Antibody-drug conjugates in cancer treatment: A review of trastuzumab emtansine and its clinical efficacy

Abstract

Antibody-drug conjugates (ADCs) represent a breakthrough in targeted cancer therapy, combining monoclonal antibodies with cytotoxic agents to selectively eliminate cancer cells while minimizing damage to healthy tissues. This review focuses on trastuzumab emtansine (T-DM1), an ADC specifically designed for human epidermal growth factor receptor (HER2)-positive breast cancer. T-DM1’s mechanism of action involves targeted delivery of the cytotoxic agent DM1 through trastuzumab binding to HER2 receptors, resulting in cancer cell apoptosis. Pre-clinical studies demonstrated T-DM1’s efficacy in HER2-positive models, including those resistant to trastuzumab. Clinical trials, such as the pivotal EMILIA study, confirmed its clinical efficacy, with improved progression-free and overall survival rates compared to standard therapies. T-DM1 also exhibits a favorable safety profile, with manageable side effects such as thrombocytopenia and elevated liver enzymes. In addition, the review explores the potential of T-DM1 in combination therapies and its emerging role in treating other HER2-positive cancers, such as gastric and colorectal cancers. Future directions include expanding the use of T-DM1 in combination with immunotherapies and novel ADCs. Overall, T-DM1 has established itself as a crucial treatment for HER2-positive breast cancer, with ongoing research expanding its application in other cancer types.