AstraZeneca and Daiichi Sankyo reported Datroway extended survival in patients with triple-negative breast cancer (TNBC) who were ineligible for immunotherapy, while Gilead’s Trodelvy continues to compete in the same setting. Presentations at ESMO 2025 delivered head-to-head data that clinicians and payers will weigh when choosing first-line options for PD‑L1–negative patients. The studies were presented at the European Society for Medical Oncology meeting; AstraZeneca and Daiichi highlighted a survival signal for their antibody‑drug conjugate (ADC) in a population with few alternatives. Gilead’s data for sacituzumab govitecan were disclosed in parallel, prompting comparative analyses among oncologists. Both ADCs target different antigens and have distinct toxicity profiles, creating a decision matrix that will influence regulatory filings, market access planning, and ongoing registrational strategies across regions. Expect debates on patient selection and sequencing in guideline committees and tumor boards.