More than Toxins-Current Prospects in Designing the Next Generation of Antibody Drug Conjugates.

Antibody drug conjugates (ADCs) are rapidly becoming a cornerstone in targeted therapies, especially for the treatment of cancer. Currently, there are 12 FDA-approved ADCs, eight of which have been approved within the last five years, with numerous candidates in clinical trials. The promising clinical perspective of ADCs has led to the development of not only novel conjugation techniques, but also antibody formats, linkers, and payloads. While the majority of currently approved ADCs relies on cytotoxic small molecule warheads, alternative modes of action imparted by novel payloads and non-classical antibody formats are gaining attention. In this review, we summarize the current state of the art of ADC technologies, as well as comprehensively examine alternative payloads, such as toxic proteins, cytokines, PROTACs and oligonucleotides, and highlight the potential of multi-specific antibody formats for the next generation of therapeutic antibody conjugates.