1. What is sacituzumab govitecan (Trodelvy)?
Sacituzumab govitecan is a combination of cancer drugs given together.
It’s made up of:
- The targeted therapy drug sacituzumab, which can find and attach itself to cancer cells.
- A drug called SN-38
Sacituzumab govitecan is the drug’s non-branded name. Its brand name is Trodelvy.
2. Who might be offered sacituzumab govitecan?
You may be offered sacituzumab govitecan if:
- You have triple negative breast cancer
- And your breast cancer cannot be removed by surgery or has spread to another part of your body (metastatic (secondary) breast cancer)
You may have it if you’ve already had 2 or more chemotherapy treatments for triple negative breast cancer, including at least one for your metastatic breast cancer or breast cancer that cannot be removed by surgery.
3. How does sacituzumab govitecan work?
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 drug attaches to the TROP2 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 sacituzumab govitecan is given
Life during treatment
Going through breast cancer treatment can affect you physically and emotionally. Read our tips to help you cope.
Sacituzumab is given into a vein (intravenously). This will be as an infusion.
Different intravenous methods may be used depending on if your chemotherapy team are able to find suitable veins in the back of your hand or arm, as well as 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. Some people may have a reaction to sacituzumab govitecan but you’ll be closely monitored. If you don’t have a reaction to the first infusion, your future infusions will usually be given over 1 to 2 hours.
You’ll have sacituzumab govitecan as an outpatient, so you can go home the same day.
How long will I have sacituzumab govitecan?
You’ll have sacituzumab govitecan for as long as your treatment team feels you’re benefitting from the drug, and any side effects are manageable (you’ll be given medicines to help reduce side effects). This will vary from person to person.
It may be stopped if you have significant side effects.
5. Side effects of sacituzumab govitecan
Like any drug, 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.
Your treatment team can change the dose of a drug to suit you and to help manage its side effects. This can sometimes help you 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. Blood is made up of red cells, white cells and platelets.
You’ll have regular blood tests. If these show 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 can increase your risk of getting an infection.
Signs of an infection
Your treatment team may give you advice on reporting signs of an infection. But generally you should contact your hospital immediately if you have any of the following:
- A high temperature (over 37.5°C) or low temperature (under 36°C)
- Suddenly feeling unwell, even with a normal temperature
- Symptoms of an infection, such as a sore throat, cough, needing to pee often or feeling cold or shivery, even if you do not have a high temperature
Before starting chemotherapy, you should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including overnight or at the weekends.
You may need treatment if you get an infection.
Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.
Anaemia
Having too few red blood cells is called anaemia. If you feel breathless, dizzy or particularly tired, let your treatment team know.
Bruising and bleeding
Sacituzumab govitecan can reduce the number of platelets. Platelets help the blood to clot.
If your platelets are low, you may:
- Bruise more easily
- Have nosebleeds
- Notice that your gums bleed when you brush your teeth
- Take longer to stop bleeding if you cut yourself
Tell your treatment team if you have any of these symptoms.
Raised blood sugar levels
Sacituzumab govitecan can cause your blood sugar levels to increase (hyperglycaemia).
Symptoms may include:
- Feeling thirstier than usual or being unable to quench your thirst
- Peeing more often
- Feeling more tired than usual
- Increased appetite but with weight loss
- Confusion
- Feeling sick (nausea)
- Being sick (vomiting)
- A fruity smell on your breath, like pear drop sweets or nail polish remover
- Difficulty breathing
- Flushed skin
You’ll have regular blood tests to check your blood sugar levels.
If you have diabetes, your blood sugar levels may be higher than usual and you may need to check them more often. Your diabetes nurse or doctor can give you advice about this.
Diarrhoea
Diarrhoea is a very common side effect of sacituzumab govitecan and can sometimes be severe.
If you have diarrhoea, drink plenty of fluids and speak to your treatment team. They can prescribe medications to help.
Contact your treatment team urgently if you have diarrhoea 3 or more times in 24 hours, compared to what’s usual for you.
If you have severe diarrhoea while having sacituzumab govitecan, your treatment team may decrease the dose, delay your next cycle of treatment or stop your treatment completely.
Nausea and vomiting
You may feel sick (nausea) or be sick (vomit) during your treatment.
You’ll be given anti-sickness medication before you have treatment. You’ll also be given anti-sickness tablets to take at home.
