AstraZeneca and Gilead presented rival antibody-drug conjugate (ADC) data at the European Society for Medical Oncology (ESMO), offering the first new first-line options in years for metastatic triple‑negative breast cancer (TNBC) patients ineligible for checkpoint inhibitors. Both companies tested ADCs against standard chemotherapy in Phase 3 trials and disclosed clinically meaningful efficacy signals that will force clinicians to choose between modalities. The back‑to‑back presentations and a shared discussant at ESMO intensified head‑to‑head scrutiny of endpoints, tolerability and patient selection. Data for Gilead’s sacituzumab govitecan (Trodelvy) and AstraZeneca/Daiichi Sankyo’s Datroway were parsed for response rates, progression metrics and safety profiles. Regulators and payers now face comparative-effectiveness questions as each firm pursues label expansion. ESMO disclosures also underscored operational differences between ADC platforms — linker/payload chemistry and target selection — that may shape sequencing and combination strategies. Ongoing subgroup and biomarker analyses were highlighted as essential to determine which patients derive the largest benefit.