The endgame for chemo?
The big shift here is not just a new drug class, but a different way of thinking about cancer treatment. Chemotherapyโs broad attack has long been effective, yet its damage to healthy fast-dividing cells explains many of the side effects patients fear most. Antibody drug conjugates aim to narrow that attack, which makes the idea of โless toxicโ treatment biologically plausible rather than simply promotional language.
Still, targeted does not automatically mean harmless or universally better. ADCs depend on finding the right marker on the cancer cell, and cancers are biologically uneven: the target may be present in some tumors, absent in others, or change over time. That means the most important question is not whether ADCs replace chemo in theory, but which cancers, which stages, and which patients are likely to benefit enough to justify the added cost and complexity.
For readers, the practical takeaway is about expectations. Early enthusiasm should be balanced with the reality that oncology often moves by trial data, not headlines. Even when a newer therapy outperforms standard treatment in one setting, it may not do so across all cancers or lines of care. The likely near-term story is selective substitution: more targeted drugs in more situations, with chemotherapy remaining important where evidence, access, or tumor biology still make it the better option.
Chemotherapy as we know it has saved millions of lives. From its beginningsย in World War I and IIย to its ubiquity as a cancer treatment today, the medicine has redefined cancer care. But its side effects, including vomiting, hair loss and infections, can be brutal for patients.
In a few years though, cancer sufferers may not have to go through all that. Chemoโs status as the go-to therapy for many cancers may soon come to an end, supplanted by a new generation of smart drugs that hunt down malignant cells without damaging healthy ones.
Chemo works by killing cancer cells that are dividing rapidly. The problem is that also harms other cells that are dividing and growing including those that produce hair and skin. Antibody drug conjugates, or ADCs, promise to deliver the toxic drug directly to the cancer cell. They do this by deploying an antibodyย thatโs designed to recognize a marker on the surface of a cancer cell.
Not only are the ADCs helping patients haveย fewer of the chemo-associated side effects, but theyโre also more effective at killing the cancer cells.
Companies are pushing to ensure they can produce these drugs, with AstraZeneca recently announcing a new $1.5 billion ADC facility in Singapore.
Eliminating chemo and replacing it with something more effective like ADCs is โabsolutelyโย an ambition, Susan Galbraith, AstraZenecaโs Executive Vice President of Oncology R&D,ย tells us.ย โThere’s good reason to expect that you can replace standard of care chemotherapy in many different settings across many different cancers,โย says Galbraith.
But that’s not going to happen tomorrow. She estimates that in the next five years ADCs will be approved as the first treatment in many cancers for patients for whom the disease has already spread.
Currently, ADCsย tend to be reserved for later stage disease. But theyย are also showing signs that they can be effective earlier on. For example, Astraโsย drug Enhertu slowed the progression of breast cancer more than chemotherapy for some womenย in a trial, the company saidย in April.
It’s providing hope that they could move from bit part to starring role. โI could see a point in time where fewer and fewer cancers will be treated with chemotherapy and more and more patients will be treated with these smart, more targeted, more specific, more tailored types of drugs,โย Sophia Karagiannis, professor of cancer immunology at Kingโs College London, says.
There’s also work afoot to improve on the current crop of ADCs. The existing drugs are just the โtip of the icebergโ in terms of what can be accomplished, says Karagiannis. The next generation of these treatments could be even more intelligent โย โsmart warheads,โ as she puts it, that could target specific vulnerabilities in cancer cells rather than just delivering general toxins.
โIf you can target that then youโre really targeting the Achillesโ heel of cancer.โ โย Chloe Meley and Ashleigh Furlong
Enjoyed this article? Sign up for our newsletter to receive regular insights and stay connected.