# Topoisomerase-I inhibitors (and ADC payloads)

Source: https://onco.cc/technologies/topoisomerase-inhibitors/  
OnCo record `topoisomerase-inhibitors` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Topoisomerase-I inhibitors jam the enzyme that untangles DNA during copying, causing double-strand breaks. As free drugs (irinotecan, topotecan) they are modest, but their analogues SN-38 and deruxtecan are the dominant antibody-drug conjugate payload class of the 2020s, active after taxane failure; cross-resistance between these ADCs is a growing problem.

## Summary

Irinotecan and topotecan are modest as systemic agents. Their analogues SN-38 (sacituzumab govitecan), DXd/exatecan derivatives (T-DXd, Dato-DXd, HER3-DXd, I-DXd, R-DXd), and belotecan derivatives (sac-TMT) are the dominant ADC payload class of the 2020s: membrane-permeable for bystander killing, short half-life limiting systemic toxicity, and effective in taxane-resistant tumours. Cross-resistance between TOP1 ADCs is a growing clinical problem.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-04
- Principle: Stabilise the TOP1-DNA cleavage complex, causing replication-associated double-strand breaks.
- Strengths: Bystander effect; Active after taxanes and anthracyclines
- Limitations: Cross-resistance between TOP1-payload ADCs (SLFN11 loss, TOP1 mutations); ILD with DXd; neutropenia and diarrhoea with SN-38

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Topoisomerase_inhibitor
- Wikipedia: https://en.wikipedia.org/wiki/Topoisomerase_inhibitor

## Connected records

- fronts: [Antibody-Drug Conjugates](https://onco.cc/fronts/adcs/), [Chemotherapy](https://onco.cc/fronts/chemotherapy/)
- technologies: [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [Payload-linker synthesis (high-potency API)](https://onco.cc/technologies/high-potency-payload-synthesis/)
- companies: [Dantari](https://onco.cc/companies/dantari/), [Pheon Therapeutics](https://onco.cc/companies/pheon-therapeutics/), [ProfoundBio](https://onco.cc/companies/profoundbio/), [Sunesis Pharmaceuticals](https://onco.cc/companies/sunesis/)
- terms: [ADC sequencing](https://onco.cc/terms/adc-sequencing/), [Bystander effect (ADC)](https://onco.cc/terms/bystander-effect/), [Chemotherapy](https://onco.cc/terms/chemotherapy-term/), [DXd](https://onco.cc/terms/dxd/), [Enzyme](https://onco.cc/terms/enzyme/), [Exatecan (and derivatives)](https://onco.cc/terms/exatecan/), [Payload (ADC)](https://onco.cc/terms/payload/), [Prodrug](https://onco.cc/terms/prodrug/), [SN-38](https://onco.cc/terms/sn-38/), [T030 (belotecan derivative)](https://onco.cc/terms/t030/), [Topoisomerase-I inhibitor payloads](https://onco.cc/terms/topoisomerase-i-payloads/)
- trials: [24BRO681 : Alternating Gnp and mFOLFIRINOX for BR-PDAC](https://onco.cc/trials/nct07043270/), [5FU/LV, Irinotecan, Temozolomide and Bevacizumab for MGMT Silenced, Microsatellite Stable Metastatic Colorectal Cancer.](https://onco.cc/trials/nct04689347/), [A Clinical Study of Liposomal Irinotecan for Second-Line Therapy in Metastatic Colorectal Cancer](https://onco.cc/trials/nct07585279/), [A Clinical Study of Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab (MK-3475) as First-line Maintenance Treatment of Cervical Canc](https://onco.cc/trials/nct07216703/), [A Clinical Study of Sacituzumab Tirumotecan (MK-2870) in Patients With Bladder Cancer (MK-2870-027)](https://onco.cc/trials/nct06637423/), [A Clinical Study of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) in People With Breast Cancer (MK-2870-032)](https://onco.cc/trials/nct06966700/), [A Clinical Study of SHR-A1811 Combined With Chemotherapy for Platinum Sensitive Recurrent Ovarian Cancer](https://onco.cc/trials/nct06840002/), [A Clinical Study of SHR-A1811 in Combination With Chemotherapy and Bevacizumab Versus Standard Therapy as First-Line Treatment for Advanced Colorectal](https://onco.cc/trials/nct07676162/), [A Clinical Study of SHR-A1811 in the Treatment of HER2-positive Locally Advanced or Metastatic Biliary Tract Cancer](https://onco.cc/trials/nct06778031/), [A Clinical Trial of Sac-TMT in People With Non-HRD Positive Advanced Ovarian Cancer (MK-2870-021)](https://onco.cc/trials/nct07318558/), [A Clinical Trial of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) to Treat Urothelial Cancer (MK-2870-031)](https://onco.cc/trials/nct07419295/), [A Clinical Trial of SHR-A1811 in the Treatment of Triple-negative Breast Cancer](https://onco.cc/trials/nct07111832/), [A Phase 1b/2 Study of T-DXd Combinations in HER2-positive Metastatic Breast Cancer](https://onco.cc/trials/nct04538742/), [A Phase II Clinical Study of Adebrelimab Combined With Chemotherapy and Concurrent Radiotherapy for Extensive-Stage Oligometastatic SCLC](https://onco.cc/trials/nct06177925/), [A Phase II Study Evaluating BMS-986504 in MTAP-deleted Pancreatic Cancer](https://onco.cc/trials/nct07283705/), [A Phase II Study of HLX22 in Combination With Trastuzumab Deruxtecan in HER2-low, Hormone Receptor Positive Locally Advanced or Metastatic Breast Cancer Patients](https://onco.cc/trials/nct06832202/), [A Phase II Trial of SHR-A1811 in HER2-Expressing