Oral mucositis associated with antibody-drug conjugates in gynecologic oncology: strategies for prevention and treatment

Antibody-drug conjugates (ADCs) have emerged as a promising therapeutic option for the treatment of gynecologic malignancies and have become a key component of treatment strategies for recurrent ovarian, endometrial, and cervical cancers. These agents offer targeted tumor cell specificity while delivering potent cytotoxic agents. Despite their selectivity, ADCs are associated with unique treatment-related adverse events. Oral mucositis (stomatitis) has become a notable on-target, off-tumor toxicity among gynecologic cancer patients receiving certain trophoblast cell surface antigen 2 targeting ADCs. Though often acute and self-limiting, oral mucositis can significantly impact patient quality of life, hinder nutritional intake, increase infection risk, and result in dose delays or discontinuation, ultimately affecting cancer treatment outcomes. This review focuses on prevention and management strategies for ADC-associated oral mucositis in the gynecologic oncology setting. We outline practical, evidence-based approaches including routine symptom monitoring, basic oral care, prophylactic interventions, and graded treatment strategies to address established mucositis. Integrating these strategies can reduce the incidence and severity of oral mucositis, thus preserving both treatment efficacy and quality of life for patients with gynecologic malignancies.