ADC TOXICITY ATLAS
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Patritumab deruxtecan

Investigational
U3-1402; HER3-DXd; MK-1022; patritumab-DX-8951 conjugate
Sponsor
Daiichi Sankyo / Merck (MSD)
Indication
EGFR-mutated NSCLC (previously treated)
Target family
Receptor tyrosine kinase
RP2D dose
5.6 mg/kg
Q3WRP2D
01
Multi-organ toxicity

Fingerprint & organ drill-down

Also reported
0%severity100%
0
Assessed · clear
true 0%
No data
never assessed
17 adverse-event terms

Ocular

Any-grade
2.7%
G3+
0%
RP2D
sagittal schematic · Reversible

Tissues shaded by reported adverse-event rate.

Cornea
AE
-
Express.
-
Limbus
AE
-
Express.
-
Conjunctiva
AE
-
Express.
-
Lens
AE
-
Express.
-
Retina / RPE
AE
-
Express.
-
Dominant tissue
Visual
Surface subtype
Visual
Reversibility
Reversible
Reported ocular events
Vision blurred8%
n=121
Dry eye7.44%
non-seriousn=121
Conjunctivitis4.4%
non-seriousn=182
Lacrimation increased2.48%
non-seriousn=121
Conjunctivitis allergic2.2%
non-seriousn=182
Keratitis2.2%
non-seriousn=182
Cataract1.65%
non-seriousn=182
Punctate keratitis1.1%
non-seriousn=182
Retinal haemorrhage1.1%
non-seriousn=182
Visual impairment1.1%
non-seriousn=182
Eye infection0.83%
seriousn=121
Conjunctival deposit0.55%
non-seriousn=182
Corneal disorder0.55%
non-seriousn=182
Foreign body in eye0.55%
non-seriousn=182
Intraocular pressure increased0.55%
non-seriousn=182
Strabismus0.55%
non-seriousn=182
Ocular AE (any eye disorder)0%
G3+
Per-trial detail

Adverse events by trial

Phase I/II Study of U3-1402 in Subjects With Human Epidermal Growth Factor RecepPHASE1|PHASE2real-worldn=182CTCAE NR (ClinicalTrials.govPooledC
210 adverse-event terms · 22 systems · expand a system below
GI24
Nausea
79.67%non-serious
145/182
Vomiting
46.15%non-serious
84/182
Diarrhoea
41.21%non-serious
75/182
Stomatitis
30.22%non-serious
55/182
Constipation
26.92%non-serious
49/182
Abdominal pain upper
7.14%non-serious
13/182
Abdominal distension
6.04%non-serious
11/182
Abdominal pain
6.04%non-serious
11/182
Dyspepsia
4.95%non-serious
9/182
Haemorrhoids
4.4%non-serious
8/182
Ascites
3.85%non-serious
7/182
Abdominal discomfort
2.2%non-serious
4/182
Gastrooesophageal reflux disease
2.2%non-serious
4/182
Gingival pain
2.2%non-serious
4/182
Dry mouth
1.65%non-serious
3/182
Dysphagia
1.65%non-serious
3/182
Angular cheilitis
1.1%non-serious
2/182
Flatulence
1.1%non-serious
2/182
Hyperaesthesia teeth
1.1%non-serious
2/182
Proctalgia
1.1%non-serious
2/182
Salivary hypersecretion
1.1%non-serious
2/182
Anal haemorrhage
0.55%non-serious
1/182
Cheilitis
0.55%non-serious
1/182
Dental caries
0.55%non-serious
1/182
Dermatologic20
Investigations19
Infections18
Pulmonary17
General14
Neurologic (other)13
Ocular13
Dry eye
7.14%non-serious
13/182
Conjunctivitis
4.4%non-serious
8/182
Conjunctivitis allergic
2.2%non-serious
4/182
Keratitis
2.2%non-serious
4/182
Cataract
1.65%non-serious
3/182
Punctate keratitis
1.1%non-serious
2/182
Retinal haemorrhage
1.1%non-serious
2/182
Visual impairment
1.1%non-serious
2/182
Conjunctival deposit
0.55%non-serious
1/182
Corneal disorder
0.55%non-serious
1/182
Foreign body in eye
0.55%non-serious
1/182
Intraocular pressure increased
0.55%non-serious
1/182
Strabismus
0.55%non-serious
1/182
Injury11
Metabolic11
Musculoskeletal8
Psychiatric8
Hematologic6
Hepatic5
Vascular5
Cardiac4
Neoplasms4
Renal3
Other3
Immune2
Ear1
Endocrine1
02
Construct

