Two antibody‑drug conjugates—AstraZeneca/Daiichi Sankyo’s Datroway and Gilead’s Trodelvy—delivered competing Phase 3 results at ESMO that both showed benefits versus chemotherapy in first‑line metastatic triple‑negative breast cancer (TNBC) patients who are ineligible for immune checkpoint inhibitors. Presentations placed the trials back‑to‑back, enabling direct discussion of comparative efficacy and safety. The sponsors reported reductions in risk of progression or death and improvements in progression‑free survival across different trial populations. Clinicians at the meeting emphasized the immediate challenge of selecting between ADCs for patients lacking immunotherapy biomarkers. Payers and guideline panels will face near‑term pressure to define preferred options as follow‑up data mature and as detailed subgroup analyses are published.