“Guided missiles” are revolutionizing cancer treatment. And they are already giving results

Chemotherapy marked a great revolution in the treatment of different cancers despite its many problems in the nonspecificity of the ‘attack’ that caused healthy cells to also be affected by its effects. Although attempts have been made to increasingly specific chemotherapiesthe reality is that the next natural step in the evolution of the treatment It is immunotherapy, which is a field that continues to advance, giving us more and more joy in the fight against cancer.

But there is a revolution that wants to go much further, and it is nothing more than taking all the good things that immunotherapy has with the high potency of chemotherapy. And this ‘cocktail’ has a name: immunoconjugates (ADC).

The current problem. Traditional chemotherapies have been seen as a really aggressive treatment that generates a large number of side effects by attacking absolutely everything they encounter. This forces us to rethink the strategy. For this, it has been thought in immunotherapy Basically what it does is ‘wake up’ our natural defenses so that it can attack the tumor with its own tools. Something that It is personalized for each individual. by extracting, for example, their T lymphocytes to ‘reprogram’ them and make them fight against the tumor, which is nothing more than their own cells.

But the next step requires this specificity with greater potency than the stimulated immune system can provide. And this forces us to look for new therapies that have a similar mechanism, although it goes further in the way of applying the drug to the target cells. And this is where we are in the fight against cancer.

The goal of treatment. Precisely the future focuses on personalized treatments for each of the patients who have cancer in their body, without having to generalize with a drug for one type of tumor. This is achieved with treatments that are considered ‘remote-controlled missiles’ or ‘Trojan horses’ that promise greater specificity when attacking a tumor cell and leaving the body’s healthy cells ‘calm’. But always taking into account the particular characteristics of a person’s tumor.

This is what is achieved with ADCs which are designed like a missile with lethal precision. Its mission is to deliver an explosive charge of chemotherapy into the tumor cell, largely ignoring healthy cells, and the results are promising in the early phases of research, demonstrating its great potential to cure more patients in the early stages.

That’s how they work. The technology behind ADCs (Antibody-Drug Conjugates) is as elegant as it is powerful. It is made up of three key parts:

1. The antibody that acts as the guidance system. A monoclonal antibody designed in a laboratory to search and fit like a key in a lock to specific proteins, a kind of “antennae” (receptors), which are found massively on the surface of tumor cells. And the point is that each tumor cell has different ‘antennas’ and that is why it is important to find the most suitable antibody.
2. The payload, which we can assume is our ‘warhead’ which is a very powerful chemotherapy molecule and so toxic that it often cannot be administered in normal chemotherapy mode due to the large effects it has. So, here we are combining chemotherapy with immunotherapy.
3. The linker. A mechanism that binds the antibody and the cargo so that it can travel ‘comfortably’ through the blood until it reaches its target tissue.

The process is pure military strategy: the ADC travels through the body, the antibody detects its target (the cancer cell), anchors to it and the cell, deceived, absorbs it. Once inside, the linker breaks and releases the chemotherapy, annihilating the malignant cell from within and without affecting the ‘neighbors’.

A before and after. At the congress of the European Society of Medical Oncology (ESMO 2025) without a doubt this treatment has been on the lips of many experts. And it is logical seeing the good results that have been reported in this regard. You just have to see a recent study published in the prestigious magazine New England Journal of Medicine that confirms that this ADC such as trastuzumab deruxtecan is more effective than conventional chemotherapy in cases of metastatic HER2+ breast cancer, showing improvements from 7 to almost 10 months without tumor progression.

Another treatment, sacituzumab govitecan, also has shown important results before him triple negative breast cancerwhich is one of the most aggressive and could have the worst prognosis. The result is also very promising: an improvement in survival and quality of life.

The hidden side. Like all cutting-edge technology, ADCs are not without challenges. They are not harmless. One of the geniuses behind these studies, the Spanish Javier Cortés pointed out to the side effects that could occur, mainly diarrhea and lowered defense. This made him have to point out that “in general, Trojan horses give a toxicity that, in relation to traditional chemotherapy, is usually somewhat better.”

But there is also another front ahead: in some patients with this treatment the tumor continues to grow. The investigation now focuses on understanding it: The tumor cell receptors may mutate and are not the appropriate target, the chemo release mechanism within the cell may fail, or the tumor may simply be resistant to that particular chemo.

The future. What is being targeted right now is the possibility of mixing ADCs with immunotherapy or even combining several ADCs with each other. But where things get more interesting is the possibility of loading these ‘Trojan horses’ with radioligands, that is, rradioactive dioisotopes to apply radiotherapy very selective on cancer cells. In this way, a wide range of possibilities open up for the treatment of cancer.

Images | Angiola Harry National Cancer Institute

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