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Breast Cancer • Medical Oncology • Triple negative • Journal Club ft. NEJM publications • Breast Cancer, Metastatic
In which scenarios would you utilize sacituzumab govitecan earlier than third line in the treatment of metastatic TNBC?
Given seemingly improved efficacy in ASCENT patients who had less prior treatment, would you consider use after only one prior agent rather than two? What is your typical preference for sequencing of agents?
Answer from: Medical Oncologist at Academic Institution
To date, we do not have a head-to-head comparison of sacituzumab govitecan prior to the 3rd line setting and insurance approval for sacituzumab govitecan prior to 3rd can be a barrier. However, I consider it under the following circumstances:
The patient has significant pre-existing neuropathy. Man...
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Answer from: Medical Oncologist at Academic Institution
The FDA approval of sacituzumab govitecan is for patients with metastatic TNBC who have received two prior lines of therapy, at least one in the metastatic setting. So, for a patient who received (neo)adjuvant chemotherapy and then had disease recurrence and received 1st line therapy with chemothera...
Answer from: Medical Oncologist at Community Practice
Sacituzumab is approved for patients with metastatic TNBC that have received at least 2 prior lines. However, the FDA specifies only one of these lines needs to be for metastatic disease – so we do have a bit of wiggle room here to use 2nd line. The place where I would be thinking of moving sa...
Answer from: Medical Oncologist at Academic Institution
Have been using second-line when possible after first-line chemo. Might consider first-line for patients who have disease relapse within 6 months of adjuvant/neoadjuvant chemotherapy.