Sacituzumab govitecan (Trodelvy)

At a glance

Sacituzumab govitecan (Trodelvy) is an antibody–drug conjugate, often shortened to ADC. It combines an antibody that recognises a target on cells with a cell-killing medicine. It is given by a trained team through a drip into a vein. Although it is targeted treatment, it can affect healthy tissues and needs careful monitoring.

Low infection-fighting blood cells and diarrhoea are the main safety priorities with Trodelvy. Both can become serious early in treatment. Have your anti-sickness medicines, bowel instructions and urgent-contact plan ready before the first dose, and report symptoms rather than waiting for the next visit.

Follow your own treatment calendar and the advice from your care team. Keep your medicine names and treatment dates handy to share with other clinicians.

How it works

Sacituzumab recognises Trop-2, a protein on the surface of certain cells. It carries SN-38, a substance that blocks an enzyme called topoisomerase I and interferes with DNA repair and cell survival. SN-38 is also related to the activity of irinotecan, but Trodelvy and irinotecan are different products with different prescriptions and cannot be substituted for one another.

The antibody, its chemical link and the attached medicine form one product. They are not separate medicines that you can take in different amounts yourself. Targeting helps deliver treatment to particular cells, but it does not mean that only cancer cells are affected. Side effects can come from the attached medicine, the antibody, your existing illness or accompanying treatment.

An ADC is different from an immune checkpoint inhibitor, even when both are given in the same treatment plan. A reaction or noticeable side effect is not proof that an ADC is working. Equally, having few side effects does not mean that treatment has failed.

Is this treatment suitable for me?

Sacituzumab govitecan is used for selected locally advanced or metastatic triple-negative breast cancers and hormone receptor-positive, HER2-negative breast cancers. Eligibility depends on previous treatments and, for some first-line plans, suitability for immunotherapy and PD-L1 results. Your oncologist will advise whether it is suitable for you, taking account of your cancer type, relevant test results, previous treatment, overall health and the applicable prescribing information and regulatory guidance in your country.

Suitability depends on the clinical setting, prior treatment and current local guidance. Routine Trop-2 testing is not a universal requirement for every person receiving Trodelvy. If pembrolizumab is part of the plan, separate biomarker and eligibility requirements apply to that combination. The team also reviews blood counts, liver function, bowel symptoms and previous treatment tolerance.

The discussion should cover the aim of treatment, the alternatives, likely appointments and how benefit will be assessed. A target found in a sample is one part of this decision; it does not guarantee a response. Tell the team what matters to you, including independence, work, caring responsibilities and the practical support available at home.

Before treatment

Bring a complete list of prescribed and non-prescribed medicines, vitamins, herbal products and allergies. Mention previous difficult reactions to infusions, infections, diabetes, liver or kidney problems and any pregnancy or breastfeeding. Explain symptoms you already have so a later change is easier to recognise.

Blood counts and liver and kidney function are checked. Pregnancy status is checked before starting if pregnancy is possible. Safety in moderate or severe liver impairment has not been established. Tell the team about frequent diarrhoea, previous severe neutropenia, serious infections and any known UGT1A1-related condition. Reduced activity of the UGT1A1 enzyme can increase the risk of early or severe toxicity. Genetic testing is not automatically required for everyone, but known results should be shared.

A nurse or pharmacist should explain the supportive medicines and which ones start before the treatment day. Ask your team to help you plan when to take each medicine. Make sure you know how to reach your hospital's urgent oncology service outside clinic hours. You may find it helpful to save the instructions on your phone or keep a copy at home. A family member or friend can help you remember them.

Discuss fertility preservation before treatment if future parenthood matters to you. Tell the team about dental problems and planned procedures. A procedure may need to be timed around blood counts and infection risk. Do not postpone reporting an active dental infection while waiting for the next routine appointment.

How treatment is given

The usual dose is 10 mg/kg on days 1 and 8 of a 21-day cycle. The first infusion takes about three hours; later infusions may take one to two hours if tolerated. Observation continues during and for at least 30 minutes after each infusion. A delay may be needed if blood counts or side effects have not recovered.

Premedicines reduce infusion reactions and nausea. They usually include a fever-reducing medicine, medicines that block histamine and a combination of anti-sickness medicines. Additional corticosteroid premedication may be used according to the reaction history and regimen. Take-home anti-sickness treatment is important because symptoms can occur after the visit.

G-CSF prevention is recommended from cycle one for patients at increased risk of febrile neutropenia, such as those with previous neutropenia, older age, poor general function, organ dysfunction or multiple other illnesses. It is not a universal instruction for every patient to self-start injections. Current US prescribing information also includes selected plans combining Trodelvy with pembrolizumab; eligibility and local approval requirements must be confirmed by your team. Follow the separate instructions for the partner treatment if prescribed.

Treatment is delivered through a cannula in a vein, a central line or an implanted port, depending on the plan and available access. Staff check the medicine, your identity, blood results and recent symptoms before starting. The appointment includes preparation and monitoring, so it will usually take longer than the infusion itself.

