Antibody-Drug Conjugates (ADCs)

Antibody-drug conjugates (ADCs) are a type of cancer treatment. They are a combination of targeted therapy and chemotherapy (chemo). ADCs deliver effective chemotherapy drugs directly to cancer cells.

How Do ADCs Work?

Monoclonal antibodies (mAb) are a type of antibody made in a lab. They are designed to find and attach to specific proteins found in cancer cells. These proteins may be absent from healthy cells in the body.

ADCs are a targeted approach to eliminate cancer cells. The structure of an ADC includes linking a mAb to a strong chemo drug. The mAb allows for the chemo drugs to directly reach the cancer cell. This treatment is more precise than traditional chemotherapy alone. This leads to very little damage to healthy cells in the body.

Is This Treatment Right for Me?

ADCs are being used more often to treat certain cancers. Providers may use ADCs when:

• cancer returns (cancer recurrence)
• the cancer spreads or progresses (metastasizes)
• a person’s first diagnosis is stage IV (4) cancer (“De novo” metastatic cancer)
• other treatments are not effective or as effective 

ADCs are not yet available for all types of cancer. Still, they are a rapidly expanding treatment option. ADCs are currently available for certain blood cancers and solid tumor cancers:
 

Blood cancers:

• Acute lymphoblastic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Anaplastic large cell lymphoma
• B-cell lymphoma
• Hodgkin lymphoma
• Multiple myeloma

Solid tumor cancers:

• Breast cancer (HER2, ER positive, TNBC, and metastatic)
• Lung cancer
• Urothelial cancer
• Cervical cancer
• Ovarian cancer
• Gastric or gastroesophageal junction

To learn if this treatment is best for you, talk with your healthcare team. Ask about ADCs that are approved or still in clinical trials. Ask your team if these trials may be an option for you.

Here are some other questions you can ask your care team:

1. What is the goal of treatment with ADCs?
2. What are the potential benefits and risks?
3. Why is this a better option for me at this time?
4. What are possible side effects? How can we manage them?
5. Is a clinical trial a good choice for me?
    

Is a Clinical Trial an Option?

Clinical trials are research studies to test new treatments or learn how to use existing treatments better. A clinical trial may be the only way to get some of the newest, most promising treatments. Talk to your healthcare team about clinical trial options.

Here are a few helpful things to know:

• The U.S. FDA and local review boards oversee all U.S. clinical trials to keep patients safe. By joining a clinical trial, you will receive the best available standard of care or a new approach that may offer improved outcomes.
• There are multiple phases of a clinical trial. Each phase is designed to answer a different question around dosing, side effects, or efficacy of the treatment.
• Almost no one receives a placebo or “sugar pill,” and you will be specifically told if this is a possibility.
• If you join a clinical trial, you can leave the trial at any time and continue to get standard treatment by your doctor.

Most often, the trial pays the costs of the drug being studied, and your health insurance only pays for “standard” treatment costs. However, your health insurance may not pay for everything. Be sure to ask your healthcare team.

ADCs may cause serious side effects. These side effects may differ from person to person. This difference may be due to:

• Your overall health
• Your type of cancer
• The type of ADC treatment you receive

It is important to let your healthcare team know right away if you notice any side effects. Common side effects of ADCs include:

• anemia
• constipation
• diarrhea
• cough
• fatigue
• fever
• headache
• mouth sores
• bleeding (hemorrhage)
• low potassium levels
• loss of appetite
• low white blood cell counts
• low platelet count
• nausea and vomiting
• nerve pain (neuropathy)
• pneumonia
• vision changes
• rash
• hair loss
• shortness of breath    

Your healthcare team can help you monitor and manage any side effects. They can advise you on medications and strategies to reduce discomfort. 

Seeing a palliative care specialist can also help provide some relief. Palliative care addresses physical, social, emotional, and spiritual concerns during treatment. This specialist will help you manage any difficult symptoms, pain, and side effects. 

Managing Treatment Costs

Cancer treatments can be costly. Worries about the costs of care are common when you are facing a cancer diagnosis. It may be helpful to address any financial concerns before you start treatment. 
 

Try these tips:

1. Ask your healthcare team if you can get this treatment as part of a clinical trial where the drug cost is covered.
2. Call your insurance or healthcare plan before you start treatment. Ask what the plan will cover and what your costs will be.
3. Ask your healthcare team if they have resources to help you. Some centers can help you access health insurance or programs that can help pay the costs of treatment. They also may have financial counselors who can walk you through your options.