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This is a combination regimen consisting of **trastuzumab deruxtecan** (an antibody-drug conjugate targeting HER2), **durvalumab** (a PD-L1 immune checkpoint inhibitor), and **pemetrexed** (a folate antimetabolite chemotherapy). Trastuzumab deruxtecan’s mechanism is HER2-targeted delivery of a cytotoxic topoisomerase I inhibitor payload, causing DNA damage specifically in HER2-expressing cancer cells. Durvalumab binds to PD-L1, blocking its interaction with PD-1 and CD80, thereby lifting immune suppression and promoting anti-tumor immunity. Pemetrexed disrupts folate-dependent metabolic processes, inhibiting enzymes crucial for DNA synthesis and tumor cell proliferation. This combination is being investigated mainly for advanced or metastatic HER2-positive malignancies, especially those of the gastroesophageal junction, and potentially HER2-positive non-squamous non-small cell lung cancers.
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