Sacituzumab govitecan (Trodelvy) — guided treatment for breast cancer and urinary tract cancer

What is sacituzumab govitecan (Trodelvy) in simple words

Sacituzumab govitecan (Trodelvy) — a treatment that delivers a chemotherapy agent directly inside cancer cells using an antibody as a carrier.

An antibody carries a chemotherapy agent directly to cancer cells. The antibody recognises a protein that sits on the surface of many tumour cells and latches onto it. The chemotherapy attached to the antibody stays dormant during transit. Once the package reaches the cancer cell and enters it, the payload activates.

This approach puts most of the toxic effect where the cancer is. Some still reaches healthy tissue — side effects do occur — but the pattern differs from giving chemotherapy without any targeting.

Two main situations where this drug is used: certain breast cancer subtypes after prior treatment has stopped working, and cancer of the urinary tract after other treatments have already been tried.

How sacituzumab govitecan works

Many tumour cells display a particular surface protein in quantities far above what is found on healthy tissue. The antibody part of this drug binds to that protein and the whole package gets pulled inside the cancer cell.

Once inside, the chemotherapy component separates and goes to work — blocking the cell from replicating. The cell dies. Some of the released agent also escapes into the surrounding area and damages nearby cancer cells. That secondary effect means the drug reaches tumour tissue beyond just the cells it directly enters.

The degree of benefit depends on how much of that surface protein the tumour carries, what prior treatments have been used, and factors specific to each patient.

What conditions sacituzumab govitecan is used for

This drug is used in:

• a breast cancer subtype without certain receptor proteins and without overexpression of a growth-related receptor — after prior systemic treatment;

• a breast cancer subtype with certain receptor proteins but no overexpression of the growth-related receptor — after prior hormone-based and cytotoxic treatment;

• cancer affecting the bladder and surrounding urinary structures — after a metal-based chemotherapy regimen and immune-based treatment have already been tried.

In the first breast cancer subtype, clinical data showed meaningful improvements in both time without disease worsening and overall survival compared to standard chemotherapy — including in patients who had received two or more prior treatments. For a disease with historically few effective later-line options, those results shifted the standard approach in oncology centres including in Israel.

In the second subtype, benefit appeared in patients who had already been through several prior treatment steps including hormone-based therapy and prior chemotherapy — a group where each progression leaves fewer viable options.

The same cancer type in two different patients can lead to very different treatment decisions. How the disease has responded before, how fast it is moving now, and what the tumour’s biology looks like all matter.

When sacituzumab govitecan may be especially relevant

It tends to come up when:

• the receptor-negative breast cancer subtype has returned and prior treatment has stopped working;

• the receptor-positive subtype has progressed after hormone-based therapy and prior chemotherapy;

• bladder cancer has progressed after both a metal-based regimen and an immune-based approach;

• further treatment is needed but a more directed delivery method is being considered;

• the disease is moving in a direction where continuing the current approach is no longer reasonable.

In bladder cancer, this drug occupies a real clinical gap. Once the two main prior treatment types have been exhausted, very few approved options exist. The clinical data in that specific situation was meaningful enough to change practice.

In breast cancer, which treatment comes first — this drug or an immune-based approach — depends on specific test results from the tumour biopsy. I always review those results before making a sequencing recommendation.

What needs to be checked before starting treatment

Before this drug is considered, the oncologist will typically review:

• confirmed tumour type and receptor profile;

• a specific genetic variation in how the body processes one part of this drug — checked before starting;

• prior treatment history and how the disease responded to each;

• blood cell counts — the infection-fighting cells in particular;

• liver function;

• kidney function;

• overall functional status.

The genetic variation check is one I always do before the first infusion. A common variation in a specific processing enzyme means the active component of this drug stays in the body longer than it should. That increases the risk of severely reduced infection-fighting cell counts and serious bowel symptoms. Adjusting the starting dose for those patients is straightforward — but only if the test has been run first. Finding out after a reaction is the wrong order.

How treatment is carried out

The drug is given by intravenous infusion on two days within each three-week treatment period — the first day and the eighth. That schedule means coming to the clinic more often than most treatments in this setting require. Worth understanding before committing.

During treatment, monitoring covers:

• blood cell counts before each infusion — infection-fighting cells specifically;

• bowel symptoms — tracked as a specific item, not just a general complaint;

• liver and kidney function;

• imaging to check how the disease is responding.

Bowel symptoms are the side effect I go through in detail before the first session. They can start within hours of the infusion or emerge days later — and those two patterns need different responses. Patients who know the difference are in a much better position to describe what they are experiencing when they call.

What patients may experience

• loose stools and bowel urgency — common and sometimes significant;

• reduced infection-fighting cell counts;

• tiredness;

• nausea;

• hair thinning or loss;

• reduced appetite;

• lower red blood cell count;

• soreness in the mouth.

Low infection-fighting cell counts are the most common reason a treatment session gets postponed. I check before every infusion. If the level is too low, we wait. Injections to stimulate cell recovery are sometimes used to keep the schedule on track — that decision is based on how counts have been trending, not made reactively.

When to contact a doctor urgently

Contact your doctor without delay if:

• fever — especially in the days after an infusion when cell counts are likely at their lowest;

• bowel symptoms that are severe or worsening quickly;

• signs of significant fluid loss — dizziness, very dark urine, almost no urine;

• breathing difficulties;

• chest discomfort;

• mouth soreness preventing normal eating or drinking;

• a sudden marked change in general condition.