Tell the nurse immediately if you notice burning, pain, swelling, redness, leakage or tightness around the infusion site. These can mean medicine is leaking outside the vein. Do not wait for the drip to finish. At home, report a site that becomes more painful, blistered or discoloured, even if it looked normal when you left.

Also report flushing, itching, shivering, chest or back discomfort, wheezing, dizziness or swelling during treatment. Staff can stop or slow the infusion and assess you. Do not adjust the pump or line yourself. If a line remains in place, follow its cleaning and dressing instructions and report fever, tenderness or drainage around it.

If an appointment is missed, contact the treatment unit to arrange the next dose. Do not simply wait for the following cycle or seek an extra dose elsewhere. The correct restart date depends on why the dose was missed, the treatment schedule and recovery from side effects.

Monitoring your treatment

Blood tests usually check infection-fighting cells, red cells, platelets, kidney function and liver function. Some abnormalities cause no early symptoms. A reassuring blood test does not make a new symptom safe to ignore, and feeling well is not a reason to miss monitoring.

Blood counts are checked to decide whether each day-1 and day-8 dose can proceed. Treatment is withheld for neutropenic fever or counts below the required threshold; the day-1 and day-8 thresholds differ. The team reviews bowel frequency, fluid intake, weight and signs of dehydration, and checks blood salts and kidney function when needed. Unusually early or severe side effects may prompt assessment for reduced UGT1A1 activity. Scans and clinical reviews determine benefit separately from the severity of side effects.

Your team compares examinations, symptoms and relevant scans or disease tests over time. Ask when the first response assessment is planned and what the result could change. A treatment break or lower dose may protect you from accumulating harm while allowing further treatment. It is not automatically evidence that the cancer has worsened. Never try to compensate for a reduced dose with supplements or closer appointments.

Common side effects

Side effects vary between people and between treatment combinations. You may experience several, a few or none of those described. Tell the team about symptoms that interfere with eating, sleeping, walking or usual tasks; a problem does not need to be severe before support is worthwhile.

Diarrhoea

Keep a record of the number of loose stools and any cramps, fever or blood. Contact the team at the onset so infection and other causes can be considered and the agreed treatment started. Loperamide may be prescribed after appropriate assessment. Do not simply keep increasing it if diarrhoea persists, there is severe pain, or you become unwell.

Nausea and vomiting

These can be troublesome and may need more than one preventive medicine. Take the scheduled medicines before symptoms become established. Ask what to do if you vomit a tablet. Repeated vomiting, dizziness or reduced urine needs prompt advice because dehydration can affect the kidneys and blood salts.

Hair loss

Hair loss is common with Trodelvy and may affect scalp and body hair. Discuss head coverings, gentle scalp care and emotional support before treatment if helpful. The amount of hair lost does not indicate how well treatment is working.

Tiredness and reduced stamina

Plan important tasks for the part of the day when you have most energy and accept practical help. Short periods of gentle activity can be useful, with rest between them. Sudden marked weakness, breathlessness, dizziness or a racing heart needs assessment for causes such as anaemia, infection or dehydration. Do not assume every new limitation is ordinary treatment fatigue.

Nausea, appetite and bowel changes

Take prescribed anti-sickness medicines on the agreed schedule. Small regular meals, cool foods and frequent sips can be easier to manage. Tell the team if you cannot keep medicines or fluids down, are passing little urine or are losing weight. A dietitian can help when eating becomes difficult.

Record loose stools and whether there is pain, blood or fever. Severe diarrhoea, repeated vomiting or a swollen painful abdomen needs prompt advice. Constipation can be worsened by anti-sickness drugs and pain relief; use the bowel plan your team recommends. Do not repeatedly add laxatives or anti-diarrhoeal medicines without checking when there is significant pain or other new illness.

Low blood counts

A low white cell count can make infection progress quickly. Follow the urgent-help instructions below. Low red cells can cause tiredness, pallor or breathlessness; sometimes transfusions are needed. Low platelets can cause easy bruising, nosebleeds, bleeding gums or tiny red-purple spots. Report new bleeding and avoid starting aspirin or anti-inflammatory painkillers without checking. Do not stop a prescribed blood thinner yourself; the team must balance bleeding and clotting risks.

Mouth comfort and skin care

Use a soft toothbrush and the mouth-care products advised by your team. Report ulcers, white patches or soreness that limits eating, because infection or dehydration may need treatment. Avoid very hot, acidic or spicy foods if they sting. Moisturise dry skin with a simple fragrance-free product and protect it from strong sunlight. Painful skin, blisters or rapidly worsening redness need medical assessment rather than a new cosmetic product.

Important side effects

Severe neutropenia and infection

Neutropenia means a low number of neutrophils, white cells that help fight infection. It can occur from the first cycle and can be life-threatening. Fever, chills or sudden illness needs immediate assessment, including when G-CSF has been prescribed. Severe abdominal pain with fever or low counts can indicate bowel inflammation and requires urgent care.

