Strategies and challenges for the next generation of antibody–drug conjugates
Abstract
Antibody-drug conjugates (ADCs) are one of the fastest growing classes of oncology therapeutics. After half a century of research, the approvals of brentuximab vedotin (in 2011) and trastuzumab emtansine (in 2013) have paved the way for ongoing clinical trials that are evaluating more than 60 further ADC candidates. The limited success of first-generation ADCs (developed in the early 2000s) informed strategies to bring second-generation ADCs to the market, which have higher levels of cytotoxic drug conjugation, lower levels of naked antibodies and more-stable linkers between the drug and the antibody. Furthermore, lessons learned during the past decade are now being used in the development of third-generation ADCs. In this Review, we discuss strategies to select the best target antigens as well as suitable cytotoxic drugs; the design of optimized linkers; the discovery of bioorthogonal conjugation chemistries; and toxicity issues. The selection and engineering of antibodies for site-specific drug conjugation, which will result in higher homogeneity and increased stability, as well as the quest for new conjugation chemistries and mechanisms of action, are priorities in ADC research.
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Theoretically, the ideal target surface antigen for an antibody-drug conjugate would be expressed exclusively on tumour cells at sufficient density and would be rapidly internalised on conjugate binding.
“Theoretically, the ideal target surface antigen for an ADC would be expressed exclusively on tumour cells at a sufficient density and would be rapidly internalised on ADC binding.79”
From Current and emerging concepts for systemic treatment of metastatic colorectal cancer (2025) · cites this paper as [79]
Most tumour antigens are more tumour-associated than specific, so ablation of healthy cells expressing the target antigen limits the therapeutic index of antibody-drug conjugates.
“Most antigens are more tumour-associated than specific and therefore, the ablation of healthy cells expressing the target antigen limits the therapeutic index of ADCs.79”
From Current and emerging concepts for systemic treatment of metastatic colorectal cancer (2025) · cites this paper as [79]
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“These fragments can be expressed in dimeric form to improve avidity, or conjugated with polyethylene glycol (‘pegylated’) for slower clearance (4), with radioisotopes for diagnostic purposes (5), or with radioisotopes or noxious small molecules/peptides for cytotoxicity (6).”
BackgroundA review of the clinical efficacy of FDA-approved antibody‒drug conjugates in human cancers
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- Authors
- Beck, A., Goetsch, L., Dumontet, C., & Corvaïa, N.
- Affiliations
- Center of Immunology Pierre Fabre (FR)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Beck, Alain
- Venue
- Nature Reviews Drug Discovery
- Published
- 2017-03-17
- Volume
- 16
- Issue
- 5
- Pages
- 315-337
- ISSN
- 1474-1776 (ISSN-L)
- 1474-1784
- OpenAlex
- W2597045666
- Cited by
- 2,271
- References
- 176
- Citations by year
- 2026: 266 · 2025: 232 · 2024: 237 · 2023: 253 · 2022: 199 · 2021: 244 · 2020: 262 · 2019: 266 · 2018: 233 · 2017: 78
- FWCI
- 34.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Drug Discovery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Monoclonal and Polyclonal Antibodies Research
- Life Sciences › Immunology and Microbiology › Immunology › Toxin Mechanisms and Immunotoxins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Degradation and Inhibitors
- Keywords
- antibody-drug conjugates, target antigen selection, linkers, site-specific conjugation, antibody engineering, brentuximab vedotin, trastuzumab emtansine, clinical trials
- MeSH terms
- Trastuzumab, Brentuximab Vedotin, Ado-Trastuzumab Emtansine, Animals, Antibodies, Monoclonal, Antigens, Neoplasm, Antineoplastic Agents, Drug Stability, Humans, Maytansine, Neoplasms, Drug Design, Immunoconjugates, Antibodies, Monoclonal, Humanized
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