Oncology Brothers: Practice-Changing Cancer Discussions Managing Toxicities of Antibody Drug Conjugates (ADCs) in Lung Cancer – Dr. Jacob Sands
Dec 13, 2025
Dr. Jacob Sands, a leading medical oncologist at Dana-Farber Cancer Institute, shares his expertise on antibody-drug conjugates (ADCs) and their impact on non-small cell lung cancer (NSCLC). He highlights the side effects of various ADCs like Trastuzumab deruxtecan, detailing risks such as interstitial lung disease and mucositis. Proactive strategies for managing toxicities are discussed, with insights on patient education and monitoring. This conversation is a goldmine for healthcare professionals seeking to enhance patient care and navigate the challenges of these innovative therapies.
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Payload Determines ADC Toxicity
- ADC toxicities are largely driven by the cytotoxic payload and linker choices.
- Different payloads explain why some ADCs cause ILD while others cause mucositis or neuropathy.
Act Fast For Severe ILD, Investigate Mild Findings
- If you suspect severe ILD on TDXd, stop the drug and start high-dose steroids immediately.
- For mild radiographic findings, weigh alternatives, involve pulmonology, and avoid reflexively labeling every change as drug-related.
Proactively Manage Nausea And Alopecia
- Use an aggressive baseline anti-emetic regimen for TDXd to prevent nausea and vomiting.
- Counsel patients that alopecia is common and can deeply affect self-image, so prepare supportive measures early.