Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer
- PMID: 33882206
- DOI: 10.1056/NEJMoa2028485
Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer
Abstract
Background: Patients with metastatic triple-negative breast cancer have a poor prognosis. Sacituzumab govitecan is an antibody-drug conjugate composed of an antibody targeting the human trophoblast cell-surface antigen 2 (Trop-2), which is expressed in the majority of breast cancers, coupled to SN-38 (topoisomerase I inhibitor) through a proprietary hydrolyzable linker.
Methods: In this randomized, phase 3 trial, we evaluated sacituzumab govitecan as compared with single-agent chemotherapy of the physician's choice (eribulin, vinorelbine, capecitabine, or gemcitabine) in patients with relapsed or refractory metastatic triple-negative breast cancer. The primary end point was progression-free survival (as determined by blinded independent central review) among patients without brain metastases.
Results: A total of 468 patients without brain metastases were randomly assigned to receive sacituzumab govitecan (235 patients) or chemotherapy (233 patients). The median age was 54 years; all the patients had previous use of taxanes. The median progression-free survival was 5.6 months (95% confidence interval [CI], 4.3 to 6.3; 166 events) with sacituzumab govitecan and 1.7 months (95% CI, 1.5 to 2.6; 150 events) with chemotherapy (hazard ratio for disease progression or death, 0.41; 95% CI, 0.32 to 0.52; P<0.001). The median overall survival was 12.1 months (95% CI, 10.7 to 14.0) with sacituzumab govitecan and 6.7 months (95% CI, 5.8 to 7.7) with chemotherapy (hazard ratio for death, 0.48; 95% CI, 0.38 to 0.59; P<0.001). The percentage of patients with an objective response was 35% with sacituzumab govitecan and 5% with chemotherapy. The incidences of key treatment-related adverse events of grade 3 or higher were neutropenia (51% with sacituzumab govitecan and 33% with chemotherapy), leukopenia (10% and 5%), diarrhea (10% and <1%), anemia (8% and 5%), and febrile neutropenia (6% and 2%). There were three deaths owing to adverse events in each group; no deaths were considered to be related to sacituzumab govitecan treatment.
Conclusions: Progression-free and overall survival were significantly longer with sacituzumab govitecan than with single-agent chemotherapy among patients with metastatic triple-negative breast cancer. Myelosuppression and diarrhea were more frequent with sacituzumab govitecan. (Funded by Immunomedics; ASCENT ClinicalTrials.gov number, NCT02574455; EudraCT number, 2017-003019-21.).
Copyright © 2021 Massachusetts Medical Society.
Comment in
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Sacituzumab govitecan improves OS.Nat Rev Clin Oncol. 2021 Jun;18(6):322. doi: 10.1038/s41571-021-00516-x. Nat Rev Clin Oncol. 2021. PMID: 33931767 No abstract available.
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Sacituzumab Govitecan in Metastatic Breast Cancer.N Engl J Med. 2021 Jul 15;385(3):e12. doi: 10.1056/NEJMc2108478. N Engl J Med. 2021. PMID: 34260847 No abstract available.
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Does sacituzumab-govitecan act as a conventional antibody drug conjugate (ADC), a prodrug of SN-38 or both?Ann Transl Med. 2021 Jul;9(14):1113. doi: 10.21037/atm-21-1103. Ann Transl Med. 2021. PMID: 34430554 Free PMC article. No abstract available.
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A plain language summary of the ASCENT study: Sacituzumab Govitecan for metastatic triple-negative breast cancer.Future Oncol. 2021 Oct 1;17(30):3911-3924. doi: 10.2217/fon-2021-0868. Epub 2021 Sep 1. Future Oncol. 2021. PMID: 34467774
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Sacituzumab govitecan: a new opportunity in the treatment of refractory metastatic triple-negative breast cancer.Ann Transl Med. 2022 Apr;10(7):389. doi: 10.21037/atm-21-6999. Ann Transl Med. 2022. PMID: 35530936 Free PMC article. No abstract available.
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Sacituzumab govitecan: ascending the treatment algorithm in triple negative breast cancer.Ann Transl Med. 2022 Apr;10(7):390. doi: 10.21037/atm-22-484. Ann Transl Med. 2022. PMID: 35530962 Free PMC article. No abstract available.
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Sacituzumab govitecan in triple-negative breast cancer.Ann Transl Med. 2022 Jun;10(11):647. doi: 10.21037/atm-22-813. Ann Transl Med. 2022. PMID: 35813338 Free PMC article. No abstract available.
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The anti-Trop-2 antibody-drug conjugate Sacituzumab Govitecan-effectiveness, pitfalls and promises.Ann Transl Med. 2022 May;10(9):501. doi: 10.21037/atm-22-621. Ann Transl Med. 2022. PMID: 35928735 Free PMC article. No abstract available.
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Sacituzumab govitecan and other antibody-drug conjugates targeting trophoblast cell-surface antigen 2 (Trop-2) in breast cancer.Ann Transl Med. 2022 Sep;10(18):1031. doi: 10.21037/atm-22-1892. Ann Transl Med. 2022. PMID: 36267779 Free PMC article. No abstract available.
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Antibody-drug conjugates (ADCs) targeting trophoblast cell surface antigen 2 (Trop-2) and precision treatment of breast cancer.Ann Transl Med. 2022 Nov;10(21):1184. doi: 10.21037/atm-22-4581. Ann Transl Med. 2022. PMID: 36467370 Free PMC article. No abstract available.
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