This review evaluates the current state of antibody-drug conjugates (ADCs) in oncology, examining mechanisms of efficacy, resistance, and toxicity, as well as the role of biomarkers, combination strategies, next-generation platforms, and curative-intent frameworks in guiding precision oncology use of ADCs.
ADC clinical successes remain limited to select tumor types; activity is shaped not only by target antigen expression but also by tumor-intrinsic features and tumor microenvironment (TME) processes — reframing ADCs as 'tumor-ecosystem-targeting therapies' governed by multidimensional biological determinants rather than strictly targeted agents.
As a narrative review, no original clinical data or statistical outcomes are reported; conclusions on biomarker utility and next-generation platforms reflect emerging or preclinical evidence rather than validated clinical findings.
Antigen expression alone is insufficient to predict ADC response — clinicians should anticipate future patient selection frameworks that integrate TME and tumor-intrinsic biomarkers alongside antigen levels. Biomarker assay standardization and validated preclinical models remain unmet needs that currently limit rational ADC use in precision oncology.
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