Breast Oncologists Discuss the Current Paradigm and Future Advancements for ADCs in TNBC
Key Points
- Antibody-drug conjugates (ADCs) are standard of care first-line therapies for patients with advanced or metastatic triple-negative breast cancer (TNBC).
- For community oncologists, understanding and managing ADC toxicities is crucial, especially as they move into earlier treatment settings.
- New ADC agents are in development that use novel targeting mechanisms, including bispecific antibodies. However, ADCs with novel payload components are needed.
At the 2026 American Society of Clinical Oncology Annual Meeting, Alexis LeVee, MD, of UCLA Health, and Hope Rugo, MD, FASCO, of City of Hope, summarized what community oncologists should know about ADCs for patients with TNBC and highlighted ongoing developments in TNBC treatment.
Based on currently available data, first-line therapy for metastatic TNBC should include an anti-TROP-2 ADC, regardless of PD-L1 status. For community oncologists, understanding and proactively managing potential toxicities of ADCs is a key component of treatment success, said Dr. Rugo. While ADCs are established in advanced or metastatic settings, they are also showing promise in different early-stage TNBC treatment settings in ongoing trials.
Looking forward, many ADCs are still being developed, including additional anti-TROP-2 agents and ADCs utilizing bispecific antibodies. Even outside of ADC combinations, anti-PD-(L)1 and VEGF bispecifics like pumitamig and ivonescimab have shown a lot of promise in TNBC, said Dr. Rugo. However, while these novel targeting strategies are meaningful, there is an unmet need for new payload components, as currently approved ADCs all use topoisomerase–directed payloads.