Sacituzumab Govitecan: Elevating Quality of Life in First-Line TNBC

Kevin Punie, MD, a medical oncologist in the Department of General Medical Oncology at University Hospitals Leuven, Gasthuisberg, discusses the design of the ASCENT-03 trial presented at the 2025 San Antonio Breast Cancer Symposium.

The study evaluated sacituzumab govitecan (SG; Trodelvy) against standard physician's choice chemotherapy in patients with advanced triple-negative breast cancer (TNBC) who were not candidates for PD-L1 inhibitors. Patient-reported outcome (PRO) data reveal that SG not only improves clinical outcomes like progression-free survival (PFS) but also provides a superior and sustained quality of life compared to traditional chemotherapy.

A primary highlight of the study was the maintenance of physical functioning. Patients receiving SG maintained their baseline physical functioning scores through week 25, whereas those on chemotherapy showed a steady decline. Specifically, at week 25, the mean change from baseline was +1.1 for the SG group vs –6.2 for the chemotherapy group.

Exploratory analyses showed that sacituzumab govitecan was consistently favored across several critical health domains, including:

• Global Health Status: Overall well-being was better preserved.
• Symptom Management: Patients reported improvements in fatigue, pain, and dyspnea.
• Role Functioning: The ability to perform daily tasks and work-related activities was significantly better in the SG arm.

While SG was associated with a higher incidence of diarrhea compared to chemotherapy, this did not negatively impact the patients' overall global health status or physical functioning scores. Most common adverse effects, such as neutropenia and diarrhea, occurred early in the treatment cycle and were effectively managed with standard supportive care. Importantly, SG led to fewer dose reductions and treatment discontinuations than chemotherapy, suggesting that the treatment is more tolerable over the long term.

These findings are crucial because roughly half of patients with metastatic TNBC do not survive long enough to receive a second line of therapy. By providing a first-line treatment that extends survival while simultaneously preserving or improving the quality of life, sacituzumab govitecan establishes itself as a potential new standard of care for this underserved patient population.

REFERENCE

Punie K, Tolaney S, Huvitz S, et al. Patient-reported outcomes (PROs) with sacituzumab govitecan (SG) vs chemotherapy in patients with previously untreated advanced triple-negative breast cancer (TNBC) who are not candidates for PD-(L)1 inhibitors in the phase 3 ASCENT-03 study. Presented at: 2025 San Antonio Breast Conference Symposium; December 9-12, 2024; San Antonio, TX. RF6-05.