Updated October 2025
Antibody–drug conjugates (ADCs) are a rapidly expanding class of targeted cancer therapies that combine the specificity of monoclonal antibodies with the potency of cytotoxic agents. These constructs are designed to deliver chemotherapy directly to tumor cells while minimizing damage to healthy tissue. As of 2024, more than 100 ADCs are in clinical development, with 20 FDA-approved indications across hematologic and solid tumors.1
The clinical trial landscape for ADCs is evolving quickly. Sponsors are exploring new payload mechanisms, including topoisomerase inhibitors, DNA alkylators, and microtubule disruptors. Trials are also investigating novel linkers and conjugation technologies to improve stability, reduce off-target toxicity, and enhance tumor penetration. HER2, TROP2, and BCMA remain dominant targets, but newer ADCs are being designed for HER3, CEACAM5, and Nectin-4, expanding the therapeutic reach.1
Dual-payload ADCs are entering early-phase trials, aiming to overcome resistance and tumor heterogeneity by delivering multiple cytotoxins simultaneously. These designs require careful dose optimization and safety monitoring, especially in solid tumors where antigen expression can vary widely. Biomarker-driven enrollment and adaptive trial designs are helping sponsors manage complexity and improve response rates.2
Geographically, ADC trials are concentrated in North America, Europe, and East Asia, with increasing interest in decentralized models to improve access. The regulatory environment is also adapting, with agencies offering expedited pathways for ADCs that demonstrate strong early efficacy and manageable safety profiles.
This article reviews the current ADC trial landscape, including trial status, geographic distribution, patient segments, and therapeutic focus. It also outlines how Precision for Medicine supports sponsors in executing ADC trials with technical precision and operational discipline.
The ADC trial pipeline spans all phases of development indicating sustained investment in clinical validation. Sponsors are balancing risk with opportunity in a competitive space.
ADC trial starts have accelerated in recent years mirroring broader oncology trends in targeted therapeutics.
ADC trials are geographically concentrated in China and the U.S., followed by Europe, Australia and East Asia.
|
Countries |
Count |
|
China |
812 |
|
United States |
524 |
|
Spain |
233 |
|
Australia |
201 |
|
South Korea |
197 |
|
France |
196 |
|
Italy |
176 |
|
Japan |
175 |
|
United Kingdom |
168 |
|
Canada |
167 |
Citeline Trialtrove® – 07OCT2025
Therapeutic area trends show a clear emphasis on cancer indications where targeted delivery offers clear advantages. This focus aligns with ADCs' mechanism of action and clinical promise.
ADC trials are most common in breast, lung, and esophageal cancers.
|
Indication |
Count |
|
Unspecified Solid Tumor |
515 |
|
Breast |
339 |
|
Lung, Non-Small Cell |
327 |
|
Esophageal |
231 |
|
Gastric |
221 |
|
Ovarian |
180 |
|
Colorectal |
140 |
|
Bladder |
139 |
|
Head/Neck |
135 |
|
Pancreas |
121 |
Citeline Trialtrove® – 07OCT2025
Phase data shows a strong emphasis on early development highlighting the exploratory nature of ADC research. Late-phase trials may increase as early data matures.
How Precision Drives ADC Clinical Research
Precision for Medicine has initiated multiple ADC trials, focusing on the last 5 years we have seen an upward trend, which aligns with overall global trends in targeted oncology. Due to our diverse experience, our study teams are equipped to manage complex ADC protocols, spanning multiple indications.
Our geographic footprint includes North America, Europe, and Asia. When it comes to ADC trial execution, Precision adapts to regional nuances.
Citeline Trialtrove® – 07OCT2025
Our work spans early discovery through late-stage validation with a strong presence in Phase 1 and Phase 1-2. Our teams successfully manage dose escalation, biomarker integration, and close safety oversight.
Our ADC trials are focused on oncology indications with complex dosing and safety profiles. We help sponsors optimize therapeutic targeting.
Our portfolio includes studies with the following participant populations, our top indications are NSCLC, Pancreas, Ovarian, and Breast Cancer. With our broad experience, Precision study teams can help sponsors navigate indication-specific challenges.
ADC trials require specialized planning and execution, particularly when managing complex dosing schedules and safety oversight. Precision for Medicine works as a partner with our sponsors to operationalize these studies efficiently. From our Precision Site Network (PSN), supporting with feasibility & site selection, to our integrated data management model providing fast data review, our teams bring experience and solution focused study management strategies helping ensure ADC trials are delivered with consistency and clarity across global geographies.