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**trastuzumab deruxtecan + rilvegostomig + fluorouracil** is an investigational combination regimen for first-line treatment of HER2-positive, locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma. Trastuzumab deruxtecan is an antibody-drug conjugate comprising an anti-HER2 monoclonal antibody linked to a topoisomerase I inhibitor (deruxtecan), inducing tumor cell death by internalizing into HER2-expressing cancer cells and releasing the cytotoxic payload. Rilvegostomig is a bispecific antibody targeting both PD-1 (programmed cell death protein 1) and TIGIT (T-cell immunoreceptor with Ig and ITIM domains), acting as an immune checkpoint inhibitor to stimulate anti-tumor immunity. Fluorouracil is a fluoropyrimidine antimetabolite that inhibits thymidylate synthase, blocking DNA synthesis and impairing tumor cell proliferation. This triple combination is being assessed in phase 3 clinical trials as an alternative to current standard therapies, aiming to enhance efficacy by integrating targeted therapy, immunotherapy, and cytotoxic chemotherapy mechanisms[1][3][6].
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