Introduction
Triple-negative breast cancer (TNBC) represents a highly aggressive subtype of breast cancer characterized by the absence of estrogen receptors, progesterone receptors, and HER2 expression. It accounts for approximately 15-20% of all breast cancers and is associated with poorer prognosis and limited targeted treatment options, primarily relying on chemotherapy. Patients with untreated, advanced, or metastatic TNBC are often in urgent need of more effective therapies to improve survival outcomes.
Recent advances in immunotherapy, particularly PD-1 and PD-L1 inhibitors, have provided new hope; however, many patients are ineligible due to previous treatments or coexisting conditions. For these patients, alternative targeted therapies are critically needed.
This context sets the stage for evaluating sacituzumab govitecan, an antibody-drug conjugate targeting Trop-2, a protein overexpressed in many TNBC tumors, as a promising agent for this patient population.
Study Design and Population
The highlighted phase 3, open-label, randomized trial enrolled 558 patients with previously untreated, advanced TNBC. The trial distinguished patients based on their PD-L1 status, using the combined positive score (CPS); those with PD-L1-negative tumors (CPS<10) and positive tumors (CPS≥10). Importantly, all participants were deemed unsuitable for PD-1 or PD-L1 inhibitor therapy due to prior treatment history or coexisting health conditions.
Participants were randomly assigned in a 1:1 ratio to receive either sacituzumab govitecan or standard chemotherapy options, including paclitaxel, albumin-bound paclitaxel, or gemcitabine plus carboplatin. The primary endpoint was progression-free survival (PFS), assessed by blinded independent central review, with secondary endpoints including overall survival (OS), objective response rate (ORR), duration of response, and safety.
Key Findings and Results
The trial’s results demonstrated a significant advantage for sacituzumab govitecan over standard chemotherapy:
- Median PFS was 9.7 months for sacituzumab govitecan versus 6.9 months for chemotherapy, with a stratified hazard ratio (HR) of 0.62 (95% CI, 0.50 to 0.77), P<0.001, indicating a 38% reduction in the risk of disease progression or death.
- Objective response rates were comparable (48% for sacituzumab govitecan vs. 46% for chemotherapy), but the median duration of response was notably longer with sacituzumab govitecan (12.2 months vs. 7.2 months).
- Safety analyses revealed grade 3 or higher adverse events in 66% of patients receiving sacituzumab govitecan, with neutropenia (43%), diarrhea (9%), and leukopenia (7%) being most common. While adverse events were frequent, the discontinuation rate due to adverse events was lower (4%) compared to chemotherapy (12%).
The overall survival data were pending at the time of the report but are anticipated to provide further insights into the long-term benefits.
Implications for Clinical Practice
The study underscores sacituzumab govitecan’s potential as a new standard of care for patients with untreated, advanced TNBC who are not candidates for immunotherapy. Its improvement in PFS and durable responses highlight its value as a targeted therapy that can overcome some limitations of conventional chemotherapy.
While safety concerns exist, the manageable toxicity profile and lower discontinuation rate suggest that sacituzumab govitecan could be integrated into treatment algorithms, especially for patients with limited options.
Limitations and Future Directions
Despite its promising findings, the study’s limitations include the open-label design and the need for mature OS data. Further research should explore combining sacituzumab govitecan with other agents, its cost-effectiveness, and its performance in broader patient populations.
Biologically, targeted delivery of payloads via antibody conjugates like sacituzumab govitecan exploits tumor-specific antigens, exemplifying precision medicine in oncology. Future trials may expand on this approach, including trials with other biomarkers and combination strategies.
Conclusion
This phase 3 trial signifies a milestone in managing advanced TNBC, especially for patients ineligible for immunotherapy. Sacituzumab govitecan offers a significant survival advantage, with an acceptable safety profile, representing a promising addition to the therapeutic landscape. Ongoing studies and longer-term data will determine its definitive role and potential to improve outcomes in this challenging cancer subtype.
Funding and Clinical Trials
The study was funded by Gilead Sciences, and registration details are available under NCT05382299.
References
Cortés J, Punie K, Barrios C, et al. Sacituzumab Govitecan in Untreated, Advanced Triple-Negative Breast Cancer. N Engl J Med. 2025; published online October 19. doi:10.1056/NEJMoa2511734.
