FDA Approves Sacituzumab Govitecan for TNBC: What Nurses Need to Know

Julia LaBarbera, NP

The FDA recently approved sacituzumab govitecan (Trodelvy) for patients with triple-negative breast cancer (TNBC) who have had 2 or more prior therapies for metastatic disease. Bringing the antibody-drug conjugate to the space was a major advancement, and there are some key points that oncology nurses need to know.

Oncology Nursing News recently spoke with Julia LaBarbera, NP, an oncology nurse at UCLA, about the exciting approval, as well as what more is needed for this patient population.

Oncology Nursing News: Can you explain the impact this approval has on the TNBC space, and why it’s exciting?

LaBarbera: Triple-negative breast cancers are so difficult to treat because, unlike hormone receptor positive or HER-2 positive breast cancers, there is no receptor to target, and approved treatment options consist primarily of traditional chemotherapy and immunotherapy.

Approval of sacituzumab govitecan opens up a new line for therapy in individuals with metastatic TNBC who have failed standard chemotherapy regimens. This is exciting and important because it not only gives this population another option for treatment, but has also been shown to improve the length of time before cancer progresses (progression free survival) and increase how long the patients live from receiving this therapy (overall survival).

What should oncology nurses know about administering sacitizumab govitecan, and how it is different from some other common breast cancer treatments?

Sacituzumab govitecan offers a novel way of delivering chemotherapy to this vulnerable population. Sacituzumab govitecan is an antibody-drug conjugate (ADC), meaning it attaches to a cell receptor, TROP-2 (trophoblast tumor antigen-2), and delivers chemotherapy (camptothecin, the active component of irinotecan) directly into the cancer cell, promoting cell death. This is different from traditional chemotherapy which targets all rapidly dividing cells and results in unintended adverse events.

What kind of adverse events should nurses look out for when treating patients with this regimen?

Sacituzumab govitecan has a black box warning for severe neutropenia and severe diarrhea, so nurses should be sure to educate patients about these risks and monitor symptoms and labs closely. Other common side effects include nausea, vomiting, fatigue, anemia, constipation, decreased appetite and rash. Pre-medications for nausea should be administered. Hematopoietic growth factor is indicated for neutropenia.

What kind of unanswered questions or further needs are there in this treatment space?

Approval for sacituzumab govitecan was based on phase II clinical trial data, which means there was no comparison arm. We do not yet know if sacituzumab govitecan is superior to traditional chemotherapy and where it should be administered in the treatment continuum. A phase III study aimed at answering these questions is currently compiling their data and we should know more later this year.