Sponsor: AstraZeneca (industry)
Phase: 3
Start date: April 11, 2024
Planned enrollment: 675
Datopotamab deruxtecan (Dato-DXd; DS-1062; marketed as Datroway) is a TROP2-directed antibody–drug conjugate developed for solid tumors. It is no longer solely investigational: in the United States it is approved for selected patients with HR-positive/HER2-negative or triple-negative breast cancer and, under accelerated approval, previously treated EGFR-mutated non-small-cell lung cancer (NSCLC). Studies in other disease settings and treatment combinations remain ongoing. (fda.gov)
Dato-DXd comprises a humanized anti-TROP2 IgG1 antibody connected through a cleavable linker to DXd, a potent exatecan-derived topoisomerase-I inhibitor. After binding TROP2 and internalization, lysosomal processing releases DXd, causing DNA damage and apoptosis. Preclinical evidence also supports a bystander effect against neighboring cells and induction of features associated with immunogenic cell death. (pmc.ncbi.nlm.nih.gov)
The characteristic toxicities include stomatitis/oral mucositis, nausea, ocular-surface reactions, alopecia and fatigue. Interstitial lung disease/pneumonitis is an important, potentially fatal risk requiring monitoring and treatment interruption when suspected. (pubmed.ncbi.nlm.nih.gov)
In TROPION-Breast01, grade 3 or higher treatment-related adverse events occurred in 20.8% with Dato-DXd versus 44.7% with chemotherapy; treatment-related oral mucositis/stomatitis occurred in 57.2%, ocular-surface events in 43.9%, and adjudicated drug-related pneumonitis in 3.9%, including one fatal event. In TROPION-Lung01, grade 3 or higher treatment-related events occurred in 25.6% versus 42.1% with docetaxel, while drug-related pneumonitis was more frequent with Dato-DXd (8.8% versus 4.1%). (ascopubs.org)
Last updated: Sep 2026
Rilvegostomig (AZD2936) is an investigational bispecific immune-checkpoint antibody being developed for solid tumors, most extensively studied in non-small-cell lung cancer (NSCLC). Clinical evidence remains preliminary and largely comes from the nonrandomized phase I/II ARTEMIDE-01 trial; randomized phase III NSCLC studies are ongoing. (pubmed.ncbi.nlm.nih.gov)
Rilvegostomig is a humanized IgG1 antibody that simultaneously targets PD-1 and TIGIT, inhibitory receptors found on T cells and natural killer cells. Dual blockade is intended to restore antitumor immune activity more effectively than inhibition of either pathway alone. Its Fc region contains three mutations designed to minimize Fc-mediated immune-effector activity. (ascopubs.org)
In checkpoint-inhibitor–experienced, PD-L1-positive advanced NSCLC, ARTEMIDE-01 established 750 mg intravenously every three weeks as the recommended phase II dose. Among patients treated at this dose, the objective response rate (ORR) was 5.6%, the six-month disease-control rate was 31.5%, and median progression-free survival (PFS) was 3.8 months. (pubmed.ncbi.nlm.nih.gov)
Updated results in 65 checkpoint-inhibitor–naïve patients receiving 750 mg every three weeks showed:
These single-arm results cannot establish whether rilvegostomig is superior to currently available checkpoint inhibitors. (annalsofoncology.org)
In 83 checkpoint-inhibitor–experienced patients, 54.2% experienced a treatment-related adverse event, including 8.4% with grade 3 events; no dose-limiting toxicities were observed, and 2.4% discontinued because of treatment-related toxicity. Immune-mediated adverse events occurred in 18.1%. (pubmed.ncbi.nlm.nih.gov)
Among the 65 checkpoint-inhibitor–naïve patients in the later analysis, grade 3 treatment-related adverse events occurred in 12.3%, treatment-related discontinuations in 3.1%, and no grade 4 or 5 treatment-related events were reported. (annalsofoncology.org)
Last updated: Sep 2026
Goal: Determine whether datopotamab deruxtecan (Dato-DXd) plus rilvegostomig or rilvegostomig alone improves first-line outcomes compared with pembrolizumab in advanced non-squamous NSCLC with high PD-L1 expression.
Patients: Adults with unresectable stage IIIB/IIIC or metastatic non-squamous NSCLC, PD-L1 expression in at least 50% of tumor cells, no actionable genomic alteration with an available first-line targeted therapy, measurable disease, and ECOG performance status 0–1. Prior systemic treatment for advanced disease is excluded, as are clinically significant interstitial lung disease or pneumonitis and certain uncontrolled illnesses.