Recurrent/Metastatic Cervical Cancer](https://onco.cc/trials/nct07051486/), [A Phase Ⅲ Study of Rilvegostomig in Combination With Fluoropyrimidine and Trastuzumab Deruxtecan as the First-line Treatment for HER2-positive Gastric Cancer](https://onco.cc/trials/nct06764875/), [A Phase III Study of SHR-A1811 Injection With or Without Pertuzumab in HER2-Positive Recurrent or Metastatic Breast Cancer](https://onco.cc/trials/nct06057610/), [A Phase III, Active-Controlled Study of SHR-A1811 Versus Trastuzumab Emtansine (T-DM1) in HER2-Positive Primary Breast Cancer Participants With Residual Invasive Disease Following Neoadjuvant Therapy](https://onco.cc/trials/nct06126640/), [A Phase III, Randomised Study of Adjuvant Dato-DXd in Combination With Rilvegostomig or Rilvegostomig Monotherapy Versus Standard of Care, Following C](https://onco.cc/trials/nct06564844/), [A Single Arm Phase 2 Study to Evaluate Efficacy and Safety of Trastuzumab Deruxtecan for Patients With HER2 Mutant NSCLC](https://onco.cc/trials/nct05246514/), [A Single-arm, Exploratory Clinical Study Evaluating the Efficacy and Safety of Bevacizumab in Combination With Anlotinib and Etoposide as First-line Therapy for](https://onco.cc/trials/nct07728955/), [A Single-arm, Single-center, Phase II Clinical Study of Aipalolitovorelizumab (QL1706) Combined With Bevacizumab and Standard Chemotherapy as First-line Treatme](https://onco.cc/trials/nct07229846/), [A Study Comparing BL-B01D1 With Topotecan in Patients With Recurrent Small Cell Lung Cancer(PANKU-Lung03)](https://onco.cc/trials/nct06500026/), [A Study Comparing QLC5508 in Combination With QL2107 Versus Tislelizumab Plus Platinum-based Chemotherapy in Participants Wih Treatment-naïve Extensive-Stage Sm](https://onco.cc/trials/nct07802821/), [A Study Comparing Tarlatamab, Durvalumab, Carboplatin, and Etoposide Versus Durvalumab, Carboplatin, and Etoposide in First-line Extensive Stage Small](https://onco.cc/trials/nct07005128/), [A Study of Benmelstobart, Anlotinib, Chemotherapy and Thoracic Radiotherapy for People With Extensive-stage Small Cell Lung Cancer](https://onco.cc/trials/nct07538271/), [A Study of BL-M07D1 in Patients With HER2-mutated, Locally Advanced or Metastatic Non-small-cell Lung Cancer](https://onco.cc/trials/nct06114511/), [A Study of BL-M11D1 in Combination With Cytarabine + Daunorubicin or Venetoclax + Azacitidine in Patients With Acute Myeloid Leukemia](https://onco.cc/trials/nct07255872/), [A Study of Dato-DXd in Chinese Patients With Advanced Non-Small Cell Lung Cancer, Triple-negative Breast Cancer and Other Solid Tumors (TROPION-PanTumor02)](https://onco.cc/trials/nct05460273/), [A Study of Efficacy and Safety of Sacituzumab Tirumotecan (MK-2870) Plus Enfortumab Vedotin (EV) With and Without Pembrolizumab in Advanced Urothelial Carcinoma (MK-3475-04C/KEYMAKER-U04)](https://onco.cc/trials/nct06483334/), [A Study of Fruquintinib Plus FOLFIRI as Second-Line Treatment for Participants With Metastatic Colorectal Cancer (FRUITFUL)](https://onco.cc/trials/nct07011576/), [A Study of GSK5764227 in Participants With Relapsed Small Cell Lung Cancer (SCLC)](https://onco.cc/trials/nct07099898/), [A Study of Invikafusp Alfa (STAR0602), a Selective T Cell Receptor (TCR)-Targeting, Bifunctional Antibody-fusion Molecule, in Combination With Sacituzumab Govitecan in Participants With Advanced Solid Tumors](https://onco.cc/trials/nct06827613/), [A Study of PM8002 (Anti-PD-L1/VEGF) in Combination With Chemotherapy in Patients With ES-SCLC](https://onco.cc/trials/nct05844150/), [A Study of Sacituzumab Govitecan Given at an Alternative Dose and Schedule in Participants With Advanced Triple-Negative Breast Cancer](https://onco.cc/trials/nct06926920/), [A Study of Sacituzumab Tirumotecan (MK-2870) as a Single Agent and in Combination With Pembrolizumab (MK-3475) Versus Treatment of Physician's Choice in Participants With HR+/HER2- Unresectable Locally Advanced or Metastatic Breast Cancer (MK-2870-010)](https://onco.cc/trials/nct06312176/), [A Study of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) as Monotherapy and in Combination With Pembrolizumab (MK-3475) in Participants With Triple-Negative Breast Cancer (MK-2870-011/TroFuse-011)](https://onco.cc/trials/nct06841354/), [A Study of SHR-4610 Injection in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct07231211/), [A Study of SHR-A1811 in First-line Treatment of Patients With Advanced or Metastatic Non-small Cell Lung Cancer With HER2 Mutations](https://onco.cc/trials/nct06430437/), [A Study of SHR-A1811 in Subjects With Ovarian Cancer](https://onco.cc/trials/nct06828354/), [A Study of T-DXd as Monotherapy or in Combination With Anti-cancer Agents in Patients With Selected HER2-expressing Tumors](https://onco.cc/trials/nct06271837/), [A Study of T-DXd for the Treatment of Solid Tumors Harboring HER2 Activating Mutations](https://onco.cc/trials/nct04639219/), [A Study of Trastuzumab Rezetecan in Combination With Adebrelimab Versus Investigator's Choice of Therapy in Subjects With Residual Triple Negative Breast Cancer](https://onco.cc/trials/nct07679360/), [A Study to Assess Efficacy and