Overview | Schedule | Side Effects | Monitoring | Questions | Tips | Patient Assistance | Emotional Wellness | Drugs | References
Treatment Name: Sacituzumab Govitecan (Trodelvy®)
Sacituzumab Govitecan (Trodelvy®) is a Chemotherapy Regimen for Breast Cancer - metastatic
How does sacituzumab govitecan work?
Sacituzumab govitecan is an antibody that targets breast cancer cells. Once it binds to the breast cancer cell surface, it then enters the inside of the cancer cell. Once inside the cell, the antibody releases a drug called SN-38, which stops the cell from growing and dividing.
Goals of therapy:
Sacituzumab govitecan is typically given after at least two other therapies for breast cancer have been tried. It is given to shrink tumors and decrease symptoms of breast cancer, but is not commonly given with the goal of cure.
How is sacituzumab govitecan therapy for breast cancer given?
- Sacituzumab Govitecan intravenous (I.V.) infusion on Days 1 and 8
- First infusion is given over 3 hours. If well tolerated, subsequent infusions are given over 1 to 2 hours
- After the infusion, you will be watched for any side effects for 30 minutes
Estimated total infusion time for this treatment:
- Up to 4 hours or more for Cycle 1, Day 1; as short as 2 hours for all following treatments if well tolerated
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Sacituzumab govitecan is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.
Sacituzumab govitecan is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common sacituzumab govitecan starting doses.
What are the most common side effects from sacituzumab govitecan (Trodelvy®) for breast cancer?
In clinical studies, the most commonly reported side effects of sacituzumab govitecan (Trodelvy®) are shown here:
- Nausea (67%)
- Low white blood cells [neutropenia] (64%)
- Diarrhea (62%)
- Fatigue (55%)
- Low red blood cells [anemia] (50%)
- Vomiting (49%)
- Hair loss (36%)
- Constipation (34%)
- Decreased appetite (30%)
- Skin rash (28%)
- Stomach pain (25%)
- High blood sugar (24%)
- Back pain (22%)
- Low blood magnesium (21%)
- Headache (21%)
- Pneumonia or sinus infection (21%)
- Dizziness (20%)
- Urinary tract infection [UTI] (20%)
- Cough (19%)
- Shortness of breath (19%)
- Nerve pain (19%)
- Low blood potassium (18%)
- Swelling in arms and legs (16%)
- Joint pain (16%)
- Itching (16%)
- Low blood phosphate (15%)
- Dry skin (14%)
- Trouble sleeping (14%)
- Weight loss (14%)
- Mouth sores (14%)
- Dehydration (13%)
- Fever (12%)
- Weakness (11%)
- Pain in arms or legs (10%)
On average, 3% of patients discontinue treatment due to unacceptable side effects.
Importantly, not all people who experience a side effect from sacituzumab govitecan will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with sacituzumab govitecan, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
Watch videos on common sacituzumab govitecan therapy side effects below
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked to see if treatment is working, if there are concerns for disease progression, or if certain side effects occur. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue sacituzumab govitecan as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
- What do I need to know regarding my blood tests, which are sometimes referred to as "labs"? Monitoring
- Unless you have access to them via your electronic chart, we recommend that you always ask for a copy of your labs. There are hundreds, if not thousands, of different blood tests available for your doctor to order. Some are common and some are not. Have your team explain to you what blood tests they have ordered and what the results mean when you do not understand. This way you will have a better understanding if the treatment is working or not. Plus, doctors may prescribe medications when your lab work is abnormal. When your lab work returns to normal you may be able to stop taking these medications, or reduce the dose.
- Do I need to see any other doctors? Monitoring
- If you have not seen a specialized cancer doctor, known as a medical oncologist for solid tumors such as breast, lung, or prostate cancer, or a hematologist for cancers such as leukemia or lymphoma, it is generally recommended that you do so. A cancer doctor will typically take over coordinating care and monitoring after surgery has been performed to remove the cancer. An oncologist or hematologist will help determine if medications may be needed to get rid of any remaining cancer cells, or to help prevent the cancer from coming back.
