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Tumour heterogeneity and dynamic antigen expression during treatment pose major challenges for conventional tissue biopsies used in patient selection. Liquid biopsy components such as circulating tumour cells (CTCs) enable real\u2010time, minimally invasive monitoring of tumour burden, molecular characteristics and target antigen status.\u00a0This review evaluates the potential of CTC analysis to overcome the key challenges in ADC therapy, including real\u2010time target profiling, enhanced patient stratification and longitudinal monitoring of treatment response. While acknowledging that direct clinical evidence for CTC\u2010guided ADC selection remains limited and prospective validation is still needed, we integrate clinical evidence from CTC\u2010guided trials across different cancer types and propose pragmatic decision\u2010making frameworks to incorporate CTC testing into ADC treatment strategies. We also examine how artificial intelligence (AI) has improved CTC detection accuracy and discuss exploratory AI models for multi\u2010omics integration and hypothetical AI\u2010guided ADC recommendation systems, clearly distinguishing these by their current level of clinical evidence. Liquid biopsy\u2010guided ADC selection has the potential to enable more personalised cancer treatment as CTC technologies advance and standardisation improves.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ctm2.70748","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:42:01Z","timestamp":1790311321000},"source":"Crossref","is-referenced-by-count":0,"title":["Circulating tumour cells for guiding antibody\u2012drug conjugate therapy: Role of artificial intelligence"],"prefix":"10.1002","volume":"16","author":[{"given":"Vahid","family":"Yaghoubi Naei","sequence":"first","affiliation":[{"name":"Institute for Biomedical Materials &amp; Devices School of Mathematical and Physical Sciences Faculty of Science University of Technology Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehran","family":"Dabiri","sequence":"additional","affiliation":[{"name":"School of Biomedical 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