Dr Cosgrove on the Evolution of ADC Treatment in Ovarian Cancer

Casey M. Cosgrove, MD, gynecologic oncologist, assistant professor, Department of Gynecologic Oncology, The Ohio State University College of Medicine, The Ohio State University Comprehensive Cancer Center—James Cancer Hospital and Solove Research Institute, discusses the evolution of treatment with antibody-drug conjugates (ADCs) for patients with ovarian cancer.

Approximately a century ago, the concept of ADCs emerged, initially perceived as a potential “magic bullet” for cancer management. Today, there are over 100 ADCs in various stages of development and investigation, Cosgrove begins. As the understanding of biomarkers—the proteins expressed on the surfaces of tumors—advances, oncologists can increasingly tailor personalized therapies, he says. The science behind ADCs is becoming more sophisticated, particularly in the design of linkers that connect chemotherapy agents to monoclonal antibodies targeting cancer cells, according to Cosgrove. This precision enhances tissue-directed therapies, paving the way for improved treatment outcomes, Cosgrove explains.

As biochemistry and biomarker knowledge evolve, alongside enhancements in chemotherapy payloads, the potential for these therapies appears limitless, he continues, noting that a crucial next step involves determining the optimal timing for administering these agents. Questions arise about whether they should be introduced earlier in treatment and which patients would benefit most from specific markers, he notes. A multidisciplinary approach, incorporating input from pathology departments, is vital in addressing these considerations, Cosgrove emphasizes.

Oncologists anticipate ongoing improvements in the science and chemistry of ADCs, refinement in patient selection, and an increase in available therapies through the identification of new biomarkers, he continues. This class of drugs is likely to remain integral to oncology, necessitating familiarity with the unique toxicities associated with these innovative treatments, he reports. Additionally, it is essential to streamline processes for testing patients at the appropriate times to ensure their timely access to these agents, Cosgrove says. The exploration of ADCs in settings beyond platinum-resistant cases, such as those involving promising new agents, represents an exciting frontier in cancer treatment that oncologists hope to investigate further in the near future, he concludes.