- What should I do if I receive a bill for something that I thought would be covered by insurance? Cost
- On occasion, items may be submitted and denied by insurance for a variety of reasons. Sometimes the medication or procedure is not covered, but sometimes claims are submitted with too little information to be approved by insurance or sometimes claims are submitted with the wrong information (example: miscoded). A denial letter from the insurance company, when issued, usually helps to explain the situation. If you receive an unexpected bill, ask your doctor if there is a financial counselor or someone you can speak with to help you.
- Am I able to enjoy an occasional glass of wine or beer now that treatment is over? Healthy Diet
Alcohol can harm your liver and interact with certain medications. Moreover, alcohol is a known risk factor for developing certain types of cancer, therefore it is very important you do not drink alcohol without being cleared to do so by your doctor first. Important Note: this question only applies to those who are of legal drinking age.
- What if I'm still experiencing anxiety after treatment? Mindset
- Anxiety after treatment is natural and may come and go. If it is physically affecting you or your ability to sleep or socialize with others, talk with your doctor about it, and consider speaking with someone such as a social worker. Talking with someone can be very therapeutic, and may be better than taking medications for anxiety that may have side effects, such as fatigue.
- What can I do if my treatment is over and I am still having side effects? Side Effects
- It is not always easy to predict if side effects from treatment will go away or when. When speaking with your doctor, try to describe what is troubling to you and how it limits the things you want to do. By setting goals, you can tell if the interventions you make to reduce the side effect are helping you get closer to goal. For example, chemo brain (cancer-related cognitive dysfunction), may limit your short-term memory. Your doctor may be able to recommend treatments, including those that do not have more medications. (Chung NC et al. Oncology. 2018)
- What resources can I use to help me make better choices regarding my diet as I begin cancer treatment? Healthy Diet
- Many oncology clinics have a dietician available to help you make positive changes in your diet. If one is not available, your nurse may be able to give you appropriate resources to help you make safe and positive dietary changes.
- What kinds of foods should I eat to prepare for treatment? Healthy Diet
Before treatment, ask your nurse if the specific treatment you are receiving is likely to change the way food tastes or if you are likely to lose weight. Now might be a good time to reevaluate what you eat on a daily basis. If you eat a lot of sugary or fatty foods, it would be good to eat more wholesome foods such as vegetables and fruits. Remember, it is not always what you are eating, it is what you are NOT eating that matters as well. Fruits and vegetables may contain valuable cancer-fighting compounds that may help you heal faster. If your healthcare team advises that you avoid vegetables, ask them for the written information that supports this recommendation.
- What should I do if I'm not a person who likes to ask for help? Mindset
Your nurse wants to make your life easier, but won't be able to unless you tell him or her what you are struggling with. Know that most health care professionals genuinely want to help you and the questions you ask now will save both you and them time by preventing problems down the road. If you can change your mindset and begin asking for assistance early, it will help them and it will help you. Problems may be able to be prevented and everyone wins!
- What type of intravenous (I.V.) access is best for this treatment? Treatment
There are many ways to infuse treatment, including a peripheral I.V. line, a port, a PICC line (pronounced 'pick'), a tunneled catheter, and others. Your doctor, nurse, and sometimes pharmacist will work together to determine what is best for you.
- If I'm afraid to start treatment, who is the best person to talk with? Treatment
Your nurse may have experience helping other patients who have received the same treatment recommended to you. If they do not have experience, ask your nurse to schedule another appointment with your Doctor to answer questions. You can also ask your nurse if a social worker is available to talk to. They may be able to help you navigate through many of the fears of starting treatment and help you take the proper steps in addressing them.
