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What to Make of Sacituzumab Govitecan in HR-Positive Breast Cancer

— Megan Kruse, MD, says we need to balance the efficacy and toxicity in a real-world setting

MedpageToday

Patients with heavily pretreated hormone receptor (HR)-positive/HER2-negative metastatic breast cancer had a progression-free survival benefit with sacituzumab govitecan (Trodelvy) versus physician's choice of chemotherapy, according to the phase III TROPiCS-02 study. The results were presented at the .

In this exclusive 51˶ video, , of the Cleveland Clinic in Ohio, offers her takeaways on the implications of the data.

Following is a transcript of her remarks:

I was excited to see the results of TROPiCS-02, the study looking at sacituzumab govitecan in patients with metastatic hormone receptor-positive/HER2-negative breast cancer, largely because we're familiar with use of this agent for triple-negative metastatic breast cancer. And since we know that TROP2 is expressed across a variety of different breast cancers, it made sense that this drug might have activity there. And I think what's important when you look at the results of the study is that these were very heavily pretreated patients who had received prior endocrine therapy, as well as multiple lines of chemotherapy. And so comparing the results of this drug, trastuzumab compared to treatments of physician's choice, we did see about a 1.5-month benefit in progression-free survival. And so while the study is positive, it's hard to really know what to do with that clinically, because while the drug is more targeted, it still remains chemotherapy.

And so there are significant side effects. There are patients that do tolerate it more poorly than some of our other standard chemotherapies. And so I think we have to really balance that efficacy and toxicity in a real-world setting. So to me it adds another potential drug in our arsenal for these patients, but it probably is not one of the magic bullets we were hoping for to know that this is for sure the next drug we should use in line for patients with metastatic hormone receptor-positive/HER2-negative [disease].

I think it's important to see the overall survival results as we continue to follow these patients and see if we get any sort of unexpected signal there of benefit. But in general, I think that this is probably the biggest part of the story we're going to get. And from there, we may just have to look at specific subgroups of patients that could benefit. I know when we looked at the ASCEND trial for triple-negative disease, we looked at TROP2 expression to see if there was a difference in response. And there, we didn't really see a big difference based on TROP2 expression. I would expect that that would be the same trend that we would see in hormone receptor-positive patients, but I would think it would be worth seeing that data just to make sure that we're not missing out on a group of patients in which effect could be enriched.

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    Greg Laub is the Senior Director of Video and currently leads the video and podcast production teams.