Design: Global, randomized, open-label, three-arm phase III trial. The primary analyses assess progression-free and overall survival in the TROP2 biomarker-positive population.
Treatments: Participants receive intravenous Dato-DXd plus rilvegostomig, rilvegostomig alone, or pembrolizumab alone on day 1 of each 21-day cycle. Dato-DXd is a TROP2-directed antibody–drug conjugate that delivers a topoisomerase-I inhibitor payload to tumor cells. In previously treated non-squamous NSCLC, Dato-DXd improved progression-free survival versus docetaxel in a prespecified subgroup analysis; its efficacy in this first-line combination remains unproven. Rilvegostomig is an investigational bispecific antibody targeting PD-1 and TIGIT to enhance antitumor immune activity. In a single-arm study of checkpoint-inhibitor–naïve NSCLC with PD-L1 expression of at least 50%, its objective response rate was 61.8%; that result does not establish superiority to pembrolizumab. Pembrolizumab is an established PD-1–blocking first-line treatment for eligible patients with high-PD-L1 NSCLC.
Outcomes: Primary endpoints are blinded independent central review–assessed RECIST 1.1 progression-free survival and overall survival in TROP2 biomarker-positive participants. Secondary measures include progression-free and overall survival in the full analysis set, objective response, duration of response, second progression-free survival, patient-reported symptoms and functioning, pharmacokinetics, and immunogenicity. Adverse events and tolerability are also assessed.
Burden on patient: Moderate: all arms require an infusion-center visit every three weeks, with additional visits or procedures for imaging, laboratory monitoring, and patient-reported questionnaires. Tumor tissue is required for PD-L1, TROP2, and other biomarker testing; pharmacokinetic and immunogenicity assessments add blood sampling. The combination arm may require closer monitoring for Dato-DXd–associated oral, ocular, and pulmonary toxicity. The protocol information does not specify scan frequency or require a new biopsy, so the additional burden beyond usual cancer care cannot be quantified precisely.
Last updated: Sep 2026
Caution: ClinicalTrials.gov appears to have newer eligibility criteria than the version saved here. Review the current criteria in ClinicalTrials.gov.
Inclusion Criteria:
* Histologically or cytologically documented non-squamous NSCLC.
* Stage IIIB or IIIC or Stage IV metastatic NSCLC (according to Edition 8 of the AJCC staging manual) not amenable to curative surgery or definitive chemoradiation.
* Absence of sensitising EGFR mutations, and ALK and ROS1 rearrangements, and absence of documented local test result for any other known genomic alteration for which there are locally approved and available targeted first-line therapies.
* Must provide tumor sample to determine PD-L1 status, TROP2 status and other biomarkers.
* Known tumour PD-L1 expression status defined as TC ≥ 50%
* At least one lesion, not previously irradiated that qualifies as a RECIST 1.1 target lesion at baseline
* ECOG performance status of 0 or 1
* Adequate bone marrow reserve and organ function within 7 days before the first dose of study intervention
Exclusion Criteria:
* Prior systemic therapy for advanced/metastatic NSCLC.
* Squamous cell histology, or predominantly squamous cell histology NSCLC; mixed small cell lung cancer; NSCLC histology, sarcomatoid variant.
* History of another primary malignancy within 3 years
* Active or prior documented autoimmune or inflammatory disorders (with exceptions)
* Any evidence of severe or uncontrolled systemic diseases, including, but not limited to active bleeding diseases, active infection, active ILD/pneumonitis, cardiac disease.
* Has clinically significant third-space fluid retention (for example pleural effusion) and is not amenable for repeated drainage.
* History of non-infectious ILD/pneumonitis that required steroids, has current ILD/pneumonitis, or has suspected ILD/pneumonitis that cannot be ruled out by imaging at screening
* Has significant pulmonary function compromise, as determined by the investigator
* Spinal cord compression, or brain metastases unless participant treated and no longer symptomatic, radiologically stable, and who require no treatment with corticosteroids or anticonvulsants.
