Trastuzumab

TOKYO, Japan & BASKING RIDGE, NJ, USA I March 31, 2025 I The first patient has been dosed in the DESTINY-Gastric05 phase 3 trial evaluating ENHERTU ® (trastuzumab deruxtecan) in combination with a fluoropyrimidine chemotherapy (5-FU or capecitabine) and Merck’s (known as MSD outside of the US and Canada) anti-PD-1 therapy KEYTRUDA ® (pembrolizumab) versus trastuzumab in combination with platinum-based chemotherapy (cisplatin plus 5-FU or oxaliplatin plus capecitabine) and pembrolizumab in previously untreated patients with unresectable, locally advanced or metastatic HER2 positive (IHC 3+ or IHC 2+/ISH+) gastric or gastroesophageal junction (GEJ) cancer with PD-L1 CPS ≥1. An exploratory cohort of patients with PD-L1 CPS <1 will be randomized to either ENHERTU plus fluoropyrimidine or trastuzumab plus platinum-based chemotherapy. 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). Gastric cancer is associated with a poor prognosis, particularly in advanced stages of the disease where the five-year survival rate is 5% to 10%. 1 Current recommended first-line treatment for HER2 positive advanced gastric cancer with PD-L1 CPS ≥1 is trastuzumab in combination with platinum-based chemotherapy (cisplatin plus 5-FU or oxaliplatin plus capecitabine) and pembrolizumab. 2,3 New treatment strategies are needed to continue to improve survival, including additional HER2 directed treatment options. “Following the positive overall survival results seen with DESTINY-Gastric04 in the second-line HER2 positive metastatic gastric cancer setting, the DESTINY-Gastric05 trial will explore the role of ENHERTU earlier in the metastatic setting as a first-line treatment,” said Mark Rutstein, MD, Global Head, Oncology Clinical Development, Daiichi Sankyo. “With DESTINY-Gastric05, we are evaluating whether a potential platinum-free chemotherapy regimen of ENHERTU combined with immunotherapy and a fluoropyrimidine chemotherapy can further improve survival in patients with previously untreated HER2 positive metastatic gastric cancer.” ENHERTU is currently approved in more than 65 countries in the second-line or third-line metastatic setting of HER2 positive gastric cancer based on DESTINY-Gastric01 , a randomized phase 2 trial, and DESTINY-Gastric02 and DESTINY-Gastric06 , two single-arm phase 2 trials. KEYTRUDA ® is a registered trademark of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. About DESTINY-Gastric05 DESTINY-Gastric05 is a global, multicenter, randomized, open-label, phase 3 trial evaluating the efficacy and safety of ENHERTU (5.4 mg/kg) in combination with a fluoropyrimidine-based chemotherapy (5-FU or capecitabine) and Merck’s (known as MSD outside of the US and Canada) anti-PD-1 therapy KEYTRUDA ® (pembrolizumab) versus trastuzumab in combination with platinum-based chemotherapy (cisplatin plus 5-FU or oxaliplatin plus capecitabine) and pembrolizumab in approximately 576 previously untreated patients with unresectable, locally advanced or metastatic HER2 positive (IHC 3+ or IHC 2+/ISH+) gastric or GEJ cancer with PD-L1 CPS ≥1. The primary endpoint is progression-free survival (PFS) as assessed by blinded independent central review. The key secondary endpoint is overall survival. Additional secondary endpoints include PFS as assessed by investigator, objective response rate, duration of response and safety. An exploratory cohort of 150 patients with PD-L1 CPS <1 will be randomized to either ENHERTU plus fluoropyrimidine (5-FU or capecitabine) or trastuzumab plus platinum-based chemotherapy (cisplatin plus 5-FU or oxaliplatin plus capecitabine). DESTINY-Gastric05 will enroll patients across multiple sites in Asia, Europe, North America and South America. For more information about the trial, visit ClinicalTrials.gov . About HER2 Positive Gastric Cancer Gastric (stomach) cancer is the fifth most common cancer worldwide and the fifth leading cause of cancer-related death. 4 Approximately one million cases were diagnosed in 2022. 4 Gastric cancer is associated with a poor prognosis, particularly in advanced stages of the disease where the five-year survival rate is 5% to 10%. 1 HER2 is a tyrosine kinase receptor growth-promoting protein expressed on the surface of many types of tumors, including gastric cancer. 5 Approximately one in five gastric cancers globally are HER2 positive. 5,6 Recommended first-line treatment for HER2 positive advanced gastric cancer with PD-L1 CPS ≥1 is trastuzumab in combination with platinum-based chemotherapy (cisplatin plus 5-FU or oxaliplatin plus capecitabine) and pembrolizumab. 2,3 In patients with PD-L1 CPS <1 recommended first-line treatment is trastuzumab plus platinum-based chemotherapy (cisplatin plus 5-FU or oxaliplatin plus capecitabine). 2 New treatment strategies, including additional HER2 directed treatment options, are needed to continue to improve survival in patients with previously untreated advanced gastric cancer. 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 75 countries 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 75 countries 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 the U.S. 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 an FDA 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 50 countries 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 65 countries worldwide for the treatment of adult patients with locally advanced or metastatic HER2 positive (IHC 3+ or IHC 2+/ISH+) gastric or gastroesophageal junction 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 Brazil, Israel, Russia and the U.S. 