Antibody drug conjugates: Next generation targeted cancer therapy

Abstract

Background Antibody–drug conjugates (ADCs) are an evolving class of targeted anticancer therapeutics that combine monoclonal antibodies, linkers, and potent cytotoxic payloads to selectively deliver drugs to cancer cells expressing specific antigens. Advances in antibody engineering, linker stability, payload development, and conjugation technologies have expanded their therapeutic potential across multiple malignancies. Objective: This review examines the structure, mechanisms of action, clinical applications, safety considerations, emerging developments, and role of pharmacists in the effective use of ADCs in cancer treatment. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, Embase, and Google Scholar for publications from January 2000 to November 2026. The search included literature on ADCs, therapeutic payloads, linkers, resistance mechanisms, interstitial lung disease, and pharmaceutical care. Following screening, 69 unique articles were selected from 103 identified records, prioritising peer-reviewed reviews and primary research, including phase I–III clinical trials. Results: ADCs have demonstrated clinically meaningful benefits across breast, urothelial, lung, gastric, gynaecological, and haematological cancers. Agents such as trastuzumab deruxtecan, sacituzumab govitecan, enfortumab vedotin, and mirvetuximab soravtansine illustrate the expanding applications of antigen-directed therapy. Their effectiveness is influenced by antigen expression, linker stability, drug-to-antibody ratio, payload activity, and intracellular drug delivery. Important safety concerns include interstitial lung disease, myelosuppression, peripheral neuropathy, ocular toxicity, gastrointestinal disturbances, and hepatotoxicity. Antigen heterogeneity, acquired resistance, manufacturing complexity, treatment costs, and limited predictive biomarkers remain significant challenges. Emerging approaches include bispecific ADCs, novel payloads, site- specific conjugation, and combination regimens. Pharmacists contribute to safe preparation, dispensing, toxicity monitoring, supportive care, patient education, and pharmacovigilance. Conclusion: ADCs represent an important advancement in precision oncology, offering targeted treatment opportunities across diverse cancer types. Further progress depends on optimising ADC design, improving patient selection, managing treatment-related toxicities, overcoming resistance, and enhancing equitable access. Multidisciplinary care, including oncology pharmacy expertise, will remain essential to maximising therapeutic benefit.

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Esha Patel, Garvi Patel, Darpi Patel, S P Srinivas Nayak. Antibody drug conjugates: Next generation targeted cancer therapy. ClinSphere Journals. 2026;undefined(undefined). https://doi.org/10.5281/zenodo.23855775

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