Sacituzumab Govitecan Versus Platinum-Based Chemotherapy for Second-Line mUC

Karine Tawagi, MD, of the University of Illinois College of Medicine, provides an update as to when sacituzumab govitecan (SG) or platinum-based chemotherapy should be preferred for patients who do not respond to EV/pembrolizumab first-line treatment.

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Dr. Tawagi: The SG approval that we have based on TROPHY is post-chemotherapy, post-immunotherapy. So, we do not really know how SG performs from trial data post-EV/pembrolizumab. There is an ECOG trial which is looking at a regimen (which includes SG) versus physician’s drug of choice. We have the TROPiCS-04 press release, which suggests negative OS for SG versus physician’s treatment of choice, which generally were different types of chemotherapy. I will be interested to see when those results read out.

But in terms of where it fits, the options really for FGFR-negative patients are either chemotherapy or sacituzumab can still be considered. It is really important if SG is being considered for whatever reason if a patient has bad neuropathy, primary G-CSF prophylaxis must be offered. We have seen a really high rate of neutropenia and febrile neutropenia, and even in some of the trials, deaths related to febrile neutropenia. There was a trial presented today for perioperative SG, and therapy was dose reduced from the 10 mg/kg to 7.5 mg/kg, and primary G-CSF prophylaxis was added.

Another thing to consider is the UGT1A1 polymorphism in terms of potentially predicting which patients might be at a higher risk of toxicity. These are all things that come into consideration for SG.

View her continued comments.