Dr. Jie Hu: The Future of ADC Drugs in Lung Cancer and the Global Positioning of Chinese Innovative Drugs | WCLC 2026

Editor's Note: The 2026 World Conference on Lung Cancer (WCLC 2026), hosted by the International Association for the Study of Lung Cancer (IASLC), was held in Seoul, South Korea, from September 12 to 15, 2026. FOCUS Clinical Scientists specially invited Dr. Jie Hu from Zhongshan Hospital, Fudan University, to share an in-depth interview on topics including the application prospects of novel agents such as ADCs in lung cancer treatment, safety management, biomarker selection, and the advantages and challenges facing Chinese innovative drugs and clinical research as they move toward the global stage.

 

FOCUS Clinical Scientists: Novel agents such as ADCs and bispecific antibodies are rapidly entering the field of lung cancer treatment. What do you think are the most critical issues that need to be addressed next for these novel agents—further improving efficacy, safety management, or precisely identifying the patient populations that will truly benefit?

Dr. Jie Hu: Antibody-drug conjugates (ADCs) have become the rising stars in lung cancer treatment in recent years. Whether used as monotherapy after resistance to first-line treatment in patients with driver gene mutations, or as shown by two important back-to-back studies presented at this year's World Conference on Lung Cancer (WCLC), which demonstrated that ADCs are significantly superior to the current standard single-agent first-line chemotherapy in second-line treatment of refractory extensive-stage small cell lung cancer (SCLC), ADCs have shown great promise. In driver gene wild-type advanced non-small cell lung cancer (NSCLC), we are currently also investigating the layout of ADCs in combination with immunotherapy in the first-line setting. Our center participated in the relevant study; enrollment has now been completed, and we are awaiting follow-up data. It is fair to say that ADCs have accumulated very substantial and convincing data in both NSCLC and SCLC, and may occupy an important position in changing the entire landscape of lung cancer treatment in the future.

The ensuing question is how to consider the position, importance, and safety management of these novel agents—currently all ADCs are targeted chemotherapeutic agents—in the field of lung cancer. Only with good safety can we have the confidence to let these effective drugs fully play their role, and even consider combining them with other drugs to further improve efficacy. Therefore, the first difficulties that ADC drugs must overcome are threefold: first, selecting appropriate clinical application scenarios; second, ensuring good safety management, which, in addition to selecting appropriate doses based on dose-escalation studies of dose-efficacy relationships in early drug development, also requires consideration of dose selection in monotherapy versus combination therapy—this point is also very critical; third, shifting safety management upstream by proactively preventing common and highly frequent adverse reactions, which helps to maximize efficacy while ensuring it. At the same time, the "Expert Consensus on Adverse Reactions and Management of ADC Treatment for NSCLC (2026 Edition)" led by our center has already been published and is available for reference. For different types of ADCs, their adverse reaction profiles still differ. Adverse reaction management requires comprehensive multidisciplinary management.

As for whether ADCs will need to select specific populations through biomarkers in the future—in other words, whether efficacy predictive markers need to be selected—this question has always been an open one, and there is currently no clear answer. But at least from the clinical study of B7-H3 ADC in the treatment of SCLC reported at this year's WCLC, the study conducted subgroup stratification based on different levels of B7-H3 expression, and the results showed that efficacy did not differ according to B7-H3 expression status. Data from clinical studies of TROP-2 ADC similarly showed that no direct association between TROP-2 expression and TROP-2 ADC efficacy has been observed to date. Therefore, the existing evidence is insufficient to indicate that ADCs need to select specific populations based on targets. But what is more important in the future is that different ADCs have different mechanisms of action; for example, HER2 ADC may require selection of the HER2-mutant population. Of course, we are currently also selecting HER2-amplified or HER2-overexpressing populations to observe the efficacy of HER2 ADC. Therefore, ultimately, selection may still need to be based on the target characteristics carried by the ADC itself, as well as the driving characteristics of that target in the mechanisms of lung cancer development and progression. In fact, what we hope for is this: if ADC drugs can achieve equally significant efficacy in the general common population, and their targets are selected as tumor-associated antigens or tumor-specific antigens that are commonly highly expressed on the surface of tumor cells and are characteristic, then it would instead be more conducive to expanding the study population in clinical research and to benefiting more patients. Therefore, biomarker selection is a very major topic in the future.

