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Proposed mechanism for the “bystander killing effect” of trastuzumab deruxtecan. The binding of trastuzumab deruxtecan to HER2 expressed on the surface of HER2-positive tumor cells (A) triggers its internalization followed by the release of DXd into the cytoplasm and the induction of apoptosis (B). (C) DXd is then transferred to and induces apoptosis in neighboring HER2-negative cells.
