At ESMO, AstraZeneca/Daiichi Sankyo’s Datroway and Gilead’s Trodelvy both reported Phase 3 results for advanced triple-negative breast cancer, setting up a head-to-head efficacy and positioning debate for ADCs in this indication. Both agents showed clinically meaningful activity in patient populations ineligible for checkpoint inhibitors, prompting clinicians to evaluate comparative efficacy, toxicity profiles and sequencing. The results raise questions about patient selection and how payers will value next-generation ADCs versus older chemotherapy regimens.