How Safety and Biomarkers Are Shaping the Next Generation of ADCs

Covering the BIO International Convention 2026 in San Diego, California, BioPharm International spoke with Sabeen Mekan, MD, Vice President of Clinical Development at Zymeworks and panelist for The Next Generation of ADCs: Building Kinder, Gentler Cancer Therapeutics. The discussion explored how advances in safety, patient selection, and biomarker strategies are helping define the next generation of targeted cancer therapies.

Are safety and biomarkers shaping the next generation of ADCs?

According to Mekan, efficacy remains the primary driver of oncology drug development, but safety is becoming an increasingly important differentiator as more ADCs enter the market. With multiple agents competing in similar indications, clinicians and patients are paying closer attention to tolerability when selecting treatment options.

"We are getting to a point where safety is becoming much, much more important than it used to be," Mekan said. "Patients want that, they deserve that. Clinicians are choosing those ADCs as well."

The growing emphasis on safety is particularly important as ADCs move into earlier lines of therapy, including first-line treatment and potentially curative settings such as adjuvant and neoadjuvant care. In these patient populations, minimizing toxicity is critical because treatments are often administered for longer periods and may be combined with other therapies.

Mekan noted that the ability to combine ADCs safely with other treatments will likely play a major role in determining which agents advance through development. As oncology continues to become more targeted and patient-centric, she expects ADC development to follow a similar trajectory.

The discussion also highlighted the increasing role of biomarkers in guiding treatment decisions. Mekan pointed to Zymeworks' folate receptor alpha-targeting ADC program as an example, noting that clinical activity appears to correlate with levels of biomarker expression. She explained that identifying the patients most likely to benefit from treatment will become increasingly important as more ADCs enter the clinic.

Beyond traditional immunohistochemistry, newer approaches to biomarker assessment are also emerging. Mekan highlighted advances in digital pathology and the exploration of mRNA-based analyses as examples of technologies that may help refine patient selection strategies in future clinical trials. Together, these developments could support more personalized approaches to ADC development and treatment selection.

Watch part one of this interview here. Click here for more conference coverage.

About the speaker

Sabeen Mekan, MD, senior VP and chief medical officer, Zymeworks, Inc.

Dr. Priyanka Mekan is senior vice president and chief medical officer at Zymeworks, a position she has held since April 2025. She brings extensive experience in oncology drug development, having previously held leadership roles at Gilead Sciences, Daiichi Sankyo, and Bristol Myers Squibb. Prior to joining industry, she served as an assistant professor and practicing hematologist/oncologist in New York. Board certified in internal medicine, oncology, and hematology, Dr. Mekan has led the development of multiple cancer therapies and authored numerous scientific publications.