Safety of Pembrolizumab With or Without Sacituzumab Tirumotecan (MK- 2870) in Adult Participants With Resectable Non Sm](https://onco.cc/trials/nct06312137/), [A Study to Compare Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab (MK-3475) Versus Pembrolizumab Alone as Treatment in Participan](https://onco.cc/trials/nct06952504/), [A Study to Compare Sacituzumab Tirumotecan (MK-2870) Monotherapy Versus Treatment of Physician's Choice as Second-line Treatment for Participants With](https://onco.cc/trials/nct06459180/), [A Study to Compare the Efficacy and Safety of YL201 With Standard Chemotherapy in Patients With Metastatic Pancreatic Cancer After Failure of Gemcitabine-Based](https://onco.cc/trials/nct07803783/), [A Study to Evaluate Sacituzumab Tirumotecan (MK-2870) in Advanced/Metastatic Gastroesophageal Adenocarcinoma (MK-2870-015)](https://onco.cc/trials/nct06356311/), [A Study to Evaluate the Efficacy and Safety of Sacituzumab Tirumotecan (MK-2870) Maintenance Treatment Versus Standard of Care in Participants With Pl](https://onco.cc/trials/nct06824467/), [A Study to Evaluate the Safety and Therapeutic Activity of GI-102 As a Single Agent and in Combination with Conventional Anti-cancer Drugs, Pembrolizu](https://onco.cc/trials/nct05824975/), [A Study to Investigate the Efficacy and Safety of Trastuzumab Deruxtecan as the First Treatment Option for Unresectable, Locally Advanced/Metastatic N](https://onco.cc/trials/nct05048797/), [A Study to Provide Continued Access to and Assess Long-Term Safety of the Study Drug(s)](https://onco.cc/trials/nct06174987/), [A Trial of Adebrelimab Plus (SHR-A1811/SHR-A1904 With Chemotherapy) or SHR-8068 as Treatment for Gastric/GEJ Cancer](https://onco.cc/trials/nct07110571/), [A Trial of Injectable SHR-A1811 in Combination With Pyrotinib or SHR-1316 in Subjects With Advanced Non-small Cell Lung Cancer](https://onco.cc/trials/nct05482568/), [A Trial of SHR-A1811 Combined With Other Antitumor Therapies in Advanced Solid Tumors.](https://onco.cc/trials/nct06015048/), [A Trial of SHR-A1811 Compared to Other Antitumor Therapies as Neoadjuvant Treatments in Early-stage or Locally Advanced HER2-positive Breast Cancer](https://onco.cc/trials/nct07196774/), [A Trial of Trastuzumab Rezetecan in Unresectable Locally Recurrent/Metastatic Breast Cancer](https://onco.cc/trials/nct07497386/), [Abemaciclib Combined With FOLFOX/FOLFIRI Regimen in Patients With Advanced Colorectal Liver Metastases Cancer](https://onco.cc/trials/nct07441369/), [Adjuvant mFOLFIRINOX for High-risk Stage III Colon Cancer](https://onco.cc/trials/nct05179889/), [Adjuvant mFOLFOXIRI vs. mFOLFOX6 in MRD Positive Stage II-III Colorectal Cancer (AFFORD)](https://onco.cc/trials/nct05427669/), [AK112 Plus FOLFIRI Versus Bevacizumab Plus FOLFIRI as Second-line Treatment of MSS/pMMR Metastatic Colorectal Cancer](https://onco.cc/trials/nct07021950/), [An Adaptive-design Prospective Cohort Study of Watch and Wait Strategy in Patients With Locally Advanced Rectal Cancer](https://onco.cc/trials/nct04443543/), [An Extension Study to Assess the Efficacy of Rina-S Compared to Treatment of Investigator's Choice in Participants With Platinum Resistant Ovarian Can](https://onco.cc/trials/nct07604766/), [ASCENT](https://onco.cc/trials/ascent/), [ASCENT-03](https://onco.cc/trials/ascent-03/), [ASCENT-04 / KEYNOTE-D19](https://onco.cc/trials/ascent-04/), [ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)](https://onco.cc/trials/ascent-05/), [Asian Study of Sacituzumab Govitecan (IMMU-132) in HR+/HER2- Metastatic Breast Cancer (MBC)](https://onco.cc/trials/nct04639986/), [Assessing a Regorafenib-irinotecan Combination Versus Regorafenib Alone in Metastatic Colorectal Cancer Patients](https://onco.cc/trials/nct03829462/), [Atezolizumab and Rechallenge Chemotherapy in Relapsed Patients With Extensive-stage Small Cell Lung Cancer (ES-SCLC).](https://onco.cc/trials/nct06663098/), [Basal-like PDAC Treated With Gemcitabine, Erlotinib, and Nab-paclitaxel](https://onco.cc/trials/nct06483555/), [Bevacizumab, Sintilimab, Cetuximab and Irinotecan in Refractory RAS Wild-type Metastatic Colorectal Cancer: BOND-4 Trial](https://onco.cc/trials/nct07722754/), [Bortezomib Combined with PD-1 MAb and MFOLFIRINOX for Metastatic Pancreatic Cancer](https://onco.cc/trials/nct06572813/), [Cetuximab Plus Irinotecan in Patients With NeoRAS Wild-type Metastatic Colorectal Cancer In Third-line Therapy](https://onco.cc/trials/nct05962502/), [Cetuximab, Irinotecan, Toripalimab in RAS/BRAF Wild-type Ultraselected Right-sided Colorectal Cancer Study](https://onco.cc/trials/nct06547203/), [CGA Guided Ultrafractionated RT and Systemic Treatment in Elderly or Frail Patients with Inoperable Localized CRC](https://onco.cc/trials/nct06652412/), [Clinical Study of Mitoxantrone Hydrochloride Liposome Injection vs. Chidamide in Patients With Relapsed/Refractory PTCL](https://onco.cc/trials/nct04668690/), [Clinical Study of Radiotherapy Combined With Adebrelimab and NALIRIFOX for Conversion Therapy in Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct07827053/), [Comparing Photon Therapy To Proton Therapy To Treat