1. What is sacituzumab govitecan (Trodelvy)?
Sacituzumab govitecan is a targeted (biological) therapy. Targeted therapies interfere with processes in cells that help cancer grow.
Sacituzumab govitecan is made up of two parts:
- The targeted drug sacituzumab, which can find and attach itself to cancer cells
- A chemotherapy drug called SN-38
Sacituzumab govitecan is the drug’s non-branded name. You may also hear it called by its brand name Trodelvy.
2. Who might be offered sacituzumab govitecan?
You may be offered sacituzumab govitecan if you have that has spread to another part of the body () or cannot be removed by surgery.
It’s given to people who have already had two or more treatments for triple negative breast cancer, including at least one for their secondary breast cancer or breast cancer that cannot be removed by surgery.
3. How does sacituzumab govitecan work?
Targeted (biological) therapies block the growth and spread of cancer.
Many triple negative breast cancer cells have a higher-than-normal level of a protein called TROP2 on their surface.
Sacituzumab govitecan attaches to the TROP2 proteins and can stop the cancer cells growing.
When the sacituzumab govitecan attaches to the proteins, it delivers the chemotherapy drug SN-38 directly into the breast cancer cells to destroy them.
Sacituzumab govitecan also has a ‘bystander effect’. This means it can destroy neighbouring cancer cells, even if they do not have a higher level of TROP2 on their surface.
4. How is sacituzumab govitecan given?
Life during treatment
Sacituzumab is given into a vein (intravenously).
This will be as an either in the back of the hand or lower arm.
Other intravenous methods may be used depending on factors such as how easy it is for your chemotherapy team to find suitable veins, and your preferences.
Sacituzumab govitecan is given in cycles
A cycle means you have the drug on a particular day or days and then have a rest to allow your body to recover.
A cycle of sacituzumab govitecan lasts 21 days, with treatment given on days 1 and 8 of the cycle. The cycle is then repeated.
You’ll have the first infusion over 3 hours. If you don’t have a bad reaction to your first infusion, your future infusions will usually be given over 1 to 2 hours.
How long is it given for?
You’ll have sacituzumab govitecan as an outpatient for as long as your treatment team feels you’re benefiting from the drug and any side effects are manageable.
5. Side effects of sacituzumab govitecan
Like any treatment sacituzumab govitecan can cause side effects.
Everyone reacts differently to drugs and some people have more side effects than others. These side effects can usually be managed and those described here will not affect everyone.
Doctors often tailor the dose of a drug by reducing it to suit an individual and to help manage its side effects. For some people this can help them stay on a treatment for longer.
You should be given a 24-hour contact number or told who to contact if you feel unwell or are concerned about side effects at any time, including at night or at the weekend.
Effects on the blood
Sacituzumab govitecan can temporarily affect the number of blood cells in the body.
You’ll have regular blood tests to check your blood count. Blood is made up of red cells, white cells and platelets.
If the number of blood cells is too low, your next cycle of treatment may be delayed or the dose reduced.
Risk of infection
Not having enough white blood cells (neutropenia) can increase the risk of getting an infection such as a urine infection, pneumonia and bronchitis.
Signs of an infection
Your treatment team may give you guidelines to follow for reporting signs of an infection. But generally you should contact your hospital immediately if you experience any of the following:
- A high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your treatment team has advised
- Suddenly feeling unwell, even with a normal temperature
- Symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery
Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body make more white blood cells to reduce your risk of infection.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.
Bruising and bleeding
This treatment can reduce the number of platelets, which help the blood to clot.
You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth.
Tell your treatment team if you have any of these symptoms.
Diarrhoea is a very common side effect of sacituzumab govitecan and can sometimes be severe.
If you have diarrhoea, drink plenty of fluids and contact your treatment team straight away so they can prescribe anti-diarrhoea medicine.
The most likely time to have diarrhoea is 2 weeks after the first dose. It may last for around 1 week.
If you develop severe diarrhoea while having sacituzumab govitecan, your doctor may decrease the dose, delay your next cycle of treatment or stop your treatment completely.
Nausea and vomiting
You may feel sick (nausea) and be sick (vomit) at times during your treatment.
If nausea and vomiting affect you, let someone in your treatment team know. Anti-sickness drugs can be prescribed to help.
Try to eat small regular meals if possible and have regular drinks.