Molecular anatomy

Antibody
IgG1
Human
Linker
Cleavable
8
DAR
Payload
TopoI inhibitor
Linker structureC25H31N5O8
[H]OC(=O)C([H])([H])N([H])C(=O)[C@@]([H])(N([H])C(=O)C([H])([H])N([H])C(=O)C([H])([H])N([H])C(=O)C([H])([H])C([H])([H])C([H])([H])C([H])([H])C([H])([H])N1C(=O)C([H])=C([H])C1=O)C([H])([H])c1c([H])c([H])c([H])c([H])c1[H]
Payload structureC26H24FN3O6
CC[C@@]1(O)C(=O)OCc2c1cc1n(c2=O)Cc2c1[C@@H](NC(=O)CO)CCc1c2nc2c(C)c(F)cc1c2
03
Antibody

Antibody & Fc engineering

Antibody
Patritumab
Isotype
IgG1
Origin
Human
Fc modifications
Noneinferred
Glycoengineering
Standardinferred
Effector silencing
Noneinferred
FcγR binding
Retained
C1q binding
Retainedinferred
Target KD (nM)
1silent
Epitope / domain
HER3
04
Linker & conjugation

Linker chemistry

Linker profile
Linker
GGFG tetrapeptide (MC-GGFG / Mc-Gly-Gly-Phe-Gly)
Class
Cleavable
Cleavage
Cleavable
Attachment
Cysteine (interchain)
Conjugation
Conventional interchain Cys (maleimide)
Symmetry
Symmetric
DAR (mean)
8
DAR homogeneity
Heterogeneous
Plasma t½
-
Cleavage trigger
Cathepsin B/L (GGFG tetrapeptide)
Release control
Conditional
Hydrophilicity mask
Hydrophilic-linker
Platform
DXd-ADCunver.
Formula
C25H31N5O8
Linker MW
529.55 Da
Linker TPSA
191.08 Ų
Linker xLogP
-1.3675
ADCdb linker
LIN0ECMCR
In-vitro stability
>95%@21d/plasma (deruxtecan GGFG platform; ~1-2% DXd released at 21 d, Nakada 2019)
05
Payload

Payload & physicochemistry

Payload profile
Payload
DXd
Class
Topoisomerase I inhibitor
Mechanism
TopoI inhibitor
Released catabolite
DXd
Mechanistic subtype
TopoI
Stereochem / salt
Free base; DXd is a single (1S,9S) exatecan-derivative stereoisomer (no payload salt counter-ion)
Bystander
Yes
PAMPA rank
-
MW
493.5 Da
XLogP3
0
logD₇.₄
1.4
TPSA
129 Ų
pKa
9.2 pKa
Charge pH 7.4
+1
H-bond donors
3
H-bond acceptors
8
IC50 (HCEC)
-
Formula
C26H24FN3O6
PubChem CID
117888634
ADCdb payload
PAY0UXDSB
Potency IC50 (nM)
0.31
Hydrophobicity · logD₇.₄
hydrophilic −2+1.4+4 lipophilic
Bioactivity note
Payload DXd is a topoisomerase I (TOP1/DNA topoisomerase 1) inhibitor; ADCdb lists DNA topoisomerase 1 as the payload's therapeutic target. No numeric payload IC50 reported on the ADCdb page. Clinical/efficacy notes from ADCdb: ~39% objective response rate in Phase 1 NSCLC; xenog
06
Dosing & regimen

Dosing

RP2D dose
5.6 mg/kg
Schedule
Q3W
Route
IV
Fractionated
No
n at RP2D
225
Dose basis
TBW
Trial phase
Phase 2
Dose-OAE available
Yes
Tox summary basis
RP2D
ADA rate (%)
3 %
08
Ocular & expression

Ocular profile & eye-tissue target expression

Target profile
OAE any-grade
2.7 %
OAE grade 3+
0 %
OAE data status
reported
Severity (weighted)
0.81
Keratopathy
-
Conjunctival
-
Dry eye
-
Blurred vision
2.7 %
Dominant tissue
Visual
Surface subtype
Visual
Grading scale
CTCAE v5.0
Reversibility
Reversible
Target expression in eye tissues (HCA detection · HPA bulk)
Cornea (central)
-
Cornea (limbal)
-
Conjunctiva
-
RPE
-
Retina (HPA)
-
Cross-trial comparability · source-verified
Ascertainment: Partial / unspecified monitoringScale: CTCAE v5Denominator: RP2D⚠ OAE rate not directly comparable across trials
Dose & schedule → ocular toxicity · keratopathy (any-grade) by cohort
1.6 mg/kg
Q3W IV
33.3%
n=3 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
4.8 mg/kg
Q3W IV
6.7%
n=15 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
4.8 mg/kg
Q3W IV
6.1%
n=33 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
5.6 mg/kg
Q3W IV
15%
n=60 · U3-1402 metastatic breast (Daiichi 2020)
5.6 mg/kg
Q3W IV
5%
n=40 · U3-1402 metastatic breast (Daiichi 2020)
5.6 mg/kg
Q3W
2.7%
n=550 · HERTHENA-Lung01
6.4 mg/kg
Q3W IV
13.3%
n=15 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
3.2/4.8/6.4 mg/kg (uptitration)
Q3W IV
8.3%
n=12 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
4.2/6.4 mg/kg (uptitration)
Q3W IV
8.3%
n=12 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
3.2->4.8->6.4 mg/kg (uptitration)
Q3W IV
8%
n=50 · HERTHENA-Lung01
up-titration (3.2 then 4.8 then 6.4 mg/kg)
Q3W
8%
n=275 · HERTHENA-Lung01
6.4 mg/kg
Q3W IV
3.2%
n=31 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
8.0 mg/kg
Q3W IV
16.7%
n=6 · U3-1402 HER3+ metastatic breast (U31402-A-J101)
9.09%
n=121 · A Study of U3-1402 (Patritumab Deruxtecan) in Subjects With Metastatic Breast Ca
3.64%
n=275 · HERTHENA-Lung01: Patritumab Deruxtecan in Subjects With Metastatic or Locally Ad
0.55%
n=182 · Phase I/II Study of U3-1402 in Subjects With Human Epidermal Growth Factor Recep
Per-cohort rates from the per-trial extraction, sorted by dose. Cross-trial comparison is subject to ascertainment / scale differences (see comparability above) — e.g. an early symptom-driven trial can read lower than a later systematic-exam trial at a higher dose.
Ocular AE grading reference — interspecialty consensus · 6 scales + dose modification
09
Identity & registry

