Clinical perspective on management of key adverse events with sacituzumab govitecan

Sacituzumab govitecan (SG) is a first-in-class trophoblast cell surface antigen-2-directed antibody-drug conjugate that selectively delivers a well-characterized and potent payload of SN-38 to cancer cells and the surrounding environment. In the United States, SG is indicated for unresectable, locally advanced or metastatic triple-negative breast cancer (TNBC) and hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (immunohistochemistry 0, 1+, or 2+/in situ hybridization-negative) breast cancer (HR+/HER2- BC). Real-world management of SG-related adverse events can vary widely from clinical studies. Therefore, it is vital to provide clinicians with first-hand experience to aid in the management and support of patients before treatment initiation. In clinical studies (IMMU-132-01, ASCENT, TROPiCS-02, and TROPHY-U-01), the pooled incidence of key adverse events was 61% for neutropenia, 64% for diarrhea, 51% for fatigue, and 45% for alopecia. Here, we discuss the incidence of neutropenia, diarrhea, fatigue, and alopecia associated with SG treatment and provide recommendations on their management based on established guidelines and personal clinical experience. We also discuss important risk factors such as UGT1A1 polymorphism and advanced age (eg, ≥65 years). From our practical experience, we present a case of a patient with TNBC experiencing neutropenia and diarrhea, and another with HR+/HER2- BC experiencing diarrhea. Our review provides practicing oncologists considering SG therapy important information regarding its safe and appropriate use in real-world settings to maximize clinical benefit for patients with locally advanced or metastatic TNBC and HR+/HER2- BC.