{"entity":{"id":"idea-organoid-guided-adc","kind":"idea","name":"Patient-derived organoids to pick ADC payloads","aka":[],"tldr":"Grow the patient's tumour in a dish and test which ADC payload kills it before choosing among three TROP2 ADCs.","summary":"Grow the patient's tumour in a dish and test which ADC payload kills it before choosing among the TROP2 ADCs. Payload sensitivity to SN-38, DXd or MMAE varies by tumour and is not predicted by antigen level, while organoids retain drug sensitivity profiles and can be tested with free payloads within two to three weeks. Functional testing already correlates with response in colorectal and pancreatic cancer, and payload effect dominates ADC efficacy once delivery is adequate. The test is a prospective observational study in metastatic TNBC starting a TROP2 ADC, comparing organoid payload IC50 with RECIST response and PFS. With preclinical evidence, it addresses the bottlenecks Lab models that fail to predict what happens in patients and Too many combinations to test.","asOf":"2026-09-04","links":[],"tags":[],"related":[],"cancers":["tnbc","breast-hr-positive"],"sections":[],"technologies":["organoids","functional-drug-testing","adc"],"targets":[],"drugs":["sacituzumab-govitecan","datopotamab-deruxtecan"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Ex vivo payload sensitivity of organoids predicts clinical response to the corresponding ADC.","rationale":"Functional testing correlates with response in colorectal and pancreatic cancer; payload effect dominates ADC efficacy once delivery is adequate.","test":"Prospective observational study in metastatic TNBC starting a TROP2 ADC: organoid payload IC50 vs RECIST response and PFS.","maturity":"preclinical-evidence"},"route":"/ideas/idea-organoid-guided-adc/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"technology":[{"id":"adc","kind":"technology","name":"Antibody-drug conjugate (ADC)","route":"/technologies/adc/"},{"id":"functional-drug-testing","kind":"technology","name":"Functional (ex vivo) drug testing","route":"/technologies/functional-drug-testing/"},{"id":"organoids","kind":"technology","name":"Patient-derived organoids","route":"/technologies/organoids/"}],"drug":[{"id":"datopotamab-deruxtecan","kind":"drug","name":"Datopotamab deruxtecan","route":"/drugs/datopotamab-deruxtecan/"},{"id":"sacituzumab-govitecan","kind":"drug","name":"Sacituzumab govitecan","route":"/drugs/sacituzumab-govitecan/"}],"bottleneck":[{"id":"b-preclinical-models","kind":"bottleneck","name":"Lab models that fail to predict what happens in patients","route":"/bottlenecks/b-preclinical-models/"},{"id":"b-combination-space","kind":"bottleneck","name":"Too many combinations to test","route":"/bottlenecks/b-combination-space/"}],"idea":[{"id":"idea-fund-organoid-translation-gate","kind":"idea","name":"A funded organoid and PDX panel as the go/no-go gate before IND-enabling money","route":"/ideas/idea-fund-organoid-translation-gate/"},{"id":"idea-tr2-synergy-ranking-engine","kind":"idea","name":"An open engine that ranks every drug pair by predicted synergy before anyone runs a trial","route":"/ideas/idea-tr2-synergy-ranking-engine/"},{"id":"idea-moon-automated-combination-discovery","kind":"idea","name":"Automated combination discovery: patient-sample screens feeding Bayesian platform trials","route":"/ideas/idea-moon-automated-combination-discovery/"},{"id":"idea-tr2-organoid-coclinical-arms","kind":"idea","name":"Grow each trial patient's tumour as organoids to decide which platform arm opens next","route":"/ideas/idea-tr2-organoid-coclinical-arms/"},{"id":"idea-bio1-co-clinical-avatar-trials","kind":"idea","name":"Run the mouse or organoid trial at the same time as the human trial","route":"/ideas/idea-bio1-co-clinical-avatar-trials/"}]}}