Antibody-Drug Conjugates in Breast Cancer: Strategies for Toxicity Management - Episode 7
Komal Jhaveri, MD, FACP, provides rationale for treating a patient with triple-negative breast cancer with sacituzumab govitecan.
Kevin Kalinsky, MD, MS: Let’s move on to the second case. This is a postmenopausal 55-year-old woman who is employed as a vice principal and discovers a lump in her left breast. She presents with intermittent chest pain. For social history, she is active, has 2 teenage children, and enjoys an occasional glass of wine on weekends. From her diagnosis, she undergoes some imaging, which reveals a suspicious multifocal lesion of 3.2 cm in the left breast and also some left axillary lymph node involvement. Biopsy shows triple-negative breast cancer. She undergoes germline testing. She’s BRCA wild type. She undergoes systemic imaging, and unfortunately, on her systemic imaging, there’s a lesion in her liver, which is biopsied and confirms metastatic cancer. As I mentioned, she’s BRCA wild type. She’s started on weekly paclitaxel. She unfortunately progresses and then receives carboplatin-gemcitabine as a doublet. Then progresses further and receives sacituzumab govitecan. With this case, Komal, talk us through your experience with utilizing sacituzumab govitecan. Would you have had a similar approach in treating this patient?
Komal Jhaveri, MD, FACP: I would have been OK with treating her in the second and third line, as has been done in this case. I would have been totally comfortable, after paclitaxel, utilizing sacituzumab govitecan for the label and the approval based on the results we’ve seen in the phase 3 ASCENT trial. It’s a very active drug, and I’ve definitely utilized it, and we give these patients this therapy as on day 1 and day 8 of a 3-week cycle. What was seen in the phase 3 ASCENT trial is what I’ve been seeing in clinic as well: response rates compared with standard of care improved from 5% to 35% in that trial, which was nice to look at. The progression-free survival improved from 1.7 to 5.7 months, and overall survival was about 13 months as well. It’s an active therapy against TROP2. It definitely is active in triple-negative breast cancer with some hint of activity in hormone receptor–positive [patients] that we’re waiting for randomized data to prove. That would have been my approach for this woman as well.
Transcript edited for clarity.