A systematic review identifies antibody-drug conjugate–induced nausea and vomiting (ADCINV) as a prevalent, clinically meaningful adverse effect across multiple ADC agents, drawing parallels to chemotherapy-induced nausea and vomiting (CINV) and highlighting an unmet need for evidence-based antiemetic protocols.
A systematic review published in Supportive Care in Cancer represents the first comprehensive analysis of nausea and vomiting prevalence specifically attributable to antibody-drug conjugates (ADCs) as a drug class. The findings establish ADCINV as a distinct and frequent toxicity profile warranting dedicated clinical attention, rather than an incidental side effect managed under existing chemotherapy-based frameworks.
ADCs combine targeted monoclonal antibodies with cytotoxic payloads, and their expanding use across oncology indications—including HER2-positive breast cancer, urothelial carcinoma, and hematologic malignancies—means that a growing proportion of oncology patients may be at risk for this toxicity. The review suggests that the emetogenic burden of ADCs has been underappreciated relative to conventional cytotoxic regimens, despite mechanistic overlap through shared cytotoxic warheads such as topoisomerase I inhibitors and auristatins.
The authors call for systematic investigation into optimal antiemetic prophylaxis strategies tailored to ADC regimens, noting that current antiemetic guideline frameworks were developed primarily around traditional chemotherapy agents and may not adequately address the unique pharmacokinetic and toxicity profiles of ADCs. Standardized emetogenicity classification for individual ADC agents is identified as a critical next step.
Limitations include the heterogeneity of ADC agents, dosing schedules, and tumor types represented across included studies, which may affect the precision of pooled prevalence estimates. The authors acknowledge that ADCINV remains incompletely characterized and that prospective trials with standardized nausea and vomiting endpoints are needed.
Key points
- First systematic review to quantify the prevalence of antibody-drug conjugate–induced nausea and vomiting (ADCINV) across the ADC drug class.
- ADCINV is characterized as a clinically significant adverse effect comparable in relevance to chemotherapy-induced nausea and vomiting (CINV).
- Current antiemetic guidelines, developed for conventional cytotoxics, may be insufficient for managing ADCINV given the distinct pharmacology of ADCs.
- Cytotoxic payloads—including topoisomerase I inhibitors and auristatins—likely contribute to the emetogenic potential of ADC agents.
- The authors advocate for ADC-specific emetogenicity classification and prospective evaluation of antiemetic prophylaxis regimens.
Why it matters
As ADC use expands rapidly across solid tumor and hematologic malignancy indications, oncology clinicians lack evidence-based antiemetic protocols specific to this drug class; recognizing ADCINV as a distinct toxicity entity is essential for improving tolerability and treatment adherence.