Cancer-related fatigue (extreme tiredness)
Cancer-related fatigue (extreme tiredness)
Cancer-related fatigue is extreme tiredness that doesn’t go away with rest or sleep.
It’s a very common side effect of breast cancer treatment and may affect you physically and emotionally.
It has many causes, from psychological factors such as the stress of coping with the diagnosis, to physical ones such as the side effects of treatment or progression (growth and spread) of the cancer.
If you have fatigue, tell your GP or treatment team so you can be fully assessed and offered advice on how to manage your energy levels.
Loss of appetite
You may not feel like eating, especially if you feel sick.
Your sense of taste can also change, and some foods and drinks may taste different.
Eating small frequent meals or snacks can help keep up your food intake.
If you struggle to maintain a healthy weight, ask your GP or treatment team about being referred to a dietitian.
Find out more about diet and breast cancer treatment.
Abdominal (belly) pain and constipation
You may have constipation, abdominal pain or discomfort, or feel bloated.
Let your treatment team or GP know so they can prescribe medication to help.
Hair thinning or hair loss
Sacituzumab govitecan may cause hair loss.
Any hair loss caused should be temporary and in most cases your hair will begin to grow back once your treatment has ended.
Read more information about hair loss.
Looking after your mouth, including your teeth and gums, is very important during treatment.
If you need to have any dental treatment, talk with your oncologist about the best time to have this.
Other common side effects
Other common side effects include:
- Dry skin, rash and itching
- Back and joint pain
- Weight loss
- Difficulty sleeping (insomnia)
- Cough and breathlessness
Your treatment team can advise you on how to manage these.
6. Other important information
Allergic reactions to drugs can occur. Reactions can vary from mild to severe.
If you have an allergic reaction to sacituzumab govitecan, it’s more likely to happen the first time you have the treatment.
Symptoms include flushing, skin rash, itching, back pain, shortness of breath, faintness, fever or chills.
If you have any of these symptoms, let your treatment team or chemotherapy nurse know immediately.
People with breast cancer have a higher risk of blood clots such as a deep vein thrombosis (DVT). Their risk is higher because of the cancer itself and some treatments for breast cancer. If the cancer has spread to other parts of the body, this also increases the risk.
People with a DVT are at risk of developing a pulmonary embolism (PE). This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.
Blood clot symptoms
If you have any of the following symptoms, contact your treatment team or go to your local A&E department immediately:
- Pain, redness/discolouration, heat and swelling of the arm or leg
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy - for example in the arm, chest area or up into the neck
- Shortness of breath
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
Medicines and food to avoid when having sacituzumab govitecan
A number of drugs should not be taken with sacituzumab govitecan. Tell your treatment team about any prescribed or over-the-counter medicines you are taking.
Many people consider taking herbal medicines or supplements while having treatment for breast cancer. Ask your treatment team before taking any herbal medicines or supplements.
Sex and contraception
You can still have sex during treatment.
Use an effective barrier method of contraception, such as condoms, during treatment and for six months after the last dose.
It’s thought that chemotherapy drugs can’t pass into vaginal fluids or semen, but this can’t be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids.
You’ll be advised not to breastfeed during treatment and for at least one month after your last dose. This is because there’s a chance your baby could absorb the drug through your breast milk, which could be harmful to them.
Sacituzumab govitecan may affect fertility in women. It’s important to discuss any fertility concerns with your treatment team before you begin your treatment.
Travel and vaccinations
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You shouldn’t have any live vaccines while you’re having treatment.
Live vaccines include mumps, measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.
Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during treatment, they could be harmful.
It’s safe to have these vaccinations six months after your treatment finishes. Talk to your GP or treatment team before having any vaccinations.
If anyone you have close contact with needs to have a live vaccine speak to your treatment team or GP. They can advise what precautions you may need to take depending on the vaccination.
Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have, or already having, chemotherapy.
The flu vaccine is not a live vaccine so doesn’t contain any active viruses. Talk to your chemotherapy team or breast care nurse about the best time to have your flu jab.
Coronavirus (Covid-19) vaccination
People having sacituzumab govitecan are advised to speak to their treatment team before having a coronavirus (Covid-19) vaccination.
7. Further support
Being diagnosed with breast cancer can make you feel lonely and isolated.
Many people find it helps to talk to someone who has been through the same experience as them. You can talk to people on our online forum.