Datopotamab Deruxtecan

1 INDICATIONS AND USAGE DATROWAY is a Trop-2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of: adult patients with locally advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) who have received prior EGFR-directed therapy and platinum-based chemotherapy. ( 1.1 ) This indication is approved under accelerated approval based on objective response rate and duration of response [see Clinical Studies (14.1) ] . Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trial. adult patients with unresectable or metastatic, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (IHC 0, IHC 1+ or IHC 2+/ISH-) breast cancer who have received prior endocrine-based therapy and chemotherapy for unresectable or metastatic disease. ( 1.2 ) 1.1 Locally Advanced or Metastatic EGFR-Mutated Non-Small Cell Lung Cancer (NSCLC) DATROWAY is indicated for the treatment of adult patients with locally advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) who have received prior EGFR-directed therapy and platinum-based chemotherapy. This indication is approved under accelerated approval based on objective response rate and duration of response [see Clinical Studies (14.1) ] . Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trial. 1.2 Unresectable or Metastatic, HR-Positive, HER2-Negative Breast Cancer DATROWAY is indicated for the treatment of adult patients with unresectable or metastatic, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (IHC 0, IHC 1+ or IHC 2+/ISH-) breast cancer who have received prior endocrine-based therapy and chemotherapy for unresectable or metastatic disease.

2 DOSAGE AND ADMINISTRATION Reconstitute DATROWAY with Sterile Water for Injection. ( 2.5 ) Dilute with 5% Dextrose Injection. ( 2.5 ) For intravenous infusion only. Do not administer as an intravenous push or bolus. DO NOT use Sodium Chloride Injection, USP. ( 2.5 ) Premedicate to reduce the risk of infusion reactions and nausea and vomiting. ( 2.3 ) The recommended dosage of DATROWAY is 6 mg/kg (up to a maximum of 540 mg for patients ≥90 kg) given as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity. ( 2.3 , 2.4 ) 2.1 Patient Selection Select patients with locally advanced or metastatic NSCLC for treatment with DATROWAY based on the presence of epidermal growth factor receptor (EGFR) mutations in tumor or plasma specimens [see Clinical Studies (14.1) ] . Testing may be performed at any time from initial diagnosis and does not need to be repeated once EGFR mutation status has been established. 2.2 Recommended Dosage The recommended dosage of DATROWAY is 6 mg/kg (up to a maximum of 540 mg for patients ≥90 kg) administered as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity. If a planned dose is delayed or missed, administer as soon as possible; do not wait until the next planned cycle. Adjust the schedule of administration to maintain a 3-week interval between doses. 2.3 Premedication, Concomitant Medications, and Required Eye Care Conduct an ophthalmic exam including visual acuity testing, slit lamp examination (with fluorescein staining), intraocular pressure, and fundoscopy at initiation of DATROWAY, annually while on treatment, at end of treatment, and as clinically indicated. Administer DATROWAY with the premedication and concomitant medications described in Table 1. Monitor patients for infusion-related reactions in a setting where cardiopulmonary resuscitation medication and equipment are available. Monitor patients for at least 1 hour for the first 2 cycles of DATROWAY infusions. If there are no infusion-related reactions observed, monitor patients for at least 30 minutes for all subsequent cycles of infusions. Table 1: Premedication and Concomitant Medications Premedication With or without systemic corticosteroid Examples (or equivalent) Timing of Treatment/Duration Eye drops [see Warnings and Precautions (5.2) ] Preservative-free lubricant eye drops Administer at least four times daily and as needed Mouthwash [see Warnings and Precautions (5.3) ] Steroid-containing mouthwash (dexamethasone oral solution 0.1 mg/mL) Administer four times daily and as needed Antihistamine [see Adverse Reactions (6.1) ] Diphenhydramine (25 to 50 mg) administered intravenously or orally Administer 30-60 minutes prior to each infusion Antipyretic [see Adverse