Payload-Driven Toxicities: Clinical Red Flags in Patients Receiving ADCs

Antibody-drug conjugates (ADCs) are becoming increasingly vital in the evolution of precision oncology, particularly for gastrointestinal (GI) malignancies where complex biology and tumor heterogeneity have historically limited the success of targeted therapies. In an interview with Targeted Oncology, Sarbajit Mukherjee, MD, GI medical oncologist at Baptist Health Miami Cancer Institute, expands on the management of antibody–drug conjugates (ADCs) in clinical practice.

A significant portion of the clinical management for ADCs involves addressing payload-dependent toxicities, with interstitial lung disease (ILD) being a notable safety concern and potentially serious adverse event.

“What we have learned is that the toxicit[ies] from ADCs are somewhat dependent on the payload,” Dr Mukherjee explained. “Some ADCs have shown more ILDs compared [with] others, where we have seen myelosuppression [and] neutropenia are more common.”

According to Dr Mukherjee, identifying ILD may be challenging because the initial symptoms can be extremely subtle, manifesting as a dry cough, mild shortness of breath, or a low-grade fever. Because patients may forget to report these minor changes, he remarks that it is imperative for clinicians to be highly vigilant and conduct thorough symptom screenings at every patient visit.

For GI oncologists using ADCs, early, proactive identification can make toxicity manageable rather than treatment-limiting.

Read the full interview here.