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 monotherapy across multiple HER2 targetable cancers. Trials in combination with other anticancer treatments, such as immunotherapy, also are underway. About the Daiichi Sankyo and AstraZeneca Collaboration Daiichi Sankyo and AstraZeneca entered into a global collaboration to jointly develop and commercialize ENHERTU in March 2019 and DATROWAY ® in July 2020 , except in Japan where Daiichi Sankyo maintains exclusive rights for each ADC. Daiichi Sankyo is responsible for the manufacturing and supply of ENHERTU and DATROWAY. About the ADC Portfolio of Daiichi Sankyo The Daiichi Sankyo ADC portfolio consists of seven ADCs in clinical development crafted from two distinct ADC technology platforms discovered in-house by Daiichi Sankyo. The ADC platform furthest in clinical development is Daiichi Sankyo’s DXd ADC Technology where each ADC consists of a monoclonal antibody attached to a number of topoisomerase I inhibitor payloads (an exatecan derivative, DXd) via tetrapeptide-based cleavable linkers. The DXd ADC portfolio currently consists of ENHERTU, a HER2 directed ADC, and DATROWAY, a TROP2 directed ADC, which are being jointly developed and commercialized globally with AstraZeneca. Patritumab deruxtecan (HER3-DXd), a HER3 directed ADC, ifinatamab deruxtecan (I-DXd), a B7-H3 directed ADC, and raludotatug deruxtecan (R-DXd), a CDH6 directed ADC, are being jointly developed and commercialized globally with Merck & Co., Inc, Rahway, NJ, USA. DS-3939, a TA-MUC1 directed ADC, is being developed by Daiichi Sankyo. The second Daiichi Sankyo ADC platform consists of a monoclonal antibody attached to a modified pyrrolobenzodiazepine (PBD) payload. DS-9606, a CLDN6 directed PBD ADC, is the first of several planned ADCs in clinical development utilizing this platform. Ifinatamab deruxtecan, patritumab deruxtecan, raludotatug deruxtecan, DS-3939 and DS-9606 are investigational medicines that have not been approved for any indication in any country. Safety and efficacy have not been established. Please see accompanying full Prescribing Information , including Boxed WARNINGS, and Medication Guide . About Daiichi Sankyo Daiichi Sankyo is an innovative global healthcare company contributing to the sustainable development of society that discovers, develops and delivers new standards of care to enrich the quality of life around the world. With more than 120 years of experience, Daiichi Sankyo leverages its world-class science and technology to create new modalities and innovative medicines for people with cancer, cardiovascular and other diseases with high unmet medical need. For more information, please visit www.daiichisankyo.com . References 1 Casamayor M, et al. Ecancermedicalscience .2018;12:883. 2 NCCN Clinical Practice Guidelines. Gastric Cancer . V.1.2025. Accessed March 2025. 3 ESMO. Gastric Cancer Living Guidelines , v 33.10. October 2022. Accessed March 2025. 4 Globocan 2022. Stomach Cancer . Accessed March 2025. 5 Abrahao-Machado LF, et al. World J Gastroenterol . 2016;22(19):4619-25. 6 Iqbal N, et al. Mol Biol Int . 2014:852748. SOURCE: Daiichi Sankyo

