Sacituzumab govitecan (Trodelvy)

Sacituzumab govitecan is a cancer drug combination. You pronounce it as sass-ih-too-zo-mab go-vih-tee-kan. It is also known as Trodelvy.

It is a treatment for some people with triple negative breast cancer . You might have it if your breast cancer:

• can't be removed with surgery (unresectable) and is locally advanced
• has spread to another part of the body (secondary or metastatic)

You might also have sacituzumab govitecan as part of a clinical trial for other types of cancer.

How does sacituzumab govitecan work?

Sacituzumab govitecan is a type of cancer drug called an antibody drug conjugate (ADC). This means it is made up of 2 drugs:

• sacituzumab – a type of targeted drug called a monoclonal antibody

• govitecan or SN-38 – a chemotherapy drug

Sacituzumab targets cancer cells by attaching to a particular protein on the surface of the cancer cell. This protein is called trophoblast cell surface 2 (TROP2).

Sacituzumab then releases the chemotherapy drug govitecan into the cancer cell. It damages or kills the cell. This stops the cancer cells from growing.  

How do you have sacituzumab govitecan?

You have sacituzumab govitecan as a drip into your bloodstream.

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have sacituzumab govitecan?

You have sacituzumab govitecan as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

Each cycle of treatment lasts 21 days (3 weeks). You continue having sacituzumab govitecan for as long as the treatment is working and you are not experiencing too many side effects. 

You have sacituzumab govitecan on day 1 and day 8 of each cycle.

You have the first drip of sacituzumab govitecan over 3 hours. Your next sacituzumab govitecan drip will usually go in quicker over 1 to 2 hours, but this will depend on how you got on with the first cycle.

Sacituzumab govitecan can cause an allergic reaction. So before each dose you have paracetamol, a steroid and an antihistamine drug such as chlorphenamine (Piriton).

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of sacituzumab govitecan?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

An allergic reaction 

Sacituzumab govitecan can cause an allergic reaction. This reaction is most likely to happen during treatment and a few hours after treatment when you first have it. Symptoms of an allergic reaction include high temperature (fever), chills, feeling or being sick, feeling itchy, swelling of your face and tongue, and difficulty breathing.  

Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse straight away if you have any symptoms of an allergic reaction. They will slow down or stop your drip for a while.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Changes to the level of minerals in your blood

It’s common to have low levels of minerals in your blood, such as low potassium and magnesium with this treatment. Less commonly you may have low levels of phosphate, calcium and sodium.

You have regular blood tests during treatment to check this.

High blood sugar levels

High blood sugar levels can cause headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you have diabetes .

Difficulty sleeping

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Dizziness

This drug might make you feel dizzy. Don’t drive or operate machinery if you have this.

Breathlessness and a cough

Tell your doctor or nurse if you're breathless or have a cough. This could be due to an infection. 

Pain in different parts of the body

It’s common with this treatment to have tummy, back and joint pain. Tell your healthcare team if you have pain. They can check the cause and give you medicine to help. 

Hair loss 

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Skin changes  

Skin problems include a skin rash and itching. Less commonly your skin might be dry, have a bumpy rash or areas that are darker than others.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

High temperature

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Weight loss

You might lose weight while having this treatment. Let your doctor or nurse know and they can recommend ways of maintaining your weight. Or they can refer you to a dietitian.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• bleeding, bruising and nosebleeds due to a low number of platelets in the blood
• a lack of fluid in the body (dehydration) that can make you feel thirsty, tired, your wee may be darker in colour and it may have a strong smell
• taste changes
• low blood pressure that can cause you to feel lightheaded or dizzy
• nose problems such as blocked, congested or runny
• mouth sores and ulcers
• indigestion - symptoms include heartburn, bloating, and burping
• a swollen or bloated tummy
• inflammation of the bowel. This is more common in the large bowel (colitis) but it can rarely happen in the small bowel too (enteritis). Symptoms include diarrhoea that may contain blood, mucus or pus, tummy pain, loss of appetite, weight loss and feeling tired
• protein in your wee – this might be picked up on tests
• fluid build up (oedema)
• chills

Rare side effects

You may develop sepsis with this treatment. This is a serious reaction to an infection. It happens in fewer than 1 in 100 people (less than 1%).

Symptoms of sepsis can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drinks 

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least 6 months after the end of treatment. Men should not get someone pregnant for at least 3 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether these drugs come through into breast milk. Doctors usually advise that you don’t breastfeed during this treatment and for 1 month afterwards.

Other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations 

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.