Top Line: There are limited effective systemic therapy options for progressive triple negative breast cancer (TNBC).
The Study: Sacituzumab govitecan (aka “Trodelvy”) is a conjugate of an antibody to human trophoblast cell surface antigen-2 (Trop-2) and the topoisomerase-2 inhibitor, SN-38. While Trop-2 is actually overexpressed in a wide range of cancer types, TNBC has been a real stand-out in early phase basket trials with a 33% response rate. The ASCENT trial randomized 468 patients with advanced, metastatic TNBC that progressed on two prior lines of therapy to either sacituzumab or physician’s choice chemo (eribulin 54%, vinorelbine 20%, capecitabine 13%, gemcitabine 12%). Compared to chemo, sacituzumab significantly prolonged median progression free survival (2 → 6 months) and overall survival (7 → 12 months). Response rate was 35% with sacituzumab compared to 5% with chemo. Overall toxicity also appeared higher with sacituzumab, with grade 3+ toxicity occurring in 45% (versus 32%), most frequently neutropenia.
TBL: Sacituzumab govitecan significantly improves overall survival in patients with TNBC who progress after two prior lines of systemic therapy and will likely be moving on up to sooner-line therapeutic paradigms. | Bardia, N Engl J Med 2021