May 28, 2024

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Key Factors Influencing the Efficacy of Antibody-Drug Conjugates (ADCs)

Key Factors Influencing the Efficacy of Antibody-Drug Conjugates (ADCs)

Key Factors Influencing the Efficacy of Antibody-Drug Conjugates (ADCs)

Antibody-Drug Conjugates (ADCs) represent a cutting-edge technology aimed at overcoming the limitations of traditional chemotherapy by selectively targeting cancer cells.

The effectiveness of ADCs relies on several physicochemical factors, including binding sites, molecular weight, linker length, spatial hindrance, half-life, and conjugation methods.

As of February 2023, globally, 15 ADCs have received FDA approval, with over 100 undergoing clinical trials.

Despite these advancements, designing an ideal ADC remains a significant challenge, emphasizing the need for a profound understanding of ADC components and their characteristics to develop safer and more efficient treatments.

Key Components of ADCs:

1. Antigen Selection: Choosing the appropriate target antigen is the first crucial step in developing an ideal ADC. The ideal antigen should be overexpressed on cancer cell surfaces, avoid secretion, and possess internalization capabilities. Commonly targeted antigens include CD33, CD30, CD22, BCMA, CD19, CD79b, HER2, Nectin-4, Trop-2, EGFR, and TF.

2. Antibody Selection: For an ideal ADC, the antibody must exhibit high affinity and low immunogenicity toward the target antigen, with a capability for long plasma half-life and rapid internalization. IgG, particularly IgG1, is the most commonly used antibody type due to its diverse subclasses and immunoeffector activation ability.

3. Linker and Payload: The linker serves as a bridge between the antibody and the cytotoxic payload, contributing to the stability and efficacy of the ADC. The payload, a highly cytotoxic drug, should demonstrate potency, stability during metabolism, and high solubility.

Key Factors Influencing the Efficacy of Antibody-Drug Conjugates (ADCs)

ADC Conjugation Strategies:

The choice of conjugation method and site is a key factor in designing ideal ADCs, influencing payload release location and rate, ultimately impacting safety and efficacy.

1. Coupling with Endogenous Amino Acids: One common coupling method involves the reaction between the amino groups of antibody lysine residues and the electrophilic N-hydroxysuccinimide (NHS) ester groups on the payload. Despite its simplicity, the abundance of lysine residues can lead to uneven mixtures in randomly distributed ADCs.

2. Disulfide Bond Bridging Strategy: Exploring inter-chain disulfide bonds within IgG antibodies provides another avenue for payload conjugation. The reduction of four disulfide bonds can generate eight thiol groups, which can react with maleimide linkers, resulting in ADCs with a DAR (drug-to-antibody ratio) of 8.

3. Glycan Conjugation: Utilizing glycosylation sites on IgG, specifically the N297 position, for payload attachment can reduce the risk of impairing antibody antigen-binding ability post-conjugation.

4. Enzyme-Guided Modification: Introducing specific amino acid labels into the antibody sequence allows highly selective payload attachment, guided by enzymes such as formylglycine-generating enzyme (FGE) or microbial transglutaminase.

5. Cysteine Engineering: Thiol-Maleimide Technology: Thiol-maleimide technology involves selective and uniform modification of desired sites on antibodies using engineered reactive cysteine residues. Computational modeling and high-throughput scanning are often employed to identify optimal mutation positions.

6. Engineering Non-Natural Amino Acids: Incorporating non-standard amino acids (ncAA) offers an alternative for site-specific conjugation. This method requires recombinant expression of tRNA and aminoacyl-tRNA synthetase orthogonal to host cell machinery.

Challenges of ADCs:

Despite advances in ADC design, challenges such as pharmacokinetics, targeted payload release, uniform drug distribution, adverse effects, and resistance persist.

1. Complex Pharmacokinetics: The dynamic interplay between intact ADCs, free antibodies, and released cytotoxic payloads poses challenges in establishing predictive models for clinical features, complicating the design of new ADCs.

2. Payload Release in Solid Tumors: Effective penetration of ADCs into solid tumor sites remains a hurdle due to their high molecular weight, impacting payload efficacy. Only a fraction of administered ADCs reach tumor cells, necessitating consideration of payload potency during ADC design.

3. Inevitable Side Effects: Key factors contributing to side effects include premature release of payloads in the systemic circulation and potential immunogenic reactions to ADC antibodies, resulting in common toxicities such as thrombocytopenia, anemia, neutropenia, leukopenia, and hepatotoxicity.

4. Resistance: Resistance to ADCs can arise through mechanisms such as reduced antigen expression, altered intracellular transport pathways, and resistance to the cytotoxic payload.


ADCs represent a promising cancer treatment technology with the potential to overcome the limitations of conventional therapies.

However, the pharmacology of ADCs is intricate, and designing and synthesizing ideal ADCs present ongoing challenges. In-depth knowledge of factors influencing ADC efficacy guides the development of more potent and stable ADCs.

The meticulous selection of antigens, antibodies, linkers, payloads, and conjugation techniques leads to the creation of ADCs with enhanced efficacy, safety, and stability.

As researchers continue their efforts in this field, the future of ADCs holds great promise for advancing targeted cancer therapies.

Key Factors Influencing the Efficacy of Antibody-Drug Conjugates (ADCs)


1.”Antibody drug conjugate: the ‘biological missile’ for targeted cancer therapy.” Signal Transduction and Targeted Therapy (2022) 7:93.
2.”A comprehensive review of key factors affecting the efficacy of antibody drug conjugate.” Biomed Pharmacother. 2023 May;161:114408.
3.”The Chemistry Behind ADCs.” Pharmaceuticals (Basel). 2021 May; 14(5): 442.

(source:internet, reference only)

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Important Note: The information provided is for informational purposes only and should not be considered as medical advice.