# T-DM1 mechanism and clinical evidence figures

Original educational figures for Cellular Stories, prepared September 7, 2026.

## Mechanism figure
A: Trastuzumab is conjugated to DM1 through a stable MCC linker; average drug-to-antibody ratio is 3.5. B: HER2 recognition precedes receptor-mediated uptake. C: Internalized cargo is trafficked toward lysosomes. D: Proteolytic processing produces DM1-containing catabolites. E: Tubulin binding disrupts microtubules. F: Cell-cycle arrest can lead to apoptosis. Drawings are schematic, not to scale, and depict selected intracellular actions rather than every antibody-mediated effect. They do not specify transport kinetics or predict a clinical response.

## Clinical evidence figure
A connects the mechanism to its prescribing-information and structural sources. B summarizes the randomized phase 3 trial. C redraws confirmed response counts from the 2026 conference analysis using randomized-arm denominators. D identifies interpretation boundaries. The original trial publication and the later conference analysis are distinct sources. This figure summarizes response, not the full efficacy and safety profile.

## Sources
1. [KADCYLA US prescribing information, March 2026, sections 11–12.1](https://www.gene.com/download/pdf/kadcyla_prescribing.pdf).
2. [Cho et al., Nature 421, 756–760 (2003)](https://doi.org/10.1038/nature01392); [HER2–trastuzumab Fab structure, PDB 1N8Z](https://www.rcsb.org/structure/1N8Z). Structural reference does not imply the glyph is an atomistic rendering.
3. [Cortés et al., NEJM 386, 1143–1154 (2022)](https://doi.org/10.1056/NEJMoa2115022). Original DESTINY-Breast03 publication.
4. [Hamilton et al., ESMO Breast 2026, poster 453P](https://datasourcebydaiichisankyo.com/documents/d/datahub/esmo-bc-2026_t-dxd_hamilton_poster_final). Investigator-assessed best confirmed response, cutoff June 27, 2025. Conference exploratory analysis, not a new peer-reviewed publication.

Machine-readable counts are in response-counts.json. SVG and PDF retain vector artwork; PNG is a 3200-pixel-wide preview. No patient-level data or reconstructed survival curves are used.