Fam-trastuzumab deruxtecan-nxki (Enhertu®, Daiichi Sankyo) has recently been FDA approved for the treatment of adult patients with locally advanced or metastatic human epidermal growth factor receptor 2 (HER2)-positive gastric or gastroesophageal adenocarcinoma previously treated with a trastuzumab-based regimen. In this interview with i3 Health, Kohei Shitara, MD, Chief of the Department of Gastrointestinal Oncology at the National Cancer Center Hospital East in Kashiwa, Japan, and lead investigator of the phase 3 DESTINY-Gastric01 trial, on which the approval was based, shares his insights on this approval, on the challenges of treating this patient population, and on the future of treatment for patients with gastric or gastroesophageal adenocarcinoma.