Reactions (6.1) ] Acetaminophen (650 to 1,000 mg) administered intravenously or orally Administer 30-60 minutes prior to each infusion Antiemetics [see Adverse Reactions (6.1) ] 5-HT3 serotonin receptor antagonist or appropriate alternatives intravenously or oral Prior to each infusion and thereafter as needed 2.4 Dosage Modifications Dosage Modifications for Adverse Reactions The recommended dose reduction levels for adverse reactions are described in Table 2. Table 2: Recommended Dosage Reductions of DATROWAY for Adverse Reactions Dose Reductions Recommended Dose First 4 mg/kg (up to a maximum of 360 mg for patients ≥90 kg) Second 3 mg/kg (up to a maximum of 270 mg for patients ≥90 kg) Third Permanently discontinue Do not re-escalate the DATROWAY dose after a dose reduction. Permanently discontinue DATROWAY in patients who are unable to tolerate 3 mg/kg intravenously once every 3 weeks. The recommended dosage modifications and management of adverse reactions for DATROWAY are described in Table 3. Table 3: Dosage Modifications and Management of Adverse Reactions for DATROWAY Adverse Reaction Severity Toxicity grades are in accordance with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. Dosage Modifications Interstitial Lung Disease (ILD)/Pneumonitis [see Warnings and Precautions (5.1) ] Asymptomatic ILD/pneumonitis Grade 1 Withhold DATROWAY until ILD/pneumonitis is completely resolved, then: if resolved in ≤28 days, maintain current dose. if resolved in >28 days, reduce one dose level (see Table 2 ). Consider corticosteroids as soon as ILD/pneumonitis is suspected. Symptomatic ILD/pneumonitis Grade 2 or greater Permanently discontinue DATROWAY. Administer corticosteroids as soon as ILD/pneumonitis is suspected. Keratitis [see Warnings and Precautions (5.2) and Adverse Reactions (6.1) ] Nonconfluent superficial keratitis Monitor. Continue DATROWAY at current dose. Confluent superficial keratitis, a cornea epithelial defect, or 3-line or more loss in best corrected visual acuity Withhold DATROWAY until improved or resolved Restart DATROWAY at the same dose level or consider dose reduction (see Table 2 ). Corneal ulcer or stromal opacity or best corrected distance visual acuity 20/200 or worse Withhold DATROWAY until improved or resolved Restart DATROWAY at reduced dose level (see Table 2 ). Corneal perforation Permanently discontinue DATROWAY. Stomatitis [see Warnings and Precautions (5.3) ] Grade 1 Optimize prophylactic and supportive medications. Continue DATROWAY at current dose. Grade 2 Withhold DATROWAY until resolved to ≤Grade 1. Restart DATROWAY at the same dose level for first occurrence. Recurrence: consider restarting at reduced dose level (see Table 2 ). Grade 3 Withhold DATROWAY until resolved to ≤Grade 1. Restart DATROWAY at reduced dose level (see Table 2 ). Grade 4 Permanently discontinue DATROWAY. Infusion-Related Reactions (IRR) [see Adverse Reactions (6.1) ] Grade 1 Reduce DATROWAY infusion rate by 50% if IRR is suspected and monitor patient closely. Grade 2 Interrupt DATROWAY infusion and administer supportive care medications. If the event resolves or improves to Grade 1, restart the infusion at 50% rate. Administer all subsequent infusions at the reduced rate. Grade 3 or 4 Permanently discontinue DATROWAY. Other Non-Hematologic Adverse Reactions [see Adverse Reactions (6.1) ] Grade 3 Withhold dose until resolved to ≤Grade 1 or baseline Restart DATROWAY at reduced dose level (see Table 2 ). Grade 4 Permanently discontinue DATROWAY. 2.5 Preparation and Administration Reconstitute and further dilute DATROWAY prior to intravenous infusion. Use appropriate aseptic technique. DATROWAY (datopotamab deruxtecan-dlnk) is a hazardous drug. Follow applicable special handling and disposal procedures. 