Oral Toxicities With Antibody-Drug Conjugates: What Physicians Should Know

Antibody-drug conjugates (ADCs) have become an increasingly important part of treatment for several advanced cancers, pairing a tumor-targeting antibody with a cytotoxic payload.

By
October 9, 2026
4 min

Baptist Health South Florida

Objective:

To describe oral toxicities among patients with advanced cancer treated with TROP2- or HER2-directed antibody-drug conjugates (ADCs).

Approach:

Study design: Multicenter retrospective cohort study of 207 patients treated at Baptist Health and Sapienza University Hospital in Rome.
Assessment: Investigators reviewed medical records for oral toxicities and related treatment management.

Key Findings:

At least one oral toxicity was documented in 22.7% of patients, including mucositis, xerostomia, dysgeusia, and oral dysesthesia.
Mucositis occurred in 14.8% of patients receiving TROP2-directed ADCs and 5.4% receiving HER2-directed ADCs; adjusted odds were approximately three times higher with TROP2-directed therapy.
TROP2-associated mucositis tended to occur earlier. Supportive treatment and dose reductions were more common in the TROP2 group; dose reductions occurred in 26.1% versus 14.1% with HER2-directed therapy.
Xerostomia and dysgeusia were more common with HER2-directed therapy, but differences were not statistically significant.
Topical corticosteroids did not improve existing mucositis or prevent new lesions in this cohort. Four patients treated with oral cryotherapy had symptomatic improvement and fewer new ulcerative lesions.

Interpretation:

The study authors report that oral toxicities differed by ADC type and that corticosteroid treatment did not show benefit in this cohort. Cryotherapy observations were based on few patients and require prospective evaluation.

Limitations:

Retrospective design.
Most participants had breast cancer, limiting generalizability.
Reliance on medical records rather than standardized prospective oral examinations may have led to underreporting.

Conclusion:

The article describes the importance of recognizing and assessing oral symptoms during ADC treatment and notes the need for prospective research on prevention and management.