Patients With Lung Cancer](https://onco.cc/trials/nct01993810/), [Continuation of Cetuximab Beyond First-Line Progression in Metastatic Colorectal Cancer](https://onco.cc/trials/nct07389265/), [CtDNA in Adjuvant Chemotherapy of Stage III Colon Cancer (REVISE Trial)](https://onco.cc/trials/nct06242418/), [DAREON ® -Lung-1: A Study in People With Advanced Small Cell Lung Cancer to Compare Obrixtamig Plus Atezolizumab, Carboplatin, and Etoposide Treatment](https://onco.cc/trials/nct07472517/), [DAREON®-NEC-1: A Study in People With Advanced Extrapulmonary Neuroendocrine Cancer (epNEC) to Compare Obrixtamig Plus Carboplatin and Etoposide Treatment With Standard Chemotherapy](https://onco.cc/trials/nct07544654/), [Datopotamab Deruxtecan (Dato-DXd) and Pembrolizumab With or Without Platinum Chemotherapy in 1L Non-Small Cell Lung Cancer (TROPION-Lung07)](https://onco.cc/trials/nct05555732/), [DESTINY-Breast03](https://onco.cc/trials/destiny-breast03/), [DESTINY-Breast04](https://onco.cc/trials/destiny-breast04/), [DESTINY-Breast05](https://onco.cc/trials/destiny-breast05/), [DESTINY-Breast06](https://onco.cc/trials/destiny-breast06/), [DESTINY-Breast09](https://onco.cc/trials/destiny-breast09/), [DESTINY-Breast11](https://onco.cc/trials/destiny-breast11/), [DESTINY-Breast12](https://onco.cc/trials/destiny-breast12/), [DESTINY-CRC01](https://onco.cc/trials/destiny-crc01/), [DESTINY-CRC02](https://onco.cc/trials/destiny-crc02/), [DESTINY-Endometrial01: A Phase III Study of Trastuzumab Deruxtecan Plus Rilvegostomig or Pembrolizumab as First-Line Treatment of HER2-Expressing (IHC](https://onco.cc/trials/nct06989112/), [DESTINY-Gastric01](https://onco.cc/trials/destiny-gastric01/), [DESTINY-Gastric02](https://onco.cc/trials/destiny-gastric02/), [DESTINY-Gastric04](https://onco.cc/trials/destiny-gastric04/), [DESTINY-Lung01](https://onco.cc/trials/destiny-lung01/), [DESTINY-Lung02](https://onco.cc/trials/destiny-lung02/), [DESTINY-PanTumor02](https://onco.cc/trials/destiny-pantumor02/), [DIAMOND](https://onco.cc/trials/diamond/), [Dual EGFR/HER2 Blockade Combined With Irinotecan for the Treatment of HER2-Positive Metastatic Colorectal Cancer](https://onco.cc/trials/nct07059338/), [Efficacy of Hyperthermic Intraperitoneal Chemotherapy](https://onco.cc/trials/nct04861558/), [EIS-12656 as Single Agent and in Combination in Patients With Specified Solid Tumors](https://onco.cc/trials/nct06525298/), [FOLFOX Via HAI Plus Intravenous Irinotecan With or Without Bevacizumab Versus Systemic FOLFOXIRI With or Without Bevacizumab in Initially Unresectable RAS-mutat](https://onco.cc/trials/nct05727163/), [FOLFOXIRI Plus Bevacizumab With or Without Atezolizumab as 1st Line Treatment of pMMR and IS IC-High Metastatic Colorectal Cancer Patients.](https://onco.cc/trials/nct06733038/), [Hepatic Arterial Infusion of Liposomal Irinotecan Plus Oxaliplatin and Capecitabine as Adjuvant Therapy for Colorectal Cancer Liver Metastases](https://onco.cc/trials/nct07570914/), [HORIZON-Breast01](https://onco.cc/trials/horizon-breast01/), [HR070803 in Combination With Oxaliplatin, 5-fluorouracil/LV Versus GX as Adjuvant Therapy for Pancreatic Cancer](https://onco.cc/trials/nct06217042/), [HR070803 in Combination With Oxaliplatin, S-1 Versus NALIRIFOX as Adjuvant Therapy for Pancreatic Cancer](https://onco.cc/trials/nct06383078/), [Hypofractionated Radiotherapy Plus Immunotherapy Versus Conventional Radiotherapy in Locally Recurrent Rectal Cancer](https://onco.cc/trials/nct06928584/), [IN10018 in Combination With Pegylated Liposomal Doxorubicin (PLD) vs. Placebo in Combination With PLD for the Treatment of Platinum-resistant Recurren](https://onco.cc/trials/nct06014528/), [Injection of SHR-A1811 Versus Physician Choiced Treatment in Patients With Advanced Colorectal Cancer Who Had Failed to Respond to Oxaliplatin, 5-fu, ](https://onco.cc/trials/nct06199973/), [Intermittent or Continuous Panitumumab Plus FOLFIRI for Left Sided RAS/B-RAF Wild-type Metastatic Colorectal Cancer](https://onco.cc/trials/nct06509126/), [Irinotecan-ChemoSeed in Surgically Resectable Glioblastoma](https://onco.cc/trials/nct07356973/), [JK-1201I Compared with Topotecan in Patients with Relapsed Extensive Stage Small Cell Lung Cancer](https://onco.cc/trials/nct06581380/), [Liposomal Irinotecan and Capecitabine Plus Bevacizumab as Second-line Therapy in Metastatic Colorectal Cancer](https://onco.cc/trials/nct06192680/), [Liposomal Irinotecan and Leucovorin/5-fluorouracil Plus Bevacizumab in Metastatic Colorectal Cancer](https://onco.cc/trials/nct06184698/), [Liposomal Irinotecan in Combination With Oxaliplatin and S-1 Versus Gemcitabine Combined With Capecitabine as Postoperative Adjuvant Therapy for Pancreatic Canc](https://onco.cc/trials/nct06571461/), [Liposomal Irinotecan With TAS102 and Bevacizumab for Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct05854498/), [LPM6690176 in Combination With Chemotherapy and Bevacizumab in Metastatic Colorectal Cancer Patients With RAS Mutation](https://onco.cc/trials/nct07391566/), [Lurbinectedin or in Combination with Irinotecan Versus Topotecan in Patients with Relapsed