OnCo
ideasIdea

Patient-derived organoids to pick ADC payloads

Grow the patient's tumour in a dish and test which ADC payload kills it before choosing among three TROP2 ADCs.

Payload sensitivity (SN-38 vs DXd vs MMAE) varies by tumour and is not predicted by antigen level. Organoids retain drug sensitivity profiles and can be tested with free payloads within 2-3 weeks.

Confidence
20%40%likelyOnCo editors (initial estimate), 2026-09-07 · Take rates and timelines limit feasibility in metastatic disease.
Hypothesis
Ex vivo payload sensitivity of organoids predicts clinical response to the corresponding ADC.
Rationale
Functional testing correlates with response in colorectal and pancreatic cancer; payload effect dominates ADC efficacy once delivery is adequate.
What would test it
Prospective observational study in metastatic TNBC starting a TROP2 ADC: organoid payload IC50 vs RECIST response and PFS.
Maturity
preclinical evidence

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