Antonio Marra, Medical Oncologist at the European Institute of Oncology, shared on LinkedIn:
“In the ADC era, precision oncology is shifting from selecting a target to selecting a therapeutic system.
Target expression alone is no longer enough to choose among antibody-drug conjugates. The antibody, linker, payload, tumour heterogeneity, prior ADC exposure and toxicity profile all matter.
At ESMO 2026, ADCs continued moving into earlier treatment settings and rare cancers, while new approaches emerged to refine patient selection.
These included HER2-PET, AI-powered digital pathology and multi-omic resistance analyses.
The next challenge is matching each patient to the right construct, payload and treatment sequence.”
ESMO added:
“The challenge is no longer simply developing new compounds, but determining the most appropriate strategy for each patient, including how ADCs should be sequenced.
As Antonio Marra explains in his Editorial, treatment decisions need to consider the three main components of an ADC: the antibody, linker and cytotoxic payload.
Each component contributes to antitumour activity and toxicity, making the overall ADC construct important when selecting therapy.
There is also a growing need for biomarkers that can support more precise patient selection and advance precision medicine in the ADC era.”
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