East Asia is not only scaling ADC manufacturing — it is also pioneering next-gen conjugation strategies that address long-standing limitations in stability, toxicity, and therapeutic window. Regional players are developing tailor-made linker and payload combinations that reflect local tumor biology, resistance patterns, and treatment paradigms.

Companies like Mabwell (China) and ATGC (South Korea) are designing cleavable linkers that remain stable in plasma but respond to tumor-specific enzymes or pH levels, enhancing payload release at the tumor site while reducing off-target effects.

South Korea–based Pinotbio is pioneering a dual linker-payload ADC platform that exemplifies the region’s drive toward mechanistic synergy and enhanced tumor selectivity. Their approach combines Two distinct linker technologies — one stable and one cleavable — for controlled, stepwise payload release, and complementary payloads designed to target different vulnerabilities in the tumor (e.g., microtubule disruption + DNA damage).

As tumors develop resistance or show heterogeneous antigen expression, combination therapy is emerging as a critical strategy in ADC development—particularly in East Asia where adaptive trial designs, rapid patient enrollment, and hospital-academic alliances make combination studies highly feasible.

With increasing access to genomic profiling tools, biobank infrastructure, and precision oncology programs, local biotech and pharma players are integrating biomarker strategies earlier in discovery and trial design. Antigen expression alone is no longer enough. East Asian developers are increasingly evaluating tumor heterogeneity, HER2-low or Trop2-low populations, and dynamic biomarkers such as ctDNA (circulating tumor DNA) or immune signatures to guide treatment and predict response to ADCs.

s combination therapy becomes more common, there’s a growing demand for deeper mechanistic insights—to truly understand how ADCs interact with other modalities at the molecular and cellular levels.

Studies in East Asia are beginning to examine whether HER2-targeting ADCs like ENHERTU can prime tumors for immune checkpoint blockade, especially in HER2-low, immune-excluded tumors. These trials rely not just on clinical endpoints but on biomarker and mechanistic data to validate synergy.