If you continue to feel sick or be sick, tell your treatment team as they may be able to prescribe a different anti-sickness drug.
Try to eat small regular meals if possible and have regular drinks.
Extreme tiredness (cancer-related fatigue)
Cancer-related fatigue is one of the most common symptoms in people with metastatic breast cancer.
Fatigue is extreme tiredness that does not go away with rest or sleep. It has many causes, from the emotional impact of a diagnosis to side effects of treatment or growth and spread of the cancer.
Fatigue may affect how you cope with your cancer and its treatment. It can also make everyday activities harder and affect your quality of life.
Find out more about managing fatigue.
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.
It might help to eat small meals regularly and have plenty of drinks. 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.
Tummy (abdominal) pain and constipation
You may have constipation, tummy 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 thinning and 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.
Sore mouth
Looking after your mouth, including your teeth and gums, is very important during treatment.
You may be given mouthwash to try to reduce soreness and prevent mouth ulcers developing. It’s a good idea to use a small, soft toothbrush during this time.
See your dentist for a check-up before treatment with sacituzumab govitecan begins. Avoid dental work during these treatments if possible.
If you do need to have dental work during treatment, talk with your treatment team about the best time to have this.
If you’re having difficulty registering with a dentist, let your treatment team know.
Other common side effects
Other common side effects include:
- Headaches
- 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 reaction
It’s possible to have an allergic reaction to sacituzumab govitecan. 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. You’ll be monitored closely while you have your first treatment.
Once you go home, contact your hospital immediately if you notice any of the following symptoms:
- Itchy red or discoloured bumps on your skin (these may be harder to see on black or brown skin)
- Swelling in your lips, tongue or throat
- Breathlessness, wheezing, a bad cough or sudden difficulty breathing
- Tight chest or chest pain
Blood clots
People with breast cancer have a higher risk of blood clots. Having sacituzumab govitecan also increases the risk of blood clots such as a DVT (deep vein thrombosis). If the cancer has spread to other parts of the body, this also increases the risk.
If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).
Blood clots can be life-threatening and should be treated quickly.
Blood clot symptoms
Contact your treatment team or go to your local A&E department straight away if you have any of the following symptoms:
- Pain in your arm or leg
- Redness/discolouration of the skin of the arm or leg
- 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 that comes on suddenly
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Some symptoms may look different on different skin tones.
Find out more about blood clots.
Medicines 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’re taking.
If you’re considering taking any herbal medicines or supplements, speak to your treatment team.
Sex, contraception and pregnancy
You can still have sex during treatment. It’s thought some drugs used to treat breast cancer cannot pass into vaginal fluids or semen, but this cannot be completely ruled out.
Most treatment teams will advise using barrier methods of contraception, such as condoms or female condoms
You’re advised not to become pregnant while having treatment because sacituzumab govitecan can harm a developing baby.
Women who can get pregnant should keep using contraception until 6 months after their last dose of treatment. Men with female partners who can get pregnant should keep using contraception for 3 months after their last dose.
Find out more about how breast cancer and its treatment can affect sex and intimacy and read our tips on how to manage these changes.
Fertility
Sacituzumab govitecan may affect fertility (the ability to get pregnant) in women. It’s not known whether it affects fertility in men.
Conversations about fertility can be hard. It’s important to discuss any fertility concerns with your treatment team before you begin your treatment.
If you were diagnosed with locally advanced or metastatic breast cancer before you started or completed a family, you may be concerned about your fertility. Depending on your diagnosis and treatment, you may be advised not to get pregnant.
Breastfeeding
Breastfeeding is not recommended while having sacituzumab govitecan and for 1 month after the last dose. This is because there’s a risk the drugs could be passed on through breast milk.
Travel and vaccinations
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You should not have any live vaccines while you’re having treatment.
For more information about vaccines, including COVID-19 and flu vaccines, see our information on vaccines and breast cancer.
7. Further support
If you’ve been diagnosed with metastatic breast cancer, you might be feeling lonely or isolated. Many people experience this and support is available.
Some people find it helps to talk to someone who has been through the same experience as them. You might find it helpful to visit our confidential online forum.
Our Living with Secondary Breast Cancer services are also here for you. Choose the type of support that suits you and you’ll be able to talk, listen and learn with people who understand the challenges that metastatic breast cancer can bring. Find out more below.