1 Reconstitution Reconstitute immediately before dilution. More than one vial may be needed for a full dose. Calculate the dose (mg), the total volume of reconstituted DATROWAY solution required, and the number of vial(s) of DATROWAY needed [see Dosage and Administration (2.2) ]. Reconstitute each 100 mg vial using a sterile syringe to slowly inject 5 mL of Sterile Water for Injection into each vial to obtain a final concentration of 20 mg/mL. Swirl the vial gently until completely dissolved. Do not shake. If not used immediately, refrigerate the reconstituted DATROWAY solution in the original vial at 2ºC to 8ºC (36°F to 46°F) for up to 24 hours from the time of reconstitution. Protect the vial from light. Do not freeze. The product does not contain a preservative. Discard unused reconstituted DATROWAY after 24 hours refrigerated. Dilution Withdraw the calculated amount from the vial(s) using a sterile syringe. Inspect for particulate matter and discoloration prior to administration. The reconstituted solution should be clear and colorless to light yellow. Do not use if visible particles are observed or if the solution is cloudy or discolored. Dilute the calculated volume of reconstituted DATROWAY in an infusion bag containing 100 mL of 5% Dextrose Injection. DO NOT use Sodium Chloride Injection. DATROWAY is compatible with an infusion bag made of polyvinylchloride or polyolefin (polypropylene or copolymer of ethylene and propylene). Gently invert the infusion bag to thoroughly mix the solution. Do not shake. Cover the infusion bag to protect from light. If not used immediately, store at room temperature at up to 25ºC (77°F) for up to 4 hours including preparation or in a refrigerator at 2ºC to 8ºC (36°F to 46°F) for up to 24 hours. Do not freeze. Discard any unused portion left in the vial. Administration The maximum time from reconstitution of the vial through the end of administration should not exceed 24 hours. Discard if storage time exceeds these limits. If the prepared infusion solution was stored refrigerated at 2ºC to 8ºC (36°F to 46°F), allow the solution to reach room temperature prior to administration, protected from light. Inspect for particulate matter and discoloration prior to administration. Administer DATROWAY as an intravenous infusion only with an infusion line and tubing set made of polyvinyl chloride, polybutadiene or low-density polyethylene. Administer DATROWAY with a 0.2-micron in-line polytetrafluoroethylene, polyethersulfone or nylon 66 filter. Do NOT administer as an intravenous push or bolus. Cover the infusion bag to protect from light during administration. Do not mix DATROWAY with other drugs or administer other drugs through the same intravenous line. Instruct the patient to hold ice chips or ice water in the mouth throughout the infusion of DATROWAY. First infusion: Administer infusion over 90 minutes. Observe patients during the infusion and for at least 1 hour following the initial dose for signs or symptoms of infusion-related reactions. Second Infusion: If first infusion was tolerated, administer second infusion over 30 minutes. Observe patients during the infusion and for at least 1 hour after infusion. Subsequent Infusions: Administer infusion over 30 minutes if prior infusions were tolerated. Observe patients during the infusion and for at least 30 min after infusion.

6 ADVERSE REACTIONS The following clinically significant adverse reactions are described elsewhere in the labeling: Interstitial Lung Disease/Pneumonitis [see Warnings and Precautions (5.1) ] Ocular Adverse Reactions [see Warnings and Precautions (5.2) ] Stomatitis [see Warnings and Precautions (5.3) ] The most common adverse reactions (≥20%), including laboratory abnormalities, in patients with: EGFR-mutated NSCLC were stomatitis, nausea, alopecia, fatigue, decreased hemoglobin, decreased lymphocytes, constipation, increased calcium, increased AST, decreased white blood cell count, increased lactate dehydrogenase, musculoskeletal pain, decreased appetite, increased ALT, and rash. ( 6.1 ) HR-positive, HER2-negative breast cancer were stomatitis, nausea, fatigue, decreased leukocytes, decreased calcium, alopecia, decreased lymphocytes, decreased hemoglobin, constipation, decreased neutrophils, dry eye, vomiting, increased ALT, keratitis, increased AST, and increased alkaline phosphatase. