Antibody-Drug Conjugates in Breast Cancer: Emerging Insights, Clinical Integration, and Toxicity Management

This OncLive Insights program reviews the rapidly expanding role of antibody-drug conjugates (ADCs) across the breast cancer continuum and their growing impact on clinical decision-making. In early-stage HER2-positive disease, emerging data from DESTINY-Breast trials support the movement of trastuzumab deruxtecan into neoadjuvant and adjuvant settings for selected high-risk patients, while highlighting the need for careful toxicity monitoring. In metastatic HER2-positive disease, ADCs are moving into the first-line setting with evolving strategies for treatment duration and maintenance. For hormone receptor–positive HER2-low disease, ADCs have redefined classification and earlier treatment sequencing, with additional agents providing options after chemotherapy. In metastatic triple-negative breast cancer, multiple ADCs, either alone or combined with immunotherapy, are reshaping first-line care. Across subtypes, key challenges include optimal sequencing, cumulative toxicity management, and patient selection. Looking ahead, next-generation ADCs, biomarker-driven strategies, and treatment de-escalation approaches are expected to further personalize therapy and improve outcomes.