Severe diarrhoea and dehydration

Frequent watery stools can cause dangerous fluid and salt losses and kidney injury. Inability to drink, very little urine, faintness, confusion or blood in the stool needs urgent review. The team may give intravenous fluids, investigate infection and hold or reduce treatment. Early diarrhoea with cramping, sweating or excessive saliva can represent a cholinergic reaction; staff may use atropine when appropriate. Do not take atropine without a prescription.

Increased toxicity with reduced UGT1A1 activity

People with particular inherited UGT1A1 variants, including two copies of UGT1A1*28, have increased risk of neutropenia and anaemia. This does not mean that every carrier has the same experience. Close monitoring and response to actual toxicity remain essential for all patients.

Severe infection or an allergic reaction

A serious infection can occur even without a high temperature, especially if steroids or fever-reducing medicines are being taken. New confusion, marked drowsiness, rapid breathing or collapse requires emergency care. Sudden throat swelling, severe wheezing or faintness can indicate a severe allergic reaction. These symptoms should not be managed by waiting at home for the next scheduled review.

Other medicines and vaccinations

Medicines that inhibit or induce UGT1A1 can affect SN-38 exposure and should be avoided according to the prescribing information. The specialist should arrange suitable alternatives. Give the pharmacist the complete list, including antivirals, seizure medicines and herbal products. If pembrolizumab is also prescribed, new symptoms may have immune-related causes and need assessment under that treatment plan too.

Ask the oncology pharmacist to check new prescriptions, over-the-counter remedies and herbal or traditional products. Products described as natural are not necessarily safe with cancer treatment. Do not use an unproven supplement in place of an essential supportive medicine. Keep the team informed about medicines prescribed by other specialists so that advice is coordinated.

Discuss influenza, COVID-19 and other vaccines with the team. Non-live vaccines may be suitable, although the response can be reduced during treatment. Live vaccines require specific specialist advice. Timing after treatment depends on immune recovery and the complete regimen; there is no single waiting interval that is correct for every ADC-treated patient.

Everyday life

Eating does not determine absorption of this intravenous medicine. Aim for enough food and fluids, adjusting for nausea and following any kidney, heart or diabetes restrictions. Avoid a restrictive anticancer diet that causes weight loss. Discuss alcohol with the team, particularly if liver tests are abnormal or other medicines cause sedation.

Work may remain possible with flexible hours and time for appointments. Increase activity gradually and avoid tasks that become unsafe because of fatigue, poor balance or impaired vision. Do not drive if dizzy, sleepy, visually affected or unable to use the pedals safely. Sedating premedicines can also affect driving, so arrange transport for early appointments until you know the plan.

Keep drinks and prescribed bowel and anti-sickness medicines available, and plan easy access to a toilet when outside. Avoid driving if dizzy or dehydrated. Tell the team early when bowel symptoms make work or travel difficult so support can be arranged before the next dose.

Discuss travel before booking, especially long journeys or travel far from urgent care. Carry your treatment summary and enough supportive medicines. Use careful hand hygiene and food safety; avoid close contact with people who are clearly infectious. Complete social isolation is not automatically required. Ask about additional precautions when blood counts are very low.

Sex is often possible if comfortable, with the pregnancy precautions below and any advice about infection or bleeding. Ask the team whether barrier protection is needed after a dose to reduce exposure to drug residues in body fluids; the interval depends on the treatment. Caregivers cleaning urine, stool or vomit should follow the unit's handling advice, wear gloves when instructed and wash their hands afterwards. Keep medicines away from children and pets.

Fertility, pregnancy and breastfeeding

Use effective contraception during treatment and for at least six months after the final dose if you could become pregnant. A treated man with a partner who could become pregnant should use effective contraception during treatment and for at least three months afterwards. Do not breastfeed during treatment or for at least one month after the final dose. Any partner medicine may extend these precautions.

Pregnancy should be discussed before treatment and reported promptly if it occurs or is suspected. Loss of periods does not reliably mean pregnancy is impossible. Vomiting or severe diarrhoea can interfere with oral contraception; seek advice about additional protection if this happens. Accompanying medicines may require longer precautions than the ADC itself, so obtain one clear end date for the complete regimen.

Fertility may be affected by treatment and previous therapies, and recovery cannot be guaranteed. Discuss sperm, egg or embryo preservation before starting when feasible. The interval for avoiding pregnancy is a safety precaution and does not itself establish whether fertility has recovered.

After treatment

Blood counts, bowel symptoms and hydration may still need monitoring after the final dose. Continue supportive medicines for the prescribed duration. Persistent diarrhoea should be investigated rather than assumed to be a harmless lasting effect of treatment.

Keep attending the recommended blood tests, scans and clinical reviews. Retain a treatment summary with the exact ADC name, dates, significant reactions and any ongoing medication. Tell new clinicians about past treatment when an unexplained symptom is assessed. Continue contraception, breastfeeding restrictions and prescribed supportive medicines for their own specified periods, counted from the relevant final dose.

Recovery can be gradual and may involve physical rehabilitation, dietary support or help with anxiety and sleep. A follow-up visit is also an opportunity to discuss returning to work, travel and persistent symptoms. New severe symptoms still need urgent assessment between appointments; finishing treatment does not remove the need for the urgent-care plan.

Common questions