AstraZeneca and Gilead presented head-to-head Phase 3 data at ESMO showing competing antibody-drug conjugates (ADCs) for metastatic triple-negative breast cancer (TNBC), creating a direct choice for clinicians treating patients ineligible for checkpoint inhibitors. AstraZeneca’s Datroway (with Daiichi Sankyo) and Gilead’s Trodelvy each reported efficacy versus chemotherapy in first-line settings for PD‑L1–negative tumors, with investigators and discussants parsing durability, safety and patient selection. The back‑to‑back presentations and a joint discussant session increased scrutiny on comparative benefit and on how payers and providers will sequence or prioritize ADC options.