Summary
Alice was diagnosed with uveal melanoma, a cancer that develops in the middle of the eye. The cancer was metastatic and she faced an uphill battle.
In 1908, Ehrlich’s laboratory created its first “magic bullet” of arsphenamine. It was the first effective treatment for syphilis. Chemotherapy is not a bullet. It is a sledgehammer, attacking both cancerous and healthy cells.
Chemotherapy is a brutal treatment, causing stress and damage to the patient’s body. For some, chemotherapy works. It kills cancer cells. If the patient can tolerate the side effects long enough, the chemotherapy can provide significant benefits.
Our immune systems create antibodies that can recognize and help kill foreign invaders like bacteria or viruses. Once an antibody binds to its target, it can either directly neutralize the invader, mark it for destruction by other immune cells, or block its ability to infect healthy cells.
Antibody Drug Conjugates (ADCs) are a way to target specific types of cancer cells. An ADC is composed of three key parts (components): Monoclonal Antibodies, Chemotherapy and Chemical Linker.
Advances in genomics, proteomics, and immunohistochemistry have helped researchers identify proteins that are uniquely or highly expressed on tumor cells. The protein should be highly present on cancer cells but minimally expressed on healthy cells.
In 1983, the first patients were treated with an ADC in a clinical trial. Today, there are over 100 ADCs available to patients in clinical trials.
Alice has been diagnosed with uveal melanoma, a type of skin cancer. She has no remaining standard treatment options. The tumors from her uvea melanoma are growing.
As research progresses, ADCs offer hope for more effective and personalized cancer treatments. The Food and Drug Administration approves new cancer treatments when they are shown in clinical trials to be more effective than the current approved cancer treatment.
In 1998, trastuzumab (Herceptin) was approved for the treatment of HER2-positive metastatic breast cancer. In 2013, the first ADC targeting HER2 was approved.
Enhertu was developed in a partnership between AstraZeneca, a global biopharmaceutical company with a heavy focus on oncology, and Daiichi Sankyo, a Japanese pharmaceutical company with expertise in ADCs. In the DESTINY-Breast03 trial, researchers looked at patients who had tumors that could be measured. They found with Entertu, 82.7% of patients had some form of tumor shrinkage compared with just 36.1% in patients receiving Kadcyla.
Her2 results used to be considered positive or negative, which predicted if Herceptin would work. With more powerful treatments like Enhertu, these tests are now being redefined into high, low, and negative.
With Kadcyla, the chemotherapy is released once pulled into the cell or when the antibody breaks down. With Enhertu, the toxin is released in the space just outside the cell and near other tumor cells.
In the past 3 years, the number of ADCs approved by the FDA has tripled. 13 ADCs have been approved by FDA, and over 100 are being tested in clinical trials.
With ADCs, the percentage of patients who experience tumor shrinkage ranges from 22-60%. ADCs and other anti-cancer treatments had very similar rates of other side effects.
There is published clinical trial data showing strong safety and efficacy data for at least 3 ADCs that are not yet approved, but are likely to gain FDA approval in 2025.
