ADC TOXICITY ATLAS
← Atlas

Trastuzumab emtansine

FDA-approved
T-DM1; Kadcyla
Sponsor
Genentech/Roche
Indication
HER2+ breast cancer
Target family
Receptor tyrosine kinase
RP2D dose
3.6 mg/kg
Q3WRP2D
01
Multi-organ toxicity

Fingerprint & organ drill-down

Also reported
0%severity100%
0
Assessed · clear
true 0%
No data
never assessed
4 adverse-event terms

Ocular

Any-grade
5%
G3+
0%
RP2D
sagittal schematic · Reversible

Tissues shaded by reported adverse-event rate.

Cornea
AE
-
Express.
46.2%
Limbus
AE
-
Express.
61.99%
Conjunctiva
AE
3.9%
Express.
61.13%
Lens
AE
-
Express.
-
Retina / RPE
AE
-
Express.
5.48%
7.5 nTPM
Dominant tissue
Ocular surface
Surface subtype
Conjunctival (on-target)
Reversibility
Reversible
Reported ocular events
Lacrimation increased6%
n=740
Dry eye4.5%
n=740
Vision blurred3.9%
n=740
Conjunctivitis3.5%
n=740
Per-trial detail

Adverse events by trial

KAMILLA (TDM4529g/BO28407)Phase 3b3.6 mg/kg q3wn=2002CTCAE 4.0B
ClinicalTrials.gov posted results NCT01702571 NCT01702571
304 adverse-event terms · 22 systems · expand a system below
Infections60
URINARY TRACT INFECTION
7.84%G3+ 0.55%
157/2002
NASOPHARYNGITIS
6.79%
136/2002
UPPER RESPIRATORY TRACT INFECTION
4%G3+ 0.15%
80/2002
PNEUMONIA
G3+ 1.1%
LOWER RESPIRATORY TRACT INFECTION
G3+ 0.45%
SEPSIS
G3+ 0.45%
CELLULITIS
G3+ 0.4%
DEVICE RELATED INFECTION
G3+ 0.3%
ERYSIPELAS
G3+ 0.2%
BRONCHITIS
G3+ 0.15%
INFECTION
G3+ 0.15%
OTITIS MEDIA
G3+ 0.15%
VASCULAR DEVICE INFECTION
G3+ 0.15%
BREAST CELLULITIS
G3+ 0.1%
ENDOCARDITIS
G3+ 0.1%
GASTROENTERITIS
G3+ 0.1%
HERPES ZOSTER
G3+ 0.1%
MASTITIS
G3+ 0.1%
PERITONITIS
G3+ 0.1%
PYELONEPHRITIS
G3+ 0.1%
STAPHYLOCOCCAL INFECTION
G3+ 0.1%
STAPHYLOCOCCAL SEPSIS
G3+ 0.1%
ABSCESS
G3+ 0.05%
ACINETOBACTER INFECTION
G3+ 0.05%
ARTHRITIS INFECTIVE
G3+ 0.05%
BACTERAEMIA
G3+ 0.05%
BACTERIAL INFECTION
G3+ 0.05%
BACTERIAL SEPSIS
G3+ 0.05%
BRAIN ABSCESS
G3+ 0.05%
CATHETER SITE INFECTION
G3+ 0.05%
CLOSTRIDIUM DIFFICILE COLITIS
G3+ 0.05%
CYSTITIS
G3+ 0.05%
ENCEPHALITIS
G3+ 0.05%
GASTROENTERITIS NOROVIRUS
G3+ 0.05%
GASTROENTERITIS VIRAL
G3+ 0.05%
GASTROINTESTINAL VIRAL INFECTION
G3+ 0.05%
INFECTIOUS PLEURAL EFFUSION
G3+ 0.05%
INFECTIVE EXACERBATION OF BRONCHIECTASIS
G3+ 0.05%
INTERVERTEBRAL DISCITIS
G3+ 0.05%
KLEBSIELLA BACTERAEMIA
G3+ 0.05%
LISTERIOSIS
G3+ 0.05%
LIVER ABSCESS
G3+ 0.05%
MENINGITIS
G3+ 0.05%
PHARYNGITIS
G3+ 0.05%
PNEUMOCOCCAL INFECTION
G3+ 0.05%
PNEUMONIA STREPTOCOCCAL
G3+ 0.05%
PNEUMONIA VIRAL
G3+ 0.05%
PYELONEPHRITIS ACUTE
G3+ 0.05%
PYELONEPHRITIS CHRONIC
G3+ 0.05%
RESPIRATORY TRACT INFECTION
G3+ 0.05%
RESPIRATORY TRACT INFECTION VIRAL
G3+ 0.05%
SEPTIC SHOCK
G3+ 0.05%
SKIN INFECTION
G3+ 0.05%
SOFT TISSUE INFECTION
G3+ 0.05%
STAPHYLOCOCCAL BACTERAEMIA
G3+ 0.05%
STREPTOCOCCAL INFECTION
G3+ 0.05%
TRACHEOBRONCHITIS
G3+ 0.05%
VIRAL INFECTION
G3+ 0.05%
VIRAL UPPER RESPIRATORY TRACT INFECTION
G3+ 0.05%
VULVAL ABSCESS
G3+ 0.05%
GI39
Neurologic (other)26
Injury24
Pulmonary21
Musculoskeletal18
General15
Investigations14
Hepatic11
Neoplasms11
Other10
Cardiac9
Metabolic9
Vascular8
Hematologic7
Psychiatric7
Renal7
Endocrine2
Ocular2
BLINDNESS
G3+ 0.05%
RETINAL VEIN THROMBOSIS
G3+ 0.05%
Immune2
Ear1
Dermatologic1
02
Construct

