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Antibody–drug conjugates (ADCs) are gaining momentum in oncology because they combine targeted recognition of cancer cells with potent drug payloads, and more candidates are moving through clinical trials. The clearest growth signal in the available figures is development activity: the American Association for Cancer Research (AACR) reported 284 ADC trials launched worldwide in 2024, nearly 100 more than in 2023. That is not a measure of sales, treatment success or patient benefit.
What is an antibody–drug conjugate?
An ADC is a medicine built from three parts: an antibody that recognizes a target, a linker that attaches the antibody to a drug, and a cytotoxic payload intended to kill cells. The American Association for Cancer Research describes the antibody as binding a target protein found mostly on cancer-cell surfaces; the linker joins it to chemotherapy, and the payload is a highly potent chemotherapeutic agent.
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This design is a form of targeted drug delivery. It does not mean that the payload reaches only cancer cells, that treatment has no effects elsewhere in the body, or that an ADC is automatically safer than another therapy. Eligibility and expected risks depend on the specific medicine, its label and the patient’s circumstances.
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How do ADCs work?
- Recognition: The antibody binds a target protein on a cell’s surface. The target must be present in the relevant cancer for the treatment to make sense.
- Entry: In the mechanism described by AACR, the target-bound ADC is taken into the cancer cell.
- Payload release: The linker is cleaved, releasing the cytotoxic payload inside the cell, where it can damage or kill it.
The intended advantage is to direct a potent drug toward cells carrying the target. In practice, the antibody, target, linker, payload and dosing all matter; “targeted” describes the design, not a guarantee of perfect selectivity or an absence of toxicity.
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Which cancers are ADCs used to treat?
ADCs are approved for particular cancers and patient groups, not for cancer in general. The AACR’s 2025 Cancer Progress Report describes recent U.S. Food and Drug Administration (FDA) approvals for two medicines, each with defined disease and treatment criteria:
- Datopotamab deruxtecan-dlnk (Datroway): AACR reports a January 2025 approval for adults with unresectable or metastatic hormone receptor-positive, HER2-negative breast cancer after endocrine-based therapy and chemotherapy. It also reports a June 2025 expansion for certain people with advanced or metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) after EGFR-targeted therapy and platinum-based chemotherapy.
- Telisotuzumab vedotin-tllv (Emrelis): AACR describes its use for locally advanced or metastatic NSCLC after prior systemic therapy when the tumor has high MET protein overexpression. AACR also reports FDA approval of a companion diagnostic assay for identifying the relevant biomarker group.
These examples should not be generalized to all breast or lung cancers. The target or biomarker, stage, prior treatments and jurisdiction-specific prescribing information define who may be eligible. Because approvals and labels can change, patients and clinicians should consult current FDA prescribing information and diagnostic requirements rather than relying on a summary of a 2025 report.
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What the reported trial results do—and do not—show
For the phase III trial supporting datopotamab deruxtecan in the breast-cancer setting, AACR reports nearly seven months without disease progression, compared with five months with standard chemotherapy. AACR also says more research is needed to establish whether the medicine extends overall survival over chemotherapy. These are different outcomes: time without progression does not by itself prove that people live longer.
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Why are ADCs attracting more clinical research?
The 284 ADC trials launched worldwide in 2024, nearly 100 more than in 2023, are a concrete indicator that the field is expanding clinically, according to AACR’s 2025 report. AACR characterizes ADCs as the fastest-growing therapeutic approach for solid tumors worldwide. Trial launches show that developers are testing more candidates and strategies; they do not establish how many candidates will succeed, become approved or improve outcomes.
Regulatory approvals provide a second signal of therapeutic progress: the two AACR examples address distinct biomarker-defined groups and treatment settings. Separately, the American Society of Clinical Oncology (ASCO) reported 14 FDA-approved ADCs as of early 2026 in its May 2026 review. That is a dated count from a professional review, not a verified FDA total for October 2026. The AACR 2026 report’s figure of 11 new cancer therapeutics approved between July 1, 2025, and June 30, 2026, is a broader oncology figure; it does not establish that those approvals were ADCs.
These approval and trial signals describe clinical and development activity, not market revenue. The cited sources do not establish a verified, current global ADC market-size estimate. A revenue figure would need a dated source with a clear method and should distinguish actual sales from forecasts.
What makes ADC development technically demanding?
An ADC is not simply an antibody with a chemotherapy drug attached. Developers must establish how the complete construct behaves in the body, how it should be dosed and which patients are most likely to benefit. The FDA’s March 2024 final guidance addresses clinical-pharmacology considerations for ADCs with cytotoxic small-molecule payloads, including:
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- Bioanalytical methods for measuring the drug and its components.
- Dosing strategy and dose- and exposure-response.
- Effects of intrinsic factors, such as patient characteristics.
- Assessment of QTc, an electrocardiographic measure.
- Immunogenicity and potential drug–drug interactions.
The FDA says the guidance may not apply to ADCs with payloads other than cytotoxic small molecules or to indications outside oncology. It is a development guide, not a finding that every ADC has the same safety profile or testing needs.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Where could ADC design go next?
ASCO’s May 2026 review describes several directions under development: bispecific ADCs designed to engage more than one target, constructs carrying two payloads, combination strategies, and investigation in earlier treatment settings. These approaches aim to broaden or refine how ADCs can be used, but they remain development directions—not proof that a particular investigational construct is approved or appropriate for every cancer.
Moving a treatment into an earlier line also changes the clinical question: it must be assessed in the relevant population against the appropriate standard of care, with benefits and risks established for that setting. Approval in one later-line or biomarker-defined group does not establish suitability earlier in treatment.
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For patients, clinicians and readers following oncology technology, keep three measures separate:
- Research activity: The number of trials launched indicates how much is being tested, not how much works.
- Regulatory progress: An approval applies to a defined label, biomarker group and treatment context, not an entire cancer type.
- Commercial scale: Trial counts and approval counts are not revenue figures. A current market-size claim requires a separate, dated and transparent market source.
The evidence points to a fast-moving therapeutic field, with increasing trial activity, recent approvals for specific patient groups and ongoing work on ADC design. It does not support treating ADCs as a universal cancer treatment or equating development growth with proven patient benefit or market growth.
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