# TROP2 ADC roadmap: sacituzumab govitecan → Dato-DXd → sac-TMT → bispecifics and PET

Source: https://onco.cc/roadmaps/trop2-adc-roadmap/  
OnCo record `trop2-adc-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

One target, three approved-or-nearly-approved drugs, and a fourth wave. How TROP2 went from an obscure trophoblast antigen to the centre of breast and lung cancer treatment.

## Summary

TROP2 is not a driver but an address, so this roadmap follows what is delivered to it. It starts with target discovery on trophoblasts and Immunomedics humanising the RS7 antibody, moves to sacituzumab govitecan proving the target in ASCENT, then to datopotamab deruxtecan and the first-line phase 3 trials ASCENT-03, ASCENT-04 and TROPION-Breast02. Sacituzumab tirumotecan and the Merck TroFuse programme form a third wave, while selection, sequencing and cross-resistance among TOP1 payloads remain unsolved, with TROP2 PET and ctDNA biomarkers entering trials. The speculative end is bispecific and next-payload TROP2 ADCs in early-stage disease. The route links TNBC, HR-positive breast cancer, NSCLC and urothelial cancer, the TROP2 target and the incentive-misalignment bottleneck.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-04

## Sources

- ASCENT: sacituzumab govitecan doubles survival in heavily pretreated metastatic triple-negative breast cancer (New England Journal of Medicine 2021): https://doi.org/10.1056/NEJMoa2028485

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Antibody-Drug Conjugates](https://onco.cc/fronts/adcs/)
- targets: [TROP2](https://onco.cc/targets/trop2/)
- trials: [ASCENT](https://onco.cc/trials/ascent/), [ASCENT-03](https://onco.cc/trials/ascent-03/), [ASCENT-04 / KEYNOTE-D19](https://onco.cc/trials/ascent-04/), [TROPION-Breast01](https://onco.cc/trials/tropion-breast01/), [TROPION-Breast02](https://onco.cc/trials/tropion-breast02/), [TROPION-Breast05](https://onco.cc/trials/tropion-breast05/), [TROPION-Lung01](https://onco.cc/trials/tropion-lung01/)
- drugs: [AK146D1](https://onco.cc/drugs/ak146d1/), [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Sacituzumab tirumotecan](https://onco.cc/drugs/sacituzumab-tirumotecan/)
- companies: [Gilead Sciences (incl. Kite)](https://onco.cc/companies/gilead/), [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Sichuan Kelun-Biotech](https://onco.cc/companies/kelun-biotech/)
- technologies: [Bispecific ADC](https://onco.cc/technologies/bispecific-adc/), [Dual-payload ADC](https://onco.cc/technologies/dual-payload-adc/), [Radio-antibody & radio-ADC](https://onco.cc/technologies/radioimmunotherapy/), [TROP2 PET](https://onco.cc/technologies/trop2-pet/)
- terms: [ADC sequencing](https://onco.cc/terms/adc-sequencing/)
- pairings: [Caution: TOP1 ADC immediately after TOP1 ADC](https://onco.cc/pairings/adc-after-adc-caution/), [TROP2 PET → TROP2 ADC selection](https://onco.cc/pairings/trop2-pet-to-adc/)
- ideas: [A randomised trial of antibody-drug conjugate sequence in metastatic triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-adc-sequencing-trial/), [TROP2 PET to choose and sequence TROP2 ADCs](https://onco.cc/ideas/idea-trop2-pet-selection/)
- key papers: [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/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/)

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