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Daiichi Sankyo, Inc. at 1-877-437-7763 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The pooled safety population described in WARNINGS AND PRECAUTIONS reflects exposure to DATROWAY in 927 patients as a single agent at 6 mg/kg administered as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity. This included 137 patients with NSCLC in TROPION-Lung05 [see Clinical Studies (14.1) ] , 297 patients with NSCLC in TROPION-Lung01 [see Clinical Studies (14.1) ] , 360 patients with HR-positive, HER2-negative breast cancer in TROPION-Breast01 [see Clinical Studies (14.2) ] , and 50 patients with NSCLC and 83 patients with breast cancer in TROPION-PanTumor01 (NCT03401385). Among 927 patients who received DATROWAY, 45% were exposed for 6 months or longer and 19% were exposed for greater than one year. In this pooled safety population, the most common (≥20%) adverse reactions were stomatitis (63%), nausea (52%), fatigue (45%), alopecia (38%), constipation (28%), decreased appetite (23%), rash (23%), vomiting (22%), and musculoskeletal pain (20%). In this pooled safety population, the most common (≥2%) Grade 3 or 4 laboratory abnormalities were decreased lymphocytes (9%) and decreased hemoglobin (3.5%). Locally Advanced or Metastatic EGFR-Mutated Non-Small Cell Lung Cancer TROPION-Lung05, TROPION-Lung01, TROPION-PanTumor01 The safety of DATROWAY was evaluated in 125 patients with EGFR-mutated NSCLC who received DATROWAY 6 mg/kg administered as an intravenous infusion once every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity in TROPION-Lung05 and TROPION-Lung01 [see Clinical Studies (14.1) ] as well as TROPION-PanTumor01 (NCT03401385). Among these patients, the median duration of treatment was 6.1 months (range 0.7 months to 41.7 months). The median age was 63 years (range: 36 to 81), 56% of patients were <65 years, 62% of patients were female; 66% were Asian, 26% were White, 0.8% were Black, 6% were other races; and 2.4% were of Hispanic ethnicity. Serious adverse reactions occurred in 26% of patients who received DATROWAY. Serious adverse reactions in >1% of patients who received DATROWAY were COVID-19 (4%), stomatitis (2.4%), and pneumonia (1.6%). Fatal adverse reactions occurred in 1.6% of patients who received DATROWAY, due to death not otherwise specified. Permanent discontinuation of DATROWAY due to an adverse reaction occurred in 8% of patients. Adverse reactions which resulted in permanent discontinuation of DATROWAY in >1% of patients included ILD/pneumonitis (2.4%) and abnormal hepatic function (1.6%). Dosage interruptions of DATROWAY due to an adverse reaction occurred in 43% of patients. Adverse reactions which required dosage interruption in >1% of patients included COVID-19 (13%), stomatitis (7%), fatigue (6%), pneumonia (4%), anemia (2.4%), amylase increased (2.4%), keratitis (2.4%), ILD/pneumonitis (1.6%), decreased appetite (1.6%), dyspnea (1.6%), rash (1.6%), and infusion-related reaction (1.6%). Dose reductions of DATROWAY due to an adverse reaction occurred in 26% of patients. Adverse reactions which required dose reduction in >1% of patients included stomatitis (14%), keratitis (1.6%), fatigue (1.6%), decreased weight (1.6%) and COVID-19 (1.6%). The most common (≥20%) adverse reactions, including laboratory abnormalities, were stomatitis, nausea, alopecia, fatigue, decreased hemoglobin, decreased lymphocytes, constipation, increased calcium, increased AST, decreased white blood cell count, increased lactate dehydrogenase, musculoskeletal pain, decreased appetite, increased ALT, and rash. Table 4: Adverse Reactions (≥10%) in Patients with Locally Advanced or Metastatic EGFR-Mutated NSCLC Who Received DATROWAY in TROPION-Lung05, TROPION-Lung01, and TROPION-PanTumor01 Adverse Reaction DATROWAY N=125 All Grades % Grades 3 or 4 % Events were graded using NCI CTCAE v5.0. Gastrointestinal disorders Stomatitis Includes other related terms 71 9 Nausea 50 0 Constipation 31 0 Vomiting 16 0.8 Diarrhea 12 0 Skin and subcutaneous tissue disorders Alopecia 49 0 Rash 20 0.8 Pruritus 12 0 General disorders and administration site conditions Fatigue Includes fatigue, asthenia, and malaise 42 6 Musculoskeletal and connective tissue disorders Musculoskeletal pain 22 0.8 Metabolism and nutrition disorders Decreased appetite 20 1.6 Infections and Infestations COVID-19 19 2.4 Respiratory, Thoracic, and Mediastinal Disorders Cough 18 0 Dyspnea 11 2.4 Eye disorders Dry eye 13 0 Keratitis Includes corneal disorder, corneal erosion, keratitis, punctate keratitis, and ulcerative keratitis 12 2.4 Injury, poisoning and procedural complications Infusion-related reaction 13 0 Nervous system disorders Headache 13 0 Clinically relevant adverse reactions occurring in <10% of patients who