SCLC](https://onco.cc/trials/nct06496048/), [mFOLFIRINOX as Adjuvent Chemotherapy in Treating Chinese Pancreatic Cancer Patients](https://onco.cc/trials/nct04084496/), [mFOLFOXIRI Plus Bevacizumab for Organ Preservation in Locally Advanced Rectal Cancer](https://onco.cc/trials/nct07817888/), [MNK Inhibitor AUM001 in Combination With Either Pembrolizumab or Irinotecan to Treat Metastatic Colorectal Cancer](https://onco.cc/trials/nct05462236/), [Modulation of the Gut Microbiome With Pembrolizumab Following Chemotherapy in Resectable Pancreatic Cancer](https://onco.cc/trials/nct05462496/), [MOnaliZumab in Combination With durvAlumab (MEDI4736) for tRreatmenT of Small Cell Lung Cancer](https://onco.cc/trials/nct05903092/), [NAPOLI 3](https://onco.cc/trials/napoli-3/), [NAPOLI-1](https://onco.cc/trials/napoli-1/), [Neoadjuvant FOLFIRINOX and Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer Patients](https://onco.cc/trials/nct06812728/), [Neoadjuvant Folfirinox Combined With Pembrolizumab Followed by Surgery for Patients With Resectable Pancreatic Cancer](https://onco.cc/trials/nct05132504/), [Neoadjuvant FOLFOXIRI and Chemoradiotherapy Versus Neoadjuvant CAPOX/FOLFOX and Chemoradiotherapy Followed by Surgery or a Watch-and-Wait Approach in High Risk](https://onco.cc/trials/nct07472868/), [Neoadjuvant FOLFOXIRI Versus CapeOX Chemotherapy for Local Advanced Rectal Cancer](https://onco.cc/trials/nct05201430/), [Neoadjuvant Treatment With mFOLFOXIRI Plus Cadonilimab (AK104) Versus mFOLFOX6 in Locally Advanced Colorectal Cancer](https://onco.cc/trials/nct05571644/), [Neoadjuvant Triple Therapy for (Borderline) Resectable Pancreatic Cancer (PREOPANC-5)](https://onco.cc/trials/nct06384560/), [NeoFOL-R Trial (Perioperative Versus Adjuvnat FOLFIRINOX in Resectable Pancreatic Cancer)](https://onco.cc/trials/nct05529940/), [Newly Emerging Immunotherapy for Pancreatic Cancer Treatment](https://onco.cc/trials/nct06370754/), [NIFE (AIO-YMO HEP-0315)](https://onco.cc/trials/nife/), [NIFTY](https://onco.cc/trials/nifty/), [Nimotuzumab Combined With mFOLFIRINOX/GX as Postoperative Adjuvant Therapy in Pancreatic Cancer](https://onco.cc/trials/nct06389760/), [Omitting CTV for Primary Tumor in LS-SCLC](https://onco.cc/trials/nct07008716/), [Oncolytic Adenovirus Coding for TNFa and IL2 (TILT-123) With Pembrolizumab or Pembrolizumab (Phase 1a) and Pegylated Liposomal Doxorubicin (Phase 1b) ](https://onco.cc/trials/nct05271318/), [Oncolytic Virus (H101) + SBRT + Chemotherapy + Targeted Therapy + Immunotherapy for Unresectable CRLM](https://onco.cc/trials/nct07381309/), [Onvansertib in Combination With NALIRIFOX for First Line Treatment of Advanced Pancreatic Cancer](https://onco.cc/trials/nct06736717/), [Organoid-guided vs Topotecan Therapy in Relapsed Extensive-Stage Small Cell Lung Cancer](https://onco.cc/trials/nct07106528/), [PANORAMIX : Optimizing 1st-line NALIRIFOX and Exploring Microbiota's Role in 2nd Line Pancreatic Cancer Treatment](https://onco.cc/trials/nct07028424/), [Pembrolizumab With or Without Maintenance Sacituzumab Tirumotecan (Sac-TMT; MK-2870) in Metastatic Squamous Non-small Cell Lung Cancer (NSCLC) [MK-287](https://onco.cc/trials/nct06422143/), [Pembrolizumab/Vibostolimab (MK-7684A) or Atezolizumab in Combination With Chemotherapy in First Line Treatment of Extensive-Stage Small Cell Lung Cancer (MK-7684A-008/KEYVIBE-008)](https://onco.cc/trials/nct05224141/), [Perioperative Treatment in High-risk Resectable Pancreatic Cancer With NALIRIFOX](https://onco.cc/trials/nct06210360/), [Personalizing Chemotherapy Selection After Surgery for Patients With Stage III Colorectal Cancer Using a Blood Test](https://onco.cc/trials/nct07340567/), [PETACC-3](https://onco.cc/trials/petacc-3/), [Ph1b/2 Study of the Safety and Efficacy of SHR-A1811 Combinations in Advanced HER2 Expression Gastric Cancer](https://onco.cc/trials/nct05671822/), [Ph1b/2 Study of the Safety and Efficacy of T-DXd Combinations in Advanced HER2-expressing Gastric Cancer (DESTINY-Gastric03)](https://onco.cc/trials/nct04379596/), [Pharmacogenomics ANDA SNP Clinical Study - Etoposide and Single Nucleotide Polymorphisms](https://onco.cc/trials/nct01064466/), [Pharmacogenomics ANDA SNP Clinical Study - Topotecan and Single Nucleotide Polymorphisms](https://onco.cc/trials/nct07145333/), [Phase 1/2 Trial of S241656 in Selected RAS/MAPK Mutation- Positive Malignancies](https://onco.cc/trials/nct05786924/), [Phase 3 Study of T-DXd and Rilvegostomig Versus SoC in Advanced HER2-expressing Biliary Tract Cancer](https://onco.cc/trials/nct06467357/), [Phase I-II, FIH, TROP2 ADC, Advanced Unresectable/Metastatic Solid Tumors, Refractory to Standard Therapies (KL264-01)](https://onco.cc/trials/nct04152499/), [Phase I/II Trial in ES-SCLC to Enhance Response to Atezolizumab Plus Chemotherapy With Total Body Irradiation](https://onco.cc/trials/nct06110572/), [Phase II Clinical Study of SHR-A1811 in Patients With HER2 Expression / Amplification of Locally Advanced Unresectable or Recurrent Metastatic Biliary Tract Cancer](https://onco.cc/trials/nct06413745/), [Phase II Study of Sacituzumab Tirumotecan in Combination With Osimertinib for Neoadjuvant