- How can I ensure I am getting adequate nutrition when I have no appetite during cancer treatment? Healthy Diet
When food becomes unappealing, focus on protein shakes, smoothies, electrolyte replenishing drinks, and broth. Ask your nurse to connect you with a dietician to help you with making food choices that agree with you. When all else fails, eat what you can! Most experts agree that a small snack that sounds delicious and stays down is better than nothing at all.
- If I am admitted to the hospital, do I need to bring my home medications with me? Home Medications
It is always helpful to bring your medications so that your healthcare team can see exactly what you are taking and determine if you need any refills before you go home. Importantly, most if not all, medications will be supplied by the hospital. However, some medications such as oral anti-cancer medication or chemotherapy pills may not be routinely stocked and may not be readily available to the hospital's pharmacy. If this is the case, and your doctor wants you to continue to take your oral anti-cancer medication, you may ask the hospital if their policy permits you to use your own medication so that you do not miss doses. If you do bring your medications, and they allow you to use your own supply, it is important to know that hospital staff often require that they oversee the administration of these medicines so that they know exactly what you are taking in order to keep you safe. If they do hold onto your medications, make sure you ask for your them back before you leave since it is common for people to forget. Your nurse may be able to help answer more specific questions about medications brought into the hospital.
- What foods or drinks, if any, should I be avoiding as I start treatment for cancer? Healthy Diet
There may be certain foods and/or drinks that interact with your treatment or may increase your risk of certain side effects. Your pharmacist can check for possible drug-food interactions to help you avoid certain foods or drinks that might cause problems when taken with your current medication regimen and cancer treatment.
- How will I know if my cancer medications are working? Monitoring
Your pharmacist may help you manage side effects allowing you to avoid cancer treatment dose delays or dose reductions. This will hopefully help you get rid of or control the cancer. Your doctor may determine if the medications are working by performing a physical exam during each clinic visit, asking you to get scans of certain body parts (examples may include X-ray, M.R.I. scan, or C.T. scan), or ordering blood tests to help understand if the cancer medications are working. Ask your doctor or clinical pharmacist to explain the results of these tests to you if you are interested.
- What can I do if I'm having trouble figuring out the best times to take my medications? Schedule
Talk to your pharmacist to try to minimize the number of times per day you need to take medication. Your pharmacist will make sure that the pills you take together at certain times of day are safe and will not interact with each other.
- How long after completion of treatment can I resume a full work schedule? Work
A pharmacist may be able to give you information about how long certain side effects are likely to last after the last dose is taken. Your doctor can assess your overall health status and provide advice regarding when they feel like you are ready to return to work based upon their assessment of your physical and mental health, as well as their experience with other patients who have taken the same treatment.
What are the most important things to know about sacituzumab govitecan while receiving therapy?
- Premedications such as diphenhydramine (Benadryl®), acetaminophen (Tylenol®), and famotidine (Pepcid®) may be given 30 minutes before treatment starts to help avoid infusion related reactions
- Diarrhea may be treated with atropine injections in the medical setting, both before and/or after the infusion. Diarrhea at home can affect quality of life and is commonly treated with loperamide (Imodium®) purchased over-the-counter at a pharmacy. You may receive special instructions on how to use loperamide for diarrhea caused by sacituzumab govitecan. Tell your doctor immediately of you have severe diarrhea at home or go to an emergency department immediately
- If you experience neutropenic fever after any treatment, filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) may given after each following treatment to stimulate production of white blood cells and help avoid long periods of severe neutropenia
- May cause nausea and vomiting for up to a few days after treatment. Be sure to get a prescription from your doctor for anti-nausea medications such as ondansetron (Zofran®) or prochlorperazine (Compazine®) to take at home if needed
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for metastatic breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Sacituzumab Govitecan (Trodelvy®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Sacituzumab Govitecan (Trodelvy®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Sacituzumab Govitecan (Trodelvy®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Sacituzumab Govitecan (Trodelvy®)