Amy Kiamos1*, Virginia Velez Quinones1, Sundas Ali1, Atif
Hussein1, Alejandra Ergle1
1Division of Hematology Oncology, Memorial Healthcare
System, Pembroke Pines, FL, USA
*For Correspondence
akiamos@mhs.net
Antibody drug conjugates (ADCs)
have transformed the therapeutic landscape of breast cancer by combining the
specificity of monoclonal antibody targeting with the potency of cytotoxic
chemotherapy. This chapter reviews the evolving role of ADCs across
neoadjuvant, adjuvant, and metastatic breast cancer, beginning with the
foundational principles of ADC design and payload structures. This chapter
traces the evolution of trastuzumab emtansine (T-DM1), trastuzumab deruxtecan
(T-DXd, sacituzumab govitecan (SG), and datopotamab deruxtecan (Dato-DXd), ADCs
that have reshaped treatment strategies across HER2-positive, HER2-low,
HER2-ultralow, and triple negative breast cancer. ADC specific toxicities are
discussed, along with a practical framework for their management as these
agents move into curative-intent settings. Mechanisms of ADC resistance, challenges
in treatment sequencing, and emerging therapeutic directions, including new ADC
targets, are also reviewed.
Keywords
Antibody Drug Conjugate, Breast Cancer, HER2-targeted Therapy, TROP2-targeted Therapy, Trastuzumab Deruxtecan, Sacituzumab Govitecan, Datopotamab Deruxtecan, Trastuzumab Emtansine
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