Treatment in Patients With Resectable Epidermal Growth Facto](https://onco.cc/trials/nct07329322/), [Phase III Study of Datopotamab Deruxtecan Versus Docetaxel in Previously Treated TROP2-positive Advanced or Metastatic Non-squamous NSCLC Without Acti](https://onco.cc/trials/nct07291037/), [Phase III, Open-label Study of First-line Osimertinib With or Without Datopotamab Deruxtecan for EGFRm Locally Advanced or Metastatic Non-small Cell L](https://onco.cc/trials/nct06350097/), [Phase III, Open-label, First-line Study of Dato-DXd in Combination With Durvalumab and Carboplatin for Advanced NSCLC Without Actionable Genomic Alterations](https://onco.cc/trials/nct05687266/), [Phase III, Open-label, Study of First-line Dato-DXd in Combination With Rilvegostomig for Advanced Non-squamous NSCLC With High PD-L1 Expression (TC ≥](https://onco.cc/trials/nct06357533/), [Post-resection/Ablation Chemotherapy in Patients With Metastatic Colorectal Cancer (FIRE-9 - PORT / AIO-KRK-0418)](https://onco.cc/trials/nct05008809/), [Pre-Operative Treatment in REseCTable COlon CanceR](https://onco.cc/trials/nct06899477/), [Preoperative Chemoradiotherapy and Toripalimab in Locally Recurrent Rectal Cancer](https://onco.cc/trials/nct06751394/), [Pressurized Intraperitoneal Aerosolized Chemotherapy With Mitomycin for the Treatment of Unresectable Appendix or Colorectal Cancer With Peritoneal Metastases,](https://onco.cc/trials/nct07271355/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [PRODIGE 4 / ACCORD 11](https://onco.cc/trials/prodige-4-accord-11/), [Prospectively Randomized Control Clinical Trial of FOLFOXIRI Preoperative Chemotherapy Alone on Rectal Cancer in Local Advance Comparing to Oral Capecitabine Co](https://onco.cc/trials/nct03671252/), [RAINFOL-01 (Rina-S)](https://onco.cc/trials/rainfol-01/), [Retinoblastoma Phase II Expanded Access Clinical Trial](https://onco.cc/trials/nct06679634/), [ROMANCE: "Irinotecan Plus Cetuximab Rechallenge Versus Trifluridine/Tipiracil Plus Bevacizumab in Molecularly Selected Metastatic Colorectal Cancer"](https://onco.cc/trials/nct07381764/), [Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab Versus Pembrolizumab Alone in Metastatic Non-small Cell Lung Cancer (NSCLC) With P](https://onco.cc/trials/nct06170788/), [Sacituzumab Tirumotecan (MK-2870) in Post Platinum and Post Immunotherapy Endometrial Cancer (MK-2870-005)](https://onco.cc/trials/nct06132958/), [Sacituzumab Tirumotecan (MK-2870) Plus Pembrolizumab Versus TPC in TNBC Who Did Not Achieve pCR (MK-2870-012)](https://onco.cc/trials/nct06393374/), [Sacituzumab Tirumotecan (MK-2870) Versus Chemotherapy in Previously Treated Advanced or Metastatic Nonsquamous Non-small Cell Lung Cancer (NSCLC) With](https://onco.cc/trials/nct06074588/), [Sacituzumab Tirumotecan (MK-2870) Versus Pemetrexed and Carboplatin Combination Therapy in Participants With Epidermal Growth Factor (EGFR)-Mutated, A](https://onco.cc/trials/nct06305754/), [Sacituzumab Tirumotecan in Participants With Locally Advanced or Metastatic Thymic Carcinoma](https://onco.cc/trials/nct07324629/), [Safety and Efficacy of BNT327, an Investigational Therapy in Combination With Chemotherapy for Patients With Untreated Small-cell Lung Cancer](https://onco.cc/trials/nct06712355/), [Safety and Efficacy of IB-FOLFIRI in BRAF V600E-Mutant Metastatic Colorectal Cancer](https://onco.cc/trials/nct07150247/), [Second-line Doublet Chemotherapy (FOLFOX or FOLFIRI) Plus Fruquintinib Versus Doublet Chemotherapy (FOLFOX or FOLFIRI) Plus Bevacizumab in Metastatic Colorectal](https://onco.cc/trials/nct07150403/), [Short-Course Radiotherapy, Nal-IRI, Capecitabine, and Camrelizumab for Locally Advanced MSS Rectal Cancer](https://onco.cc/trials/nct07521605/), [SHR-A1811 Combination Regimen for the Treatment of Recurrent or Metastatic Cervical Cancer](https://onco.cc/trials/nct06859775/), [SHR-A1811 for Subjects With Her2-positive Gastric Cancer and Gastroesophageal Junction Adenocarcinoma After Progression on or After First-line Anti-HER2 Therapy-containing Regimen](https://onco.cc/trials/nct06123494/), [SHR-A1811 Versus Investigator's Chemotherapy in Recurrent/Metastatic Breast Cancer Clinical Trial](https://onco.cc/trials/nct05814354/), [Stereotactic Body Radiation Therapy Followed by NALIRIFOX vs NALIRIFOX for Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct06259058/), [Study in mCRC Patients RAS/BRAF wt Tissue and RAS Mutated LIquid BIopsy to Compare FOLFIRI Plus CetuxiMAb or BevacizumaB](https://onco.cc/trials/nct04776655/), [Study of Atezolizumab Plus Carboplatin and Etoposide With or Without Tiragolumab in Participants With Untreated Extensive-Stage Small Cell Lung Cancer](https://onco.cc/trials/nct04665856/), [Study of Dato-DXd as Monotherapy and in Combination With Anti-cancer Agents in Patients With Advanced Solid Tumours (TROPION-PanTumor03)](https://onco.cc/trials/nct05489211/), [Study of LY01610 in Patients With Recurrent Small Cell Lung Cancer](https://onco.cc/trials/nct06128837/), [Study Of Palbociclib Combined With Chemotherapy In Pediatric Patients With Recurrent/Refractory Solid Tumors](https://onco.cc/trials/nct03709680/), [Study