Dr Patel on ADCs in Early-Stage NSCLC

“These antibody-drug conjugates [ADCs] have a variety of different targets, [such as] HER2, HER3, TROP2, and many others. Where ADCs could potentially play a role is at least two-fold in the early-stage setting.”

Sandip P. Patel, MD, professor, medicine, Department of Medicine, medical oncologist, Precision Immunotherapy Clinic, Moores Cancer Center, University of California San Diego (UCSD), UCSD Health, discusses where antibody-drug conjugates (ADCs) may emerge in the treatment paradigm for patients with early-stage non–small cell lung cancer (NSCLC).

The development of ADCs has produced agents with a variety of targets, which include HER2, HER3, and TROP2, among others, Patel notes, allowing these agents to directly deliver potent cytotoxic payloads to tumor cells. In the early-stage NSCLC setting, ADCs could play a significant role in treatment, particularly in patients who do not achieve a pathologic complete response (pCR) after treatment with chemoimmunotherapy, he says. One approach, depending on the toxicity profile, may be ADCs safely administered with immunotherapy, Patel explains. Another approach could be to integrate ADCs with immunotherapy and chemotherapy as neoadjuvant treatment to increase pCR rates and potential cure rates, he notes.

Patel emphasizes that perioperative approaches with ADCs and immunotherapy are of interest; however, it’s crucial to note that ADCs have similar toxicity profiles to chemotherapy. This could mean compromising other treatments in the early-stage setting, he says.

Currently, ADCs in the early-stage NSCLC setting are actively being researched, Patel explains, and more research is needed before there is a clear answer about whether ADCs may be paradigm-changing. Patel notes that thus far, ADCs are better understood in the refractory metastatic setting as treatment following chemoimmunotherapy. He also explains that these agents will one day graduate to the early-stage setting, which may help eradicate more of the tumor and increase cure rates. Nonetheless, Patel concludes that there isn’t a known drug or combination strategy yet that can lead to those positive outcomes.