During a Case-Based Roundtable® event, Timothy J. Pluard, MD, discussed the use of sacituzumab govitecan advanced breast cancer as well as dosing considerations in the first article of a 2-part series.
Timothy J. Pluard, MD (Moderator)
Medical Director
Saint Luke’s Cancer Institute
Kansas City, MO
CASE SUMMARY
Two Years After Completing Adjuvant Therapy
After 16 Months on Treatment
After 10 Months on Treatment
After 8 Months on Treatment
DISCUSSION QUESTIONS
TIMOTHY J. PLUARD, MD: Is anyone not doing sequential antibody-drug conjugates [ADCs] and giving intravenous chemotherapy?
STEPHAN B. ROSENFELD, MD: I've never done it, but it certainly would be reasonable to do. It's a different mechanism of action and I think these are the 2 best single-agent chemotherapy drugs for patients with breast cancer [using sacituzumab and trastuzumab deruxtecan (T-DXd)] and you have to use them based on the HER2 status in my opinion.
PLUARD: Are you implying that you go T-DXd first if they are HER2 low?
ROSENFELD: I would, yes. I also think the diarrhea you have to pay attention to, but it's a pretty well-tolerated regimen with the dosing and the intervals. I've used it a handful of times, and I like it.
PLUARD: I'm curious about growth factor support. Are you prophylactically using granulocyte-colony stimulating factor [GCSF] in these cases? Are there patients you would particularly use GCSF support in?
ROSENFELD: I haven't prophylactically [given GCSF], but I have when it was needed.
BASSAM I. MATTAR, MD: Not the first cycle prophylactically but if they need it, then we'll become prophylactic.
PLUARD: Are you using short-acting GCSF or is anybody using PD-Lasta?
ROSENFELD: I've not used the long-acting GCSF, no.
PLUARD: Is everybody starting at 10 mg/kg full dose? Is anybody preemptively dose reducing?
ROSENFELD: I've dose reduced a few times just based on the fear of the diarrhea in the patients I can think of that we're frail and had quite a few comorbid conditions. I didn't want to put them in the hospital with dehydration, so I dose reduced on those instances.
YIFAN TU, MD: I usually do every 2 weeks to have the space for [pegfilgrastim] and all that.
PLUARD: So, you're dosing every other week and using pegfilgrastim after each dose. I've heard others shifting to that schedule.
MARK W. KARWAL, MD: I don't even how many ADCs we have now. One for myeloma was pulled [from the] market, but it was 10 maybe, but they're all given once every 3 weeks—IgG is a long half-life molecule—so I don't know why sacituzumab is [given on] day 1 and day 8. I think if day 8 becomes a problem, you just skip it and go every 3 weeks like all the other ones. It's metastatic disease; you don't have [to overburden the patient].
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