Mechanisms of ADC Toxicity and Strategies to Increase ADC Tolerability.
Toan D NguyenBrandon M BordeauJoseph P BalthasarPublished in: Cancers (2023)
Anti-cancer antibody-drug conjugates (ADCs) aim to expand the therapeutic index of traditional chemotherapy by employing the targeting specificity of monoclonal antibodies (mAbs) to increase the efficiency of the delivery of potent cytotoxic agents to malignant cells. In the past three years, the number of ADCs approved by the Food and Drug Administration (FDA) has tripled. Although several ADCs have demonstrated sufficient efficacy and safety to warrant FDA approval, the clinical use of all ADCs leads to substantial toxicity in treated patients, and many ADCs have failed during clinical development due to their unacceptable toxicity profiles. Analysis of the clinical data has demonstrated that dose-limiting toxicities (DLTs) are often shared by different ADCs that deliver the same cytotoxic payload, independent of the antigen that is targeted and/or the type of cancer that is treated. DLTs are commonly associated with cells and tissues that do not express the targeted antigen (i.e., off-target toxicity), and often limit ADC dosage to levels below those required for optimal anti-cancer effects. In this manuscript, we review the fundamental mechanisms contributing to ADC toxicity, we summarize common ADC treatment-related adverse events, and we discuss several approaches to mitigating ADC toxicity.
Keyphrases
- diffusion weighted imaging
- oxidative stress
- diffusion weighted
- drug administration
- induced apoptosis
- cancer therapy
- newly diagnosed
- ejection fraction
- gene expression
- cell cycle arrest
- randomized controlled trial
- signaling pathway
- oxide nanoparticles
- magnetic resonance
- squamous cell carcinoma
- magnetic resonance imaging
- drug delivery
- risk assessment
- young adults
- open label
- endoplasmic reticulum stress
- deep learning
- replacement therapy
- childhood cancer
- peritoneal dialysis