Molecular anatomy

Antibody
IgG1
Humanized
Linker
Non-cleavable
3.5
DAR
Payload
Tubulin inhibitor
Linker structureC16H18N2O6
[H]C1=C([H])C(=O)N(C([H])([H])C2([H])C([H])([H])C([H])([H])C([H])(C(=O)ON3C(=O)C([H])([H])C([H])([H])C3=O)C([H])([H])C2([H])[H])C1=O
Payload structureC53H75ClN6O15S
CC1C2CC(C(C=CC=C(CC3=CC(=C(C(=C3)OC)Cl)N(C(=O)CC(C4(C1O4)C)OC(=O)C(C)N(C)C(=O)CCSC5CC(=O)N(C5=O)CC6CCC(CC6)C(=O)NCCCCC(C(=O)O)N)C)C)OC)(NC(=O)O2)O
03
Antibody

Antibody & Fc engineering

Antibody
trastuzumab
Isotype
IgG1
Origin
Humanized
Fc modifications
None
Glycoengineering
Standard
Effector silencing
None
FcγR binding
Retained
C1q binding
Retained
Target KD (nM)
0.5
Thermal stability Tm (°C)
2
Epitope / domain
HER2 extracellular subdomain IV
04
Linker & conjugation

Linker chemistry

Linker profile
Linker
SMCC
Class
Non-cleavable
Cleavage
Non-cleavable
Attachment
Lysine
Conjugation
Conventional Lys (SMCC)
Symmetry
Asymmetric
DAR (mean)
3.5
DAR homogeneity
Heterogeneous
Plasma t½
4.0 d
Cleavage trigger
Non-cleavable
Release control
Unconditional
Hydrophilicity mask
None
Platform
Random lysine amine conjugation
Conjugation site
92 possible sites
DAR distribution
DAR0-8 mixture, average 3.53 +/- 0.05 by intact MS
%HMW aggregate
1.64 %
Formula
C16H18N2O6
Linker MW
334.328 Da
Linker TPSA
101.06 Ų
Linker xLogP
0.325
ADCdb linker
LIN0EBJON
In-vitro stability
-
Stability note
acAb t½ 3.94 d; SMCC is the highest intrinsic plasma stability among clinical linkers — non-cleavable thioether to charged Lys-MCC-DM1 catabolite (no bystander); deconjugation is not a significant pathway
05
Payload

Payload & physicochemistry

Payload profile
Payload
Lys-SMCC-DM1
Class
Maytansinoid
Mechanism
Tubulin inhibitor
Released catabolite
Lys-MCC-DM1 (lysine-Nε-MCC-DM1; = Lys-SMCC-DM1 in literature), the principal charged catabolite; MCC-DM1 and free DM1 also detected at low levels in plasma
Mechanistic subtype
Tubulin-maytansinoid
Stereochem / salt
Free thiol maytansinoid; neutral
Bystander
No
PAMPA rank
5
MW
1103.7 Da
XLogP3
-0.2
logD₇.₄
-0.5
TPSA
312 Ų
pKa
2.2 pKa
Charge pH 7.4
Zwitterion
H-bond donors
5
H-bond acceptors
17
IC50 (HCEC)
-
Formula
C53H75ClN6O15S
PubChem CID
74832310
ADCdb payload
PAY0JCIBW
Potency IC50 (nM)
1
Hydrophobicity · logD₇.₄
hydrophilic −2-0.5+4 lipophilic
Bioactivity note
ADCdb lists T-DM1 cellular IC50 values spanning ~0.04 nM (high HER2-expressing lines) to >500 nM (low/negative HER2 lines), HER2-expression dependent. No isolated free-payload (DM1) IC50 is given on the ADCdb ADC page; DM1 is a potent antimitotic maytansinoid that inhibits tubuli
06
Dosing & regimen