of Pembrolizumab (MK-3475) Monotherapy Versus Sacituzumab Govitecan in Combination With Pembrolizumab for Participants With Metastatic Non-small Cell Lung Cancer (NSCLC) With Programmed Cell Death Ligand 1 (PD-L1) Tumor Proportion Score (TPS) ≥50% (MK-3475-D46)](https://onco.cc/trials/nct05609968/), [Study of Sacituzumab Govitecan (SG) in Japanese Participants With Advanced Solid Tumors](https://onco.cc/trials/nct05101096/), [Study of Sacituzumab Govitecan (SG) Versus Docetaxel in Participants With Advanced or Metastatic Non-Small Cell Lung Cancer (NSCLC)](https://onco.cc/trials/nct05089734/), [Study of Sacituzumab Govitecan Combinations in First-line Treatment of Participants With Advanced or Metastatic Non-Small-Cell Lung Cancer (NSCLC)](https://onco.cc/trials/nct05186974/), [Study of Sacituzumab Govitecan in Chinese Patients With Metastatic Triple-negative Breast Cancer Who Received at Least Two Prior Treatments](https://onco.cc/trials/nct04454437/), [Study of Sacituzumab Govitecan in Participants With Metastatic Solid Tumors](https://onco.cc/trials/nct03964727/), [Study of Sacituzumab Govitecan in Participants With Urothelial Cancer That Cannot Be Removed or Has Spread](https://onco.cc/trials/nct03547973/), [Study of Sacituzumab Govitecan in Patients With Solid Tumor](https://onco.cc/trials/nct05119907/), [Study of Sacituzumab Govitecan Versus Standard of Care in Participants With Previously Treated Extensive Stage Small Cell Lung Cancer](https://onco.cc/trials/nct06801834/), [Study of Sacituzumab Govitecan Versus Treatment of Physician's Choice in Participants With Endometrial Cancer After Platinum-Based Chemotherapy and Im](https://onco.cc/trials/nct06486441/), [Study of Sacituzumab Govitecan Versus Treatment of Physician's Choice in Patients With Hormone Receptor-positive/Human Epidermal Growth Factor Receptor 2 Negative (HR+/HER2-) Metastatic Breast Cancer Who Have Received Endocrine Therapy](https://onco.cc/trials/nct05840211/), [Study of TDXd, Chemotherapy, Pembrolizumab, and Trastuzumab in First-Line Metastatic HER2-Positive Gastric or Gastroesophageal Junction Cancer](https://onco.cc/trials/nct06731478/), [Study of Trastuzumab Deruxtecan Versus Standard of Care Chemotherapy for HER2-Expressing (IHC 3+/2+) Endometrial Cancer](https://onco.cc/trials/nct07022483/), [Study of Trastuzumab Deruxtecan With Bevacizumab Versus Bevacizumab Monotherapy for First-line Maintenance in HER2-Expressing Ovarian Cancer (DESTINY-](https://onco.cc/trials/nct06819007/), [Study of Trastuzumab Deruxtecan, Pembrolizumab, and Platinum-based Chemotherapy in First-line HER2 Overexpressing Non-small Cell Lung Cancer](https://onco.cc/trials/nct06899126/), [Study on the Efficacy and Safety of Neoadjuvant Radiotherapy Combined With Tislelizumab, Liposomal Irinotecan, and Capecitabine in the Treatment of pMMR Locally](https://onco.cc/trials/nct07104604/), [Study to Assess the Efficacy and Safety of Rina-S Compared to Treatment of Investigator's Choice in Participants With Endometrial Cancer](https://onco.cc/trials/nct07166094/), [Study to Assess the Efficacy and Safety of Rina-S in Participants With Non-small Cell Lung Cancer](https://onco.cc/trials/nct07288177/), [Study to Assess the Efficacy and Safety of Rina-S Plus Standard of Care Compared to Standard of Care for Maintenance Treatment of Participants With Re](https://onco.cc/trials/nct07225270/), [Study to Assess the Efficacy of Rina-S Compared to Treatment of Investigator's Choice in Participants With Platinum Resistant Ovarian Cancer](https://onco.cc/trials/nct06619236/), [Surufatinib in Combination With Iparomlimab and Tuvonralimab Injection and AG Chemotherapy for Neoadjuvant Therapy of HRPC or BRPC](https://onco.cc/trials/nct07833241/), [Surufatinib Plus mFOLFIRINOX and PD-1 Inhibitor as the Neoadjuvant Therapy for High-risk or Borderline Resectable Pancreatic Cancer](https://onco.cc/trials/nct07469956/), [SYS6090 Combination Therapy in Advanced Lung Cancer](https://onco.cc/trials/nct07472647/), [Systemic Oxaliplatin or Intra-arterial Chemotherapy Combined With LV5FU2 +/- Irinotecan and an Target Therapy in First Line Treatment of Metastatic Colorectal C](https://onco.cc/trials/nct02885753/), [Testing Higher Dose Radiation Therapy for Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct06958328/), [Testing the Addition of a New Immunotherapy Drug, Atezolizumab (MPDL3280A), to the Usual Chemoradiation (CRT) Therapy Treatment for Limited Stage Small Cell Lun](https://onco.cc/trials/nct03811002/), [Testing the Addition of an Anti-Cancer Drug, Irinotecan, to the Standard Chemotherapy Treatment (FOLFOX) After Long-Course Radiation Therapy for Advanced-Stage](https://onco.cc/trials/nct05610163/), [Testing the Addition of an Antibody to Standard Chemoradiation Followed by the Antibody for One Year to Standard Chemoradiation Followed by One Year of the Anti](https://onco.cc/trials/nct04092283/), [Testing the Addition of High Dose, Targeted Radiation to the Usual Treatment for Locally-Advanced Inoperable Non-Small Cell Lung Cancer](https://onco.cc/trials/nct05624996/), [The Combination of Hypofractionated Radiotherapy and