Trodelvy (sacituzumab govitecan-hziy) is indicated for metastatic triple-negative breast cancer, in patients who have received ≥2 prior treatments, including ≥1 for metastatic disease.1 Patients should ideally know that breast cancer that has spread to other parts of the body (metastatic disease) can be treated, but not cured. With Trodelvy, one goal is to slow the progression of the disease by as much as possible and for as long as possible. In clinical trials, patients taking Trodelvy showed no signs of their disease getting worse for 4.8 months, compared with only 1.7 months for patients on chemotherapy (ie, a higher progression-free survival).1
Trodelvy had a 3-times longer median PFS than single-agent chemotherapy in the brain metastases–negative (BM-neg) cohort (5.6 months with Trodelvy vs 1.7 months with single-agent chemotherapy). Trodelvy had a 1-year greater median overall survival in the BM-neg population; 12.1 months compared with 6.7 months with single-agent chemotherapy. Eribulin, capecitabine, gemcitabine, and vinorelbine were used as single-agent chemotherapy. Progression-free survival and overall survival outcomes were statistically significant in both the BM-neg and whole populations, with 88% in the full group being BM-neg.1,2 It is important that patients understand this information and that they are taking Trodelvy to lengthen their lives.
Once your patients understand why they are taking Trodelvy, they should be educated on the possible risks associated with treatment. Trodelvy can cause neutropenia, which is quite common. Patients should understand these risks and be reassured that neutropenia can be successfully managed through dose modifications or with granulocyte colony-stimulating factor (G-CSF) therapy but also be aware that severe neutropenia is a potentially serious adverse event. G-CSF should be considered as a preventive measure. To ensure prompt treatment if neutropenia develops and the patient requires G-CSF, healthcare practitioners should obtain authorization for G-CSF at the same time as prescribing Trodelvy. Based on the patient, illness, and treatment-related risk factors, the American Society of Clinical Oncology guidelines advocate prophylactic administration of G-CSF (pegfilgrastim or filgrastim) with chemotherapy regimens that have a ≥20% chance of febrile neutropenia.1 Patients with a <10% risk of febrile neutropenia should not get preventive G-CSF on a regular basis.2 G-CSF should not routinely be given to afebrile neutropenic patients. If your patient’s neutropenia becomes severe, they may also require antibiotics if the neutropenia is suspected to be infectious in nature.2
Diarrhea is a common adverse event. If diarrhea becomes too severe, patients should be aware of the risks of losing too much body fluid and becoming dehydrated. They need to understand that there is a good chance that their diarrhea can be managed; however, if it becomes too severe, they may need to stop their Trodelvy treatment, at least temporarily. Patients should be supplied with the patient product information and be told that they can speak to their healthcare professionals at any time about their concerns, including adverse events. Common side effects of Trodelvy include low white blood cell counts, anemia, nausea, diarrhea, fatigue, vomiting, hair loss, constipation, rash, decreased appetite, and abdominal pain.3 Patients should inform their physician if they suffer from any of these adverse effects.3
If your patients encounter any of the following symptoms, they should know who to contact from their healthcare team and to call them immediately: chills, cough, shortness of breath, or burning or discomfort while urinating. These are all possible indicators of infection, as are fevers of 100.4°F or higher. Swelling of the face, lips, tongue, or throat; hives, skin rash, or flushing of the skin; difficulty breathing or wheezing; lightheadedness; dizziness; feeling faint; or passing out are all signs of an allergic reaction. Black or tarry stools, or blood in the stools are also signs of an allergic reaction. Dizziness, lightheadedness, or faintness are symptoms of dehydration.4
Patients should be aware that while taking Trodelvy, they will be evaluated by their entire care team, including their nurses and doctor(s) on a frequent basis to monitor side effects and assess their response to therapy.4 Patients should be reminded of the benefits that come from treatment with Trodelvy, including lengthening their lives, but to also be cautious and vigilant for any warning signs.
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