Canadian Expert Recommendations on Safety Overview and Toxicity Management Strategies for Sacituzumab Govitecan Based on Use in Metastatic Triple-Negative Breast Cancer

Mita Manna; Michelle Brabant; Rowen Greene; Michael Dean Chamberlain; Aalok Kumar; Nimira Alimohamed; Christine Brezden-Masley

doi:10.3390/curroncol31090422

Canadian Expert Recommendations on Safety Overview and Toxicity Management Strategies for Sacituzumab Govitecan Based on Use in Metastatic Triple-Negative Breast Cancer

Curr Oncol. 2024 Sep 21;31(9):5694-5708. doi: 10.3390/curroncol31090422.

Authors

Mita Manna^{1

2

3}, Michelle Brabant¹, Rowen Greene⁴, Michael Dean Chamberlain^{2

3}, Aalok Kumar⁵, Nimira Alimohamed⁶, Christine Brezden-Masley⁷

Affiliations

¹ Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada.
² Department of Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
³ Saskatoon Cancer Centre, Saskatchewan Cancer Agency, Saskatoon, SK S7N 4H4, Canada.
⁴ Department of Biochemistry, Microbiology, and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
⁵ BC Cancer Surrey, University of British Columbia, Surrey, BC V3V 1Z2, Canada.
⁶ Department of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada.
⁷ Department of Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada.

Abstract

Sacituzumab Govitecan (SG) is an antibody-drug conjugate (ADC) comprised of an anti-Trop-2 IgG1 molecule conjugated to SN-38, the active metabolite of irinotecan, via a pH-sensitive hydrolysable linker. As a result of recent Canadian funding for SG in advanced hormone receptor (HR)-positive breast cancer and triple-negative breast cancer (TNBC), experience with using SG and managing adverse events (AEs) has grown. This review presents a summary of evidence and adverse event recommendations derived from Canadian experience, with SG use in metastatic TNBC for extrapolation and guidance in all indicated settings. SG is dosed at 10 mg/kg on day 1 and day 8 of a 21-day cycle. Compared to treatment of physicians' choice (TPC) the phase III ASCENT and TROPiCS-02 studies demonstrated favorable survival data in unresectable locally advanced or metastatic TNBC and HR-positive HER2 negative metastatic breast cancer, respectively. The most common AEs were neutropenia, diarrhea, nausea, fatigue, alopecia, and anemia. This review outlines AE management recommendations for SG based on clinical trial protocols and Canadian guidelines, incorporating treatment delay, dose reductions, and the use of prophylactic and supportive medications.

Keywords: adverse event management; antibody-drug conjugate; sacituzumab govitecan; triple-negative breast cancer.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Antibodies, Monoclonal, Humanized* / pharmacology
Antibodies, Monoclonal, Humanized* / therapeutic use
Antineoplastic Agents / therapeutic use
Camptothecin* / analogs & derivatives
Camptothecin* / therapeutic use
Canada
Female
Humans
Immunoconjugates* / therapeutic use
Neoplasm Metastasis
Triple Negative Breast Neoplasms* / drug therapy

Substances

sacituzumab govitecan
Antibodies, Monoclonal, Humanized
Camptothecin
Immunoconjugates
Antineoplastic Agents

Grants and funding

This research received no external funding. M.D.C. is funded by the Saskatchewan Health Research Foundation (SHRF), the Cancer Foundation of Saskatchewan and the College of Medicine of the University of Saskatchewan. R.G. is funded by the College of Medicine of the University of Saskatchewan and a NSER USRA scholarship.