Antibody–drug conjugates in solid tumors: current landscape, challenges, and future directions

Abstract China is confronted by a high burden of malignant tumors, characterized by a distinct epidemiological profile in which solid tumors such as esophageal and gastric cancers predominate. These challenges highlight an urgent need for more precise and effective therapeutic strategies. Antibody–drug conjugates (ADC), which combine targeted antibody with potent cytotoxic payloads, have demonstrated transformative clinical efficacy across multiple refractory solid tumors and have rapidly become a major focus in global oncology drug development. However, the clinical application of ADC remains constrained by the limited availability of actionable targets, suboptimal predictive biomarkers, and safety concerns such as ocular toxicity and interstitial lung disease. With the emergence of bispecific ADC, immune-stimulating ADC platforms, and next-generation payload designs are now driving the evolution of ADC technology toward broader patient applicability and improved safety profiles. These advances hold the potential to translate into new therapeutic opportunities for patients with high-incidence solid tumors in China.