Antibody–drug conjugates (ADCs) have revolutionized the treatment landscape for metastatic breast cancer, offering targeted delivery of cytotoxic agents with improved efficacy and tolerability compared to conventional chemotherapy. This narrative review explores key predictive factors influencing the efficacy of ADCs, focusing on HER2-targeted therapies, such as trastuzumab emtansine and trastuzumab deruxtecan, as well as sacituzumab govitecan for triple-negative breast cancer. HER2 expression, TROP-2 levels, hormone receptor status, and the tumor microenvironment emerge as critical biomarkers for patient selection and therapeutic outcomes. Additionally, we discuss resistance mechanisms, such as antigen loss, impaired drug internalization, and the role of circulating tumor DNA in predicting ADC response. Finally, future perspectives on the sequential use of ADCs and potential combination therapies are highlighted, along with emerging agents targeting alternative antigens like HER3 and LIV-1. Overall, identifying predictive biomarkers and overcoming resistance mechanisms are essential for optimizing the use of ADCs in metastatic breast cancer, thereby improving patient outcomes.
抗体药物偶联物（ADC）已彻底改变转移性乳腺癌的治疗格局，通过靶向递送细胞毒性药物，相较于传统化疗展现出更优的疗效与耐受性。本文综述了影响ADC疗效的关键预测因素，重点关注HER2靶向疗法（如曲妥珠单抗-美坦新偶联物和曲妥珠单抗-德鲁替康偶联物）以及用于三阴性乳腺癌的戈沙妥珠单抗。HER2表达水平、TROP-2水平、激素受体状态及肿瘤微环境已成为患者筛选和治疗效果评估的关键生物标志物。此外，本文探讨了抗原丢失、药物内化障碍等耐药机制，以及循环肿瘤DNA在预测ADC疗效中的作用。最后，文章展望了ADC序贯疗法、联合治疗策略的发展前景，并介绍了针对HER3、LIV-1等新兴靶点的在研药物。总体而言，识别预测性生物标志物并克服耐药机制对于优化ADC在转移性乳腺癌中的应用至关重要，这将为改善患者预后提供关键支持。
肿瘤(癌症)患者之家