100+创始人齐聚海南，对话“先行先试”政策机会，共探 CGT全产业发展之路，欢迎报名！从2020年开始，乳腺癌发病率超过了肺癌发病率，成为全球第一大恶性肿瘤，是药企必争之地。罗氏曾凭借HER2单抗——曲妥珠单抗、帕妥珠单抗、HER2 ADC药物T-DM1（恩美曲妥珠单抗）等，使乳腺癌患者的生存获益显著提高，自己也成为该领域的主导者。不过花无百日红，随着核心产品迎来专利悬崖，T-DM1被DS-8201头对头击败，罗氏在乳腺癌领域的辉煌逐渐成为过去式。在后续一众虎视眈眈的围猎者中，第一三共和阿斯利康是其中的佼佼者。1DS-8201横空出世，重塑乳腺癌治疗体系作为日本百年药企，第一三共独有的DXd ADC技术平台已成为ADC新药开发的一面旗帜。其首款重磅ADC药物Enhertu（德曲妥珠单抗，DS-8201）的横空出世，更是重新点燃了全球ADC药物的研发热情。德曲妥珠单抗是一款靶向HER2的抗体偶联药物（ADC），由第一三共研发，并由第一三共和阿斯利康共同开发和商业化。HER2是一种酪氨酸激酶受体促生长蛋白，在多种肿瘤细胞表面均有表达。作为一款HER2靶向ADC，德曲妥珠单抗采用第一三共独有的DXd ADC技术设计，由靶向HER2的人源化单克隆抗体通过四肽可裂解连接子与拓扑异构酶1抑制剂（喜树碱类衍生物，DXd）有效载荷连接组成。自2019年获FDA批准上市以来（用于治疗接受过2种或以上抗HER2疗法的治疗的无法切除或转移性HER2阳性乳腺癌患者），德曲妥珠单抗就不断书写它的传奇，并一步步重塑乳腺癌治疗格局。首次惊艳业界的是与恩美曲妥珠单抗的头对头随机对照研究。DESTINY-Breast03是首个头对头比较德曲妥珠单抗和恩美曲妥珠单抗在 HER2 阳性晚期乳腺癌二线治疗中疗效的 Ⅲ 期临床研究。在2022 年圣安东尼奥国际乳腺癌研讨会（SABCS）上公布的研究结果显示，德曲妥珠单抗组无进展生存期（PFS）获益明显（28.8 个月 vs 6.8 个月），约为恩美曲妥珠单抗组的 4 倍，并且降低患者疾病进展或死亡风险67%。2022年5月，德曲妥珠单抗扩展适应症获美FDA批准，用于治疗无法切除或转移性HER2+乳腺癌患者，这些患者曾经接受过一种抗HER2靶向疗法的治疗。德曲妥珠单抗重塑了HER2+乳腺癌的二线治疗标准。随后的DESTINY-Breast04研究则更进一步，将HER2低表达（IHC 1+或2+/ISH阴性）乳腺癌确立为新的治疗亚型，开创了HER2低表达晚期乳腺癌治疗的新时代。研究结果显示，在激素受体（HR）阳性/HER2低表达乳腺癌患者中，德曲妥珠单抗组的中位PFS绝对值较化疗组延长了近5个月（10.1个月 vs 5.4个月，HR=0.51，95%CI：0.40-0.64）；中位总生存期（OS）也显著延长（23.9个月 vs 17.5个月，HR=0.64，95%CI：0.48-0.86）；德曲妥珠单抗组客观缓解率（ORR）达52.6%，而化疗组仅为16.3%。基于DESTINY-Breast04研究的出色结果，德曲妥珠单抗获得了国内外权威指南的一致推荐。美国NCCN乳腺癌指南（2022.V4版）将“HER2低表达乳腺癌（IHC 1+或IHC 2+/ISH-）”作为一种全新的治疗分型，将德曲妥珠单抗作为伴有内脏危象/内分泌难治HER2低表达乳腺癌的二线治疗方案。随后德曲妥珠单抗获批HER2低表达转移性乳腺癌适应症，使得乳腺癌治疗从传统的非阴即阳二分法时代迈入更加精准的三分法时代（阳性/低表达/阴性），不仅将受益人群扩大至60%-70%，更是推动整个抗HER2乳腺癌治疗模式的革新。据第一三共2024财年业绩，德曲妥珠单抗在HER2阳性乳腺癌二线治疗和HER2低表达乳腺癌适应症上，都实现了两位数的增长（德曲妥珠单抗2024全球销售额约34.77亿美元）。DESTINY-Breast系列研究还在继续。今年1月27日，FDA批准德曲妥珠单抗用于治疗不可切除或转移性、激素受体（HR）阳性且HER2低表达（IHC 1+或IHC 2+/ISH-）或超低表达（IHC 0但具有膜染色）的乳腺癌患者。这一批准基于DESTINY-Breast06研究，结果显示，在总人群中，德曲妥珠单抗相比标准治疗组，将中位PFS显著延长了5.1月（13.2个月 vs 8.1个月，HR=0.63，P<0.0001）；在HER2低表达患者亚组中，德曲妥珠单抗相比标准治疗组，中位PFS显著延长（13.2个月 vs 8.1个月，HR=0.62，P<0.0001），OS达到12个月的比例更高（87.6% vs 81.7%，HR=0.83）；在HER2超低表达患者亚组中，德曲妥珠单抗展现出与HER2低表达亚组相似的获益趋势，相比标准治疗组，中位PFS显著延长（13.2个月 vs 8.3个月，HR=0.78），OS达到12个月的比例更高（84.0% vs 78.7%，HR=0.75）。至此，德曲妥珠单抗从HER2阳性到HER2低表达、超低表达，都已积累了循证医学证据，重新塑造了乳腺癌治疗格局。2阿斯利康不语，只一味卷自己在乳腺癌治疗领域，阿斯利康是不能被忽视的存在。阿斯利康瞄准HR+乳腺癌患者这一大群体，陆续推出了他莫昔芬、戈舍瑞林、阿那曲唑和氟维司群四款内分泌治疗基石药物，并不断在此基础上超越自己。以经典药物氟维司群（fulvestrant）为例，这是一款选择性雌激素受体降解剂（SERD），其通过与癌细胞表面的ER相结合，降低ER的稳定性，诱导它们被细胞正常的蛋白降解机制降解，从而降低雌激素受体水平，抑制癌细胞的生长。其优势在于能够更全面地抑制雌激素受体的功能，并且可能解决雌激素受体突变产生的耐药性。2002年4月，Faslodex（氟维司群）获FDA批准上市，用于雌激素治疗（如他莫昔芬）后疾病进展的绝经后乳腺癌患者。作为全球首款SERD药物，氟维司群可将达到总生存期5年的晚期乳腺癌患者的比例，由22.5%提升至50%。在二十年的时间中，氟维司群独占SERD市场，销售峰值达到10.28亿美元。不足的是，氟维司群只能肌肉注射给药，生物利用度低且可及性欠佳。所以业界开始追求效果更强、可及性更好、极具替代潜力的SERD口服药，不过，这一路走来并不顺利。