received DATROWAY included dry skin, blurred vision, abdominal pain, conjunctivitis, dry mouth, ILD/pneumonitis, skin hyperpigmentation, increased lacrimation, and visual impairment. Table 5: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with Locally Advanced or Metastatic EGFR-Mutated NSCLC Who Received DATROWAY in TROPION-Lung05, TROPION-Lung01, and TROPION-PanTumor01 Laboratory Abnormality Frequencies were based on NCI CTCAE v5.0 grade-derived laboratory abnormalities. DATROWAY The denominator used to calculate the rate varied from 115 to 124 based on the number of patients with a baseline value and at least one post-treatment value. All Grades % Grades 3 or 4 % Hematology Decreased hemoglobin 34 4.8 Decreased lymphocytes 32 11 Decreased white blood cell count 27 1.6 Chemistry Increased calcium 31 0 Increased AST 28 2.4 Increased lactate dehydrogenase 23 0 Increased ALT 20 2.4 Unresectable or Metastatic, HR-Positive, HER2-Negative Breast Cancer TROPION-Breast01 The safety of DATROWAY was evaluated in 360 patients with unresectable or metastatic HR-positive, HER2-negative (IHC 0, IHC1+ or IHC2+/ISH-) breast cancer who received at least one dose of DATROWAY 6 mg/kg in TROPION-Breast01 [see Clinical Studies (14.2) ] . DATROWAY was administered by intravenous infusion once every three weeks. The median duration of treatment was 6.7 months (range: 0.7 months to 16.1 months) for patients who received DATROWAY. Serious adverse reactions occurred in 15% of patients who received DATROWAY. Serious adverse reactions in >0.5% of patients who received DATROWAY were urinary tract infection (1.9%), COVID-19 infection (1.7%), ILD/pneumonitis (1.1%), acute kidney injury, pulmonary embolism, vomiting, diarrhea, hemiparesis, and anemia (0.6% each). Fatal adverse reactions occurred in 0.3% of patients who received DATROWAY and were due to ILD/pneumonitis. Permanent discontinuation of DATROWAY due to an adverse reaction occurred in 3.1% of patients. Adverse reactions which resulted in permanent discontinuation of DATROWAY in >0.5% of patients included ILD/pneumonitis (1.7%) and fatigue (0.6%). Dosage interruptions of DATROWAY due to an adverse reaction occurred in 22% of patients. Adverse reactions which required dosage interruption in >1% of patients included COVID-19 (3.3%), infusion-related reaction (1.4%), ILD/pneumonitis (1.9%), stomatitis (1.9%), fatigue (1.7%), keratitis (1.4%), acute kidney injury (1.1%), and pneumonia (1.1%). Dose reductions of DATROWAY due to an adverse reaction occurred in 23% of patients. Adverse reactions which required dose reduction in >1% of patients included stomatitis (13%), fatigue (3.1%), nausea (2.5%), and weight decrease (1.9%). The most common (≥20%) adverse reactions, including laboratory abnormalities, were stomatitis, nausea, fatigue, decreased leukocytes, decreased calcium, alopecia, decreased lymphocytes, decreased hemoglobin, constipation, decreased neutrophils, dry eye, vomiting, increased ALT, keratitis, increased AST, and increased alkaline phosphatase. Table 6: Adverse Reactions (≥10%) in Patients Who Received DATROWAY in TROPION-Breast01 Adverse Reactions DATROWAY N=360 Chemotherapy N=351 All Grades % Grades 3 or 4 % All Grades % Grades 3 or 4 % Events were graded using NCI CTCAE v5.0. Gastrointestinal Disorders Stomatitis Includes other related terms. 59 7 17 2.6 Nausea 56 1.4 27 0.6 Constipation 34 0.3 17 0 Vomiting 24 1.1 12 1.1 Diarrhea 11 0.6 19 1.4 Abdominal pain 11 0.6 15 1.4 General Disorders and Administration Site Conditions Fatigue Includes fatigue, asthenia, lethargy, malaise 44 4.2 40 3.7 Skin and Subcutaneous Tissue Disorders Alopecia 38 0 22 0 Rash 19 0 17 2.3 Eye Disorders Dry eye 27 0.8 13 0 Keratitis Includes corneal disorder, corneal erosion, corneal infiltrates, corneal lesion, corneal toxicity, injury corneal, keratitis, keratopathy, punctate keratitis, and ulcerative keratitis 24 1.1 10 0 Metabolism and Nutrition Disorders Decreased appetite 16 1.4 16 0.9 Infections and Infestations COVID-19 16 1.4 13 0.9 Respiratory, Thoracic, and Mediastinal Disorders Cough 15 0 10 0 Clinically relevant adverse reactions occurring in <10% of patients who received DATROWAY included infusion-related reactions (including bronchospasm), ILD/pneumonitis, headache, pruritus, dry skin, dry