Advances and perspectives in CEA-targeted therapies: From classic biomarker toward actionable therapeutic target

Carcinoembryonic antigen (CEA) stands as a classic and widely applied tumor biomarker mainly for epithelial malignancies. Its restricted tumor expression pattern and role in cellular adhesion render it a promising therapeutic target. However, the translation of CEA into effective therapies has long been hindered by multiple challenges. As the first comprehensive review of CEA-targeted therapies, we leveraged peer-reviewed literature and officially disclosed global pharmaceutical data to delineate the landscape and evaluate the prospects across all subfields of CEA-targeted drug modalities, including antibody-drug conjugates, chimeric antigen receptor T cells, bispecific antibodies, vaccines, and radionuclide conjugates. We also dissected the underlying mechanisms of the challenges contributing to these setbacks. By proposing multifaceted and innovative strategies, this review facilitates CEA's transition from a diagnostic and predictive biomarker to a viable therapeutic target, ultimately supporting improved clinical outcomes for patients with CEA-expressing cancers.