Antibody-drug conjugates: From oncological milestones to emerging non-oncological applications

Antibody-drug conjugates (ADCs) have come forth as one of the most promising classes of targeted therapeutics that integrates the specificity of monoclonal antibodies (mAbs) with the potency of diverse payloads. Since their introduction, they have undergone significant evolution in design which entails optimization of antibodies, linkers, and cytotoxic payloads to improve selectivity, stability, and overall therapeutic scope. These advances have transformed ADC design leading to multiple Food and Drug Administration (FDA) approvals and improved patient outcomes across different cancer types. In the recent years, the scope of ADCs has extended beyond oncology by utilizing their innovative design for non-oncological indications such as autoimmune, inflammatory, and infectious diseases. This review delves into the fundamental components, mechanisms, and clinical evolution of ADCs in oncology. It further highlights the development approach, progress and emerging translational opportunities in applying ADC-based targeted delivery in non-oncological therapeutics.