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From the idea of a guided missile to the bispecific and dual-payload ADCs now in trials, in eleven pages.
An antibody that finds the tumour, carrying a tiny dose of very strong chemotherapy that is released only inside it.
Why here The front in one paragraph.
An antibody-drug conjugate is an antibody that homes to a protein on the tumour cell, is swallowed, and releases a chemotherapy payload inside it. That widens chemotherapy's safe dose window about a hundredfold, which is why payloads too toxic to give alone can be used, though lung inflammation, neutropenia and eye toxicity from the payload still occur.
Why here How the antibody, linker, and payload work together, and where they fail.
The payload is the poison an ADC carries, usually a chemotherapy far too toxic to give on its own.
Why here The warhead: why topoisomerase-I inhibitors took over.
The linker is the chemical tether between antibody and payload. It must hold in the blood and let go inside the tumour.
Why here Cleavable or not decides whether neighbouring cells die.
When a released payload leaks out of the targeted cell and kills its neighbours, including cells that lack the target.
Why here The single idea that explains HER2-low.
Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.
Why here The most successful ADC and what it changed.
The first TROP2-targeted ADC. It delivers a strong chemotherapy directly to breast and bladder cancer cells and is now a first-line option in triple-negative breast cancer.
Why here The first TROP2 ADC; now first line in TNBC.
Twenty-five years of trying to make chemotherapy hit only cancer cells, from the unstable first ADC to today's third-generation blockbusters and the fourth generation now in trials.
Why here Twenty-five years in seven steps.
A bispecific ADC is an ADC whose antibody grabs two different proteins on the cancer cell, so it sticks better to tumour and less to healthy tissue.
Why here The next generation, with the first positive phase 3.
The open question of whether a second ADC works after the first one fails, especially when both carry the same type of payload.
Why here The unsolved clinical problem.
When one ADC fails, the next should carry a different kind of poison, not just aim at a different protein.
Why here One proposal for solving it.