Antibody-Drug Conjugates in urothelial, prostate, and renal cell cancers: A review of current and emerging therapies

Abstract

This review explores the therapeutic potential of Antibody-Drug Conjugates (ADC) in urological malignancies, emphasizing treatment efficacy, safety, and future prospects. ADC selectively deliver cytotoxic agents to cancer cells, reducing off-target toxicity compared to conventional therapies. Comprising a monoclonal antibody (mAb) linked to a cytotoxic payload, ADC exert their effects through apoptosis, antibody-dependent cellular cytotoxicity (ADCC), and complement-dependent cytotoxicity (CDC). This review highlights ADC advancements in urothelial cancer (UC), prostate cancer (PC), and renal cell carcinoma (RCC). Recent trials demonstrate encouraging outcomes with ADC such as Enfortumab Vedotin (EV), Sacituzumab Govitecan (SG), Trastuzumab Deruxtecan (T-DXd), and Disitamab Vedotin (DV) in UC, improving response rates and Progression-Free Survival (PFS). The influence of antigen expression, particularly Nectin-4 and Trop-2, on ADC treatment outcomes is investigated. In addition, efficacy and safety of ADC combinations with anti–PD-(L)1 therapies and dual immune checkpoint inhibitors to further enhance therapeutic benefit are explored. In PC, ADC targeting prostate-specific membrane antigen (PSMA), Trop-2, and B7-H3 exhibit promising antitumor activity, with research optimizing safety, efficacy, and monitoring strategies. In RCC, ADC against ENPP3, CD70, and TIM-1 show durable responses in early trials, though challenges such as dose-limiting toxicities require further investigation. Overall, this review underscores ADC as a transformative approach in uro-oncology, highlighting ongoing advancements in combination strategies and biomarker-driven applications to refine therapeutic outcomes and expand treatment options for these challenging malignancies.