Sacituzumab Govitecan in Hormone-Positive Breast Cancer Headlines ESMO 2022

The most notable presentation on the first day of the ESMO 2022 Congress, which began on 9 September, concerned a medicine previously approved by the FDA for triple-negative breast cancer in 2020 and urothelial cancer in 2021: sacituzumab govitecan. This time, TROPiCS-02 demonstrated its efficacy in hormone-positive / HER2-negative breast cancer.

TROPiCS-02 suggests an overall survival benefit from sacituzumab govitecan in heavily pretreated patients, while raising questions about its optimal clinical use.

Sacituzumab govitecan is an antibody–drug conjugate, one of the next-generation cancer medicines developed using advanced biotechnology.

These data suggest that sacituzumab govitecan, targeting Trop-2, is highly promising for heavily pretreated metastatic breast cancer. Effective endocrine treatments already significantly improve overall survival in HR-positive/HER2-negative disease, for example with CDK4/6 inhibitors. When these treatments fail, however, chemotherapy is used, and available medicines become less effective with successive treatment lines. More recently, trastuzumab deruxtecan for HER2-low tumours has shown notable clinical benefit. This does not help those whose tumours are not HER2-low, however, and heavily pretreated patients still face limited options and poor outcomes.

Although the benefit in TROPiCS-02 was smaller than that seen with sacituzumab in triple-negative breast cancer, the TROPiCS-02 results show a clinically meaningful effect. Sacituzumab should now be considered for later treatment lines in hormone-positive / HER2-negative advanced breast cancer.

Several critical issues remain for optimal use: sacituzumab’s efficacy after trastuzumab deruxtecan in HER2-low disease; identifying potential biomarkers for patients most likely to benefit; and interpreting efficacy alongside quality of life, patient-reported outcomes and adverse effects.

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The summary results graphic for TROPiCS-02 appears below: