What is an antibody-drug conjugate?

An ADC is a targeted cancer therapy that links a monoclonal antibody (which finds cancer cells) to a powerful chemotherapy drug (which kills them). This "smart bomb" approach delivers chemotherapy directly to cancer cells, reducing damage to healthy tissue.

Are ADCs better than chemotherapy?

ADCs are not necessarily "better" — they work differently. They can be more effective than traditional chemotherapy for certain cancers because they deliver the drug directly to tumour cells. In some cases, ADCs have shown response rates 2-3x higher than standard chemotherapy in previously treated patients.

What cancers can be treated with ADCs?

ADCs are approved or in trials for breast cancer, lung cancer, bladder cancer, lymphoma, cervical cancer, ovarian cancer, gastric cancer, colorectal cancer, and head & neck cancer. The number of cancer types is growing rapidly as new targets are identified.

Is ADC treatment available on the NHS?

Several ADCs are now approved by NICE for NHS use, including trastuzumab deruxtecan (Enhertu), sacituzumab govitecan (Trodelvy), enfortumab vedotin (Padcev), and trastuzumab emtansine (Kadcyla). Access depends on your specific cancer type, stage, and prior treatments.

Treatment Guide

Antibody-Drug Conjugate (ADC) Clinical Trials in the UK 2026

26 May 2026 12 min read

150+

UK ADC trials

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NHS sites

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Cancer types

Antibody-drug conjugates (ADCs) are one of the fastest-growing areas in oncology. These "smart bombs" combine the targeting precision of monoclonal antibodies with the cell-killing power of chemotherapy, delivering treatment directly to cancer cells while sparing healthy tissue. With breakthrough drugs like Enhertu and Trodelvy transforming cancer care, UK clinical trials are rapidly expanding into new cancer types and earlier treatment lines.

How ADCs Work

Targeting Antibody

A monoclonal antibody engineered to recognise and bind to a specific protein found on the surface of cancer cells (e.g. HER2, TROP2, Nectin-4). This provides the "GPS" that guides the drug to the tumour.

Linker

A chemical connector that attaches the toxic payload to the antibody. Modern linkers are designed to remain stable in the bloodstream but release the payload once inside the cancer cell. Linker stability is crucial for ADC effectiveness.

Cytotoxic Payload

A powerful chemotherapy drug — often 100-1000x more potent than conventional chemo — that would be too toxic to give systemically. The ADC carries it safely to the cancer cell, where it's released to destroy the cell from within.

Bystander Effect

Some ADCs (like trastuzumab deruxtecan) release payload that can kill neighbouring cancer cells even if they don't express the target protein. This "bystander killing" effect makes them effective against heterogeneous tumours.

Key ADC Drugs in UK Trials

Trastuzumab deruxtecan (Enhertu) — HER2-targeted. Approved for HER2+ breast cancer and HER2-mutant lung cancer. Trials expanding to HER2-low breast, gastric, and colorectal cancers.
Sacituzumab govitecan (Trodelvy) — TROP2-targeted. Approved for metastatic triple-negative breast cancer. Trials in HR+ breast cancer, urothelial cancer, and NSCLC.
Enfortumab vedotin (Padcev) — Nectin-4-targeted. Approved for advanced bladder cancer. Trials combining with pembrolizumab as 1st-line treatment showing remarkable results.
Tisotumab vedotin (Tivdak) — Tissue Factor-targeted. Approved for cervical cancer. Trials expanding to other gynaecological cancers.
Loncastuximab tesirine (Zynlonta) — CD19-targeted for relapsed/refractory DLBCL lymphoma. Trials in earlier lines and combinations.
Next-generation ADCs — Dual-payload ADCs, immunostimulatory ADCs, and ADCs with novel targets (B7-H3, HER3, CD25) are entering UK trials.

Eligibility for ADC Trials

ADC trial eligibility depends on the specific drug and cancer type, but common requirements include:

Target expression — Your tumour must express the target protein the ADC is designed to recognise (confirmed by pathology testing)
Prior treatment history — Most ADC trials specify the number and type of prior therapies
Measurable disease — Tumours that can be assessed on scans (RECIST criteria)
Adequate organ function — Particularly important for ADCs due to potential lung, liver, and eye toxicity
No interstitial lung disease — Especially for trastuzumab deruxtecan, which has a risk of pneumonitis

Tip: ADCs are expanding into earlier lines of treatment. If you have newly diagnosed or limited prior treatment, there may be trials available. Our Smart Matcher can help find trials matched to your treatment history.

Side Effects and Monitoring

ADC side effects differ from traditional chemotherapy — they're a combination of the antibody and payload effects
Nausea and fatigue — Common but usually manageable with anti-sickness medications
Hair loss — Less common than with traditional chemotherapy but can occur
Low blood counts — Neutropenia (risk of infection) and anaemia are common
Pneumonitis — Inflammation of the lungs, particularly with trastuzumab deruxtecan. Monitored with regular chest scans
Eye toxicity — Some ADCs cause dry eyes, blurred vision, or corneal changes. Regular eye exams may be needed
Skin reactions — Rash and hand-foot syndrome can occur

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