The enhanced efficacy of T-DM1 over trastuzumab is attributed to the combined anti-tumor activity of both trastuzumab (e.g., inhibition of HER2-mediated signaling, inhibition of HER2 ECD shedding, and induction of ADCC) and DM1 (cell death due to mitotic catastrophe caused by the failure of formation of a functional mitotic spindle due to tubulin depolymerization) [219]. Here, ERBB2 is linked to neoplasm.