Dosing

RP2D dose
3.6 mg/kg
Schedule
Q3W
Route
IV
Fractionated
No
n at RP2D
490
Dose basis
TBW
Trial phase
Approved
Dose-OAE available
No
Tox summary basis
RP2D
ADA rate (%)
5.3 %
07
Pharmacology

Clinical pharmacokinetics

By analyte · FDA label §12.3 + Drugs@FDA clinical-pharmacology reviews
Intact ADCTotal antibodyFree payload
Cmax
83.4ug/mL+1
86.3ug/mL
4.61ng/mL+1
AUC
489ug*day/mL
816ug*day/mL
9.11ng*day/mL
Tmax
end of infusionh
end of infusionh
~4days
7.8days
CL
0.68L/day
5.4mL/day/kg
Vd
3.13L
45.2mL/kg
FDA label §12.3 Drugs@FDA reviewhover a value for dose / population / source · “+N” marks additional reported values
08
Ocular & expression

Ocular profile & eye-tissue target expression

Target profile
OAE any-grade
5 %
OAE grade 3+
0 %
OAE data status
reported
Severity (weighted)
1.5
Keratopathy
-
Conjunctival
3.9 %
Dry eye
3.9 %
Blurred vision
4.5 %
Dominant tissue
Ocular surface
Surface subtype
Conjunctival (on-target)
Grading scale
CTCAE v3.0
Reversibility
Reversible
Target expression in eye tissues (HCA detection · HPA bulk)
Cornea (central)
46.2 %
Cornea (limbal)
61.99 %
Conjunctiva
61.13 %
RPE
5.48 %
Retina (HPA)
7.5 nTPM
Cross-trial comparability · source-verified
Ascertainment: Symptom-driven reportingScale: CTCAE v3Denominator: RP2D
Dose & schedule → ocular toxicity · ocular AE (any-grade) by cohort
2.4 mg/kg
weekly
18.75%
n=16 · First-in-human Ph1
3.6 mg/kg
q3w
11.76%
n=51 · T-DM1 QT study
3.6 mg/kg
q3w
11.49%
n=383 · ATEMPT
3.6 mg/kg
q3w
9.82%
n=112 · TDM4374g
3.6 mg/kg
q3w
8.7%
n=69 · TDM4450g/BO21976
3.6 mg/kg
q3w
8.22%
n=912 · KAITLIN
3.6 mg/kg
q3w
8.18%
n=110 · TDM4258g
3.6 mg/kg
q3w
7.81%
n=64 · T-DM1+pertuzumab Ph1b/2
3.6 mg/kg
q3w
7.17%
n=223 · KRISTINE (TRIO-021)
3.6 mg/kg
q3w
6.93%
n=361 · MARIANNE
3.6 mg/kg
q3w
6.67%
n=15 · First-in-human Ph1
3.6 mg/kg
q3w
6.08%
n=148 · T-DM1 Ph2
3.6 mg/kg
Q3W
6%
n=740 · KATHERINE
3.6 mg/kg
Q3W
4.5%
n=490 · EMILIA
3.6 mg/kg
q3w
1.43%
n=70 · TDM-India Ph4
3.6 mg/kg
q3w
0.25%
n=403 · TH3RESA (TDM4997g/BO25734)
3.6 mg/kg
q3w
0.14%
n=740 · KATHERINE (BO27938)
3.6 mg/kg
q3w
0.05%
n=2002 · KAMILLA (TDM4529g/BO28407)
Per-cohort rates from the per-trial extraction, sorted by dose. Cross-trial comparison is subject to ascertainment / scale differences (see comparability above) — e.g. an early symptom-driven trial can read lower than a later systematic-exam trial at a higher dose.
Ocular AE grading reference — interspecialty consensus · 6 scales + dose modification
09
Identity & registry

Identifiers, registry & notes

ADC id
trastuzumab-emtansine
Approval status
FDA-approved
Approval year
2013
UniProt
P04626
ADCdb ADC
DRG0CYMEB
ADCdb antibody
ANI0FIZAK
ADCdb target
TAR0THKZD
Primary source
KADCYLA DailyMed label; EMILIA NEJM 2012
Aliases & development codes
T-DM1; Kadcyla
Notes
V3.1: Non-cleavable SMCC + charged Lys-MCC-DM1 catabolite → no bystander → low OAE despite high HER2 cornea expression. oae_any_pct=5.0 is DERIVED (sum of decomposed AEs); label gives individual Eye AEs only: conjunctivitis 3.9%, dry eye 3.9%, blurred vision 4.5%, lacrimation 3.3%. oae_g3plus_pct=0 derived (G3-4 not separately specified).