertu, T-DXd, DS-8201, TDxd)
Daiichi Sankyo / AstraZeneca·HER2
243 trials
Overview
Program
Ziihera (zanidatamab)Herceptin (trastuzumab)Enhertu (fam-trastuzumab deruxtecan-nxki)
Overview
Company
Jazz Pharmaceuticals / ZymeworksRoche / GenentechDaiichi Sankyo / AstraZeneca
Overview
Modality
ANTIBODYANTIBODYADC
Overview
Target
HER2 (biparatopic)HER2HER2
Overview
Indication
First-line HER2-positive gastric, GEJ, or esophageal adenocarcinoma; previously treated HER2-positive biliary tract cancerHER2+ breast cancer, HER2+ gastric/GEJ adenocarcinomaHER2-positive breast cancer (including regimen-specific first-line and early-stage indications); HER2-low/ultralow breast cancer, HER2-positive gastric cancer, HER2-mutant NSCLC and HER2-positive solid tumors: consult the current US label
Overview
Phase
APPROVEDAPPROVEDAPPROVED
Overview
Status
APPROVEDAPPROVEDAPPROVED
Overview
Content status
Curated CoreCurated CoreCurated Core
Overview
Data Confidence
Editorial scope · Curated CoreEditorial scope · Curated CoreEditorial scope · Curated Core
Overview
Development Signal
Development Signal · EstablishedDevelopment Signal · EstablishedDevelopment Signal · Established
Overview
Approval status
FDA approvedFDA approvedFDA approved
Positioning
Key differentiator
Dual-epitope binding drives receptor clustering, faster internalization, and stronger signaling blockade than either monoclonal alone. In GEA the label splits IHC 3+ (chemo doublet) from IHC 3+ or 2+/ISH+ (chemo + Tevimbra).novel bifunctional chelator (2E-C-NETA) for applications in 177 Lu-based TRTHigh DAR (~8), bystander effect, HER2-low activity
Positioning
Known limitation
HER2 heterogeneity, PI3K pathway activation, and bypass RTK signaling.resistance to trastuzumab-based targeted therapy and limited intratumoral antibody penetration continue to restrict clinical outcomesHER2 antigen loss/downregulation, payload efflux, and dose-limiting ILD/pneumonitis leading to discontinuation.
Positioning
Development positioning
1L GEA with fluoropyrimidine-platinum ± Tevimbra; 2L+ BTC monotherapy—Indication- and regimen-specific; includes 1L + pertuzumab in HER2-positive metastatic breast cancer
Technology
Payload
——DXd (topo-I inhibitor)
Technology
Linker
——Cleavable tetrapeptide
MoA
Mechanism
Simultaneous binding of two non-overlapping HER2 epitopes crosslinks adjacent receptors, causing receptor clustering, internalization, and degradation alongside ADCC and complement activity.Trastuzumab binds domain IV of HER2, inhibiting ligand-independent HER2 signaling, mediating ADCC via Fcγ receptors, and inducing internalization/degradation of HER2.Fam-trastuzumab deruxtecan is a HER2-directed antibody-drug conjugate: humanized anti-HER2 IgG1 linked via a cleavable tetrapeptide linker to DXd, a membrane-permeable topoisomerase I inhibitor. After binding HER2 on tumor cells, the conjugate is internalized; lysosomal proteases cleave the linker and release DXd, causing DNA damage and apoptosis. Released DXd can exert a bystander effect in neighboring cells.
MoA
Biomarker
GEA: PATHWAY 4B5 IHC and VENTANA Dual ISH. IHC 3+ for chemo doublet; IHC 3+ or IHC 2+/ISH+ when Tevimbra is added. BTC: HER2 IHC 3+.HER2 IHC 3+ or ISH amplified (ASCO/CAP guidelines).HER2 expression (IHC/ISH per indication); higher systemic exposure associated with greater ILD incidence (FDA label §12.2).
Toxicology
Species
—RatCynomolgus monkey, NHP, Rat, Hamster
Toxicology
Animal (cat.)
——NHP
Toxicology
Major finding
Embryo-fetal toxicity warning. Diarrhea, infusion-related reactions, and left ventricular dysfunction require monitoring, as with the HER2 antibody class.Cardiotoxicity (LVEF decline, CHF risk especially with anthracyclines); infusion reactions; myelosuppression in combos.ILD-like lung findings at high exposure
Toxicology
CRS
N/AN/AMinimal
Toxicology
NOAEL
——10 mg/kg
Clinical
Safety signal
Embryo-fetal toxicity warning. Diarrhea, infusion-related reactions, and left ventricular dysfunction require monitoring, as with the HER2 antibody class.Cardiotoxicity (LVEF decline, CHF risk especially with anthracyclines); infusion reactions; myelosuppression in combos.ILD-like lung findings at high exposure
Clinical
Selected reported efficacy
——ORR 87%
Clinical
Reported ORR
——87% vs 81% (THP)
Clinical
Reported PFS
——40.7 months vs 26.9 months (THP)
Clinical
Reported OS
——Immature at the reported PFS analysis
Clinical
Result source
——FDA label 2026, Table 28 — DESTINY-Breast09 (NCT04784715)
Clinical
Program phase
APPROVEDAPPROVEDAPPROVED
Clinical
Trial activity
No active/completed countsNo active/completed countsNo active/completed counts
Clinical
Trial ref
——NCT04784715
Preclinical
Animal (cat.)
—Mouse, In vitroHuman, Mouse, In vitro