Five durum wheat cultivars were grown in a Mediterranean area (Southern Italy) under conventional and organic farming with the aim to evaluate agronomic, technological, sensory, and sanitary quality of grains and pasta. The cultivar Matt produced the best pasta quality under conventional cropping system, while the quality parameters evaluated were unsatisfactory under organic farming. The cultivar Saragolla showed the best yield amount and pasta quality in all the experimental conditions, thus proving to be the cultivar more adapt to organic farming. In all the tested experimental conditions, nivalenol (NIV) and deoxynivalenol (DON) occurrence was very low and the other mycotoxins evaluated were completely absent. These data confirm the low risk of mycotoxin contamination in the Mediterranean climate conditions. Finally, it has been possible to produce high-quality pasta in Southern Italy from durum wheat grown both in conventional and organic farming.