Onkológia 4/2026

Antibody-drug conjugates in the treatment of advanced gynaecological malignancies

Antibody-drug conjugates (ADCs) represent an important advance in the targeted treatment of gynaecological malignancies. By combining the selectivity of a monoclonal antibody for a tumour-associated antigen with a highly potent cytotoxic payload, they enable preferential drug delivery to tumour tissue. Three therapeutic strategies are currently of greatest clinical relevance. Mirvetuximab soravtansine improved survival in adults with folate receptor alpha-positive, platinum-resistant, high-grade serous epithelial ovarian, fallopian tube, or primary peritoneal cancer after one to three prior systemic treatment regimens. Its use requires standardised immunohistochemical testing and rigorous prevention of ocular toxicity. Tisotumab vedotin improved overall survival in recurrent or metastatic cervical cancer after prior systemic therapy; a specific ocular prophylaxis protocol is an integral part of its administration. In the European Union, trastuzumab deruxtecan is indicated for adults with previously treated unresectable or metastatic solid tumours with high human epidermal growth factor receptor 2 (HER2) expression, defined as an immunohistochemistry score of 3+, when no satisfactory treatment alternative is available. Trophoblast cell-surface antigen 2 (TROP2)-directed conjugates remain under clinical investigation. Optimal patient selection should therefore integrate the quality of biomarker testing, treatment history, payload characteristics, and early recognition of organ-specific toxicity.

Keywords: antibody-drug conjugate, gynaecological malignancies, folate receptor alpha, mirvetuximab soravtansine, tisotumab vedotin, trastuzumab deruxtecan, TROP2