Scott T. Tagawa, MD, MS, FACP, FASCO, a urothelial carcinoma specialist, discusses adverse events seen in patients receiving sacituzumab govitecan.
Case 1: A 72-Year-Old Man with Metastatic Urothelial Carcinoma
Initial Clinical Presentation:
Initial Clinical Workup:
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This is a synopsis of a Case-Based Peer Perspectives series featuring Scott T. Tagawa, MD, MS, FACP, FASCO, of Weill Cornell Medicine.
Scott T. Tagawa, MD, MS, FACP, FASCO discussed key adverse events associated with sacituzumab govitecan (Trodelvy) in metastatic urothelial carcinoma. The main toxicities are neutropenia and diarrhea.
Overall, about one third of patients experience grade 3-4 neutropenia. Febrile neutropenia, which requires prompt evaluation and treatment, occurs in approximately 10% of patients per trial data. Dr. Tagawa noted that many urothelial carcinoma patients have risk factors predisposing to neutropenia based on ASCO guidelines. Strategies to mitigate neutropenia risk include dose delays/reductions and growth factor support. Through these interventions, most patients can continue sacituzumab govitecan with adjusted dosing.
The other common toxicity is diarrhea, which affects over 50% of patients. However, grade 3 diarrhea occurred in about 10% of patients in trials. Grade 2 diarrhea, defined as up to 7 loose stools above baseline per day, is also clinically meaningful. Dr. Tagawa emphasized patient education on diarrhea risk and preemptive use of antidiarrheals starting with cycle 1. Diarrhea onset is typically acute following infusion. While some dose reductions are needed for persistent higher grade diarrhea, most cases can be managed supportively.
In summary, Dr. Tagawa reviewed key toxicity monitoring and management approaches for patients receiving sacituzumab govitecan for advanced urothelial carcinoma. As a newer therapy, vigilance for neutropenia and diarrhea is imperative, given potential to cause serious complications. Through dose modifications and supportive care interventions, majority of patients can continue treatment safely. Ongoing research is investigating biomarkers or clinical factors associated with increased toxicity risk on sacituzumab govitecan.
*Video synopsis is AI-generated and reviewed by Urology Times editorial staff.