Reading paths11 pages · about 30 minutes

ADCs in 30 minutes

For: Anyone who keeps hearing about Enhertu and wants to understand why

From the idea of a guided missile to the bispecific and dual-payload ADCs now in trials, in eleven pages.

1
Front
Antibody-Drug Conjugates
An antibody that finds the tumour, carrying a tiny dose of very strong chemotherapy that is released only inside it.
Why here The front in one paragraph.
2
TechnologyApproved
Antibody-drug conjugate (ADC)
An antibody-drug conjugate is a guided missile: an antibody homes to the tumour cell, is swallowed, and releases a chemotherapy so potent it could never be given on its own.
Why here How the antibody, linker, and payload work together, and where they fail.
3
Term
Payload (ADC)
The payload is the poison an ADC carries, usually a chemotherapy far too toxic to give on its own.
Why here The warhead: why topoisomerase-I inhibitors took over.
4
Term
Linker (ADC)
The linker is the chemical tether between antibody and payload. It must hold in the blood and let go inside the tumour.
Why here Cleavable or not decides whether neighbouring cells die.
5
Term
Bystander effect (ADC)
When a released payload leaks out of the targeted cell and kills its neighbours, including cells that lack the target.
Why here The single idea that explains HER2-low.
6
ProductApproved
Trastuzumab deruxtecan
Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.
Why here The most successful ADC and what it changed.
7
ProductApproved
Sacituzumab govitecan
The first TROP2-targeted ADC. It delivers a strong chemotherapy directly to breast and bladder cancer cells and is now a first-line option in triple-negative breast cancer.
Why here The first TROP2 ADC; now first line in TNBC.
8
Roadmap
ADC roadmap: from Mylotarg to bispecific and dual-payload ADCs
Twenty-five years of trying to make chemotherapy hit only cancer cells, from the unstable first ADC to today's third-generation blockbusters and the fourth generation now in trials.
Why here Twenty-five years in seven steps.
9
TechnologyPhase 3
Bispecific ADC
A bispecific ADC is an ADC whose antibody grabs two different proteins on the cancer cell, so it sticks better to tumour and less to healthy tissue.
Why here The next generation, with the first positive phase 3.
10
Term
ADC sequencing
The open question of whether a second ADC works after the first one fails, especially when both carry the same type of payload.
Why here The unsolved clinical problem.
11
Idea
Payload-class switching as the rule for ADC sequencing
When one ADC fails, the next should carry a different kind of poison, not just aim at a different protein.
Why here One proposal for solving it.

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