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MUC1-C-targeting antibody-drug conjugates (ADCs) represent a therapeutic class designed to selectively target the transmembrane C-terminal subunit of Mucin 1 (MUC1-C). Unlike the shed extracellular N-terminal domain (MUC1-N), which can act as a decoy in circulation, MUC1-C remains anchored to the tumor cell membrane, reducing antigen sink and improving the therapeutic index. MUC1-C is an oncoprotein overexpressed in diverse epithelial cancers and is implicated in driving cell lineage plasticity, epithelial-mesenchymal transition (EMT), and resistance to targeted, cytotoxic, and immune therapies. By binding to the extracellular domain of MUC1-C, these ADCs undergo internalization to deliver a cytotoxic payload (such as exatecan or monomethyl auristatin E) directly into the cancer cells, inducing cell death. Preclinical and clinical-stage candidates, such as XYA02, are being evaluated across multiple solid tumors, including non-small cell lung cancer, breast cancer, pancreatic cancer, and castration-resistant prostate cancer.
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