In Column B, we translate the themes of this series into a practical checklist for people who must make decisions about ADCs in their daily work:
- executives and R&D / BD leaders at pharma companies,
- biotechs and start-ups developing ADCs,
- healthcare investors, CVCs, and corporate venture teams,
- strategy consultants and equity / industry analysts.
The aim is to provide ten questions that help clarify
“How should we engage with ADCs, given our specific position and constraints?”
1. For Pharma Companies: Five Questions on ADC Portfolios
Q1: Why are we doing ADCs at all?
The first question is deceptively simple: Why ADCs?
- In our core disease areas, where do ADCs create value that other modalities cannot capture as effectively?
- Can we articulate that value in terms of biology, evidence, market dynamics, and health economics?
If this foundation is vague, ADC projects risk becoming short-term “patent-cliff patch” initiatives rather than strategic pillars.
Q2: Do we have a clear disease–target–modality map?
A robust ADC strategy requires a clear disease–target–modality matrix:
- For which targets and indications are ADCs the first-choice modality?
- How do ADCs share roles with bispecific antibody drugs, cell therapies, radiopharmaceuticals, and small molecules?
- Are we choosing ADCs because of a comparative assessment, or simply because they are fashionable?
Q3: Is our ADC exposure too high?
Pharma companies should quantify:
- the proportion of pipeline assets, budget, and headcount devoted to ADCs,
- whether this concentration creates medium- to long-term risk,
- how the 2030s ADC patent cliffs are factored into portfolio design.
The question is not just whether ADCs are attractive today, but whether over-exposure will constrain future flexibility.
Q4: Are biomarkers and diagnostic infrastructure built into the plan?
ADC value is tightly coupled to biomarkers and diagnostics. Key checks include:
- Is our definition of the target population (including concepts like “HER2-low”) clinically robust?
- Have we considered diagnostic capacity and reimbursement across major regions (Japan, US, EU, China, etc.)?
Many ADC plans look attractive on the basis of theoretical eligible populations that may not materialize in practice.
Q5: Do we have a cross-functional team that truly “owns” ADCs?
Because ADCs sit at the intersection of biology, chemistry, CMC, safety, regulation, and commercialization, companies need:
- a cross-functional leadership group that can steer ADC strategy across silos,
- a clear approach to partnering with CDMOs, biotechs, and academic groups.
Without such a team, even good science may struggle to translate into robust programs and partnerships.
2. For Biotechs and Start-ups: Three Questions on Positioning
Q6: As an ADC biotech, where exactly do we intend to win?
ADC-focused biotechs cannot afford to be everything to everyone. They need one or two clear winning angles:
- novel targets, novel payloads, novel linkers, novel conjugation, distinctive CMC capabilities, etc.,
- a clearly differentiated concept, not just “another Enhertu follower.”
The litmus test: can you explain in one sentence to an investor or partner
“how we differ from other ADC biotechs”?
Q7: Up to which stage do we develop in-house, and when do we partner?
From an exit-design perspective, biotechs should clarify:
- whether their default goal is preclinical/Phase 1/Phase 2 completion,
- what kinds of partners they seek in each region (global, regional, China-based, etc.),
- which platform rights they must retain and which they are willing to share or out-license.
This clarity helps align internal R&D decisions with BD and financing strategies.
Q8: Are China/Asia ADC players competitors, partners, or both?
In ADCs, the relationship with China and broader Asia cannot be an afterthought. Relevant questions include:
- Do we primarily view these players as competitors, as partners, or as both over time?
- How do we evaluate technology transfer, data sharing, and co-development in light of geopolitical risk?
A “wait and see” stance can be costly if not paired with a clear internal view of red lines and opportunities.
3. For Investors: Two Questions on Managing ADC Exposure
Q9: How much ADC exposure do we have, and in what forms?
Investors first need a clean map of their current ADC exposure:
- public and private holdings, plus LP interests in funds with ADC-heavy portfolios,
- the balance between platform-centric and single-asset-centric investments,
- indirect exposure to China/Asia ADC markets.
Only after this mapping can you meaningfully debate how much ADC risk is appropriate.
Q10: Have we thought through “pain and upside” across multiple 2030+ scenarios?
Using the kinds of scenarios discussed in Part 7 (core modality, niche, second wave), investors should ask:
- How would our portfolio be perceived and valued in each scenario?
- Do we have hedges or options that prevent any single scenario from becoming catastrophic?
Thinking explicitly about both “ADC outperforms expectations” and “ADC underperforms expectations” helps avoid overly narrow positioning.
4. For Advisors and Analysts: A Note on Framing
For consultants and analysts, the core work is partly about how ADCs are framed to clients and markets:
- Do we clearly separate short-term news flow from long-term structural trends?
- When assessing a company’s ADC plans, do we explicitly consider its overall modality mix?
- When discussing deal terms or valuations, do we specify how much we are implicitly relying on “Enhertu-like” success stories?
Making these assumptions explicit is often what turns a generic ADC story into differentiated, decision-relevant insight.
My Reflections
ADC strategy is not fundamentally about what “the industry” is doing; it is about what makes sense for a given organization or investor, given their goals, constraints, and existing assets. The ten questions in this column are only one possible checklist, but they offer a way to test whether an ADC strategy can be explained in coherent, internally consistent terms. Over the next decade, I suspect that organizations with a clear, well-articulated stance on why, where, and to what extent they engage with ADCs will navigate volatility more effectively than those that are simply pulled along by the current wave.
There is no single “correct” set of answers to these questions. The optimal stance depends on company size, therapeutic focus, existing portfolio, geographic footprint, and risk appetite. In that sense, ADCs function as a mirror: how an organization chooses to engage with them reveals a great deal about its underlying strategy and self-image. The real challenge is to avoid being defined solely by market momentum and instead to build an ADC narrative that is genuinely aligned with long-term value creation—for patients, health systems, and stakeholders alike.
This article has been edited by the Morningglorysciences team.
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