Antibody-drug conjugates: A review of cutaneous adverse effects

Antibody-drug conjugates are an emerging class of anticancer agents that combine targeting antibodies with potent cytotoxic agents. Their molecular configuration allows for increased therapeutic efficacy and reduced adverse-effect profiles compared to monoclonal antibodies or cytotoxic chemotherapy alone. Antibody-drug conjugates cause off-target toxicities through several mechanisms, including premature deconjugation of the cytotoxic agent in the serum and the presence of the targeted antigen on normal tissues. Given cutaneous adverse events comprise 31.3% of all-grade adverse events in clinical trials involving antibody-drug conjugates, dermatologists are increasingly called upon to manage the cutaneous toxicities caused by these drugs. In this review, we summarize known cutaneous toxicities of the antibody-drug conjugates that have been approved for use by the U.S. Food and Drug Administration to date. Dermatologists can play a key role in recognizing cutaneous reactions associated with antibody-drug conjugates, contributing to guidelines for their management, and aiding during clinical trials to generate detailed morphologic and histopathologic descriptions of cutaneous toxicities caused by antibody-drug conjugates.