Drug resistance to antibody-drug conjugates: mechanisms, challenges, and perspectives
Yajing Liu1,2, Yuwei Liu1,2, Tingting Wu1,2
1Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Abstract:
Antibody-drug conjugates (ADCs) have emerged as a transformative class of cancer therapeutics by combining the target precision of antibodies with the potent cytotoxic effects of chemotherapeutic agents. This unique approach aims to enhance the effectiveness of cancer treatment while minimizing systemic toxicity. This review provides a comprehensive overview of ADC development, starting with explorations of the structural and mechanistic foundations, and advancing to in-depth analyses of ADCs that have achieved clinical success. Despite remarkable progress, the development of drug resistance remains a significant barrier to broader clinical application. We discuss the mechanisms underlying resistance, including alterations in target antigens, disruptions in ADC internalization, and dysfunctions of intracellular trafficking. To address these challenges, we propose several strategies, such as designing next-generation ADCs equipped with improved linkers and novel payloads, implementation of combination therapies, and simultaneous targeting of multiple pathways to circumvent resistance. In conclusion, this review highlights the critical need for innovative approaches in the evolving ADC landscape, aiming to overcome resistance mechanisms and fully harness the therapeutic promise of ADCs in cancer treatment.
Insights
Antibody-drug conjugates (ADCs) offer targeted cancer therapy by linking antibodies to chemotherapy. Overcoming drug resistance is key to maximizing their therapeutic potential.
Area of Science:
- Oncology
- Pharmacology
- Biotechnology
Background:
- Antibody-drug conjugates (ADCs) represent a significant advancement in cancer treatment, merging antibody specificity with cytotoxic payloads.
- This approach aims to improve therapeutic efficacy and reduce systemic toxicity in oncology.
- ADCs leverage targeted delivery to enhance cancer cell killing.
Purpose of the Study:
- To provide a comprehensive review of antibody-drug conjugate (ADC) development and clinical success.
- To analyze mechanisms of drug resistance encountered with ADCs.
- To propose strategies for overcoming resistance and advancing ADC therapeutics.
Main Methods:
- Literature review of ADC structural and mechanistic foundations.
- Analysis of clinically successful ADCs.
- Discussion of resistance mechanisms and potential therapeutic strategies.
Main Results:
- ADCs have demonstrated remarkable progress in cancer treatment.
- Drug resistance, including target antigen alterations and intracellular trafficking defects, poses a significant challenge.
- Next-generation ADCs, combination therapies, and multi-pathway targeting are promising strategies.
Conclusions:
- Innovative approaches are crucial for overcoming ADC resistance.
- Further development is needed to fully realize the therapeutic promise of ADCs in cancer.
- Addressing resistance mechanisms will expand the clinical application of ADCs.
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