Fever in the period after infusion when infection-fighting cells are at their lowest is not something to wait out at home. The body’s defences are reduced. A temperature that would ordinarily feel minor can indicate something serious developing. The same day — not the next morning.

Why sacituzumab govitecan is not right for everyone

What affects whether it is appropriate:

• cancer type that does not fall within the approved uses;

• blood test results showing insufficient cell levels before the first infusion — treatment may be postponed until recovery;

• the genetic processing variation — not a barrier, but changes the starting approach;

• significant impairment of liver function;

• overall condition that makes tolerating the treatment difficult.

The surface protein level on the tumour is becoming more relevant in some settings. Higher levels seem to be associated with stronger responses. I look at whatever testing data exists and, where testing was not done, discuss whether it would add useful information to the picture.

Can sacituzumab govitecan be combined with other treatments

In the approved uses, it is given alone. Studies combining it with other cancer agents are underway but not part of standard practice yet.

In breast cancer with the receptor-positive profile, whether ongoing hormone-based treatment continues alongside this drug is discussed individually depending on the clinical picture.

What ‘no quick response’ means

Imaging to assess response is typically done after two or three cycles. Some patients show early change. Others take longer.

I look at images alongside how the patient is feeling and any symptom changes. One set of results at eight weeks is one data point. The pattern across several assessments tells a clearer story.

Oncology consultation for sacituzumab govitecan (Trodelvy) in Israel

At Tel Aviv Medical Clinic in Israel, consultations are available on sacituzumab govitecan (Trodelvy) for breast cancer and urinary tract cancer. Oncologists at the clinic follow ESMO and NCCN guidelines and regularly see patients at later treatment stages — making decisions between this drug, immune-based approaches and other targeted options based on tumour receptor profile, surface protein expression, genetic processing variation and prior treatment history. Israel has oncology centres with active clinical experience using this drug in the approved settings.

In Tel Aviv Medical Clinic, you can discuss:

• whether this drug fits your specific diagnosis and treatment history;

• the genetic processing test and what it means for how treatment starts;

• the surface protein level and how it influences the expected benefit;

• managing bowel symptoms and blood cell counts during treatment;

• second opinion on a proposed plan;

• treatment options available in Israel and internationally.

Some patients arrive not knowing a genetic test run before the first dose can shape how the drug is given. That information changes the starting point.

Frequently Asked Questions — Dr. Stefanskoy

1. How is this different from giving chemotherapy directly?

When chemotherapy is given without a delivery system, it travels throughout the body and affects healthy dividing tissue as well as cancer. The antibody in this drug acts as a carrier — it finds cancer cells by recognising a surface protein and deposits the chemotherapy there rather than releasing it everywhere.

The result is a different side effect pattern — more bowel symptoms, somewhat less nausea and hair loss than some standard regimens. But it is not without side effects. Some of the active agent does escape and circulate. The targeting narrows exposure without eliminating it entirely.

2. What is the genetic processing test?

A specific enzyme in the liver is responsible for breaking down the active component of this drug. A common inherited variation makes that enzyme less effective — the drug clears from the body more slowly and accumulates.

In patients with that variation, the risk of very low infection-fighting cell counts and serious bowel symptoms is higher than average. I run the test before starting and adjust the initial dose accordingly. A straightforward step that prevents a predictable problem.

3. How serious are the bowel symptoms?

Significant enough that I address them specifically before every first infusion. They can come on within hours — or emerge two to three days after. Each pattern needs a different response.

Most patients manage with appropriate medication and diet changes. For some, the symptoms are severe enough to require a dose adjustment. The critical thing is calling early rather than waiting several days. Dehydration from ongoing bowel symptoms, in a patient whose cell counts are also reduced, becomes a more serious situation quickly.

4. Why are clinic visits more frequent than usual?

The treatment is given on two days within each three-week cycle rather than once. Plus blood cell count checks before each session. That is a real time commitment — more than many other treatments at this stage.

I talk through this before starting. For patients who find frequent travel to the clinic difficult, it matters for whether this is the right practical choice at this point.

5. What happens when cell counts drop?

The infusion waits until counts recover sufficiently. Injections to stimulate recovery are sometimes added to keep the schedule on track. Occasionally the dose is adjusted if counts fall repeatedly.

None of this is unexpected — it is a known pattern with this drug. The situation becomes more difficult when patients feel unwell and wait before reporting a fever. That is the scenario where things escalate unnecessarily.

6. What else is available if this drug does not suit?

In the receptor-negative breast cancer subtype, immune-based approaches, other chemotherapy combinations and targeted drugs linked to specific genetic changes in the tumour are among the options. In the receptor-positive subtype, other chemotherapy agents and targeted regimens may still be applicable.

In bladder cancer at this stage, choices are genuinely limited — which is why this drug fills a real role there.

7. Is this treatment available in Israel?

Yes. It is in use at oncology centres in Israel for the relevant cancer types. Patients with the applicable breast cancer subtypes and bladder cancer can access it through the Israeli healthcare system.

If you want to understand whether it fits your situation, or want a second opinion on a plan that has already been proposed, a consultation is the right starting point.

Important information

Sacituzumab govitecan (Trodelvy) is considered only after assessment of tumour type, receptor profile, prior treatment, genetic processing variation, organ function and overall patient condition.

Do not start, stop or change treatment without speaking to your treating physician first.

For a consultation in Israel:

📞 +972-73-374-6844
📧 [email protected]
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