ADCs Could Move Up the Treatment Line in GI Cancers

In the evolving landscape of gastrointestinal (GI) oncology, the sequencing of antibody–drug conjugates (ADCs) is becoming a critical area of focus for clinicians as these agents move from trials into the clinic. In an interview with Targeted Oncology, Sarbajit Mukherjee, MD, GI medical oncologist at Baptist Health Miami Cancer Institute, highlights a growing shift toward earlier-line use.

Watch the first part of Dr Mukherjee’s interview.

Currently, the number of approved ADCs for GI malignancies remains lower compared to other fields, such as breast cancer. Because of this limited availability, these potent therapies—which combine targeted specificity with cytotoxic payloads—are typically reserved for later-line settings, administered only after a patient’s disease has progressed on standard first-line options like chemotherapy or chemoimmunotherapy.

Dr Mukherjee identifies a significant challenge with this traditional approach: by the time patients receive ADCs in later lines, they are often physically exhausted from previous treatments. Furthermore, the underlying disease biology often shifts significantly by the time a patient reaches third- or fourth-line therapy, which may complicate the effectiveness of the ADC. As noted in part 1, the success of these agents also depends on rigorous toxicity management, particularly for adverse effects like interstitial lung disease (ILD), which requires high clinician vigilance.

In Dr Mukherjee’s view, the future of GI oncology points toward moving these agents into earlier-line settings. He anticipates that data from emerging clinical trials will provide the necessary evidence to support the efficacy of ADCs in earlier lines of therapy. This proactive strategy aims to apply the precision and potency of ADCs before the disease becomes more resistant, ultimately optimizing patient outcomes.

Read the full interview here.