2022年，赛诺菲的SERD口服药Amcenestrant在用于局部晚期或转移性HR+/HER2-乳腺癌患者的II期临床研究，以及联合CDK4/6抑制剂哌柏西利用于HR+/HER2-晚期乳腺癌的III期研究均失败。赛诺菲遂终止Amcenestrant项目的所有临床试验。同一年，罗氏宣布其SERD口服药Giredestrant在II期研究中未能达到PFS主要终点，OS尚不成熟。2023年，在经历14年临床开发后，美纳里尼集团旗下子公司美纳里尼集团的ORSERDU（Elacestrant，艾拉司群）获FDA批准上市，用于治疗局部晚期或转移性乳腺癌的绝经后女性或者成年男性，患者具有HR+/HER2-和ESR1突变，并且接受了至少一种内分泌治疗后病情出现进展。艾拉司群成为首个成功上市的SERD口服药物。看来，SERD口服药的研发远不如想象般容易。幸运的是，阿斯利康近日也传来好消息。2月26日，阿斯利康宣布，其SERD口服药物camizestrant在治疗HR+局部进展或转移性乳腺癌患者的III期SERENA-6临床研究中达到主要终点。即camizestrant 联合CDK4/6抑制剂在PFS的主要终点方面显示出具有统计学意义和临床意义的改善。该试验新颖之处在于，利用ctDNA监测来识别患者的内分泌耐药性早期迹象和ESR1突变的出现。ESR1基因突变是内分泌耐药的关键驱动因素，大约30%的内分泌敏感HR+疾病患者在一线治疗期间出现ESR1突变。SERENA-6研究表明，在检测到ESR1突变（尚无疾病进展）后，从芳香化酶抑制剂（阿那曲唑或来曲唑）转换为camizestrant联合CDK4/6抑制剂，可以延缓疾病进展并延长一线治疗的益处。至此，Camizestrant成为了首个证明与CDK4/6抑制剂联用时具有一线治疗获益的新一代SERD口服药物。在内分泌治疗领域，阿斯利康还率先推出了AKT抑制剂Capivasertib，该药于2023年11月，获FDA批准用于治疗HR+/HER2-局部晚期或转移性乳腺癌患者，这些患者在接受内分泌基础方案治疗过程中或之后疾病复发或进展。除在内分泌治疗不断进行自我迭代外，阿斯利康还推出了全球首款PARP抑制剂——奥拉帕利，也是首个利用DNA损伤修复通路缺陷来杀死癌细胞的靶向治疗药物。目前，在乳腺癌领域，奥拉帕利获批用于辅助治疗BRCA生殖系突变（gBRCAm）的HER2阴性高危早期乳腺癌患者，这是首款也是唯一一款获得批准治疗BRCA突变早期乳腺癌患者的疗法。在乳腺癌领域，阿斯利康产品已覆盖从早期到晚期、从绝经前到绝经后的HR+乳腺癌患者。3深耕技术平台 vs 多元合作创新，都有“美好的未来”第一三共在乳腺癌领域的异军突起，来自于对平台技术数十年磨一剑的专注。其ADC研发最早可追溯至20世纪80年代，经过40年迭代，其通过靶点选择及连接子、细胞毒药物的技术优化等，打造了独特的DXd-ADC技术平台，以实现精准靶向、高效低毒的技术优势。依托该平台，第一三共改良的DXd以10倍药物活性与极强的渗透细胞膜的能力，能够更好地发挥“旁观者效应”，这也是德曲妥珠单抗对于HER2低表达乳腺癌有优异疗效的关键因素。除德曲妥珠单抗之外，第一三共还布局了6款ADC药物，包括Dato-DXd（靶向TROP2 ADC），HER3-DXd（靶向HER3 ADC）， I-DXd（B7H3 ADC）和 R-DXd（CDH6 ADC） 等。其中Dato-DXd 由第一三共研发，第一三共和阿斯利康共同开发和商业化，是一款新型TROP2 ADC，具有抗肿瘤旁观者效应，且药物安全性更高。目前Dato-DXd已被日本药品与医疗器械管理局（PMDA）、FDA批准用于治疗既往接受过化疗和内分泌治疗的不可切除或转移性HR+/HER2阴性（IHC 0、IHC 1+或IHC 2+/ISH-）乳腺癌成人患者（商品名：Datroway）。此外，Dato-DXd的研究布局还拓展至三阴性乳腺癌（TNBC）的早期和晚期治疗领域。这类乳腺癌为雌激素受体（ER）阴性、孕激素受体（PR）阴性、以及HER2阴性，由于缺乏有效治疗靶点，且预后差，素有“乳腺癌之王”之称。对于TNBC，寻找新的有效疗法刻不容缓。第一三共和阿斯利康已经启动多项III期临床研究评估Dato-DXd单药或联合疗法治疗TNBC的潜力。第一三共凭借独有的DXd-ADC技术平台，在乳腺癌治疗领域后来居上，用创新实力重新定义疾病分类，重塑了乳腺癌治疗体系。阿斯利康则通过自研和外部合作，在乳腺癌领域成功搭建出了一个有规模有层次的产品管线。从他莫昔芬到氟维司群，从奥拉帕利到Capivasertib，再从氟维司群到Camizestrant，阿斯利康的产品覆盖多个前沿靶点，同时在现有药物基础上不断改良升级，占领创新高地，实现治疗场景全覆盖。对比第一三共和阿斯利康，两家药企虽然模式不同，但都心系研发，最终印证了创新突破与商业的共振逻辑。大浪淘沙，乳腺癌药物市场虽大，最终也只能奖赏专注研发、不断自我超越的真创新药企。参考文献：1.Latest global cancer data: Cancer burden rises to 19.3 million new cases and 10.0 million cancer deaths in 2020. Retrieved Nov 16 ,2020,fromhttps://www.iarc.who.int/faq/latest-global-cancer-data-2020-qa/.2.Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer. The New England Journal of Medicine. 2022; 387(1):9-20.3.Curigliano G, Hu XC, Dent R, et al. Trastuzumab deruxtecan (T-DXd) vs physicians choice of chemotherapy (TPC) in patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)-low or HER2-ultralow metastatic breast cancer (mBC) with prior endocrine therapy (ET): Primary results from DESTINY-Breast06 (DB-06). 2024 ASCO. LBA1000.4.https://www.daiichisankyo.com/files/news/pressrelease/pdf/202412/20241227_E.pdf.