Of course, there are also ADCs currently carrying other effective payloads, including special structural modifications at the antibody end, combining with bispecific or trispecific antibodies. In such cases, it is still necessary to verify whether there is a potential correlation between ADCs and biomarkers through clinical studies, especially prospective translational research. In the future, ADCs may also further move upstream, and in addition to advanced lung cancer, clinical studies may also be laid out in early-stage surgery and early-stage operable patients. At this year's China Day, the joint meeting of the International Association for the Study of Lung Cancer (IASLC) and the Chinese Society of Clinical Oncology (CSCO) held the day before WCLC, original research by Chinese scholars was also presented to the world on the global stage. In the final segment of China Day, we held a vote, and all participants jointly voted on the most anticipated hot topics in the field of lung cancer for next year, among which ADCs accounted for a very high proportion—it can be said that ADCs received everyone's common attention. But as a class of drugs, ADCs cannot rely on a single drug to address all tumors; this is neither realistic nor consistent with clinical reality. Therefore, important future directions include: first, modifying the molecular structure of drugs; second, exploring mechanisms of resistance; third, exploring their combination with other treatment methods and strategies, as well as selecting precision treatment in different clinical scenarios. I believe these are the directions for the future.

 

FOCUS Clinical Scientists: The forum you participated in particularly emphasized "Chinese innovation going global." From your observations, what are currently the most critical advantages and challenges for innovative drugs and clinical research in China's lung cancer field to truly achieve global translation?

Dr. Jie Hu: In recent years, China's innovative drug development has advanced rapidly. Many domestic innovative companies have developed various novel anti-tumor drugs, including bispecific antibodies, ADCs, cell therapy, and vaccine therapy, and hope to bring these drugs to the international stage. Among the studies presented at this year's conference, two B7-H3 ADCs were involved, and these two drugs are also innovative drugs available globally only in China. Foreign experts are very envious that Chinese experts have so many studies and drugs to choose from; some overseas patients even come to China for treatment because China also has some tyrosine kinase inhibitors (TKIs) that are globally unique. This shows that China's biopharmaceutical R&D technology and speed are continuously advancing and are in a leading position. But we also hope that these innovative drugs can benefit more patients globally, so Chinese original drugs need to go abroad.

Setting aside policy and other factors, from a physician's perspective, I believe: first, data obtained in the Chinese population need to be further validated in the global population—this is what scientific questions require us to answer, and this process is indispensable. Of course, if we want to accelerate drug development, we can actually consider including foreign populations and foreign centers in the initial enrollment when designing clinical studies from the outset; some domestic innovative drugs have already begun to do this. Second, we need to design more reasonable and more cutting-edge clinical studies to accumulate more evidence and answer scientific questions that are currently unmet in clinical practice. At present, leading researchers in China's lung cancer field already possess an international perspective, and in terms of drug research design, they are not inferior to foreign scholars—they have even incorporated the wisdom of Chinese scholars. Therefore, we are fully capable of achieving this.

Of course, we still hope that Chinese scholars will have more voices on the world stage, so that international colleagues can understand China's achievements in related fields, as well as the capabilities and wisdom of Chinese clinical researchers. Only in this way can all parties work together to promote Chinese innovative drugs to the international stage, and this is also a responsibility that we Chinese clinical researchers and drug development personnel should jointly shoulder.

Expert Profile

Dr. Jie Hu

Zhongshan Hospital, Fudan University

Specializes in the diagnosis and treatment of pulmonary nodules, lung cancer screening and early diagnosis, individualized precision targeted and immunotherapy for lung cancer guided by molecular markers, respiratory endoscopic interventional diagnostic and therapeutic techniques, and comprehensive diagnosis and treatment of lung cancer comorbidities.