Integrating antibody-drug conjugates into solid tumor oncology: Current standards and future directions

Antibody-drug conjugates (ADCs) represent a major advance in precision oncology, combining the selectivity of monoclonal antibodies with the cytotoxic potency of chemotherapy. By enabling targeted intracellular delivery of highly potent payloads, ADCs aim to maximize antitumor activity while minimizing systemic toxicity. This review summarizes the structural principles, mechanisms of action, and pharmacokinetic features that define ADC performance, and provides an updated overview of their clinical impact across solid tumors. The authors discuss pivotal trials that established ADCs as standards of care in breast, gynecologic, gastrointestinal, and lung cancers, and highlight emerging targets such as HER3, CLDN18.2, and B7-H3. Mechanisms of resistance, including antigen loss, impaired internalization, and payload-specific adaptations, are examined alongside strategies to overcome them, such as bispecific and dual-payload designs, rational combinations with immunotherapy or targeted agents, and next-generation linker technologies. Finally, the authors explore future directions, including biomarker-driven patient selection, integration into earlier lines of therapy, and innovative formats designed to widen the therapeutic window. With continued advances in engineering and clinical development, ADCs are poised to expand their role from salvage settings to frontline treatment, offering the potential for deeper and more durable responses across a broad spectrum of solid tumors.