exatecan + STING agonist

**Exatecan + STING agonist** is an investigational combination therapy pairing exatecan, a potent **topoisomerase I (TOP1) inhibitor** that traps TOP1-DNA cleavage complexes to induce replication-dependent DNA damage, with a **STING agonist** that activates the stimulator of interferon genes pathway to trigger type I interferon production, dendritic cell activation, and adaptive anti-tumor immunity. This pairing leverages exatecan's DNA-damaging cytotoxicity—synergistic with DNA damage response inhibitors—with STING-mediated immunostimulation to enhance tumor immunogenicity and overcome resistance, particularly in **solid tumors**. Preclinical data support dual-payload antibody-drug conjugates (ADCs) incorporating both agents for precise tumor delivery, minimizing systemic toxicity while promoting immune-mediated tumor clearance; developers include **Sutro Biopharma** (with Astellas) exploring site-specific conjugation for optimized ratios.