Antibody-Drug Conjugate-Associated Oral Toxicities

Aim: Antibody-drug conjugates (ADCs) are an emerging class of anti-cancer therapies, designed to specifically target cancer cells while minimizing impact on healthy tissues; however, they are associated with a broad spectrum of toxicities. The goal of this paper is to review the current knowledge about ADC-associated oral toxicities with a focus on the oral mucosa. Methods: A literature search of PubMed and Google Scholar from inception through June 2026 was conducted, supplemented by official FDA pharmaceutical drug information. The review encompasses oral mucosal toxicity, dry mouth, xerostomia, and dysgeusia associated with ADCs. Findings were qualitatively assessed and compared with established guidelines for cancer therapy-associated mucositis. Results: ADC-associated oral mucosal toxicity (OMT) presents as erosions or ulcers, often causing moderate to severe pain. OMT typically occurs early in ADC treatment, with high prevalence rates and varying severity, depending on the ADC type, dose, and treatment cycles. ADC-associated dry mouth can worsen OMT, and ADC-associated dysgeusia may complicate oral intake. OMT management involves a multidisciplinary approach, focusing on basic oral care, pain management, and adequate oral intake tailored to severity. Limited evidence is available regarding steroid-based mouthwashes and cryotherapy, and their efficacy is unclear. Severe OMT may require ADC therapy adjustments, such as dose reduction, cycle spacing, or temporary discontinuation. Conclusions: ADC-associated oral toxicities manifest in various tissues. These toxicities may arise from on-target, off-target, or immune-mediated mechanisms. They require a multidisciplinary approach for management. Further research is needed to establish effective protocols for the prevention and treatment of ADC-associated oral toxicities.