mouth, conjunctivitis, blepharitis, meibomian gland dysfunction, blurred vision, increased lacrimation, photophobia, visual impairment, skin hyperpigmentation, and madarosis. Table 7: Select Laboratory Abnormalities (≥20%) in Patients Who Received DATROWAY in TROPION-Breast01 Laboratory Abnormality DATROWAY The denominator used to calculate the rate varied from 264 to 359 based on the number of patients with a baseline value and at least one post-treatment value. Chemotherapy All Grades % Grades 3-4 % All Grades % Grades 3-4 % Frequencies were based on NCI CTCAE v5.0 grade-derived laboratory abnormalities. Hematology Decreased leukocytes 41 1.1 63 18 Decreased lymphocytes 36 9 42 11 Decreased hemoglobin 35 2.8 51 4.4 Decreased neutrophils 30 1.6 61 35 Chemistry Decreased calcium 39 1.4 43 1.2 Increased AST 23 1.9 28 0.9 Increased ALT 24 1.7 31 0.6 Increased alkaline phosphatase 23 0.6 20 0.6

12.3 Pharmacokinetics Datopotamab deruxtecan-dlnk and DXd exposure after the first dose of the approved recommended dosage of cycle 1 are provided in Table 8. Datopotamab deruxtecan-dlnk and released DXd maximum concentration (C max ) and area under the time-concentration curve (AUC) increases proportionally over a dose range of 4 mg/kg to 10 mg/kg (approximately 0.7 to 1.7 times the approved recommended dosage). No clinically significant datopotamab deruxtecan-dlnk accumulation occurs between cycles 1 and 3. Table 8: Datopotamab Deruxtecan-dlnk and DXd Mean (CV%) Exposure After the First Dose PK Parameter Datopotamab deruxtecan-dlnk DXd Abbreviations: C max =maximum concentration; AUC =area under the time-concentration curve C max 154 µg/mL (20%) 2.8 ng/mL (58%) AUC 671 µg*day/mL (31%) 18 ng*day/mL (43%) Distribution Datopotamab deruxtecan-dlnk mean steady state volume of distribution is 3.5 (23%) L. DXd plasma protein binding is approximately 98% and the blood-to-plasma concentration ratio is 0.6 in vitro. Elimination The datopotamab deruxtecan-dlnk median elimination half-life (t 1/2 ) is 4.8 days (1.0, 8.2) and the released DXd median apparent t 1/2 is approximately 5.5 days (3.2, 8.8). The estimated datopotamab deruxtecan-dlnk clearance is 0.6 (31.5%) L/day. Metabolism Datopotamab deruxtecan-dlnk undergoes intracellular cleavage by lysosomal enzymes to release DXd . The humanized Trop-2 IgG1 monoclonal antibody is expected to be degraded into small peptides and amino acids via catabolic pathways in the same manner as endogenous IgG. In vitro, DXd is primarily metabolized by CYP3A4. Specific Populations The mean volume of distribution and clearance of datopotamab deruxtecan-dlnk and DXd increase with increasing body weight (36 kg to 156 kg). No clinically significant differences in the pharmacokinetics of datopotamab deruxtecan-dlnk or DXd were observed based on age (26 to 86 years), race (Asian, White, or Black), sex, mild hepatic impairment (total bilirubin ≤ULN and any AST >ULN or total bilirubin >1 to 1.5 times ULN and any AST), or mild to moderate renal impairment (CLcr 30 to <90 mL/min). The pharmacokinetics of datopotamab deruxtecan-dlnk in patients with moderate hepatic impairment (total bilirubin >1.5 to 3 times ULN and any AST) was comparable to patients with normal hepatic function (total bilirubin and AST ≤ULN). The steady state average DXd AUC was 2.4-fold higher in patients with moderate hepatic impairment compared to patients with normal hepatic function. The effect of severe hepatic impairment (total bilirubin >3 times ULN and any AST) or severe renal impairment (CLcr <30 mL/min) on datopotamab deruxtecan-dlnk or DXd pharmacokinetics is unknown. Drug Interaction Studies Clinical Studies and Model-Informed Approaches No clinically significant differences in DXd pharmacokinetics were predicted when used concomitantly with itraconazole (strong CYP3A inhibitor) or ritonavir (dual OATP1B and CYP3A inhibitor). In Vitro Studies CYP450 Enzymes : DXd does not inhibit CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, or CYP3A and does not induce CYP1A2, CYP2B6, or CYP3A. UDP-Glucuronosyltransferase (UGT): DXd does not undergo significant metabolism by UGT enzymes. Transporters Systems : DXd is a substrate of OATP1B1, OATP1B3, MATE2-K, P-gp, MRP1, and BCRP. DXd does not inhibit OAT1, OAT3, OCT1, OCT2, OATP1B1, OATP1B3, MATE1, MATE2-K, P-gp, BCRP, or BSEP transporters.