* History of leptomeningeal carcinomatosis
* Known clinically significant corneal disease
* Active infection with TB, HBV, HCV, Hepatitis A, or known HIV infection that is not well controlled
* History of active primary immunodeficiency
Blacktown, 2148, Australia
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Kingwood, Texas, 77339, United States
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Odessa, Texas, 79761, United States
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Tacoma, Washington, 98405, United States
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Vancouver, Washington, 98684, United States
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Wenatchee, Washington, 98801, United States
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Appleton, Wisconsin, 54911, United States
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Vĩnh Yên, 280000, Vietnam
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Ho Chi Minh City, 700000, Vietnam
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Hà Nội, 100000, Vietnam
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Da Nang, 550000, Vietnam
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Changchun, 130000, China
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Berlin, 10249, Germany
No email / No phone
Status: Not yet recruiting
Essen, 45136, Germany
No email / No phone
Status: Not yet recruiting
München, 81925, Germany
No email / No phone
Status: Not yet recruiting
Székesfehérvár, 8000, Hungary
No email / No phone
Status: Not yet recruiting
Gyöngyös - Mátraháza, 3200, Hungary
No email / No phone
Status: Not yet recruiting
Gyula, 5700, Hungary
No email / No phone
Status: Not yet recruiting
Surat, 395002, India
No email / No phone
Status: Not yet recruiting
Matsusaka-shi, 515-8544, Japan
No email / No phone
Status: Not yet recruiting
Barcelona, 08041, Spain
No email / No phone
Status: Not yet recruiting
Newport Beach, California, 92663, United States
No email / No phone
Status: Not yet recruiting
Orlando, Florida, 32806, United States
No email / No phone
Status: Not yet recruiting
Atlanta, Georgia, 30303, United States
No email / No phone
Status: Not yet recruiting
Paducah, Kentucky, 42003, United States
No email / No phone
Status: Not yet recruiting
Greenville, North Carolina, 27834, United States
No email / No phone
Status: Not yet recruiting
Midlothian, Virginia, 23114, United States
No email / No phone
Status: Not yet recruiting
Ho Chi Minh City, 700000, Vietnam
No email / No phone
Status: Not yet recruiting
Hanoi, 100000, Vietnam
No email / No phone
Status: Not yet recruiting
Melbourne, 3000, Australia
No email / No phone
Status: Withdrawn
Anderlecht, 1070, Belgium
No email / No phone
Status: Withdrawn
Winnipeg, Manitoba, R3E 0V9, Canada
No email / No phone
Status: Withdrawn
Newmarket, Ontario, L3Y 2P9, Canada
No email / No phone
Status: Withdrawn
Toronto, Ontario, M4N 3M5, Canada
No email / No phone
Status: Withdrawn
Hefei, 230031, China
No email / No phone
Status: Withdrawn
Düsseldorf, 40489, Germany
No email / No phone
Status: Withdrawn
Gera, 07548, Germany
No email / No phone
Status: Withdrawn
Gyöngyös, 3200, Hungary
No email / No phone
Status: Withdrawn
Marg Jaipur, 302004, India
No email / No phone
Status: Withdrawn
Salamanca, 37007, Spain
No email / No phone
Status: Withdrawn
London, SE1 9RT, United Kingdom
No email / No phone
Status: Withdrawn
Orlando, Florida, 32827, United States
No email / No phone
Status: Withdrawn
Atlanta, Georgia, 30342, United States
No email / No phone
Status: Withdrawn
Traverse City, Michigan, 49684, United States
No email / No phone
Status: Withdrawn
Bozeman, Montana, 59715, United States
No email / No phone
Status: Withdrawn
Reno, Nevada, 89502, United States
No email / No phone
Status: Withdrawn
Columbus, Ohio, 43210, United States
No email / No phone
Status: Withdrawn
Portland, Oregon, 97213, United States
No email / No phone
Status: Withdrawn
Knoxville, Tennessee, 37920, United States
No email / No phone
Status: Withdrawn
Chattanooga, Tennessee, 37404, United States
No email / No phone
Status: Withdrawn
Houston, Texas, 77030, United States
No email / No phone
Status: Withdrawn
Huế, 530000, Vietnam
No email / No phone
Status: Withdrawn
Vinh, 460000, Vietnam
No email / No phone
Status: Withdrawn
Ho Chi Minh City, 700000, Vietnam
No email / No phone
Status: Withdrawn
Koblenz, 56068, Germany
No email / No phone
Status: SUSPENDED
Inverness, IV2 3UJ, United Kingdom
No email / No phone
Status: SUSPENDED
Cheltenham, GL53 7AN, United Kingdom
No email / No phone
Status: SUSPENDED
Voorhees Township, New Jersey, 08043, United States
No email / No phone
Status: SUSPENDED
Houston, Texas, 77090, United States
No email / No phone
Status: SUSPENDED