Data presented at ESMO show antibody-drug conjugates (ADCs) moving into earlier-stage breast cancer, with Enhertu demonstrating benefits when used pre‑operatively and next-generation ADCs showing activity in early HER2-positive disease. The findings suggest ADCs are shifting from salvage settings to potentially curative intent, altering development and market strategies for oncology portfolios. AstraZeneca and Daiichi Sankyo’s Enhertu extended efficacy signals beyond metastatic disease, while several next-gen ADC platforms reported encouraging response rates in adjuvant or neoadjuvant contexts. ADCs deliver cytotoxic payloads selectively to tumor cells; as these drugs move earlier in treatment pathways, trial endpoints, safety management and commercial opportunity sets will change for drugmakers and clinicians.