Immunotherapy in Locally Recurrent Rectal Cancer](https://onco.cc/trials/nct05628038/), [The Sagittarius Trial](https://onco.cc/trials/nct06490536/), [The Study of JMT101 Combined With Irinotecan as a ≥3rd-Line Treatment in Metastatic Colorectal Cancer](https://onco.cc/trials/nct07134205/), [Tovecimig Plus FOLFIRI in Second Line Metastatic Colorectal Cancer](https://onco.cc/trials/nct07662031/), [Trastuzumab Deruxtecan (T-DXd) in Patients Who Have Hormone Receptor-negative and Hormone Receptor-positive HER2-low or HER2 IHC 0 Metastatic Breast Cancer](https://onco.cc/trials/nct05950945/), [Trial of NP-G2-044 (Prilukae) Combined With PLD for Treatment of Platinum-Resistant Ovarian Cancer (ULTIMUS-1)](https://onco.cc/trials/nct07109414/), [TRIBE](https://onco.cc/trials/tribe/), [TROPiCS-02](https://onco.cc/trials/tropics-02/), [TROPION-Breast01](https://onco.cc/trials/tropion-breast01/), [TROPION-Breast02](https://onco.cc/trials/tropion-breast02/), [TROPION-Breast03](https://onco.cc/trials/tropion-breast03/), [TROPION-Breast05](https://onco.cc/trials/tropion-breast05/), [TROPION-Lung01](https://onco.cc/trials/tropion-lung01/), [TROPION-Lung05](https://onco.cc/trials/tropion-lung05/), [Tumor Subtypes in Subjects on FOLFIRINOX With Non-Metastatic Pancreatic Cancer](https://onco.cc/trials/nct03977233/), [TUXEDO-1](https://onco.cc/trials/tuxedo-1/), [ValproIc Acid to Potentiate Anti-EGFR Treatment Efficacy and Prevent/Revert Resistance in Colorectal Cancer](https://onco.cc/trials/nct06714357/), [Vitamin D3 With Chemotherapy and Bevacizumab in Treating Patients With Advanced or Metastatic Colorectal Cancer](https://onco.cc/trials/nct04094688/)
- drugs: [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Daunorubicin](https://onco.cc/drugs/daunorubicin/), [Epirubicin](https://onco.cc/drugs/epirubicin/), [Etoposide](https://onco.cc/drugs/etoposide/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [FOLFOXIRI (5-FU, leucovorin, oxaliplatin, irinotecan)](https://onco.cc/drugs/folfoxiri/), [Idarubicin](https://onco.cc/drugs/idarubicin/), [Irinotecan (and liposomal irinotecan)](https://onco.cc/drugs/irinotecan/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [Mitoxantrone](https://onco.cc/drugs/mitoxantrone/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [Pegylated liposomal doxorubicin](https://onco.cc/drugs/pegylated-liposomal-doxorubicin/), [Platinum + etoposide (EP / CE)](https://onco.cc/drugs/platinum-etoposide/), [Rinatabart sesutecan](https://onco.cc/drugs/rinatabart-sesutecan/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Sacituzumab tirumotecan](https://onco.cc/drugs/sacituzumab-tirumotecan/), [Topotecan](https://onco.cc/drugs/topotecan/), [Trastuzumab brengitecan](https://onco.cc/drugs/trastuzumab-brengitecan/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Trastuzumab rezetecan](https://onco.cc/drugs/trastuzumab-rezetecan/), [Valrubicin](https://onco.cc/drugs/valrubicin/)
- key papers: [ASCENT: sacituzumab govitecan doubles survival in heavily pretreated metastatic triple-negative breast cancer](https://onco.cc/key-papers/paper-ascent-nejm-2021/), [Datopotamab deruxtecan in patients with untreated, advanced triple-negative breast cancer (TROPION-Breast02): a randomised, open-label, international, phase III trial](https://onco.cc/key-papers/paper-tropion-breast02-ann-oncol-2026/), [DESTINY-Breast03: trastuzumab deruxtecan beats T-DM1 as second-line treatment of HER2-positive metastatic breast cancer](https://onco.cc/key-papers/paper-destiny-breast03-nejm-2022/), [Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial](https://onco.cc/key-papers/paper-napoli-1-nanoliposomal-irinotecan-lancet-2016/), [NAPOLI-3: NALIRIFOX versus gemcitabine plus nab-paclitaxel as first treatment for metastatic pancreatic cancer](https://onco.cc/key-papers/paper-napoli-3-lancet-2023/), [TROPION-Breast01: datopotamab deruxtecan versus chemotherapy in pretreated hormone-receptor-positive breast cancer, and why a PFS win did not translate to survival](https://onco.cc/key-papers/paper-tropion-breast01-jco-2024/)
- ideas: [A randomised trial of antibody-drug conjugate sequence in metastatic triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-adc-sequencing-trial/), [Payload-class switching as the rule for ADC sequencing](https://onco.cc/ideas/idea-payload-switching/), [Test DPYD, UGT1A1 and TPMT/NUDT15 before the first dose, everywhere](https://onco.cc/ideas/idea-tr1-pre-emptive-pharmacogenomic-testing/), [Use SLFN11 status to decide which antibody-drug payload to give next](https://onco.cc/ideas/idea-bio1-slfn11-payload-guidance/)
- institutions: [Auckland City Hospital / Te Pūriri o Te Ora Cancer and Blood Service](https://onco.cc/institutions/auckland-city-hospital/)
- pathways: [DNA replication & origin licensing](https://onco.cc/pathways/dna-replication-licensing/), [Drug efflux pumps (ABC transporters)](https://onco.cc/pathways/drug-efflux-pumps/)
- cancers: [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [HER2-mutant non-small-cell lung cancer](https://onco.cc/cancers/her2-mutant-nsclc/)

---
JSON: https://onco.cc/api/v1/entities/topoisomerase-inhibitors.json