To date, 12 ADCs (gemtuzumab ozogamicin, brentuximab vedotin, trastuzumab emtansine, inotuzumab ozogamicin, moxetumomab pasudotox, polatuzumab vedotin, trastuzumab deruxtecan, enfortumab vedotin, sacituzumab govitecan, belantamab mafodotin, loncastuximab tesirine-lpyl, and tisotumab vedotin-tftv) have been approved by the FDA to treat various solid tumors and hematological malignancies. [3] An ADC is typically composed of a monoclonal antibody (mAb; recognizes a specific target) linked to a potent cytotoxic molecule (payload drug). In addition, a linker is required to connect these two components and maintain ADC stability. [4] Two types of linkers, namely cleavable [5] and noncleavable linkers, [6] have been developed, and these have met different requirements of preclinical and clinical studies. Cleavable linkers are designed to remain stable in the bloodstream and selectively release the payload drug in the target cell, whereas noncleavable linkers mainly rely on lysosomal degradation to release the payload drug after ADC internalization. [7] All components of an ADC can be distinctively designed to maximize its binding affinity and therapeutic effect (Figure 1).The ADC as a complex fully exerts biological effect of the two components and selectively delivers the payload drug to target tissues through the mAb. The ADC initially binds to cell surface antigens and enters tumor cells through clathrin-mediated endocytosis. [8] It is then transported to the early endosome, and it subsequently enters the lysosome where it is degraded by proteolytic enzymes to release the payload drug into the cytoplasm. [9] Ultimately, cytotoxic drugs induce tumor cell death or apoptosis via different mechanisms, such as by damaging DNA or inhibiting microtubule synthesis. [10] This process results in minimal systemic toxic effects, but it improves the treatment window of cytotoxic drugs, and the therapeutic efficacy is enhanced accordingly. [11]
Development History of Antibody-Drug ConjugatesThe history of ADC drug development occurred in three stages and provided three generations of ADCs. For first-generation ADCs, cytotoxic drugs were mainly conjugated with mouse mAbs via non-cleavable linkers. This increased the possibility of inducing antidrug antibody effects. In addition, off-target Antibody-drug conjugates (ADCs) are composed of monoclonal antibodies linked to cytotoxic payload drugs, each of which can be diversely designed in accordance with pharmacological and clinical requirements. The use of ADCs is effective for the treatment of different diseases, including cancers, and is gaining widespread attention. To date, 12 ADCs have been approved by the U.S. Food and Drug Administration for treating cancer and improving the quality of life of patients. To expand the application of ADCs and improve their treatment efficiency, various formats have recently been manufactured, including pattern recognition receptor (PRR) agonist-based ADCs. The antibody has a unique structure that enables the specific delivery of PRR agonists ...