Identifiers, registry & notes

ADC id
patritumab-deruxtecan
Approval status
Investigational
Approval year
-
UniProt
P21860
ADCdb ADC
DRG0DAKKB
ADCdb antibody
ANI0GBIAA
ADCdb target
TAR0MYDAB
Primary source
ClinicalTrials.gov NCT04619004 (HERTHENA-Lung01 posted results); Yu HA et al., JCO 2023;41(35):5363, doi:10.1200/JCO.23.01476
Aliases & development codes
U3-1402; HER3-DXd; MK-1022; patritumab-DX-8951 conjugate
Notes
HER3 (ERBB3)-targeted DXd ADC on the deruxtecan platform: fully human IgG1 patritumab, DAR 8, cleavable MC-GGFG linker (ADCdb LIN0ECMCR, shared with trastuzumab deruxtecan / datopotamab deruxtecan / trastuzumab rezetecan), conventional interchain-Cys conjugation, DXd (exatecan-derivative TopoI inhibitor) payload. RP2D = 5.6 mg/kg Q3W (HERTHENA-Lung01, NCT04619004, Phase 2, n=225, CTCAE v5.0). OCULAR PROFILE IS MILD (the reason this ADC qualifies): vision blurred is the ONLY eye-disorder preferred term in the CT.gov posted results -- 2.7% (6/225) at 5.6 mg/kg and 8.0% (4/50) in the up-titration arm; all non-serious, no serious eye disorders in either arm, and no eye disorder appears among grade>=3 TEAEs (so oae_g3plus_pct=0). No corneal/keratitis/dry-eye PTs were reported (below the 5% CT.gov reporting threshold). Subtype = Visual. dose_oae_available=TRUE (two dose contexts). Markedly milder than the sibling TROP2 deruxtecan ADC datopotamab deruxtecan (~36% ocular AEs / corneal-dominant in the DB). Dominant non-ocular toxicities: hematologic (thrombocytopenia 43.6% any / 20.9% G3+; neutropenia ~37.3% any / 19.1% G3+; anaemia 32.9% any / 14% G3+) and the deruxtecan-platform AESI interstitial lung disease (centrally adjudicated drug-related 5.3%, including one grade-5 death; updated ESMO 2024 analysis 6.2%). GI is high any-grade but low-grade (nausea 65.3%). Hepatic transaminase elevations modest (AST 16.9%, ALT 11.6%). Sourcing/derivation notes: any-grade grouped neutropenia (37.3% = 84/225) derived by summing the two CT.gov posted-results PTs (neutropenia 23 + neutrophil count decreased 61); the same additive grouping reproduces the published thrombocytopenia 43.6% exactly (33+65=98/225), validating the method. G3+ heme and ILD from the primary JCO 2023 publication (= ASCO Post coverage); updated values (ESMO 2024, ESMO Open S2059-7029(24)00358-2) differ slightly with longer follow-up (anaemia G3+ 15.1%, ILD 6.2%) and are noted per-row. Infusion-related reactions and peripheral neuropathy were NOT in the CT.gov otherEvents list (i.e., <5%); left blank, not 0. Payload physchem are DB-standard DXd values (consistent with T-DXd/Dato-DXd rows; xLogP3 0.0 per DB convention). Linker physchem confirmed directly from the ADCdb LIN0ECMCR page. Regulatory: NOT FDA-approved -- BLA received a Complete Response Letter (June 2024) citing inspection findings at a third-party manufacturer (per Merck/Daiichi Sankyo); the phase 3 HERTHENA-Lung02 (NCT05338970) subsequently did not improve overall survival. No FDA label exists, hence Tier A unavailable; overall Tier B from the primary publication + registered CT.gov results. Sponsor: Daiichi Sankyo with Merck (MSD) co-development (Merck code MK-1022).