Cited by 269Monoclonal and Polyclonal Antibodies ResearchCancer Immunotherapy and BiomarkersPharmacovigilance and Adverse Drug Reactions

Optimizing the safety of antibody–drug conjugates for patients with solid tumours

Tarantino, Paolo, Ricciuti, Biagio, Pradhan, Shan M., Tolaney, Sara M.·2023·Nature Reviews Clinical Oncology

Abstract

Over the past 5 years, improvements in the design of antibody-drug conjugates (ADCs) have enabled major advances that have reshaped the treatment of several advanced-stage solid tumours. Considering the intended rationale behind the design of ADCs, which is to achieve targeted delivery of cytotoxic molecules by linking them to antibodies targeting tumour-specific antigens, ADCs would be expected to be less toxic than conventional chemotherapy. However, most ADCs are still burdened by off-target toxicities that resemble those of the cytotoxic payload as well as on-target toxicities and other poorly understood and potentially life-threatening adverse effects. Given the rapid expansion in the clinical indications of ADCs, including use in curative settings and various combinations, extensive efforts are ongoing to improve their safety. Approaches currently being pursued include clinical trials optimizing the dose and treatment schedule, modifications of each ADC component, identification of predictive biomarkers for toxicities, and the development of innovative diagnostic tools. In this Review, we describe the determinants of the toxicities of ADCs in patients with solid tumours, highlighting key strategies that are expected to improve tolerability and enable improvements in the treatment outcomes of patients with advanced-stage and those with early stage cancers in the years to come.

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Crossref · 10.1038/s41571-023-00783-w

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  • ADCs were designed to improve the therapeutic index of cytotoxic agents by using monoclonal antibodies to enhance tumor cell selection.

    “By using mAbs to enhance tumor cell selection, ADCs were designed to improve the therapeutic index of cytotoxic agents6,7.”
  • Linker instability and side effects from systemic exposure to ADC payloads remain a significant challenge, with off-target and on-target toxicities frequently resembling those of unconjugated cytotoxic agents.

    “However, clinical experience has shown that linker instability and side effects from systemic exposure to ADC payloads remain a significant challenge, with both off-target and on-target toxicities frequently resembling those of the unconjugated cytotoxic agents6,7.”
  • Antibody-drug conjugates have substantial toxicity, primarily affecting the bone marrow.

    “their substantial toxicity (primarily affecting the bone marrow) must be considered.69 70”

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Authors
Tarantino, P., Ricciuti, B., Pradhan, S. M., & Tolaney, S. M.
Affiliations
  • Harvard University (US)
  • United States Food and Drug Administration (US)
Corresponding author
Tolaney, Sara M.
Venue
Nature Reviews Clinical Oncology
Published
2023-06-09
Volume
20
Issue
8
Pages
558-576
ISSN
  • 1759-4774 (ISSN-L)
  • 1759-4782
OpenAlex
W4379986466
Cited by
269
References
200
Citations by year
2026: 86 · 2025: 89 · 2024: 76 · 2023: 18
FWCI
11.33
Type
journal article
Language
en
Open access
closed
Locations
  • Nature Reviews Clinical Oncology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Monoclonal and Polyclonal Antibodies Research
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
antibody-drug conjugates, solid tumors, drug toxicity, off-target toxicity, on-target toxicity, predictive biomarkers, dose optimization, treatment schedule, early-stage cancer, combination therapy, therapeutic index
MeSH terms
Antineoplastic Agents, Humans, Neoplasms, Immunoconjugates

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