Precision Prophylaxis: Managing Diverse ADC Safety Profiles at ASCO 2026

While the oncology community often groups antibody-drug conjugates (ADCs) under a single three-letter acronym, clinical management requires a far more nuanced approach. During an interview at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, Paolo Tarantino, MD, of the Dana-Farber Cancer Institute, emphasized that the safety profiles of these agents are as diverse as the patients they treat. According to Tarantino, understanding the specific requirements for each individual ADC is the cornerstone of modern oncology nursing and patient safety.

The nuance of deruxtecan-based agents

Tarantino noted that even within similar classes, such as those utilizing a deruxtecan payload, monitoring requirements can vary significantly. For trastuzumab deruxtecan (T-DXd, Enhertu), the primary safety focus remains the detection of interstitial lung disease (ILD) and cardiotoxicity. Nurses should ensure patients receive regular CT scans to monitor for lung toxicity and echocardiograms to assess cardiac function.

Furthermore, aggressive antiemetic prophylaxis is essential to prevent T-DXd-induced nausea.In contrast, datopotamab deruxtecan (Dato-DXd, Datroway) presents a different set of challenges. While the risk for lung and cardiac toxicity is lower than that of T-DXd, Dato-DXd necessitates unique prophylactic measures. Specifically, clinicians must implement the use of mouthwash to mitigate the risk of stomatitis and eye drops to address potential ocular toxicities.

Addressing hematologic concerns with SG

The management of sacituzumab govitecan (SG, Trodelvy) requires a shift in focus toward hematologic stability. Tarantino identified neutropenia as the primary safety concern for patients receiving SG. To manage this, the proactive use of prophylactic growth factors is critical to maintaining dose intensity and preventing infection.

Prophylaxis as a bridge to longevity

The overarching message of the interview was clear: prophylaxis is not merely a supportive measure but a vital component of therapeutic success. Tarantino argued that most ADCs currently in use require some form of distinct prophylaxis. By identifying the specific risks associated with an ADC before treatment begins, the oncology team can ensure that patients remain on therapy longer.

"With the right prophylaxis, patients can be safe, can be treated for a long time, and can live longer," Tarantino concluded.

For oncology nurses, this means staying vigilant and tailoring education and supportive care plans to the specific drug being administered, rather than applying a "one-size-fits-all" ADC protocol.